Meningitis NCLEX Questions Nursing

This meningitis NCLEX-Style quiz is for nursing students and designed to reinforce your knowledge of the meninges, cerebrospinal fluid, physical assessment findings, vaccines, diagnostic procedures, and nursing interventions related to meningitis. Questions range from basic anatomy and physiology to clinical application, including identification of meningeal signs, interpretation of cerebrospinal fluid (CSF) results, precautions for different types of meningitis, and post-lumbar puncture care.

Each question includes a clear rationale to help you understand why the correct answer is chosen, preparing you for NCLEX-style exams and clinical practice. Test your knowledge and improve your confidence in providing safe, evidence-based care for patients with meningitis.

Don’t forget to watch the meningitis nursing lecture and to review the nursing notes on meningitis before taking the quiz below.

For more nursing reviews, check out our nursing neuro videos.

Meningitis NCLEX Questions

1. Which of the following correctly lists the layers of the meninges from innermost to outermost?
   A. Arachnoid Mater -> Dura Mater -> Pia Mater
   B. Pia Mater -> Arachnoid Mater -> Dura Mater
   C. Dura Mater -> Pia Mater -> Arachnoid Mater
   D. Pia Mater -> Dura Mater -> Arachnoid Mater
   The answer is B: Pia Mater -> Arachnoid Mater -> Dura Mater. Remember the mnemonic PAD that was discuss in the YouTube review lecture. The meninges are the protective coverings of the brain and spinal cord. From innermost to outermost, the layers are pia mater (thin layer adhering directly to the brain and spinal cord), arachnoid mater (web-like middle layer), and dura mater (tough, outermost layer).
2. Which space within the meningeal layers contains cerebrospinal fluid (CSF)?
   A. subdural space
   B. epidural space
   C. subarachnoid space
   D. epiarachnoid space
   The answer is C: subarachnoid space. The subarachnoid space, located between the arachnoid mater and pia mater, contains cerebrospinal fluid (CSF), which cushions and protects the brain and spinal cord. In contrast, the epidural and subdural spaces do not normally contain CSF.
3. Select which of the layers of the meninges are known as the leptomeninges:
   A. dura mater
   B. pia mater
   C. arachnoid mater
   D. subpial mater
   The answers are B and C: pia mater and arachnoid mater. The leptomeninges consist of the pia mater and arachnoid mater, the thinner, more delicate layers of the meninges. The dura mater is the tough outer layer and is not part of the leptomeninges. The term “subpial mater” is not a standard meningeal layer, so it is incorrect.
4. A 11 year old child received a vaccine to prevent meningitis. The child will return at 16 years of age to get booster. Which pathogen is this child receiving protection from?
   A. Steptococcus pneumoniae
   B. Hameophilus influenzae
   C. Cryptococcus
   D. Neisseria meningitidis
   The answer is D: Neisseria meningitidis. The meningococcal conjugate vaccine (MCV4) is routinely given at 11–12 years with a booster at 16 years to protect against Neisseria meningitidis, a leading cause of bacterial meningitis in adolescents. Vaccines for Streptococcus pneumoniae and Haemophilus influenzae type b are administered earlier in childhood, while there is no routine vaccine for Cryptococcus.
5. You are assessing a patient with suspected meningitis. When the patient is placed in the supine position with the hips and knees flexed at 90 degrees, extending the knee causes pain and resistance. This finding is documented as a positive __ sign.
   A. Cullen’s
   B. McBurney’s
   C. Brudzinski’s
   D. Kernig’s
   The answer is D: Kernig’s sign. Kernig’s sign is a classic physical exam finding in meningitis. It is positive when pain or resistance occurs during passive extension of the knee while the hip is flexed at 90 degrees. This indicates irritation of the meninges. Brudzinski’s sign is another meningeal test, but it is positive when hip and knee flexion occur involuntarily in response to neck flexion. Cullen’s and McBurney’s signs are unrelated to meningitis; they indicate intra-abdominal pathology.
6. A patient with meningitis reports severe headache and photophobia. Which nursing interventions should NOT be included in the plan of care? Select all that apply.
   A. Elevate the head of the bed (HOB) 30–45° with the head in a neutral position
   B. Administer IV morphine every 4 hours as needed for pain
   C. Darken the room to reduce light sensitivity
   D. Keep the neck flexed to either side
   E. Monitor temperatures orally
   The answers are B and D: Administer IV morphine every 4 hours as needed for pain and Keep the neck flexed to either side. For a patient with meningitis, interventions focus on reducing pain, minimizing meningeal irritation, and preventing increased intracranial pressure (ICP). Keeping the neck in a neutral position and avoiding unnecessary opioids like IV morphine every 4 hours are important, as neck flexion can worsen meningeal irritation and opioids may mask neurological changes. Acetaminophen can be used to treat pain. Elevating the HOB and darkening the room are appropriate. It is also important to monitor temperature regularly, preferably orally, because detecting hyperthermia early helps prevent increases in ICP.
