To determine the legality of an advance directive, which laws should the nurse know?

• A. State
• B. Federal
• C. Local
• D. County

Answer: (A)

Understanding how advance directives are recognized hinges on state law. Each state enacts statutes that govern how an advance directive is created, witnessed or notarized, who can serve as a surrogate, when it takes effect, and how it can be revoked. Because these rules vary, a nurse must look to the specific state's laws (and related healthcare regulations) to determine whether a given directive is valid and enforceable in that setting. Federal law, such as the Patient Self-Determination Act, provides important procedural requirements for facilities and supports honoring directives within the bounds of state law, but it does not determine which directives are legally valid. Local or county laws do not typically set the primary standard for validity; they may influence policy, but the controlling rules come from the state. So, the nurse should know state laws to determine legality, while also applying relevant federal requirements and facility policies.