RN Nursing · ACLS Protocols · Practice question
A patient presents in cardiac arrest with a rhythm showing ventricular fibrillation. What is the most appropriate initial action by the nurse?
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Perform high-quality CPR for 2 minutes and then analyze the rhythm.
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Administer IV epinephrine immediately and prepare for intubation.
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✓
Deliver a shock immediately to restore a normal heart rhythm.
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Check for a pulse for 5 seconds before proceeding.
Answer & explanation
Correct: Deliver a shock immediately to restore a normal heart rhythm.
Ventricular fibrillation (VF) is a shockable cardiac arrest rhythm, and according to current Advanced Cardiac Life Support (ACLS) guidelines, the single most important and time-sensitive intervention for a patient in VF is immediate defibrillation. Every minute without defibrillation reduces survival by approximately 7–10%, so delivering the shock as quickly as possible is the priority action. The correct response is to deliver a shock immediately to restore a normal heart rhythm. High-quality CPR is critically important and should begin immediately after the shock is delivered — or if a defibrillator is not yet available — but when a defibrillator is present and VF is confirmed on the monitor, the shock comes first. Administering epinephrine and preparing for intubation are appropriate later in the resuscitation algorithm, but neither is the initial priority for VF. Checking for a pulse for 5 seconds before proceeding is not recommended once a shockable rhythm is identified on the monitor; delaying defibrillation to verify a pulse wastes precious time. The streamlined sequence for witnessed VF is: confirm the rhythm, charge the defibrillator, clear, shock, then immediately resume CPR for 2 minutes before reassessing rhythm and considering medications like epinephrine. Prompt recognition and defibrillation remain the cornerstones of VF management.
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