7. A patient with meningitis experiences extreme pain and stiffness when bending the neck forward toward the chest. This physical finding is known as:
   A. Brudzinski’s sign
   B. Nuchal rigidity
   C. Kernig’s sign
   D. Uveitis
   The answer is B: nuchal rigidity. The hallmark finding of nuchal rigidity is neck stiffness and pain with forward flexion, commonly seen in meningitis. Brudzinski’s sign involves involuntary hip and knee flexion in response to neck flexion. Kernig’s sign is pain with knee extension while the hip is flexed. Uveitis is inflammation of the eye and unrelated to meningitis.
8. A patient with suspected meningitis is having a lumbar puncture. Which lab result will the nurse ensure has been collected before the procedure? Select all that apply:
   A. Hemoglobin and hematocrit
   B. Troponin
   C. BUN and creatinine
   D. Prothrombin time and international ratio
   E. Platelets
   The answer is D and E: Prothrombin time and international ratio and platelets. Before the procedure, the healthcare provider should order for blood coagulation labs like PT/INR and platelet count to ensure it’s safe. These levels should within normal range to prevent the development of a bleeding complications.
9. The patient arrives back to the room following a lumbar puncture. Which action by the nurse is correct?
   A. Assists the patient to the bathroom
   B. Educates the patient to avoid caffeine for the next 48 hours
   C. Keeps the patient in a flat position for 2 hours
   D. Elevates the head of the bed to 30 degrees
   The answer is C: Keeps the patient in a flat position for 2 hours. After a lumbar puncture, the patient should remain lying flat for 1–2 hours to reduce the risk of a post-procedure headache caused by cerebrospinal fluid leakage. Elevating the head of the bed too soon (even to 30°) can worsen headache symptoms. Assisting the patient to the bathroom immediately is not recommended (a bedpan should be used). Caffeine can actually help prevent a post-dural headache that can sometimes occur so the patient does not need to avoid it.
10. In a patient with bacterial meningitis, how is the glucose level in the cerebrospinal fluid (CSF) typically affected?
    A. Normal
    B. High
    C. Low
    D. None of the above; glucose cannot be detected in CSF
    The answer is C: low. In bacterial meningitis, CSF glucose is typically low. Bacteria in the CSF consume glucose for energy, and the inflammatory response impairs glucose transport across the blood–brain barrier. In contrast, CSF glucose is usually normal in viral (aseptic) meningitis. Therefore, a low CSF glucose level is a key diagnostic clue for bacterial meningitis.
11. In viral meningitis, which type of white blood cell is typically predominant in the cerebrospinal fluid (CSF)?
    A. Lymphocytes
    B. Neutrophils
    C. Eosinophils
    D. Basophils
    The answer is A: lymphocytes. In viral meningitis, the cerebrospinal fluid (CSF) typically shows a predominance of lymphocytes. Lymphocytes are the primary white blood cells involved in the immune response to viral infections. In contrast, neutrophils are more prominent in bacterial meningitis, while eosinophils and basophils are rarely elevated in CSF and are not characteristic of viral meningitis.
12. Which of the following findings are typically present in the cerebrospinal fluid (CSF) of a patient with bacterial meningitis? Select all that apply.
    A. Cloudy CSF
    B. Clear CSF
    C. Predominantly neutrophils
    D. Predominantly lymphocytes
    E. High glucose
    F. Low glucose
    G. High protein
    H. Low protein
    The answers are A, C, F, and G. In bacterial meningitis, the CSF typically shows cloudy appearance due to the presence of bacteria, inflammatory cells, and protein. The white blood cells are predominantly neutrophils, reflecting the acute bacterial infection. Glucose is low because bacteria consume glucose and inflammation impairs transport across the blood–brain barrier. Protein is high due to increased permeability of the meninges and inflammatory exudate.
13. The nurse receives report from interventional holding about their patient who just had a lumbar puncture. In the report, it is noted that the patient had an opening pressure of 22 mmHg. How does the nurse interpret this finding?
    A. normal
    B. low
    C. high
    The answer is C: high. A normal opening pressure during a lumbar puncture is 6–20 cm H₂O (≈ 5–15 mmHg). A high opening reading could suggest an increase in intracranial pressure due to tumor, infection (bacterial), bleeding, pseudotumor cerebri etc. A low opening reading could be due to CSF leak, dehydration, or chronic intracranial hypotension.
