A school nurse is caring for a child who has asthma and begins to have difficulty breathing. Which of the following actions should the nurse take?

When a child with asthma begins experiencing acute difficulty breathing at school, the immediate priority intervention is administering a rescue bronchodilator. Albuterol, a short-acting beta-2 agonist, is the first-line treatment for acute bronchospasm. Standard dosing for an acute episode is two puffs via metered-dose inhaler, ideally with a spacer, which rapidly relaxes bronchial smooth muscle and relieves bronchospasm within minutes. This is the recognized standard of care for acute asthma exacerbations and is consistent with school asthma action plans. Placing the child in the supine position is contraindicated during respiratory distress because lying flat increases the work of breathing and worsens dyspnea; an upright or slightly forward-leaning position is preferred to optimize lung expansion. Instructing the child to perform controlled breathing exercises is a maintenance and prevention technique, not appropriate during an acute episode when the child is already struggling to breathe. A flutter mucus clearance device is used for airway clearance in conditions such as cystic fibrosis or chronic bronchitis, not for acute bronchospasm in asthma. Prompt administration of albuterol is the correct and prioritized action in this acute scenario.