A 67-year-old client with severe chronic obstructive pulmonary disease is admitted to the intensive care unit after respiratory failure and is now intubated and unresponsive. A valid do-not-resuscitate order and living will are on file stating the client does not want cardiopulmonary resuscitation or re-intubation if extubated. Current assessment: blood pressure 98/56 mm Hg, heart rate 112/min, oxygen saturation 92% on the ventilator; the client's adult son insists the team "do everything" if the client's heart stops. What should the nurse do FIRST when the family member disagrees with the advance directive?
- Ask the son to sign the hospital's revocation form so the do-not-resuscitate order is removed from the chart and resuscitation can proceed if needed.
- Notify the provider of the son's request for full resuscitation and ask for new orders to override the advance directive.
- Confirm the advance directive is in the medical record and communicate the client's documented wishes to the health care team. (correct answer)
- Call the hospital attorney to determine whether the son's verbal request can override the living will before making a care decision.
Explanation: The best first action is to confirm that the client's advance directive is in the medical record and then communicate the client's documented wishes to the health care team. Because the do-not-resuscitate order and living will are valid, they speak for the client now; the son's disagreement does not change their legal authority. The choice asking the son to sign a revocation form is incorrect because a family member cannot revoke a valid advance directive by signing a hospital form, and it would place the son's preference over the client's autonomy. The choice asking the provider for new orders to override the advance directive is also incorrect: a valid directive cannot be set aside simply because the family requests full resuscitation. The choice calling the hospital attorney is not the first nursing action and is unnecessary when the directive has already been verified as valid; it delays bedside advocacy. After confirming and communicating the documented wishes, the nurse can support the son and, if needed, involve an ethics committee.