Advance directives NCLEX-RN Practice Questions

Advance Directives NCLEX-RN Practice Questions help you master essential decision-making in the Management of Care domain. Advance directives guide the healthcare team when patients cannot speak for themselves, defining preferences for life-sustaining treatments, code status, surrogate decision-makers, and comfort-focused care. As a nurse, you play a crucial role in verifying documents, advocating for patient autonomy, ensuring appropriate orders (e.g., DNR, POLST/MOLST), and facilitating ethical, culturally sensitive conversations with patients and families. The following practice questions reflect real NCLEX-RN exam complexity, testing safe, legal, and ethical nursing actions across multiple settings. Use these items to strengthen critical thinking related to capacity, documentation, conflict resolution, and interprofessional collaboration, especially in high-stakes, time-sensitive scenarios.

Q1. On admission, which action best ensures a patient’s advance directive is actionable across the care team?

• Ask if the patient has an advance directive and request a copy to upload to the EHR and flag in the chart
• Ask the family to complete a new advance directive at the bedside regardless of the patient’s wishes
• Delay medication administration until a notarized advance directive is obtained
• Tell the provider to write a default DNR order until documents are found

Correct Answer: Ask if the patient has an advance directive and request a copy to upload to the EHR and flag in the chart

Q2. A patient lacks decision-making capacity. Who is authorized to make healthcare decisions when a valid durable power of attorney for health care exists?

• The eldest child automatically becomes the decision-maker
• The healthcare agent named in the durable power of attorney for health care
• The spouse always overrides the appointed healthcare agent
• The physician may override the living will at any time

Correct Answer: The healthcare agent named in the durable power of attorney for health care

Q3. A patient with intact capacity verbally states they want full resuscitation, but an old living will in the record declines CPR. What should the nurse do first?

• Ignore the patient’s verbal request and follow the old living will
• Ask the patient to clarify their current wishes and notify the provider to update orders
• Ask the family to decide which to follow
• Call security to remove the family from the room

Correct Answer: Ask the patient to clarify their current wishes and notify the provider to update orders

Q4. Which statement reflects the nurse’s appropriate role when witnessing an advance directive signature?

• The nurse may witness the signature if not named as the agent or beneficiary and without giving legal advice
• The nurse should select the healthcare agent to avoid conflicts
• The nurse should provide legal interpretation of state-specific witnessing requirements
• The nurse should refuse to witness any advance directive to avoid liability

Correct Answer: The nurse may witness the signature if not named as the agent or beneficiary and without giving legal advice

Q5. Which best describes POLST/MOLST in relation to advance directives?

• They are informal preferences not used by clinicians
• They are legal titles for the healthcare agent
• They are medical orders that translate patient goals into actionable, portable treatment orders
• They are only valid inside operating rooms

Correct Answer: They are medical orders that translate patient goals into actionable, portable treatment orders

Q6. A patient with a DNR is scheduled for surgery. What is the nurse’s best action regarding perioperative resuscitation plans?

• Automatically suspend the DNR for surgery without discussion
• Ensure a “required reconsideration” discussion occurs with the patient/surrogate and surgical/anesthesia teams and is documented
• Cancel the procedure
• Ask the family to sign a new DNR postoperatively

Correct Answer: Ensure a “required reconsideration” discussion occurs with the patient/surrogate and surgical/anesthesia teams and is documented

Q7. A patient with a card refusing blood transfusions is profoundly anemic. What is the nurse’s priority action?

• Discard the card and administer blood
• Verify the refusal, notify the provider, and facilitate alternatives and informed refusal documentation
• Call risk management after transfusing
• Ask the family to consent instead

Correct Answer: Verify the refusal, notify the provider, and facilitate alternatives and informed refusal documentation

Q8. A deceased patient’s living will indicates organ donation. What is the nurse’s best action?

• Ask the family to consent, and if they refuse, do not notify anyone
• Immediately remove organs before notifying anyone
• Notify the organ procurement organization per policy for evaluation, regardless of family objections
• Wait for the funeral home to arrive

Correct Answer: Notify the organ procurement organization per policy for evaluation, regardless of family objections

Q9. A patient lacks capacity and has a DNR order consistent with the advance directive. The family demands “full code.” What should the nurse do?

