A nurse in an emergency department is assessing a 3-year-old child who has a high fever, severe dyspnea, and is drooling. Which action is the nurse's priority?

A. Perform a neurovascular assessment: This is the correct answer. After a cast is applied, it’s crucial to regularly assess the client’s neurovascular status (sensation, movement, temperature, color, and capillary refill) to ensure that the cast is not too tight and that circulation is not compromised.
B. Provide reassurance to the client and parents: While this is important, the immediate priority is to ensure the client’s physical well-being.
C. Apply an ice pack to the casted leg: This can help reduce swelling and pain, but it’s not the immediate priority. The nurse first needs to ensure that the cast is not compromising circulation or nerve function.
D. Explain the discharge instructions to the client and parents: This is typically done later, closer to the time of discharge. The immediate priority is to assess the client’s physical condition.

A. “Place your child in a sitting position with her head tilted back.”: This is not recommended because it can cause the blood to flow down the back of the throat, which can lead to gagging or choking.
B. “Apply ice at the base of the nose for 5 min and then check for bleeding.”: While applying ice can help constrict the blood vessels and slow the bleeding, it’s not the most effective initial step in managing a nosebleed.
C. “Have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes.”: This is the correct answer. Tilting the head forward prevents the blood from flowing down the back of the throat, and applying pressure to the nostrils can help stop the bleeding.
D. “Place your child in a supine position with a pillow under her back.”: Lying down can increase blood pressure in the veins of the nose, which can make the nosebleed worse. It’s better to keep the head elevated.