A patient arrives for dialysis with shortness of breath and a heart rate of 48. What should the nurse do first?

In a situation where a patient presents with shortness of breath and bradycardia (a heart rate of 48), it is critical to first ensure accurate assessment of the patient's vital signs. Verifying the heart rate apically and radially allows the nurse to confirm the diagnosis of bradycardia and ensures that the vital signs are accurate before any interventions are taken.

By checking both the apical and radial pulse, the nurse can determine if the heart rate is consistently low or if there are discrepancies between the two measurements. This is crucial in evaluating the severity of the patient's condition because consistent bradycardia might indicate a pressing cardiac issue that requires immediate intervention.

Taking this step first provides essential data that can influence subsequent decisions regarding patient care, such as whether administering oxygen or notifying the physician is warranted based on the confirmed vital signs. Thus, assessing the heart rate accurately is foundational in managing the patient's symptoms appropriately and ensuring safe and effective care.