A nurse is providing care to a client with end-stage throat cancer who is unresponsive and unable to eat. The client has been receiving total parenteral nutrition (TPN) to meet their nutritional needs. The family has requested the nurse to withdraw the TPN and stop all further treatments. What should the nurse perform first?

Managing end-of-life care and the withdrawal of life-sustaining treatment involves applying ethical principles and legal protocols. The nurse must recognize the chain of command and the necessity of medical orders when modifying a treatment plan requested by the family for an unresponsive patient. Choice A rationale The physician is legally responsible for the medical treatment plan and must be informed of the family's request to change the goals of care. Withdrawing TPN requires a formal medical order to ensure legal and ethical compliance in end-of-life situations. Choice B rationale Withdrawing feedings without a physician's order is outside the nursing scope of practice and constitutes medical neglect or a breach of protocol. The nurse must follow the legal process of obtaining an order before terminating any life-sustaining nutritional support. Choice C rationale While a chaplain can provide emotional and spiritual support to the family, they cannot authorize the medical withdrawal of treatment. This is a secondary intervention that should follow the legal communication with the primary healthcare provider regarding the plan. Choice D rationale Meeting with a social worker is helpful for long-term planning and support, but it does not address the immediate legal requirement for medical orders. The nurse's first action must be to engage the physician to discuss the ethics and legality of the request.