NCLEX · General

A client's medical record contains an advance directive stating 'DNR/DNI — do not resuscitate, do not intubate.' The client is found unresponsive on the unit. What should the nurse do?

Correct answer

Check for valid advance directive in the chart; if a valid, current DNR/DNI order is confirmed, provide comfort measures and do not initiate CPR or intubation; notify the RN, physician, and family; document the time, assessment findings, and actions

  1. A Begin CPR immediately — advance directives are not binding
  2. B Check for valid advance directive in the chart; if a valid, current DNR/DNI order is confirmed, provide comfort measures and do not initiate CPR or intubation; notify the RN, physician, and family; document the time, assessment findings, and actions
  3. C Ignore the DNR since it was written years ago
  4. D Begin CPR then check the chart

Why this is the answer

ADVANCE DIRECTIVE AND DNR ORDERS: LEGAL STATUS: A valid advance directive and physician's do-not-resuscitate order is a LEGAL DOCUMENT that must be honoured; CPR against a DNR order is assault; VALIDITY CHECK: Is the document current? Is it in the medical record? Is there a corresponding physician's order (the advance directive alone is not sufficient — a physician's order translating it to a specific DNR order is usually required in hospitals); DNR ≠ NO CARE: DNR means no CPR — all other comfort care, pain management, dignity care continue; NURSE'S ROLE: Know the DNR/advance directive status of all patients before a crisis; ensure the order is properly documented; follow the order; notify the team; support the family; DISCREPANCIES: If family members are demanding resuscitation despite a valid DNR — this is a care conference/ethics consultation situation; the physician and team should be contacted; the DNR order is valid; DOCUMENTATION: Time of death; assessment; notifications; comfort measures provided.
Source: NCLEX-PN Safe Care — Management of Care, DNR and Advance Directive Compliance

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