A nurse is reviewing the medical record of a client who has a do-not-resuscitate (DNR) order. The nurse notes that the order was written by the physician after consulting with the client's health care proxy, who is the client's adult daughter. The nurse also notes that the client is alert and oriented and has not expressed any objections to the DNR order.

What is the appropriate action by the nurse in this situation?

Rationale: The appropriate action by the nurse in this situation is to confirm the DNR order with

the client and document the conversation in the medical record. The nurse should ensure that

the client understands what a DNR order means and that they agree with it. The nurse should

also respect the client's right to change their mind at any time and revoke the DNR order if they wish.

Incorrect options:

B) Contact the physician and request that the DNR order be revoked, as the client has not given consent. - This is an inappropriate action, as it would violate the client's autonomy and dignity. The nurse should not assume that the client has not given consent, as they may have discussed their wishes with their health care proxy or physician beforehand. The nurse should confirm the DNR order with the client instead of requesting its revocation.

C) Respect the DNR order and provide palliative care to the client, as the health care proxy has authority to make decisions. - This is a partially correct action, as the nurse should respect the DNR order and provide palliative care to the client. However, the nurse should not rely solely on the health care proxy's authority to make decisions, asthe client is alert and oriented and may have their own preferences and opinions. The nurse should confirm the DNR order with the client as well.

Rationale: The nurse's priority action in this situation is to review the client's advance directives and code status with the family, as these documents indicate the client's preferences and wishes regarding end-of-life care and resuscitation measures. The nurse should ensure that the family understands and respects the client's choices and that they have a copy of these documents available at home.

Incorrect options:

B) Assess the client's pain level and administer analgesics as prescribed. - This is an important action, but not the priority in this situation. The nurse should assess and manage the client's pain and other symptoms as part of palliative care, but this should be done after reviewing the advance directives and code status with the family.

C) Provide emotional support and counseling to the client and the family. - This is an important action, but not the priority in this situation. The nurse should provide emotional support and counseling to the client and the family as part of holistic care, but this should be done after reviewing the advance directives and code status with the family.

D) Educate the client and the family about the signs and symptoms of impending death. - This is an important action, but not the priority in this situation. The nurse should educate the client and the family about what to expect as death approaches, such as changes in breathing, circulation, consciousness, and skin color, but this should be done after reviewing the advance directives and code status with the family.