# A 4-year-old child with bacterial meningitis is admitted to the pediatric intensive care unit. The child is receiving IV antibiotics and has been placed on seizure precautions. Which nursing intervention should be the highest priority during the acute phase of treatment?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542425  
> language: ko  
> subject: Adult Health

## 문제

A 4-year-old child with bacterial meningitis is admitted to the pediatric intensive care unit. The child is receiving IV antibiotics and has been placed on seizure precautions. Which nursing intervention should be the highest priority during the acute phase of treatment?

## 보기

1. Monitor neurological status every 15 minutes and assess for signs of increased intracranial pressure **✔ 정답**
2. Encourage oral fluid intake to prevent dehydration from fever
3. Provide age-appropriate activities to reduce anxiety and promote comfort
4. Maintain strict isolation precautions for 48 hours after antibiotic initiation

**정답: 1**

## 해설

Continuous neurological monitoring is the highest priority to detect early signs of increased intracranial pressure, which can rapidly progress to brain herniation. Other interventions are important but less immediately life-threatening.

## 심화 해설

Acute Phase Priority in Pediatric Bacterial Meningitis

The correct answer is monitoring neurological status every 15 minutes and assessing for signs of increased intracranial pressure (ICP). During the acute phase of bacterial meningitis, the inflammatory response and purulent exudate can obstruct the flow of cerebrospinal fluid (CSF) and cause cerebral edema, leading to a rapid rise in ICP. This is a life-threatening complication that can result in brain herniation within hours. The 2004 Practice Guidelines for the Management of Bacterial Meningitis emphasize that careful neurological assessment is a cornerstone of supportive care, as deterioration can be swift and requires immediate intervention to prevent irreversible neurological injury or death [2]. While these guidelines are foundational, the 2017 IDSA guidelines for healthcare-associated ventriculitis and meningitis further reinforce the critical nature of serial neurological examinations in patients with CNS infections to detect complications like ventriculitis, cerebritis, or ICP crises [3].

The other options are inappropriate or lower priority during the acute phase. Encouraging oral fluid intake is contraindicated because a child with an altered level of consciousness and a risk of seizures is at high risk for aspiration; fluid management is typically handled intravenously with careful monitoring to avoid overhydration, which can worsen cerebral edema. Providing age-appropriate activities, while important for development and psychosocial well-being, is not a physiological priority when the child is critically ill and requires minimal stimulation to prevent spikes in ICP. Maintaining strict isolation is necessary for the first 24 hours after effective antibiotic therapy initiation, not 48 hours, making the timeframe in that option incorrect; more importantly, preventing neurological catastrophe always takes precedence over infection control measures in the hierarchy of immediate nursing actions. The consensus guidelines on idiopathic intracranial hypertension, while focused on a different condition, highlight the universal principle that in any state of raised ICP, the primary goal is to preserve neurological function through vigilant monitoring and reducing factors that increase intracranial pressure [4].References (research sources)

- [2]Practice Guidelines for the Management of Bacterial MeningitisGuidelineAllan R. Tunkel, Barry J. Hartman, Sheldon L. Kaplan, Bruce A. Kaufman, Karen L. Roos, W. Michael Scheld (2004) · DOI: 10.1086/425368

- [3]2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*GuidelineAllan R. Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L. Kaplan, W. Michael Scheld (2016) · DOI: 10.1093/cid/ciw861

- [4]Idiopathic intracranial hypertension: consensus guidelines on managementGuidelineSusan P. Mollan, Brendan Davies, N. C. Silver, Simon Shaw, Conor Mallucci, Benjamin R. Wakerley (2018) · DOI: 10.1136/jnnp-2017-317440

## 임상 시나리오

Pediatric Meningitis: Acute Phase PrioritySerial neurological assessment to detect rising ICP
The highest priority in the acute phase of bacterial meningitis is monitoring neurological status every 15 minutes to assess for signs of increased intracranial pressure (ICP). Cerebral edema and purulent exudate can obstruct CSF flow, risking rapid deterioration and brain herniation.

Key assessments include level of consciousness, pupillary response, motor function, and vital signs for Cushing's triad (bradycardia, hypertension, irregular respirations). Any change necessitates immediate reporting.

CautionAvoid oral fluids due to aspiration risk with altered consciousness. Minimize environmental stimulation, as it can raise ICP. Maintain droplet precautions for 24 hours after effective antibiotic initiation, not 48 hours.

## 핵심 개념

- **Increased Intracranial Pressure (ICP)** — A life-threatening rise in pressure inside the skull caused by cerebral edema or obstructed CSF flow, common in meningitis, which can lead to brain herniation.
- **Acute Phase of Meningitis** — The initial period of bacterial meningitis characterized by active inflammation, high risk for rapid neurological deterioration, and the need for intensive monitoring.
- **Seizure Precautions** — Safety measures including padded side rails, suction and oxygen at the bedside, implemented to protect a patient at risk for seizure activity.
- **Droplet Precautions** — Infection control measures used for organisms like Neisseria meningitidis, requiring a private room and mask for close contact, maintained until 24 hours of effective antibiotics.

## 같은 주제 문제

- [A nurse is assessing a 28-year-old patient admitted with suspected bacterial meningitis. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=541237)
- [A 28-year-old patient presents to the emergency department with a 12-hour history of sever…](https://mymerci.kr/pages/nclex_q.php?qn_id=541238)
- [A nurse is caring for a patient with bacterial meningitis who has been receiving antibioti…](https://mymerci.kr/pages/nclex_q.php?qn_id=541239)
- [A nurse is caring for a client with bacterial meningitis who has been receiving IV antibio…](https://mymerci.kr/pages/nclex_q.php?qn_id=541240)
- [A nurse is caring for a patient with bacterial meningitis who has been receiving IV antibi…](https://mymerci.kr/pages/nclex_q.php?qn_id=541241)
- [A 28-year-old patient presents to the emergency department with a 12-hour history of sever…](https://mymerci.kr/pages/nclex_q.php?qn_id=541242)
- [A 30-year-old healthcare worker is admitted to the emergency department with a 12-hour his…](https://mymerci.kr/pages/nclex_q.php?qn_id=541243)
- [A nurse is caring for a patient with suspected bacterial meningitis. Which nursing action …](https://mymerci.kr/pages/nclex_q.php?qn_id=541244)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._