How are do not resuscitate (DNR) orders and advance directives used in nursing practice?

• A. DNR applies only to physicians.
• B. DNR specifies not to perform CPR; advance directives document patient preferences about end-of-life care; nurses must honor valid directives and communicate with the team.
• C. Advance directives override patient wishes in every case.
• D. DNR means no treatment at all; advance directives are optional; nurses ignore.

Answer: (B)

Understanding patient autonomy in end-of-life care is the key here. A Do Not Resuscitate (DNR) order is a specific directive that CPR should not be attempted if the patient’s heart or breathing stops. It is not something only physicians decide; the nursing team is responsible for recognizing and implementing it when a patient has a valid order, and for communicating the code status to the rest of the team.

Advance directives are documents that capture a patient’s preferences for end-of-life care, such as which treatments they want or do not want if they become unable to speak for themselves. These can include a living will or a durable power of attorney for health care. Nurses must honor valid advance directives and ensure the care provided aligns with the patient’s stated wishes, while also communicating those wishes clearly to the rest of the health care team.

In practice, a DNR means CPR will not be attempted, but it does not mean all treatment is stopped. Other medical and comfort measures can still be provided according to the patient’s directives and clinical judgment. Advance directives are intended to guide care and protect patient autonomy; they are not loose suggestions to be ignored, nor are they optional in most settings.