An 8-year-old child, who has a history of asthma, is seen in the office of the school nurse with coughing and wheezing. Which of the following actions should the nurse perform first?

Choice A reason: This response is not the priority action because dehydration is not an immediate threat to the child's life. The nurse should first rule out any signs of hemorrhage, which is a common complication of tonsillectomy.

Choice B reason: This response is not the priority action because pain medication may mask the symptoms of bleeding, such as increased swallowing or restlessness. The nurse should first assess the child for any signs of hemorrhage, and then administer pain medication as needed.

Choice C reason: This response is not the priority action because cherry popsicles may irritate the throat and cause bleeding. The nurse should first assess the child for any signs of hemorrhage, and then offer clear fluids or ice chips to the child.

Choice D reason: This response is the priority action because post-op bleeding is a serious and potentially fatal complication of tonsillectomy. The nurse should assess the operative site for any signs of bleeding, such as fresh blood, clots, or increased swallowing. The nurse should also monitor the child's vital signs, oxygen saturation, and level of consciousness. If bleeding is suspected, the nurse should notify the physician immediately and prepare for emergency interventions.

Choice A reason: Notifying the child's parents of his condition is important, but it is not the first action that the nurse should take. The nurse should prioritize the child's immediate needs and assess his respiratory status.

Choice B reason: Educating the child to avoid triggers is a preventive measure that can help reduce the frequency and severity of asthma attacks, but it is not helpful in an acute situation. The nurse should focus on providing relief and monitoring the child's response.

Choice C reason: Transporting the child to the emergency department may be necessary if the child does not respond to the initial interventions or if his condition worsens, but it is not the first action that the nurse should take. The nurse should first attempt to manage the child's symptoms in the office using the Asthma Action Plan.

Choice D reason: Assessing the child's peak expiratory flow and comparing it to the Asthma Action Plan is the first action that the nurse should take. This will help the nurse determine the severity of the child's asthma attack and the appropriate steps to follow. The Asthma Action Plan is a written document that provides individualized instructions for managing asthma based on the child's symptoms and peak flow readings.