Author Question: The nurse observes drainage from a client's ears after a head injury, and suspects a cerebral spinal ... (Read 84 times)

wrbasek0

  • Hero Member
  • *****
  • Posts: 560
The nurse observes drainage from a client's ears after a head injury, and suspects a cerebral spinal fluid (CSF) leak. Which description of the fluid supports the nurse's suspicion?
 
  1. Yellow without sediment.
  2. Blood-tinged without sediment.
  3. Clear, colorless.
  4. Pink without sediment.

Question 2

The nurse is performing a neurological assessment and needs to assess for vibration, as well as sharp and dull sensation. Which objects will the nurse use to complete this assessment? Select all that apply.
 
  1. Tuning fork.
  2. Paper clip.
  3. Safety pin.
  4. Cotton ball.
  5. Tongue blade.



kristenb95

  • Sr. Member
  • ****
  • Posts: 318
Answer to Question 1

Correct Answer: 3
It is important to recognize CSF as clear and colorless. Due to its appearance, it can be mistaken for normal drainage such as rhinorrhea. Yellow drainage, blood-tinged fluid, and pink drainage without sediment are not consistent with cerebral spinal fluid.

Answer to Question 2

Correct Answer: 1, 3
To test for sharp and dull sensation, areas of the client's skin are touched with the sharp and blunt ends of a safety pin. The client then verbalizes if the sensation is dull or sharp. Vibration is tested by striking a tuning fork and placing it on bony parts of the client's body. The paper clip may be used to assess for the ability to determine the identity of an object unseen. A cotton ball may be used to assess sensation when evaluating the facial nerve. A tongue blade would be used to assess the gag reflex and the movements of the tongue.



Related Topics

Need homework help now?

Ask unlimited questions for free

Ask a Question
 

Did you know?

There are more nerve cells in one human brain than there are stars in the Milky Way.

Did you know?

About 80% of major fungal systemic infections are due to Candida albicans. Another form, Candida peritonitis, occurs most often in postoperative patients. A rare disease, Candida meningitis, may follow leukemia, kidney transplant, other immunosuppressed factors, or when suffering from Candida septicemia.

Did you know?

Dogs have been used in studies to detect various cancers in human subjects. They have been trained to sniff breath samples from humans that were collected by having them breathe into special tubes. These people included 55 lung cancer patients, 31 breast cancer patients, and 83 cancer-free patients. The dogs detected 54 of the 55 lung cancer patients as having cancer, detected 28 of the 31 breast cancer patients, and gave only three false-positive results (detecting cancer in people who didn't have it).

Did you know?

Since 1988, the CDC has reported a 99% reduction in bacterial meningitis caused by Haemophilus influenzae, due to the introduction of the vaccine against it.

Did you know?

About one in five American adults and teenagers have had a genital herpes infection—and most of them don't know it. People with genital herpes have at least twice the risk of becoming infected with HIV if exposed to it than those people who do not have genital herpes.

For a complete list of videos, visit our video library