A nurse is planning care for a client who has bacterial meningitis. Which of the following interventions should the nurse implement?
Ensure the client's bed is positioned to greater than 45°.
Initiate airborne precautions.
Ensure lights are dimmed in the client's room.
Encourage frequent ambulation.
The Correct Answer is C
A. The head of the bed should be elevated to 30 degrees to reduce intracranial pressure.
B. Bacterial meningitis is transmitted through hematogenous route and airborne precautions are not always necessary.
C. Clients with meningitis may be sensitive to light, dimming the lights should be implemented to increase comfort by reducing stimuli.
D. Encourage frequent ambulation is not appropriate for bacterial
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Bladder spasms are a common postoperative complication after TURP, and they are typically associated with the irritation of the bladder wall. Cold compresses may be helpful for reducing muscle spasms or swelling in other situations, but they are not typically effective for relieving bladder spasms specifically.
B. Securing the urinary catheter is important to prevent dislodgement and ensure proper drainage. However, securing it to the upper left quadrant of the abdomen is not a standard practice.
C. The appropriate response is often to irrigate the catheter to relieve the obstruction and restore normal flow. While 0.9% sodium chloride (normal saline) is typically used for irrigation, the term "intermittent" refers to manually irrigating the catheter at intervals to flush out any blockages, which is an appropriate approach when there is a concern about obstruction.
D. Encouraging the client to urinate every 2 hours is not feasible or necessary in this situation.
Correct Answer is D
Explanation
Muscle twitching can a feature of hypocalcemia which may eventually lead to tetany. It is therefore, necessary to report muscle twitching to avoid serious complications such as bronchospasm.
A. Neck stiffness is anticipated due to manipulation of neck muscles during surgery.
B. Hoarseness occurs due to injury of recurrent laryngeal nerve or manipulation of the vocal cords and surrounding structures during surgery.
C. Some drainage from the incision site is expected after surgery, including a total thyroidectomy
D. Muscle twitching may indicate neuromuscular irritability or electrolyte imbalances, which could be unrelated to the thyroidectomy surgery.
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