You receive a new patient who received severe trauma to the front of her face from a suspected spousal abuse assault. You notice both blood and a clear fluid draining from the patient's nose.
What is your best treatment to prevent further injury to your patient?
Place an NG tube so patient does not have to swallow any medications.
Test the clear fluid for presence of glucose.
Encourage the patient to cough and deep breathe.
Place a mustache dressing on the patient.
The Correct Answer is B
Choice A rationale
Placing an NG tube could potentially worsen a basilar skull fracture or cause further injury by penetrating the cranial vault if the cribriform plate is compromised. This intervention is contraindicated when clear fluid, possibly cerebrospinal fluid, is draining from the nose, indicating a potential breach in the dura mater.
Choice B rationale
Testing the clear fluid for the presence of glucose is a critical diagnostic step. Cerebrospinal fluid (CSF) contains glucose, whereas nasal secretions do not. A positive glucose test strongly indicates a CSF leak, which is a significant complication of facial trauma that requires specific management to prevent intracranial infection. Normal CSF glucose ranges from 40 to 70 mg/dL.
Choice C rationale
Encouraging coughing and deep breathing would increase intrathoracic and intracranial pressure, which could exacerbate a CSF leak and potentially introduce pathogens into the intracranial space. This action should be avoided as it poses a risk for further neurological complications such as meningitis.
Choice D rationale
Placing a mustache dressing on the patient might absorb the drainage but does not address the underlying issue of a potential CSF leak. Furthermore, applying pressure or occluding the nares could impede the free flow of CSF, potentially leading to a build-up of pressure and increasing the risk of retrograde infection into the central nervous system.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale
Suctioning should be performed only when clinically indicated, such as in the presence of visible secretions, adventitious breath sounds, or a decline in oxygen saturation. Routine, unnecessary suctioning can cause mucosal trauma, hypoxemia, and increased risk of infection. This "as needed" approach minimizes potential complications and preserves airway integrity.
Choice B rationale
Hyperoxygenating the patient with 100% oxygen for 30-60 seconds prior to suctioning helps to create an oxygen reserve in the lungs and minimize the risk of hypoxemia during the procedure. Suctioning can transiently reduce lung volumes and gas exchange, and pre-oxygenation mitigates this by saturating hemoglobin and dissolved plasma oxygen.
Choice C rationale
Suctioning for longer than 10-15 seconds on each pass significantly increases the risk of hypoxemia, atelectasis, and vagal stimulation leading to bradycardia. Prolonged suctioning depletes oxygen from the airways and can cause physiological distress. Brief passes allow for reoxygenation between attempts and minimize adverse events.
Choice D rationale
Performing hand hygiene prior to suctioning is a critical infection control measure. This practice reduces the transmission of microorganisms from the healthcare provider's hands to the patient's airway, thereby preventing healthcare-associated infections like ventilator-associated pneumonia. Adherence to strict aseptic technique is paramount in airway management.
Choice E rationale
Suctioning should never be performed while inserting the catheter into the artificial airway. Applying negative pressure during insertion can cause significant mucosal trauma, bleeding, and increased risk of infection by pulling tissue into the catheter lumen. Suction should only be applied intermittently and during withdrawal of the catheter, to remove secretions effectively and safely.
Correct Answer is B
Explanation
Choice A rationale
The presence of bacteria in the cerebrospinal fluid is a hallmark indicator of bacterial meningitis. Therefore, an absence of bacteria would typically rule out a bacterial infection, suggesting either a different etiology or a sterile CSF culture due to prior antibiotic administration.
Choice B rationale
In bacterial meningitis, bacteria consume glucose from the CSF for their metabolic needs. This leads to a characteristic decrease in CSF glucose levels (normal range 40-70 mg/dL or approximately 2/3 of blood glucose). This metabolic activity of the bacteria is a key diagnostic marker.
Choice C rationale
Bacterial meningitis is characterized by a significant inflammatory response within the central nervous system. This response includes a robust influx of leukocytes, predominantly neutrophils, into the cerebrospinal fluid. Therefore, an absence of leukocytes would contradict a diagnosis of bacterial meningitis.
Choice D rationale
The inflammation and increased permeability of the blood-brain barrier associated with bacterial meningitis often lead to an elevated protein concentration in the cerebrospinal fluid (normal range 15-45 mg/dL). Therefore, an absence of protein would be inconsistent with the expected findings.
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