A patient presents to the emergency department after a fall. The nurse notes raccoon eyes and rhinorrhea. The healthcare provider suspects a skull fracture. Which of the following nursing interventions is most appropriate?

A. Instill normal saline into the nose to clear any possible obstructions: Flushing the nasal passages could increase intracranial pressure or dislodge clots, potentially worsening a skull fracture or causing CSF leakage. This intervention is unsafe in suspected basilar skull fractures. B. Use a sterile dressing to collect the nasal drainage and send it for testing: Raccoon eyes and clear rhinorrhea suggest a possible basilar skull fracture with cerebrospinal fluid (CSF) leakage. Collecting drainage on a sterile dressing and testing for glucose or beta-2 transferrin confirms the presence of CSF. This intervention protects the patient from infection and provides diagnostic information safely. C. Apply ice packs to the nose to reduce swelling and drainage: While ice may reduce swelling in minor facial injuries, it does not address the risk of CSF leakage or confirm the diagnosis of a skull fracture. Applying ice does not take priority over diagnostic assessment and infection prevention. D. Instruct the patient to cough to clear nasal passages: Coughing increases intracranial pressure and may exacerbate CSF leakage or worsen the fracture. Patients with suspected basilar skull fractures should avoid actions that increase pressure in the skull.