The nurse is assessing a 16-year-old patient who has suffered ...

[tiffannnnyyyyyy]

The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal?
 
  a. If the drum has ruptured, then purulent drainage will result.
  b. Bloody or clear watery drainage can indicate a basal skull fracture.
  c. The auditory canal many be occluded from increased cerumen.
  d. Foreign bodies from the accident may cause occlusion of the canal.

Question 2

The nurse is performing an otoscopic examination on an adult. Which of these actions is correct?
 
  a. Tilting the person's head forward during the examination
  b. Once the speculum is in the ear, releasing the traction
  c. Pulling the pinna up and back before inserting the speculum
  d. Using the smallest speculum to decrease the amount of discomfort

[asware1]

Answer to Question 1

ANS: B
Frank blood or clear watery drainage (cerebrospinal leak) after a trauma suggests a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media.

Answer to Question 2

ANS: C
The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed.

[tiffannnnyyyyyy]

Thank you

[asware1]

Happy to help you