A client who has amyotrophic lateral sclerosis (ALS) has an advance directive that states they do not want any life-sustaining measures, including artificial nutrition and hydration, if they become unable to make decisions for themselves. The client's family disagrees with this decision and asks the nurse to insert a feeding tube in the client. What should the nurse do?

A) Insert the feeding tube in the client, as the family has the right to make decisions for the client.

B) Refuse to insert the feeding tube in the client, as the advance directive is legally binding and must be honored.

C) Consult with the ethics committee and seek a resolution that respects both the client's and the family's wishes.

D) Ask the physician to override the advance directive and order artificial nutrition and hydration for the client.

The nurse should respect the client's autonomy and follow their advance directive, which is a legal document that expresses their wishes regarding end-of-life care. The nurse should not insert a feeding tube in the client, as this would violate their right to self-determination and informed consent.

Incorrect options:

A) Insert the feeding tube in the client, as the family has the right to make decisions for the client. - This is an incorrect option, as the family does not have the right to make decisions for the client that are contrary to their advance directive. The family should be educated about the purpose and scope of the advance directive and supported in coping with their emotions.

C) Consult with the ethics committee and seek a resolution that respects both

the client's and the family's wishes. - This is an incorrect option, as there is no need to consult with the ethics committee when there is a clear advance directive that states the client's wishes. The ethics committee can be involved if there is a conflict or uncertainty about the interpretation or validity of the advance directive.

D) Ask the physician to override the advance directive and order artificial nutrition and hydration for the client. - This is an incorrect option, as the physician cannot override the advance directive without the client's consent or a court order. The physician should respect the client's autonomy and follow their advance directive.

Rationale: The nurse should verify the DNR order with the client or their surrogate decision-maker and document it in the EHR before proceeding. The nurse should ensure that the DNR order is clear, current, and consistent with the client's wishes and goals of care. The nurse should also communicate the DNR order to other members of the health care team.

Incorrect options:

A) Intubate and ventilate the client, as the DNR order is not valid without documentation in the EHR. - This is an incorrect option, as intubating and ventilating the client would violate their right to refuse treatment and die naturally. The DNR order is valid even if it is not documented in the EHR, as long as it is written by a physician and signed by the client or their surrogate decision-maker.

B) Contact the physician who wrote the DNR order and ask them to enter it in the EHR as soon as possible. - This is an incorrect option, as contacting the physician who wrote the DNR order would delay providing appropriate care to the client. The nurse should verify and document the DNR order themselves, as they are accountable for following it.

C) Refuse to intubate and ventilate the client, as the DNR­ order is valid regardless of documentation in the EHR. - This is an incorrect option, as refusing to intubate and ventilate the client without verifying and documenting the DNR order would put the nurse at risk of legal liability and professional misconduct. The nurse should ensure that there is evidence of the DNR order in the EHR before acting on it.