Never withhold CPR without a valid written DNR order in the chart; begin full resuscitation if none exists.
Before you read
Test yourself first: 5 questions
Question 1 of 5
The nurse is reviewing orders for a client admitted with an acute ischemic stroke who is NOT a candidate for thrombolytics. Which order should the nurse QUESTION?
Answer: A. For an ischemic stroke client who is not receiving thrombolytics, a swallow screen before any oral intake is essential to prevent aspiration; therefore an order to begin a regular oral diet immediately, before swallowing is evaluated, should be questioned. Aspirin, deep vein thrombosis prophylaxis, and continuous neurologic monitoring are appropriate standard orders.
Question 2 of 5
A physical restraint order is required for a client who is an imminent danger. Which statement about the order is correct?
Answer: B. Restraint and seclusion for behavioral emergencies require a provider order; PRN or standing as-needed restraint orders are prohibited. The provider must conduct a face-to-face evaluation within one hour, and orders are time-limited and renewed per policy.
Question 3 of 5
A client has a do-not-resuscitate (DNR) order and stops breathing. The nurse should:
Answer: B. A valid DNR means no CPR/intubation. Provide comfort care and notify the provider/family; honoring the order is required.
Question 4 of 5
The nurse receives several new orders. Which order should the nurse implement first?
Answer: A. Administering a STAT dose of an antiarrhythmic for a client with a symptomatic life-threatening dysrhythmia addresses an immediate circulation threat and takes priority over routine or scheduled orders.
Question 5 of 5
A client has a valid do-not-resuscitate (DNR) order and goes into cardiac arrest. What is the nurse's appropriate action?
Answer: B. A valid DNR order means CPR and advanced resuscitation are not initiated. The nurse continues comfort and supportive care and honors the client's documented wishes.
Keep the streak going with more questions like these, each with a full rationale.
What is do not resuscitate orders?
It must be a written provider order in the chart and reflects the patient's wishes. A DNR limits resuscitation only; all other comfort and supportive care continues.
Key points to remember
- A DNR requires a written order from the provider; it is not valid as a verbal-only or assumed order.
- A DNR means no CPR and no ACLS, but all other treatment and comfort care continues.
- A DNR is not the same as 'do not treat'; pain control, oxygen, hygiene, and dignity care are still provided.
- A competent patient or their proxy can request a DNR, and it can be reversed at any time.
- Without a valid DNR order, full resuscitation must be initiated if the patient arrests.
- DNR status should be clearly communicated at every shift handoff and transfer.
Nursing priorities
- Verify the DNR is a current, signed provider order in the chart before withholding resuscitation.
- Communicate DNR status clearly during handoff, transfer, and to all team members.
- Continue all comfort, pain, hygiene, and supportive measures regardless of DNR status.
- Support the patient and family emotionally and clarify what a DNR does and does not mean.
- Notify the provider promptly if the patient or proxy wishes to revoke the DNR.
Patient teaching
- A DNR means we will not perform CPR, but we will keep you comfortable and treat your symptoms.
- You can change your mind about a DNR at any time; just let us know.
- A DNR does not mean we stop caring for you; all other care continues.
Red flags: report now
- Never withhold CPR without a valid written DNR order in the chart; begin full resuscitation if none exists.
- Never reduce comfort care, pain management, or basic care because a patient is DNR.
- Report immediately any confusion or conflict among family members about the DNR status.
References
Clinical references for this topic
