When finding a client unresponsive, what is the first action the nurse should take?

In an emergency situation where a client is found unresponsive, the first action a nurse should take is to shake the client and shout. This step is crucial because it allows the nurse to assess the responsiveness of the client. By attempting to stimulate the client verbally and physically, the nurse can determine if there is any reaction, which is essential before proceeding with further assessments or interventions.

Assessing responsiveness helps to establish the level of consciousness and can guide subsequent actions, such as checking for breathing or pulse. If the client does not respond to shaking or shouting, the nurse can then shift to checking for breathing or pulse, but initial responsiveness checks are fundamental in situational assessments. This approach aligns with basic life support protocols and ensures that urgent actions are only taken based on clear observations of the client's condition.

In contrast, jumping to other procedures like checking breathing or calling a code without first assessing responsiveness could delay vital interventions that may be necessary for the client's well-being.