Meningitis
A patient with suspected meningococcal meningitis arrives in the ED. What nursing action must occur first?
ANSWER:
Initiate droplet precautions
RATIONALE:
Neisseria meningitidis is highly contagious and precautions protect others before antibiotics begin.
Morning headaches in a patient with a brain abscess are associated with what condition?
ANSWER:
Increased intracranial pressure
RATIONALE:
ICP rises overnight when supine, worsening morning headaches.
Creutzfeldt–Jakob disease is caused by which infectious agent?
ANSWER:
Prions
RATIONALE:
Abnormal proteins resistant to sterilization cause neurodegeneration.
Why does muscle weakness worsen later in the day in myasthenia gravis?
ANSWER:
Depletion of acetylcholine
RATIONALE:
Repeated muscle use exhausts available ACh.
Ascending paralysis in GBS is caused by what pathophysiology?
ANSWER:
Autoimmune demyelination of peripheral nerves
RATIONALE:
Loss of myelin slows nerve conduction
A patient with bacterial meningitis becomes confused and restless. This change suggests what complication?
ANSWER:
Increased intracranial pressure
RATIONALE:
Early ICP elevation presents as confusion and restlessness before vital sign changes.
Which diagnostic intervention best guides antibiotic therapy for a brain abscess?
ANSWER:
CT-guided aspiration and culture
RATIONALE:
Identifies causative organism for targeted antibiotic therapy.
What is the primary nursing focus for advanced Creutzfeldt–Jakob disease?
ANSWER:
Supportive, comfort-focused care
RATIONALE:
Disease is progressive and fatal with no cure
Respiratory distress after missed MG meds suggests what complication?
ANSWER:
Myasthenic crisis
RATIONALE:
Undermedication leads to severe weakness and respiratory failure.
Which finding requires immediate escalation of care in GBS?
ANSWER:
Declining vital capacity
RATIONALE:
Respiratory failure can occur rapidly.
IV dexamethasone is given in bacterial meningitis to reduce what process?
ANSWER:
Reduce inflammatory response and cerebral edema
RATIONALE:
Steroids decrease inflammation and neurologic complications
Why is acyclovir started immediately for suspected HSV encephalitis?
ANSWER:
Prevent permanent neurologic damage
RATIONALE:
Early acyclovir improves survival in HSV encephalitis.
Variant Creutzfeldt–Jakob disease is linked to what exposure?
ANSWER:
Ingestion of infected beef
RATIONALE:
Variant CJD is associated with bovine exposure
Which finding suggests cholinergic rather than myasthenic crisis?
ANSWER:
Excess secretions and muscle twitching
RATIONALE:
Signs of overmedication causing cholinergic excess
IVIG and plasma exchange improve outcomes by doing what?
ANSWER:
Reduce circulating antibodies
RATIONALE:
IVIG and plasma exchange shorten disease course.
Which feature most strongly differentiates bacterial from viral meningitis?
ANSWER:
Rapid onset with severe altered LOC
RATIONALE:
Bacterial meningitis progresses faster and is more severe than viral.
Which encephalitis assessment finding requires immediate provider notification?
ANSWER:
New seizures or declining LOC
RATIONALE:
Indicates worsening cerebral inflammation or ICP.
Which infection-control precaution is essential with suspected prion disease?
ANSWER:
Strict blood and body fluid precautions
RATIONALE:
Prions are not spread casually but invasive exposure poses risk.
What is the priority nursing intervention during myasthenic crisis?
ANSWER:
Maintain airway and ventilation
RATIONALE:
Respiratory failure is leading cause of death.
Which intervention best addresses autonomic instability in GBS?
ANSWER:
Continuous cardiac and BP monitoring
RATIONALE:
Autonomic instability causes life-threatening dysrhythmias
A patient with bacterial meningitis becomes confused and restless. This change suggests what complication?
ANSWER:
Increased intracranial pressure
RATIONALE:
Early ICP elevation presents as confusion and restlessness before vital sign changes.
A patient with a known brain abscess suddenly develops a worsening headache, vomiting, and unequal pupils. Which nursing interpretation is most accurate?
What is impending brain herniation due to increased intracranial pressure?
Rationale:
Worsening headache, vomiting, and pupillary asymmetry are late signs of increased ICP. In a patient with a brain abscess, these findings suggest expanding mass effect and possible brain herniation, which is a life-threatening emergency requiring immediate intervention.
The nurse recognizes that the most distinguishing feature of prion diseases compared with other neurodegenerative disorders is this pattern of progression.
What is rapid, progressive neurologic decline leading to death within months?
Rationale
Unlike Alzheimer’s or Parkinson’s disease, prion diseases such as Creutzfeldt–Jakob disease progress very rapidly, often over weeks to months. This accelerated decline is a key diagnostic clue and helps nurses anticipate rapid loss of function and early need for supportive and palliative care planning.
A patient with myasthenia gravis is scheduled for physical therapy and meals. To maximize safety and functional ability, the nurse should plan these activities at what time in relation to medication administration?
hat is shortly after administration of anticholinesterase medication (such as pyridostigmine)?
Rationale
Anticholinesterase medications temporarily improve neuromuscular transmission by increasing acetylcholine availability. Scheduling activity and meals during peak medication effect reduces fatigue, improves swallowing safety, and decreases aspiration risk, which is a key nursing management principle in myasthenia gravis.
During discharge teaching, the nurse explains that recovery from Guillain–Barré syndrome typically occurs in which pattern?
hat is gradual return of function in the reverse order of symptom onset?
Rationale (Faculty):
In Guillain–Barré syndrome, paralysis usually ascends from the lower extremities upward, and recovery occurs in the opposite direction, with motor function returning first in areas affected last. Understanding this pattern helps set realistic expectations and reduces patient and family anxiety during rehabilitation.