A nurse finds a client in bed, unresponsive and breathing. Which of the following actions should the nurse take first?

A. Initiate cardiac monitoring for the client: Cardiac monitoring is important but should not occur before assessing the client's immediate circulatory status. Monitoring provides information about electrical activity but does not replace the need to confirm whether the client has a pulse, which determines the next steps in emergency care. B. Establish an IV access: Establishing IV access is useful for administering emergency medications, but it should not occur until the nurse determines whether the client has a pulse. Interventions requiring vascular access are secondary to assessing airway, breathing, and circulation. C. Palpate for the client's carotid pulse: The first priority in an unresponsive but breathing client is to assess circulation by checking for a carotid pulse. Determining whether the client has a pulse guides the nurse to initiate CPR if pulseless or continue supportive care if the pulse is present. This assessment directs all subsequent actions in the emergency response. D. Apply a blood pressure cuff: Measuring blood pressure is part of a full assessment but is not the first action in an unresponsive client. Vital signs can be obtained after confirming pulse and ensuring that immediate life-threatening conditions are addressed.