14. A patient with bacterial meningitis is prescribed intravenous dexamethasone. Which is the correct nursing action regarding the administration time of this medication?
    A. Administer before or with the first dose of antibiotic
    B. Administer after the last dose of antibiotic
    C. Administer within 1 hour after the first dose of antibiotic
    D. Administer immediately after the last dose of antibiotic
    The answer is A: Administer before or with the first dose of antibiotic. In bacterial meningitis, dexamethasone is given to reduce inflammation and prevent neurologic complications, such as hearing loss. It is most effective when administered before or with the first dose of antibiotics, because it helps limit the inflammatory response triggered by bacterial cell lysis. Administering it after antibiotic therapy begins or after the last dose reduces its effectiveness in preventing complications.
15. Your patient was dignosed with Neissera meningitditis. What type of precautions will you initate for the patient?
    A. airborne
    B. droplet
    C. standard only
    The answer is B: droplet. Neisseria meningitidis is transmitted through respiratory droplets from close contact. Therefore, patients require droplet precautions, which include wearing a mask when within 3 feet of the patient and ensuring the patient wears a mask when outside their room. Airborne precautions are not necessary because the bacteria are not transmitted via small aerosolized particles, and standard precautions alone are insufficient to prevent spread.
16. A pediatric patient is scheduled to receive the Haemophilus influenzae type b (Hib) vaccine to help prevent bacterial meningitis. How many doses are recommended, and at which ages?
    A. 4 doses: 2, 4, 6, and 12–15 months
    B. 4 doses: 4, 6, 12, and 18 months
    C. 2 doses: 11–12 years with a booster at 16 years
    D. 3 doses: 11–12 years, 16 years, and 18 years
    The answer is A: A. 4 doses: 2, 4, 6, and 12–15 months. The Hib vaccine is given during childhood and helps prevent bacterial meningitis.
17. In a patient with bacterial meningitis, which assessment finding requires immediate nursing intervention?
    A. Headache
    B. Photophobia
    C. Temperature 103.6°F
    D. Nuchal rigidity
    The answer is C: temperature 103.6 °F . In bacterial meningitis, all the listed symptoms are concerning, but a temperature of 103.6°F requires immediate attention. High fever can indicate severe infection, risk of sepsis, or increased intracranial pressure, and may lead to complications if not managed promptly. Headache, photophobia, and nuchal rigidity are important findings but are less immediately life-threatening than a dangerously elevated temperature.
18. Which teaching point should the nurse include in discharge instructions for a patient with fungal meningitis?
    A. Avoid contact with others while lesions are active
    B. Wear a mask in public places
    C. Adhere to long-term treatment, which may last several months
    D. Stop medications once symptoms improve
    The answer is C: Adhere to long-term treatment, which may last several months. Patients with fungal meningitis are not typically contagious, so avoiding others or wearing a mask is not required, making options A and B unnecessary. The critical teaching point is adherence to long-term antifungal therapy, which can last months to ensure full eradication of the infection. Stopping medications early (option D) can lead to treatment failure or relapse, making it a clearly incorrect choice.
19. Which signs and symptoms are most likely to be observed in an infant with meningitis? Select all that apply.
    A. Photophobia
    B. Nuchal rigidity
    C. Bulging fontanelle
    D. Headache
    E. Poor feeding or refusal to eat
    The answers are C and E. Infants with meningitis often present differently than older children or adults. Bulging fontanelles (C) and poor feeding or refusal to eat (E) are classic early signs in infants due to increased intracranial pressure and general malaise. Photophobia (A), nuchal rigidity (B), and headache (D) are common in older children and adults but may be absent or difficult to assess in infants, making them less reliable indicators at this age.
20. A patient is diagnosed with Mycobacterium tuberculosis meningitis. Which type of transmission-based precautions should the nurse implement?
    A. droplet
    B. airborne
    C. standard only
    The answer is B: airborne. Mycobacterium tuberculosis is transmitted through droplet nuclei that remain suspended in the air for long periods, making it highly contagious. Because of this, the nurse must initiate airborne precautions, which include placing the patient in a negative-pressure private room, ensuring the door remains closed, and having staff wear an N95 respirator (or higher-level protection) when entering the room.

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