A nurse is preparing a child who has suspected bacterial meningitis for a lumbar puncture. Which of the following cerebrospinal fluid findings supports the diagnosis?
Decreased WBCs.
Elevated glucose.
Elevated total protein.
Decreased pressure.
The Correct Answer is C
Choice A rationale:
Decreased white blood cells (WBCs) in cerebrospinal fluid (CSF) would not support the diagnosis of bacterial meningitis. In bacterial meningitis, the presence of bacteria triggers an inflammatory response, leading to an increase in WBCs in the CSF (pleocytosis).
Choice B rationale:
Elevated glucose levels in CSF would actually be more consistent with viral rather than bacterial meningitis. In bacterial meningitis, glucose levels are typically decreased due to the high metabolic demands of bacteria on the glucose present in the CSF.
Choice C rationale:
Elevated total protein in cerebrospinal fluid (CSF) is indicative of inflammation and disruption of the blood-brain barrier. Bacterial meningitis causes an intense inflammatory response, leading to an increase in total protein in the CSF.
Choice D rationale:
Decreased pressure in the CSF would not be a characteristic finding in bacterial meningitis. In fact, bacterial meningitis often leads to an increase in CSF pressure due to the inflammation and accumulation of inflammatory cells and proteins.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choiceb. Perceives death as a punishment.
Choice A rationale:
Preschool-aged children generally do not understand that death is permanent.They often view death as temporary or reversible, similar to what they see in cartoons.
Choice B rationale:
Preschoolers may perceive death as a punishment for something they did or thought.This age group often feels guilt and shame, believing their actions or thoughts caused the illness or death.
Choice C rationale:
Worrying about physical body changes is more typical in older children who have a better understanding of the physical aspects of illness and death.
Choice D rationale:
Feelings of isolation are more common in older children and adolescents who are more aware of social dynamics and the implications of their illness.
Correct Answer is B
Explanation
Choice A rationale:
Administer pain medication. Administering pain medication is important for the preschooler's comfort, but it is not the nurse's priority action in this scenario. The priority is to ensure adequate circulation to the extremities, which can be assessed by checking capillary refill.
Choice B rationale:
Check capillary refill. This is the correct answer because the nurse's priority is to assess the child's circulation and tissue perfusion. In 90-90 traction, there is a risk of impaired circulation to the extremities due to the positioning. Checking capillary refill provides information about the adequacy of blood flow to the capillaries and is crucial for early detection of any circulation problems.
Choice C rationale:
Cleanse and dress the pin sites. While caring for the pin sites is important to prevent infection, it is not the priority action at this moment. Ensuring proper circulation and perfusion takes precedence over pin site care.
Choice D rationale:
Reposition the child every 2 hr. Repositioning the child is important to prevent complications associated with immobility, but it is not the nurse's priority action in this situation. The primary concern is to assess and address any circulation issues.
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