• Follow the family’s wishes to avoid conflict
• Uphold the DNR order and notify the provider; explain the advance directive governs care
• Remove the DNR bracelet without documentation
• Begin CPR immediately

Correct Answer: Uphold the DNR order and notify the provider; explain the advance directive governs care

Q10. A patient with limited English proficiency wants an advance directive. Which approach ensures validity and understanding?

• Use a qualified medical interpreter for discussion and signing
• Ask a bilingual family member to interpret
• Provide an English-only form and ask them to sign
• Delay the process until discharge

Correct Answer: Use a qualified medical interpreter for discussion and signing

Q11. A living will states to forgo artificial nutrition in terminal illness. The patient is now terminal with a feeding tube in place. What should the nurse do?

• Ignore the document and maintain the feeding rate
• Advocate to align the plan with the living will; notify the provider to discuss discontinuation with the surrogate and ensure comfort care
• Ask housekeeping to remove the tube
• Tell the family they must decide without the team

Correct Answer: Advocate to align the plan with the living will; notify the provider to discuss discontinuation with the surrogate and ensure comfort care

Q12. How can a competent patient revoke an advance directive in the hospital?

• Only by notarized letter delivered to the hospital’s legal office
• Verbally at the bedside; the nurse documents and notifies the provider to update orders
• Only during business hours with two attorneys present
• They cannot revoke it once admitted

Correct Answer: Verbally at the bedside; the nurse documents and notifies the provider to update orders

Q13. A patient hospitalized on an involuntary psychiatric hold asks to complete an advance directive. What should the nurse assess first?

• Whether the provider agrees with the patient’s choices
• Decision-making capacity at the time of completion
• Whether the family approves
• Their insurance status

Correct Answer: Decision-making capacity at the time of completion

Q14. An unresponsive patient arrives wearing a state-issued out-of-hospital DNR bracelet. What is the nurse’s immediate action in the ED?

• Initiate full CPR while ignoring the bracelet
• Quickly verify the DNR per policy and present to the provider to honor the order
• Remove the bracelet and call the family
• Delay all care until the attorney arrives

Correct Answer: Quickly verify the DNR per policy and present to the provider to honor the order

Q15. A patient has a court-appointed legal guardian and a spouse. The patient now lacks capacity. Who should make decisions?

• The spouse, because marriage overrides all other designations
• The charge nurse
• The court-appointed legal guardian
• The eldest child

Correct Answer: The court-appointed legal guardian

Q16. After obtaining a copy of a patient’s advance directive, which action is essential to ensure care aligns with the document?

• Place the copy in the bedside drawer only
• Scan/upload into the EHR and ensure the provider writes corresponding medical orders (e.g., code status)
• Tell the night shift verbally without documentation
• Store it in the nurse’s locker

Correct Answer: Scan/upload into the EHR and ensure the provider writes corresponding medical orders (e.g., code status)

Q17. A patient’s advance directive states “comfort-focused care only.” Which action best aligns with this goal?

• Titrate opioids to relieve dyspnea and pain while monitoring comfort and side effects
• Escalate to mechanical ventilation for hypoxemia
• Start vasopressors to maintain MAP above 65 mm Hg
• Begin hemodialysis for rising creatinine

Correct Answer: Titrate opioids to relieve dyspnea and pain while monitoring comfort and side effects

Q18. A 17-year-old emancipated minor presents with a completed healthcare proxy form. What is the nurse’s best action?

• Discard the form because minors cannot appoint an agent
• Verify emancipation status and honor the proxy per policy
• Call the parents to co-sign
• Delay all care until age 18

Correct Answer: Verify emancipation status and honor the proxy per policy

Q19. The healthcare agent supports comfort care, but other family members demand full treatment. What should the nurse do?

• Follow the loudest family member’s request
• Request an ethics consultation and support the agent’s authority while maintaining communication
• Dismiss the agent and appoint a new one
• Transfer the patient without discussion

Correct Answer: Request an ethics consultation and support the agent’s authority while maintaining communication

Q20. Which statement about DNR orders is accurate?

