Leadership / Delegation Question #4
The nurse is caring for a client with stage IV cancer. The client asks the nurse about “do not resuscitate orders” (DNR). Which statement best represents the nurse’s response to a client asking about end of life options?
- “I can witness that for you right now if you would like.”
This answer is not correct because the nurse should not encourage witnessing the document, as this could lead to the client asking questions that only the doctor should answer. It is not the responsibility of the nurse to provide answers to questions by clients regarding DNR or the informed consent process.
- “I need to speak with your designated health care proxy prior to discussing these options."
This answer is not correct because the nurse should always ensure client rights and confidentiality. A health care proxy is someone who will make health care decisions for the client only in the event of the client’s incapacitation.
- “I will contact your healthcare provider to discuss “do not resuscitate” options.”
This answer is correct because the health care provider will need to discuss “do not resuscitate” (DNR) orders with the client and must be signed by the health care provider. While many states vary on the mechanisms of such a directive, DNR still must be discussed and signed by the attending provider. Oral consent in most states includes having two witnesses with the attending provider as one of the witnesses. The advance directives should be maintained in the client record.
- “Why don’t you allow the chemo to do its work?”
This answer is not correct because the nurse should never offer advice on stopping or continuing chemo and other life-saving treatments. This is not appropriate and nontherapeutic.
“Do not resuscitate” orders are only written by a doctor when a client has provided informed consent for DNR status. If a client asks about DNR orders, the nurse should arrange a time for the healthcare provider to inform the client.
There are many variables to consider in DNR orders. For this reason, only the physician can discuss this with the client. The nurse’s role is opening the line of communication between the client and the physician regarding DNR. The nurse should make sure the client was provided with the information needed to make such a decision. The nurse should always follow the DNR order that has been put in place. It is the nurse’s duty to know if her client has a DNR order. A nurse who performs CPR on a client with a DNR order is subject to legal consequences, since this is considered committing battery against the client.
Test Taking Tip
Knowing and understanding the nurse’s role with DNR orders and its implications is one of the most important functions of a nurse.