Advance Directives, DNR, POLST

Advance directives are legal documents completed by a competent adult that communicate healthcare wishes when the client can no longer speak for themselves. The three main types tested on NCLEX are the living will, durable power of attorney for healthcare (DPOA-HC), and Do Not Resuscitate (DNR) orders. A living will specifies which treatments the client does or does not want (ventilators, tube feeding, CPR) but only activates when the client is terminally ill or permanently unconscious. A DPOA-HC designates a specific person — the healthcare proxy — to make decisions when the client lacks capacity; it covers any medical situation, not just end-of-life. A DNR is a provider order, not a client document — it must be signed by a provider to be actionable. POLST (Physician/Provider Orders for Life-Sustaining Treatment) converts a client's wishes into portable medical orders covering CPR status, level of intervention, and artificial nutrition. Unlike a living will, POLST is immediately actionable by EMS and transfers across care settings. The nurse's role is to verify that documents are completed, on the chart, and accessible — not to witness the signing in all states (check facility policy). Nurses advocate by ensuring the client understands the documents and that the healthcare team honors them. A client can revoke or change any advance directive at any time while competent, verbally or in writing.