After two minutes of cardiopulmonary resuscitation, the client's electrocardiogram (ECG) displays third degree heart block with no palpable pulse. Which intervention should the nurse implement?

Rationale: A. Apply external pacing pads: Transcutaneous pacing is appropriate for symptomatic bradycardia with a pulse, not for pulseless electrical activity (PEA). In this case, the client has no pulse, so pacing will not generate effective cardiac output and should not be the first intervention. B. Obtain blood pressure reading: During cardiac arrest, the client has no palpable pulse or measurable blood pressure. Attempting to obtain a blood pressure reading wastes valuable time that should be spent on life-saving interventions such as medication administration and high-quality CPR. C. Insert second peripheral IV: While establishing additional IV access can be useful for administering fluids or medications, it is not the immediate priority during a pulseless event. The focus should remain on pharmacologic support and maintaining perfusion through CPR. D. Prepare epinephrine 1 mg IV: Epinephrine is the first-line medication for PEA and asystole because it enhances myocardial contractility and increases coronary and cerebral perfusion during CPR. It should be administered as soon as possible, followed by continued chest compressions and rhythm reassessment every 2 minutes.