A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums?

A. While methotrexate can cause mucositis, bleeding gums may indicate thrombocytopenia, a serious and potentially dangerous side effect that requires assessment, not reassurance as “expected.” B. Referring to a dentist is premature. While dental care is important, the immediate concern is evaluating the client for possible hematologic complications from methotrexate, such as low platelet counts, which can cause spontaneous bleeding. C. Instructing the client to use an electric toothbrush is inappropriate at this time. Electric toothbrushes can cause trauma and exacerbate bleeding in clients with thrombocytopenia. Soft-bristled toothbrushes are recommended, but the first step is to assess platelet levels. D. Checking the client’s current platelet count is the correct initial action. Methotrexate can cause bone marrow suppression, leading to thrombocytopenia and increased bleeding risk. Assessing platelet levels helps determine the severity of the problem and guides interventions, such as holding the medication, initiating platelet transfusions, or providing bleeding precautions.