Comprehensive Professional Nursing Examination:
Pediatric Bacterial Meningitis & External
Ventricular Drain (EVD) Care
Target Audience: Pediatric and Critical Care Registered Nurses
Total Questions: 200 with Comprehensive Clinical Rationales
Section I: EVD Management and ICP Monitoring
Question 1: A nurse is caring for an 8-month-old infant with
bacterial meningitis and an external ventricular drain (EVD).
Which of the following parameters is the most critical to verify at
the start of every shift regarding the EVD system?
A) The color and clarity of the CSF in the burette
B) The exact level of the drip chamber relative to the infant's
external auditory meatus (Foramen of Monro)
C) The patency of the peripheral IV line
D) The temperature of the room
Correct Answer: B
Rationale: Ensuring the EVD transducer/zero reference point is
aligned with the Foramen of Monro is vital. Improper leveling can
result in overdrainage (if too low) or underdrainage (if too high).
Question 2: An infant with an EVD becomes irritable, and the ICP
waveform dampens. What is the nurse's priority action?
A) Flush the EVD catheter vigorously with sterile saline.
B) Lower the drainage system by 15 cm.
C) Check for kinking, clamping, or patient positioning issues
obstructing the tubing, and notify the neurosurgeon if unresolved.
D) Administer oral analgesics.
,Correct Answer: C
Rationale: Tubing inspection for mechanical obstruction is the first
nursing step. Never flush EVD catheters without an explicit
provider order.
Question 3: When transporting an infant with an active EVD for a
CT scan, what is standard protocol?
A) Leave the drain open and elevated on the movable pole at all
times.
B) Clamp the EVD during movement as ordered, ensuring prompt
un-clamping and re-leveling upon arrival at the destination.
C) Disconnect the drainage bag completely.
D) Prime the tubing with heparinized saline.
Correct Answer: B
Rationale: Clamping during transit prevents accidental siphoning
from position changes, but must be managed per hospital policy
and re-established immediately.
Question 4: What is the primary danger associated with an EVD
drainage system being positioned too low relative to the patient's
head?
A) Intracranial hypertension
B) Rapid CSF overdrainage leading to ventricular collapse,
subdural hematoma, or herniation
C) Subcutaneous edema
D) Respiratory alkalosis
Correct Answer: B
,Rationale: Low positioning decreases hydrostatic pressure
resistance, causing excessive CSF drainage.
Question 5: How often should CSF output from an EVD be
measured and recorded in the critical care setting?
A) Every 1 to 2 hours
B) Once every 12-hour shift
C) Every 24 hours
D) Only when the bag is full
Correct Answer: A
Rationale: Hourly CSF output tracking is essential to monitor for
sudden volume changes, hemorrhage, or CSF leak.
Question 6: An infant's EVD site has a small amount of clear fluid
leakage around the catheter. What is the priority nursing
intervention?
A) Apply pressure with a sandbag.
B) Notify the neurosurgeon immediately and reinforce the sterile
dressing per protocol.
C) Remove the catheter at the bedside.
D) Flush the catheter with antibiotic solution.
Correct Answer: B
Rationale: CSF leakage around the insertion site increases
infection risk (ventriculitis) and requires prompt physician
evaluation.
Question 7: When zeroing the EVD transducer, where should the
laser level or zero reference point be placed?
A) Level with the infant's external auditory meatus (Foramen of
Monro)
, B) Level with the infant's sternal notch
C) Level with the umbilicus
D) At the level of the mattress
Correct Answer: A
Rationale: The Foramen of Monro is the standard anatomical
landmark for intracranial pressure referencing.
Question 8: What is the primary purpose of an external ventricular
drain in an infant with bacterial meningitis and hydrocephalus?
A) To continuously deliver intrathecal antibiotics
B) To monitor ICP and divert CSF to relieve intracranial pressure
C) To measure central venous pressure
D) To obtain continuous blood gas samples
Correct Answer: B
Rationale: EVDs provide vital diagnostic ICP monitoring and
therapeutic CSF diversion when hydrocephalus complicates
meningitis.
Question 9: A nurse is caring for an 8-month-old infant with
bacterial meningitis and an external ventricular drain (EVD).
Which of the following parameters is the most critical to verify at
the start of every shift regarding the EVD system?
