NCLEX-RNManagement of CareHard
A client with a documented advance directive stating 'no cardiopulmonary resuscitation' goes into cardiac arrest. The client's adult child, who just arrived, demands that the healthcare team 'do everything, including CPR.' What should the nurse do?
- ABegin CPR because the family member is present and requesting it
- BFollow the advance directive and do not initiate CPR
- CPerform CPR until the physician arrives to make a final decision
- DDelay the decision until the ethics committee can be consulted
Show answer & explanationAnswer & explanation
Correct answer: B. Follow the advance directive and do not initiate CPR
A valid advance directive reflects the client's own wishes and takes legal precedence over family requests when the client cannot speak for themselves; the family cannot override a documented DNR order. Delaying care or performing CPR against the directive violates the client's autonomy and legal rights.
Why the other options are wrong
- A. Family cannot override a legally valid advance directive/DNR.
- C. Performing CPR against a valid DNR violates the client's legal directive.
- D. Cardiac arrest requires immediate action; there is no time to consult ethics committee.
Advance Directive/DNR Authority
A valid advance directive or DNR order documents the client's wishes and legally overrides family requests when the client cannot make decisions for themselves.
- Advance directives must be honored even if family disagrees
- DNR orders must be verified/documented by the healthcare team
- Client autonomy is a core ethical principle guiding end-of-life decisions
Memory trick: The paper speaks for the patient, not the family