# A 65-year-old adult is admitted to the hospital with suspected bacterial meningitis. Which nursing action should be the nurse's FIRST priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542428  
> language: ko  
> subject: Adult Health

## 문제

A 65-year-old adult is admitted to the hospital with suspected bacterial meningitis. Which nursing action should be the nurse's FIRST priority?

A 3-year-old toddler is brought to the emergency department by parents who report that the child has been increasingly irritable over the past 24 hours, refusing to eat, and crying when moved. The child has a temperature of 102.8°F (39.3°C), appears lethargic when not crying, and demonstrates resistance when the nurse attempts to flex the neck forward. The physician suspects bacterial meningitis and has ordered a lumbar puncture, blood cultures, and immediate antibiotic therapy.

## 보기

1. Implement droplet precautions immediately **✔ 정답**
2. Prepare the child for lumbar puncture
3. Administer prescribed antibiotics
4. Obtain vital signs and neurological assessment

**정답: 1**

## 해설

Droplet precautions are the first priority to prevent transmission of bacterial meningitis via respiratory droplets. Other interventions like lumbar puncture and antibiotics are important but can wait briefly after isolation is established.

## 심화 해설

Clinical Context and Priority Setting

This question presents a classic NCLEX-RN priority-setting scenario involving a toddler with suspected bacterial meningitis. The key to answering correctly lies in understanding the chain of infection and the nurse's immediate responsibility to protect others before initiating patient-specific treatments. Bacterial meningitis caused by organisms such as Neisseria meningitidis or Haemophilus influenzae type b is transmitted through respiratory droplets. The clinical presentation of fever, lethargy, irritability, and nuchal rigidity (resistance to neck flexion) strongly supports this diagnosis.

Rationale for the Correct Answer: Implement Droplet Precautions Immediately

The first priority nursing action is to initiate droplet precautions. According to infection control principles, which are foundational to safe nursing practice and heavily tested on the NCLEX-RN, the safety of the environment, other patients, and healthcare personnel takes precedence. The review by Baer and Warltier on post-dural puncture meningitis highlights a critical infection control point: contamination of the puncture site by aerosolized mouth commensals from medical personnel is a suspected cause of iatrogenic meningitis [4]. This underscores the immediate need for a mask, not just for the nurse, but for anyone entering the room, to prevent the spread of the organism from the patient and to protect the patient's open puncture site from external flora during the upcoming lumbar puncture.

While preparing for the lumbar puncture, administering antibiotics, and performing a neurological assessment are all essential components of care, they are secondary to establishing a safe environment. The nurse must don appropriate personal protective equipment (PPE) and place the child on droplet precautions before proceeding with any other intervention that requires close, prolonged contact. Delaying this step exposes the healthcare team and the child to additional risk.

Analysis of Incorrect Options

- Option 2: Prepare the child for lumbar puncture. A lumbar puncture is the definitive diagnostic procedure for meningitis. However, preparing the child involves close physical contact and positioning that can induce coughing or crying, which generates infectious droplets. This preparation must occur after the nurse and others in the room have donned a mask and the child is under droplet precautions.

- Option 3: Administer prescribed antibiotics. Timely antibiotic administration is critical for patient survival and reducing morbidity from bacterial meningitis. However, from a nursing priority perspective, the brief moment required to implement droplet precautions does not constitute a clinically significant delay in antibiotic therapy. The nurse must first ensure a safe environment for the act of administering the medication, which includes hanging IV fluids and antibiotics at the bedside.

- Option 4: Obtain vital signs and neurological assessment. Assessment is a cornerstone of the nursing process, but it is not the first action in this scenario. Obtaining a full set of vital signs and performing a neurological check requires the nurse to be at the bedside, within droplet transmission range, for an extended period. The nurse must first apply a mask and initiate isolation protocols to protect themselves during this assessment.

Integration of Evidence and Clinical Reasoning

The NCLEX-RN tests the ability to prioritize using a safety and infection control framework. The evidence from the reviewed literature reinforces this. While the provided guidelines on community-acquired pneumonia [1, 2] do not directly address meningitis, they share the foundational principle of identifying the causative organism and its mode of transmission to guide initial management. The scoping review on vaccines and antimicrobial resistance  discusses population-level prevention, but the immediate clinical scenario demands an individual-level safety action. The direct link to the correct answer is in the meningitis-specific review, which emphasizes the danger of aerosolized bacteria from medical personnel during procedures like lumbar punctures [4]. This creates a dual imperative for a mask: to prevent the nurse from acquiring the infection and to prevent the nurse's respiratory flora from contaminating the sterile procedure site. The nurse's first physical action upon suspecting the diagnosis, before gathering equipment or touching the patient, is to apply a mask and initiate the protocol that requires the same of all caregivers.References (research sources)

- [4]Post–Dural Puncture Bacterial MeningitisResearch articleEstelle Traurig Baer, David C. Warltier (2006) · DOI: 10.1097/00000542-200608000-00022

## 임상 시나리오

Suspected Meningitis: Immediate Nursing ActionPrioritizing Droplet Precautions in the Emergency Setting
For a patient with suspected bacterial meningitis, the nurse's first priority is to implement droplet precautions. This includes placing the patient in a private room and wearing a mask for all interactions within 3 feet.

This action prevents airborne transmission of organisms like Neisseria meningitidis to healthcare staff, other patients, and visitors. It also protects the patient's potential lumbar puncture site from contamination by oral flora from personnel, which can cause iatrogenic meningitis.

CautionDo not delay isolation to complete a full assessment or prepare for procedures. Droplet precautions must be in place before moving the patient or performing a lumbar puncture to ensure a safe care environment.

## 핵심 개념

- **Droplet Precautions** — Infection control measures used for pathogens transmitted via large respiratory droplets, requiring a private room and mask use within 3 feet of the patient.
- **Nuchal Rigidity** — Stiffness of the neck with resistance to passive flexion, a classic sign of meningeal irritation often seen in meningitis.
- **Lumbar Puncture** — A sterile procedure where a needle is inserted into the subarachnoid space to collect cerebrospinal fluid for diagnostic analysis.
- **Iatrogenic Meningitis** — Meningitis caused by a medical procedure, such as contamination of a lumbar puncture site by aerosolized bacteria from healthcare personnel.
- **Priority Setting** — A clinical decision-making process that ranks patient needs by urgency, often prioritizing immediate threats to safety, such as infection transmission.

## 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._