A nurse in a provider's clinic is assessing a client who has rheumatoid arthritis and is prescribed methotrexate. Which action should the nurse take first when the client reports bleeding gums?

A. Assisting the client with a dental appointment addresses oral hygiene but fails to identify the underlying systemic cause of the bleeding. In a patient taking methotrexate, bleeding gums are often a clinical manifestation of drug-induced bone marrow suppression rather than primary dental disease. Delaying a clinical investigation to focus on dentistry could allow a life-threatening hematologic crisis to go untreated. B. Disinfecting the toothbrush is an appropriate measure to prevent secondary infections in immunocompromised patients, but it does not address the physiological cause of the hemorrhage. While infection control is important, the nurse must prioritize diagnostic assessment over routine hygiene instructions when a new symptom of toxicity appears. This action provides no data regarding the patient's current hematologic stability or safety. C. Educating the client on iron-rich meals might eventually help if the patient develops iron-deficiency anemia due to chronic blood loss. However, it is an inappropriate immediate response to an acute report of bleeding, as it does not address the likely mechanism of thrombocytopenia. The nurse must first determine why the patient is bleeding before implementing long-term nutritional interventions that do not provide acute stabilization. D. Checking the complete blood count results is the priority action because methotrexate is a folic acid antagonist that can cause severe myelosuppression. Bleeding gums are a hallmark sign of a critically low platelet count, known as thrombocytopenia, which increases the risk of internal hemorrhage. The nurse must use the nursing process to assess the physiological status before recommending any other interventions or dental appointments.