# A 78-year-old male client with end-stage pancreatic cancer is enrolled in inpatient hospice care. The advance directive and the chart clearly document a Do-Not-Resuscitate (DNR) order. The client becomes apneic and pulseless. Two adult children at the bedside become distressed and demand that CPR be started immediately. Which is the priority nursing action? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question A 78-year-old male client with end-stage pancreatic cancer is enrolled in inpatient hospice care. The advance directive and the chart clearly document a Do-Not-Resuscitate (DNR) order. The client becomes apneic and pulseless. Two adult children at the bedside become distressed and demand that CPR be started immediately. Which is the priority nursing action? ## Option 1. Open the airway with a jaw thrust, apply high-flow oxygen via non-rebreather mask, and refrain from chest compressions, interpreting the DNR as allowing basic physiological care short of full resuscitation. 2. Honor the documented DNR by withholding CPR, deliver compassionate communication to the children, summon the hospice/palliative care team, and provide post-death support and bereavement resources. **✔ Correct answer** 3. Begin full CPR including chest compressions, defibrillation, and code blue activation, believing that the family's insistence and the client's cardiac arrest status necessitate overriding the DNR. 4. Explain that CPR is contraindicated in hospice, firmly direct the children to the waiting area, and then ensure privacy by closing the door to complete postmortem care without interruption. **Correct answer: 2** ## Explanation A documented DNR order is a binding clinical directive that overrides family requests for resuscitation. The legal and ethical standard is to honor the written wishes of the patient. The priority is to (a) withhold CPR, (b) provide compassionate communication and presence, (c) summon the hospice/palliative care team, and (d) support the family with bereavement resources. Option 3 violates the directive and the autonomy of the patient. Option 4 dismisses the family and compounds acute grief. Option 1 partial resuscitation is not a recognized compromise; any active resuscitative intervention contradicts the directive and is ethically inconsistent. ## In-depth explanation Clinical Judgment Apply NCJMM: Recognize cues (documented DNR + apneic and pulseless + family demanding CPR + acute grief) → Analyze cues (advance directive is binding; family request cannot override) → Generate solutions (withhold CPR + compassionate communication + hospice team + bereavement support) → Take action (no CPR, presence, summon the team, support the family) → Evaluate outcomes (autonomy honored, family supported, bereavement initiated). Memory Tip Patient autonomy > family wishes. A documented DNR is binding even when family demands CPR in the moment. Nurse role = honor the directive + emotional presence + summon the palliative team. KR vs US In Korean practice, CPR is often performed at end of life because the family demands it. In the US, advance directives and DNR orders are legally binding. NCLEX always treats written patient wishes as the priority, and partial resuscitation as a compromise is also wrong. ## Clinical scenario Clinical Practice Guide AHA & ANA position statements + state DNR statutes: a properly executed advance directive (POLST/MOLST in many states) is legally binding. Healthcare staff must honor the directive even when family requests differ. After expected death, post-mortem care, family bereavement support, and hospice/palliative team follow-up are standard. Caution NCLEX traps: (1) "family insists, so do CPR" (autonomy violation), (2) "explain DNR rules and dismiss family" (lack of compassion), (3) "partial CPR as a compromise" (ethically inconsistent). The fix is always to honor the directive plus active emotional support. ## Key concepts - **Do-Not-Resuscitate (DNR) order** — A medical order, derived from the advance directive of the patient or a surrogate decision in the absence of capacity, that instructs healthcare staff not to perform CPR in the event of cardiac or respiratory arrest. May appear on a POLST/MOLST form depending on state law. Other end-of-life interventions (oxygen, comfort medications) continue per the care plan. - **Advance directive** — A written legal document in which a competent adult specifies preferences for future medical care if capacity is lost. Includes a living will (treatment preferences) and a healthcare proxy / durable power of attorney for healthcare (designated decision-maker). Honored by healthcare staff and binding under state law. - **Bereavement support** — A coordinated set of services for family and friends after a death, including initial presence, follow-up calls, written materials, referrals to grief counseling, support groups, and chaplaincy. A standard component of hospice and palliative care; often continues for 12-13 months post-death. ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=360523&lang=en) - [A client with newly diagnosed metastatic colon cancer is admitted to a medical-surgical un…](https://mymerci.kr/pages/nclex_q.php?qn_id=362185&lang=en) - [A 65-year-old female client received intravenous morphine 30 minutes ago for postoperative…](https://mymerci.kr/pages/nclex_q.php?qn_id=362206&lang=en) - [A nurse on a medical-surgical unit is starting a 0700 round and reviews these four assigne…](https://mymerci.kr/pages/nclex_q.php?qn_id=362403&lang=en) - [An RN is assigning care on a medical-surgical unit to an LPN/VN and a trained unlicensed a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362464&lang=en) - [A 63-year-old female is being discharged after a 14-day hospitalization following complex …](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=en) - [The charge nurse on a medical-surgical unit is assigning tasks for a licensed practical nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=393555&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._