End-of-Life Discussion and Advance Directives Practice Questions
12 free End-of-Life Discussion and Advance Directives practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
When is the optimal time for a nurse to initiate discussion about advance directives?
- A Only when the client is terminal and already in crisis
- B On admission or when the client is stable, not during crisis
- C After the client has fully recovered from the illness
- D Not until the client's family raises the topic first
Correct answer: On admission or when the client is stable, not during crisis
Introducing the topic when the patient is stable allows better reflection and informed decision-making rather than during crisis.
A client holds a durable power of attorney for health care (health-care proxy). The nurse recognises that this document:
- A Is valid only after the patient becomes unconscious
- B Lets the named agent decide if the patient cannot speak
- C Remains valid for only 24 hours after it is signed
- D Can override the patient's wishes stated at the time of crisis
Correct answer: Lets the named agent decide if the patient cannot speak
A durable power of attorney for health care enables a designated person to make medical decisions when the patient lacks capacity.
Which statement by the nurse about a DNR (do not resuscitate) order is most accurate and therapeutic?
- A “A DNR means we will stop providing all of your care.”
- B “A DNR applies only to CPR; other comfort care continues.”
- C “Once you sign a DNR you can never change your decision.”
- D “If you sign a DNR, your family will not be allowed to visit.”
Correct answer: “A DNR applies only to CPR; other comfort care continues.”
Clarifying that a DNR focuses on resuscitation but doesn’t mean abandonment is both accurate and supportive of patient understanding.
A client says, “If I can’t make decisions, I want my daughter to decide for me.” As the nurse, the most appropriate response is:
- A “Great — I'll chart that and won't need to ask you anything more.”
- B “Would you and your daughter like to discuss your wishes with me together?”
- C “Well, she might not make the same choices that you would make.”
- D “I'm sorry — these decisions are yours to make alone.”
Correct answer: “Would you and your daughter like to discuss your wishes with me together?”
This approach promotes shared discussion, clarifies values, and supports the surrogate’s understanding—therapeutic and best practice.
A client appears emotional and tearful when discussing end-of-life care. The nurse responds: “You’re crying—I can see this is upsetting. Would you like to share what you're feeling?” This response is an example of:
- A Changing the subject to a lighter topic
- B Minimizing the client's emotional response
- C Reflecting and validating the client's feelings
- D Giving quick advice to ease the moment
Correct answer: Reflecting and validating the client's feelings
Acknowledging the client’s emotional state and inviting elaboration supports therapeutic communication.
During an advance-care planning discussion, the nurse realises the client is unsure about the meaning of “life-sustaining treatment.” The best action is to:
- A Assume the client understands and move on with the visit
- B Use plain language to explain options and check understanding
- C Avoid the topic because it is too complex to explain now
- D State that everything must be done unless the client refuses it
Correct answer: Use plain language to explain options and check understanding
Explaining in plain language and verifying comprehension is essential in advance directive discussions.
A client has an advance directive but the health care team cannot locate it. The nurse should first:
- A Proceed with full aggressive treatment until it is located
- B Assume the client wants no treatment at this time
- C Verify the client's wishes with the designated proxy or family
- D Document “no advance directive found” and continue care
Correct answer: Verify the client's wishes with the designated proxy or family
When the document is missing, verifying verbally with the proxy or family aligns with respecting patient wishes and continuing communication.
The nurse is preparing to facilitate an end-of-life discussion with a family. The nurse recognises that a meaningful goal of the conversation is to:
- A Persuade the client to refuse all further treatment
- B Dictate the plan without input from patient or family
- C Clarify the patient's values and goals for the care team
- D Avoid discussing prognosis to limit the client's distress
Correct answer: Clarify the patient's values and goals for the care team
Clarifying values and goals with the patient and family is a core objective of end-of-life communication and advance-care planning.
A client nearing end of life says: “I don’t want to be a burden.” The nurse’s best response is:
- A “You're not a burden at all; please stop worrying about it.”
- B “I hear that this feels heavy. What does 'burden' mean to you?”
- C “Everything will be fine,” without exploring the concern further.
- D “If you feel like a burden, we can consider providing less care.”
Correct answer: “I hear that this feels heavy. What does 'burden' mean to you?”
Exploring the meaning of the client’s concern invites discussion and supports emotional and end-of-life decision-making.
Which statement correctly reflects the legal and nursing role in advance directives?
- A Nurses cannot witness power-of-attorney documents in any state
- B Nurses may clarify and discuss advance directives but cannot create or invalidate them
- C Nurses should complete the advance directive document for the client
- D Nurses must decide which treatments are given based on their own judgement
Correct answer: Nurses may clarify and discuss advance directives but cannot create or invalidate them
Nurses facilitate discussion and clarify documents but the actual legal documents are created by the client or with legal help; the nurse cannot override them.
The nurse is caring for a client whose advance directive states: “No artificial hydration if I’m unable to swallow and in a terminal state.” The client is now unable to swallow and the physician recommends IV hydration. The nurse’s best action is to:
- A Administer the hydration because the physician recommended it
- B Withhold hydration without clarifying the directive's context
- C Honour the directive and confirm interpretation with team and family
- D Disregard the directive because it was signed at an earlier date
Correct answer: Honour the directive and confirm interpretation with team and family
The nurse must honour the directive (autonomy) while collaborating with the team and family to ensure clarity and ethical implementation.
A client changes their mind and wants to revise their advance directive to include organ donation. The nurse’s best action is:
- A Tell the client that it is now too late to make any change
- B Encourage the client to discuss the change with the proxy and update it legally
- C Ignore the change because the original directive still stands
- D Discourage organ donation because it complicates end-of-life care
Correct answer: Encourage the client to discuss the change with the proxy and update it legally
Clients have the right to revise their advance directives at any time when they are competent; the nurse supports the process and clarifies steps.