What is the first action a nurse should take upon seeing an abnormal ECG rhythm?

What is the first action a nurse should take upon seeing an abnormal ECG rhythm?

• A. Check the patient's pulse
• B. Call for help immediately
• C. Administer a medication
• D. Record and wait

Answer: (A)

Assessing circulation by checking the patient’s pulse is the first step when an abnormal ECG rhythm is seen. The monitor may show an irregular rhythm, but that doesn’t tell you whether the heart is actually delivering a pulse and perfusing the body. If a pulse is present, you’ll continue with careful monitoring and targeted evaluation for stability and underlying causes. If there is no pulse, you must initiate life-saving actions immediately, such as CPR and activating the emergency response team. Medications or recording and waiting are not appropriate as the initial move until you know whether there’s a pulse.

Assessing circulation by checking the patient’s pulse is the first step when an abnormal ECG rhythm is seen. The monitor may show an irregular rhythm, but that doesn’t tell you whether the heart is actually delivering a pulse and perfusing the body. If a pulse is present, you’ll continue with careful monitoring and targeted evaluation for stability and underlying causes. If there is no pulse, you must initiate life-saving actions immediately, such as CPR and activating the emergency response team. Medications or recording and waiting are not appropriate as the initial move until you know whether there’s a pulse.