A nurse is caring for a client who has a living will on file stating no feeding tube insertion. The client's durable power of attorney for health care, their sibling, requests a feeding tube to prolong life, refusing to honor the living will. What is the nurse's best action?

Rationale:
A. Discussing palliative care options and symptom management is correct because it aligns with the goals of care for a client with a DNI order. The nurse should provide support, education, and interventions focused on comfort, alleviating distressing symptoms, and respecting the client’s wishes.

B. Providing chest compressions and defibrillation is incorrect if the client has a code status that limits resuscitation efforts. A DNI order typically applies to intubation, but many clients also specify “Do Not Resuscitate” (DNR); the nurse must clarify the client’s preferences regarding CPR. Blindly performing compressions may violate the client’s wishes.

C. Preparing for endotracheal intubation is incorrect because the client has a DNI order. Intubation is explicitly prohibited, and preparing for it would contradict the client’s legally documented directive.

D. Administering medications such as epinephrine during resuscitation is incorrect unless the client’s code status allows certain interventions. The nurse must follow the limits specified in the code status.

E. Administering oxygen therapy via nasal cannula is correct because it is a non-invasive measure to support oxygenation and relieve respiratory distress. It does not violate a DNI order and is consistent with comfort-focused care.

F. Using non-invasive ventilation without client consent is incorrect because any intervention that significantly impacts breathing requires the client’s agreement, especially if it could be uncomfortable or invasive. Respecting autonomy is essential.

G. Withholding all forms of CPR, including chest compressions, is incorrect unless the client has a documented DNR order in addition to the DNI. DNI specifically restricts intubation, not necessarily other resuscitation measures, so blanket withholding could misinterpret the client’s wishes.

Rationale:

A. Transporting a client who experienced a stroke 72 hr ago to the radiology department is incorrect because this is a non-invasive, low-risk task that can be safely delegated to an AP. The AP can assist with mobility and ensure the client’s safety during transport under supervision or according to facility policy.

B. Removing and cleaning the cannula of a client who has a new tracheostomy is correct because this is a complex, sterile procedure that requires nursing knowledge, assessment, and clinical judgment. Improper care can lead to airway compromise, infection, or other serious complications. Only a licensed nurse (RN or LPN, depending on state regulations and policy) should perform tracheostomy care for a newly established airway.

C. Performing oral hygiene for a client who is 1 day postoperative following an amputation of the right arm is incorrect because oral hygiene is a basic care activity that can safely be delegated to APs. It does not require professional judgment or assessment beyond routine observation for oral health issues.

D. Providing a back rub to a client who has right-sided paralysis is incorrect because this is a comfort measure and basic care activity within the AP’s scope. It does not require specialized nursing skills or judgment.