A client with a prescription for do-not-resuscitate (DNR) begins to manifest signs of impending death. After notifying the family, what is the priority action the nurse should implement?

• A. Notify the physician immediately.
• B. Determine the client's need for pain medication.
• C. Initiate CPR if the client’s heart stops.
• D. Move the client to a private room.

Answer: (B)

In end-of-life care for a patient with a DNR, the priority is comfort and symptom relief. When signs of impending death appear, the nurse needs to assess and address distress right away, starting with pain control. Providing timely analgesia to relieve pain and discomfort prevents unnecessary suffering and can also ease agitation and breathing difficulties that often accompany dying. A DNR means do not perform CPR if the heart stops, but it does not negate the need for symptom management or comfort measures, so initiating or adjusting pain medication is the most immediate and appropriate action.

Notifying the physician remains important for ongoing orders and symptom management, and moving the patient to a private room does not directly address immediate comfort. Initiating CPR is not consistent with a DNR and is not the priority action in this scenario.