NCLEX-PN® ExaminationCoordinated CareMedium
A licensed practical nurse (LPN) is reviewing a client's medical record and notes a 'Do Not Resuscitate' (DNR) order. The client's family approaches the LPN requesting aggressive life-sustaining measures if the client's condition deteriorates. What is the LPN's initial ethical responsibility in this situation?
- ANotify the registered nurse (RN) and the healthcare provider (HCP) about the family's request.
- BExplain to the family that the DNR order cannot be overridden.
- CDocument the family's request in the client's chart without further action.
- DInitiate a discussion with the client about their current wishes.
Show answer & explanationAnswer & explanation
Correct answer: A. Notify the registered nurse (RN) and the healthcare provider (HCP) about the family's request.
The LPN's initial responsibility is to communicate the family's concerns to the appropriate members of the healthcare team, specifically the RN and HCP. This allows for a comprehensive review of the DNR order, client's wishes, and family's request, facilitating an ethical resolution.
Why the other options are wrong
- B. The LPN should not unilaterally dismiss the family's request without involving the broader healthcare team and reviewing the client's capacity and wishes.
- C. Simply documenting without action is insufficient; the conflict requires resolution by the healthcare team.
- D. While discussing with the client is important, the LPN's scope requires escalation to the RN/HCP to address a conflict involving a legal order and family wishes, especially if the client's capacity is uncertain.
Ethical Practice: DNR Conflict
When a conflict arises between a client's advance directive (like a DNR) and family wishes, the LPN's role is to ensure the client's autonomy is respected while escalating the issue to the interdisciplinary team for resolution.
- Client's advance directives take precedence over family wishes if the client has decision-making capacity.
- LPNs must report conflicts to the RN and healthcare provider.
- The interdisciplinary team is responsible for resolving ethical dilemmas.
Memory trick: Ethics demand clear talk, team action, and client's voice.