A nurse is caring for a client who is comatose and requires a non-life-threatening surgical procedure. Which of the following actions should the nurse take?

A. "Bacterial meningitis can be prevented with immunization": Vaccines such as the meningococcal, pneumococcal, and Haemophilus influenzae type b (Hib) vaccines significantly reduce the risk of bacterial meningitis. Immunization is a primary preventive measure, especially for high-risk populations, including children, adolescents, and certain adults.

B. "Bacterial meningitis is an infection that causes inflammation of the sinus cavity.": Bacterial meningitis causes inflammation of the meninges, which are the protective membranes covering the brain and spinal cord, not the sinuses. Confusing the site of infection can lead to inappropriate assessment and treatment.

C. "Bacterial meningitis is spread by contaminated food or water; therefore, infection is unlikely": This statement is incorrect because bacterial meningitis is typically spread through respiratory droplets, close contact, or asymptomatic carriers, not through food or water.

D. "Bacterial meningitis rarely occurs in young adults unless their immune system is suppressed.": Young adults, particularly those in communal settings like college dorms or military barracks, are at increased risk regardless of immune status. Immunocompetent individuals can still acquire bacterial meningitis.

Rationale for correct choices

• Seizures: The client presents with severe hypertension (BP 162/112 mm Hg and 166/110 mm Hg), +3 pitting edema, and proteinuria (3+), which are classic indicators of severe preeclampsia. These factors place the client at high risk for eclampsia, which manifests as seizures during pregnancy. Close monitoring and early intervention are critical to prevent maternal and fetal complications.

• Placental abruption: Severe hypertension and preeclampsia increase the risk of placental abruption, a condition in which the placenta separates prematurely from the uterine wall. This can compromise fetal oxygenation and lead to significant maternal bleeding. The client’s elevated blood pressure, edema, and decreased fetal movement indicate a higher likelihood of this obstetric emergency.

Rationale for incorrect choices

• Heart failure: Although hypertension and fluid shifts in preeclampsia can strain the heart, there is no current evidence of pulmonary edema, dyspnea, or heart failure symptoms in this client. Heart failure is a less immediate risk compared with seizures and placental abruption in the context of severe preeclampsia.

• Hypoglycemia: There is no indication of low blood glucose in the client; laboratory results show glucose within normal limits (85 mg/dL). Hypoglycemia is not a typical complication of preeclampsia and is therefore not an immediate concern in this scenario.

• Cervical insufficiency: Cervical insufficiency typically presents earlier in gestation with painless dilation and risk of preterm birth, rather than in a 31-week client with hypertensive complications. The client’s symptoms of headache, edema, and proteinuria do not indicate cervical insufficiency.