A nurse is assessing a client who sustained a basal skull fracture and notes a thin stream of clear drainage coming from the client’s right nostril. Which of the following actions should the nurse take first?

Choice A reason: Asking the client to blow their nose is contraindicated in basal skull fractures, as it can increase intracranial pressure or force bacteria into the cranial cavity, risking meningitis. The clear drainage may be cerebrospinal fluid (CSF), and blowing the nose could exacerbate the fracture-related dural tear. Choice B reason: Suctioning the nostril is dangerous in basal skull fractures, as it may introduce infection or worsen a dural tear if the drainage is CSF. The negative pressure could disrupt intracranial structures, increasing complications like meningitis or brain herniation, making this an inappropriate first action. Choice C reason: Testing the drainage for glucose is the priority, as clear nasal drainage in basal skull fractures may indicate CSF leakage due to a dural tear. CSF contains glucose, unlike nasal secretions, and a positive test confirms the need for urgent intervention to prevent infection or further neurological damage. Choice D reason: Notifying the physician is important but secondary to confirming the nature of the drainage. Testing for glucose first identifies if the fluid is CSF, critical in basal skull fractures due to risks of meningitis or brain injury, ensuring the physician receives accurate, actionable information.