A) The color and clarity of the CSF in the burette
B) The exact level of the drip chamber relative to the infant's
external auditory meatus (Foramen of Monro)
C) The patency of the peripheral IV line
D) The temperature of the room
Correct Answer: B
Pediatric Bacterial Meningitis & External
Ventricular Drain (EVD) Care
Target Audience: Pediatric and Critical Care Registered Nurses
Total Questions: 200 with Comprehensive Clinical Rationales
Section I: EVD Management and ICP Monitoring
Question 1: A nurse is caring for an 8-month-old infant with
bacterial meningitis and an external ventricular drain (EVD).
Which of the following parameters is the most critical to verify at
the start of every shift regarding the EVD system?
A) The color and clarity of the CSF in the burette
B) The exact level of the drip chamber relative to the infant's
external auditory meatus (Foramen of Monro)
C) The patency of the peripheral IV line
D) The temperature of the room
Correct Answer: B
Rationale: Ensuring the EVD transducer/zero reference point is
aligned with the Foramen of Monro is vital. Improper leveling can
result in overdrainage (if too low) or underdrainage (if too high).
Question 2: An infant with an EVD becomes irritable, and the ICP
waveform dampens. What is the nurse's priority action?
A) Flush the EVD catheter vigorously with sterile saline.
B) Lower the drainage system by 15 cm.
C) Check for kinking, clamping, or patient positioning issues
obstructing the tubing, and notify the neurosurgeon if unresolved.
D) Administer oral analgesics.
,Correct Answer: C
Rationale: Tubing inspection for mechanical obstruction is the first
nursing step. Never flush EVD catheters without an explicit
provider order.
Question 3: When transporting an infant with an active EVD for a
CT scan, what is standard protocol?
A) Leave the drain open and elevated on the movable pole at all
times.
B) Clamp the EVD during movement as ordered, ensuring prompt
un-clamping and re-leveling upon arrival at the destination.
C) Disconnect the drainage bag completely.
D) Prime the tubing with heparinized saline.
Correct Answer: B
Rationale: Clamping during transit prevents accidental siphoning
from position changes, but must be managed per hospital policy
and re-established immediately.
Question 4: What is the primary danger associated with an EVD
drainage system being positioned too low relative to the patient's
head?
A) Intracranial hypertension
B) Rapid CSF overdrainage leading to ventricular collapse,
subdural hematoma, or herniation
C) Subcutaneous edema
D) Respiratory alkalosis
Correct Answer: B
,Rationale: Low positioning decreases hydrostatic pressure
resistance, causing excessive CSF drainage.
Question 5: How often should CSF output from an EVD be
measured and recorded in the critical care setting?
A) Every 1 to 2 hours
B) Once every 12-hour shift
C) Every 24 hours
D) Only when the bag is full
Correct Answer: A
Rationale: Hourly CSF output tracking is essential to monitor for
sudden volume changes, hemorrhage, or CSF leak.
Question 6: An infant's EVD site has a small amount of clear fluid
leakage around the catheter. What is the priority nursing
intervention?
A) Apply pressure with a sandbag.
B) Notify the neurosurgeon immediately and reinforce the sterile
dressing per protocol.
C) Remove the catheter at the bedside.
D) Flush the catheter with antibiotic solution.
Correct Answer: B
Rationale: CSF leakage around the insertion site increases
infection risk (ventriculitis) and requires prompt physician
evaluation.
Question 7: When zeroing the EVD transducer, where should the
laser level or zero reference point be placed?
A) Level with the infant's external auditory meatus (Foramen of
Monro)
, B) Level with the infant's sternal notch
C) Level with the umbilicus
D) At the level of the mattress
Correct Answer: A
Rationale: The Foramen of Monro is the standard anatomical
landmark for intracranial pressure referencing.
Question 8: What is the primary purpose of an external ventricular
drain in an infant with bacterial meningitis and hydrocephalus?
A) To continuously deliver intrathecal antibiotics
B) To monitor ICP and divert CSF to relieve intracranial pressure
C) To measure central venous pressure
D) To obtain continuous blood gas samples
Correct Answer: B
Rationale: EVDs provide vital diagnostic ICP monitoring and
therapeutic CSF diversion when hydrocephalus complicates
meningitis.
Question 9: A nurse is caring for an 8-month-old infant with
bacterial meningitis and an external ventricular drain (EVD).
Which of the following parameters is the most critical to verify at
the start of every shift regarding the EVD system?
A) The color and clarity of the CSF in the burette
B) The exact level of the drip chamber relative to the infant's
external auditory meatus (Foramen of Monro)
C) The patency of the peripheral IV line
D) The temperature of the room
Correct Answer: B
