# A 5-year-old arrives with fever, nuchal rigidity, altered responsiveness, and a petechial rash. Bacterial meningitis with possible meningococcal disease is suspected. Select all appropriate immediate assessments and actions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375046&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A 5-year-old arrives with fever, nuchal rigidity, altered responsiveness, and a petechial rash. Bacterial meningitis with possible meningococcal disease is suspected. Select all appropriate immediate assessments and actions.

1Place the child on droplet precautions immediately when bacterial meningitis is suspected.
2Obtain blood cultures promptly and prepare for lumbar puncture when no contraindication is present.
3Administer empiric IV ceftriaxone plus vancomycin without waiting for lumbar-puncture results.
4Give IV dexamethasone with or just before the first antibiotic dose when indicated by protocol.
5Use standard precautions alone until cerebrospinal-fluid results confirm the diagnosis.
6Delay empiric antibiotics until lumbar puncture, Gram stain, and culture results are completed.
7Treat the petechial rash as a routine fever symptom and give oral ibuprofen before evaluating perfusion.
8Monitor level of consciousness, pupils, seizures, perfusion, and other signs of increased intracranial pressure or shock.
9Initiate the process to identify close contacts for chemoprophylaxis if meningococcal disease is suspected.

## Explanation

Suspected bacterial meningitis with petechiae is an emergency. Start droplet precautions, obtain blood cultures promptly, prepare for lumbar puncture when safe, and do not delay empiric ceftriaxone plus vancomycin for imaging or lumbar puncture. Dexamethasone is given with or just before the first antibiotic when indicated by the pediatric protocol. Monitor neurologic status, seizures, increased intracranial pressure, perfusion, and shock. If meningococcal disease is suspected or confirmed, public-health processes identify close contacts who need chemoprophylaxis. Standard precautions alone, waiting for CSF results before antibiotics, and treating petechiae as a routine fever problem are unsafe.

## In-depth explanation

Droplet precaution duration: 24 hours after effective antibiotics for meningococcal. Family/close contacts get rifampin, ciprofloxacin, or ceftriaxone prophylaxis.

## Clinical scenario

Sudden fever 39.8 C, severe headache, neck stiffness, photophobia, petechial rash on lower extremities. Drowsy.

## Key concepts

- **meningococcal meningitis** — Neisseria meningitidis CNS infection — petechial purpura is characteristic.
- **droplet precautions** — Mask within 6 ft, single room or cohort; for respiratory droplet pathogens.
- **empiric antibiotics** — Therapy started before culture results based on likely pathogens.

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