A nurse in an emergency department is assessing a client who has a nasal fracture. Which of the following findings should cause the nurse to suspect a skull fracture?

Clear fluid drainage from the nares

Report of pain around the eyes

Dried blood in the mouth

Mandibular asymmetry

Answer and Explanation

The Correct Answer is A

A. Clear fluid drainage from the nares, especially if it is continuous or persistent, may indicate a cerebrospinal fluid (CSF) leak, which can occur with a skull fracture.

B. Pain around the eyes is more commonly associated with a nasal fracture or orbital fracture, rather than a skull fracture.

C. Dried blood in the mouth may indicate nasal bleeding but does not necessarily indicate a skull fracture.

D. Mandibular asymmetry may indicate a jaw fracture or injury but is not typically associated with a skull fracture.

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Correct Answer is B

Explanation

A. Place the client's valuables in the facility's safe - While securing the client's valuables is important, it is not the priority upon admission.

B. Observe the client's level of mobility - This is the priority as it allows the nurse to assess the client's immediate physical condition and risk of falls or other mobility-related issues.

C. Administer prescribed medications - Medication administration can wait until the client's initial assessment, including mobility, has been completed.

D. Electronically enter the prescriptions from the provider - Entering prescriptions can be done after the initial assessment and immediate needs of the client have been addressed.

A. "Wear an underwire bra between feedings." B. "Cover your breasts immediately after feedings." C. "Apply cold compresses to your breasts before feedings." D. "Try to have your baby empty your breasts with each feeding."

Correct Answer is D

Explanation

A. Wearing an underwire bra between feedings can compress the breasts and potentially lead to mastitis. Nursing bras without underwire are recommended.

B. Covering the breasts immediately after feedings can trap moisture and promote bacterial growth, increasing the risk of mastitis.

C. Cold compresses can help relieve discomfort from engorgement, but applying them before feedings may hinder milk flow and emptying of the breasts, which could increase the risk of mastitis.

D. Ensuring the baby fully empties the breasts with each feeding helps prevent engorgement and decreases the risk of mastitis by promoting effective milk removal.

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A nurse in an emergency department is assessing a client who has a nasal fracture. Which of the following findings should cause the nurse to suspect a skull fracture?

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