The ED nurse is caring for a patient who has been brought in by ambulance after sustaining a fall at home. What physical assessment finding is suggestive of a basilar skull fracture?
A) Epistaxis
B) Periorbital edema
C) Bruising over the mastoid
D) Unilateral facial numbness
Ans: C
Feedback:
An area of ecchymosis (bruising) may be seen over the mastoid (Battle's sign) in a basilar skull fracture. Numbness, edema, and epistaxis are not directly associated with a basilar skull fracture.
You might also like to view...
The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse?
1. "Make sure that anything you say is clear and concise." 2. "Don't feel as if you are responsible for fixing every problem." 3. "Avoid using phrases such as ‘sort of' when talking to females." 4. "Don't personalize everything."
A nurse is teaching a client with a new tracheostomy self-care measures and evaluates that teaching goals have been met when the client says
a. "I can shower if I am careful not to get water into the stoma." b. "I don't see why I should quit smoking now; what more could happen?" c. "Stoma covers aren't used because they can lead to suffocation." d. "When my tube comes out I can go swimming again."
A nurse working in the emergency department who must obtain data to identify the patient's primary care provider should ask the patient about
a. hospital stays. b. low-cost health care providers. c. receiving specialized care aimed at restoring the function of a body part. d. the referring physician, nurse practitioner, or ambulatory care setting.
A nurse is assessing a premature newborn for the possibility of necrotizing enterocolitis (NEC). Which assessment findings should the nurse expect to find if NEC is confirmed? (Select all that apply.)
a. Minimal gastric residual b. Abdominal distention c. Apnea d. Urinary output at 2 ml/kg/hr e. Unstable temperature