• A DNR order stops all treatments, including antibiotics and oxygen
• A DNR order limits only resuscitative efforts (CPR) and does not preclude other treatments unless specified
• A DNR applies only in the ICU
• A DNR allows nurses to withhold food and water

Correct Answer: A DNR order limits only resuscitative efforts (CPR) and does not preclude other treatments unless specified

Q21. When is the best time to initiate goals-of-care and advance directive discussions?

• Only during a cardiac arrest
• Early in the care trajectory and at admission, before crises occur
• Only if the patient is terminal
• At discharge when the patient is leaving

Correct Answer: Early in the care trajectory and at admission, before crises occur

Q22. Which intervention is generally considered life-sustaining treatment in advance directive discussions?

• Mechanical ventilation via endotracheal tube
• Routine oral care
• Warm blankets
• Music therapy

Correct Answer: Mechanical ventilation via endotracheal tube

Q23. A patient asks about state-specific witnessing requirements for an advance directive. What is the nurse’s best response?

• Provide general information and connect the patient with social work/chaplaincy or legal resources per policy
• Give personal legal advice based on prior experience
• Tell the patient all states require notarization
• Advise the patient to skip witnesses to avoid delays

Correct Answer: Provide general information and connect the patient with social work/chaplaincy or legal resources per policy

Q24. A patient’s POLST conflicts with an older living will. Which document should guide immediate care?

• The oldest document
• The POLST, as current medical orders, while clarifying discrepancies with the surrogate and provider
• Neither document should be used
• The nurse’s judgment

Correct Answer: The POLST, as current medical orders, while clarifying discrepancies with the surrogate and provider

Q25. The team proposes a time-limited trial of noninvasive ventilation aligned with uncertain goals. What is the nurse’s priority action?

• Initiate trial without documentation
• Ensure goals-of-care are confirmed with the surrogate and that the trial parameters and endpoints are documented as medical orders
• Tell the family that trials are not ethical
• Refuse to participate

Correct Answer: Ensure goals-of-care are confirmed with the surrogate and that the trial parameters and endpoints are documented as medical orders

Q26. Which statement accurately describes a Do Not Intubate (DNI) order?

• A DNI prohibits any oxygen use
• A DNI forbids endotracheal intubation and mechanical ventilation; CPR may still be performed unless a DNR is also in place
• A DNI automatically implies hospice enrollment
• A DNI discontinues all medications

Correct Answer: A DNI forbids endotracheal intubation and mechanical ventilation; CPR may still be performed unless a DNR is also in place

Q27. A living will declines artificial nutrition and hydration in persistent vegetative state. The family requests TPN. What should the nurse do?

• Clarify the living will’s directive and advocate to forgo TPN, notifying the provider and supporting comfort measures
• Start TPN immediately
• Ask nutrition to persuade the surrogate
• Ignore the document and defer to the eldest child

Correct Answer: Clarify the living will’s directive and advocate to forgo TPN, notifying the provider and supporting comfort measures

Q28. The patient’s advance directive requests comfort-only care, and the provider estimates a prognosis of six months. What is the nurse’s next best step?

• Continue all curative therapies and avoid referrals
• Request a hospice or palliative care referral and align treatments with comfort-focused goals
• Stop all medications without discussion
• Transfer to ICU for monitoring

Correct Answer: Request a hospice or palliative care referral and align treatments with comfort-focused goals

Q29. Which statement about advance directives and autopsy is accurate?

• Advance directives determine whether a medical examiner can mandate an autopsy
• Advance directives control all postmortem decisions, including autopsy
• Advance directives may indicate organ donation, but autopsy decisions typically follow next-of-kin consent or legal/medical examiner requirements
• Autopsies are illegal if an advance directive exists

Correct Answer: Advance directives may indicate organ donation, but autopsy decisions typically follow next-of-kin consent or legal/medical examiner requirements

Q30. A patient reports registering their advance directive in a statewide electronic registry but has no paper copy. What should the nurse do?

• Rely on the patient’s verbal summary only
• Access the registry per policy to retrieve the document and place it in the EHR; confirm congruent medical orders
• Tell the patient to bring it next admission
• Proceed to full code care without verification

Correct Answer: Access the registry per policy to retrieve the document and place it in the EHR; confirm congruent medical orders

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