If a client with a basal skull fracture has clear drainage from the nostril, what is the first action the nurse should take?

When a client with a basal skull fracture presents with clear drainage from the nostril, it raises the concern of cerebrospinal fluid (CSF) leakage. The first action the nurse should take is to test the drainage for glucose. This is because CSF is expected to contain glucose, and a positive glucose test would confirm the presence of CSF, indicating a potential complication from the fracture, such as a breach in the protective meninges.

Testing for glucose is a critical step before other actions can be taken, as it helps in determining the appropriate treatment and management plan. If the drainage is confirmed to be CSF, further interventions will need to take place to protect the client from risks such as infection or complications related to the depletion of cerebrospinal fluid.

Other options, such as suctioning the nostril or asking the client to blow their nose, could potentially worsen the situation. Doing so could increase intracranial pressure or force more fluid out, further compromising the integrity of the meninges. Notifying the physician is also essential, but it should occur after confirming the nature of the drainage through a glucose test. Thus, testing the drainage for glucose is the priority action.