# A 19-year-old college student is admitted from the ED with fever 39.5 °C, severe headache, photophobia, neck stiffness, and a petechial rash. Bacterial meningitis is suspected. Which immediate interventions should the nurse implement? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372758&lang=en > language: en > subject: Postsurgical Complications > category: PA ## Question A 19-year-old college student is admitted from the ED with fever 39.5 °C, severe headache, photophobia, neck stiffness, and a petechial rash. Bacterial meningitis is suspected. Which immediate interventions should the nurse implement? Select all that apply. 1 Anticipate empiric IV ceftriaxone plus vancomycin, with adjunctive dexamethasone given before or with the first antibiotic dose. 2 Place the patient in a negative-pressure airborne isolation room and use N95 respirators for the first 24 hours of antibiotic therapy. 3 Obtain blood cultures and prepare the patient for lumbar puncture; do not delay antibiotic administration if the lumbar puncture cannot be performed quickly. 4 Initiate droplet precautions on admission and maintain them until 24 hours of effective antibiotic therapy. 5 Identify close contacts (roommates, intimate contacts) for chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone per public health guidance. ## Explanation Bacterial meningitis is a medical emergency. (1) Droplet precautions on admission until 24 hours of effective antibiotics — the most likely organisms (Neisseria meningitidis, Streptococcus pneumoniae) spread by respiratory droplets. (2) Empiric ceftriaxone + vancomycin (covers Strep pneumo, Neisseria, and resistant Strep pneumo) with adjunctive dexamethasone before or with the first dose to reduce neurologic complications, especially in pneumococcal disease. (3) Blood cultures, then lumbar puncture, but do NOT delay antibiotics for LP — every hour of delay raises mortality. (5) Public health follow-up — meningococcal disease requires post-exposure prophylaxis for close contacts (rifampin, ciprofloxacin, or ceftriaxone). Choice 2 is incorrect — bacterial meningitis is droplet, NOT airborne; airborne precautions are reserved for tuberculosis, measles, and varicella. ## In-depth explanation Bacterial meningitis is a clinical and microbiologic emergency. The most likely community-acquired organisms in this age group are Neisseria meningitidis (often presenting with petechial rash) and Streptococcus pneumoniae. Standard inpatient management combines droplet precautions until 24 hours of effective antibiotics, empiric IV ceftriaxone plus vancomycin to cover S. pneumoniae and Neisseria, and adjunctive dexamethasone given just before or with the first antibiotic dose to reduce neurologic complications (especially in pneumococcal disease). Diagnostic workup includes blood cultures and lumbar puncture, but antibiotics must not be delayed for LP — every hour of delay increases mortality. Public health steps include identifying close contacts (roommates, intimate contacts) for post-exposure chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone. Bacterial meningitis is transmitted by droplet, not airborne, so a negative-pressure airborne room with N95 is not the standard precaution. ## Clinical scenario A **19-year-old college student** is admitted with **fever 39.5 °C, severe headache, photophobia, neck stiffness, and a petechial rash**. **Bacterial meningitis is suspected**. The nurse plans immediate interventions. ## Key concepts - **Bacterial Meningitis Likely Pathogens** — Adolescents and young adults: Neisseria meningitidis (often with petechial rash) and Streptococcus pneumoniae. Older adults and immunocompromised: add Listeria monocytogenes (covered with ampicillin). Empiric therapy is broad until cultures and Gram stain return. - **Empiric Therapy** — IV ceftriaxone plus vancomycin to cover Streptococcus pneumoniae (including resistant strains) and Neisseria meningitidis. Add ampicillin if Listeria is a concern (older adults, immunocompromised, neonates). Adjunctive dexamethasone reduces neurologic complications, given just before or with the first dose. - **Public Health and Prophylaxis** — Meningococcal disease is reportable. Close contacts (household, kissing, eating utensils, sleeping together) need post-exposure prophylaxis with rifampin, ciprofloxacin, or ceftriaxone. 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