advanced directives, code status, life support, medical futility

Question 1

What are advanced directives?

Answer 1

Legal documents expressing a person’s treatment wishes if they become unable to decide

Question 2

Can families override advanced directives?

Answer 2

Yes—families can technically circumvent them, creating ethical issues

Question 3

What are the two main types of advanced directives?

Answer 3

Living will AND Healthcare Surrogate/Durable POA

Question 4

What is a living will?

Answer 4

Specifies desired or undesired end-of-life treatments (e.g., DNR, DNI, no feeding tube)

Question 5

What is a healthcare surrogate/POA?

Answer 5

Person designated to make medical decisions when the patient cannot

Question 6

What is the nurse’s role with advanced directives?

Answer 6

Educate, ensure documents are current & accessible, advocate for wishes, respect cultural/spiritual beliefs

Question 7

What is the core question in resuscitation issues?

Answer 7

“Should this patient be coded?”

Question 8

What is a DNR order?

Answer 8

Medical order to not initiate CPR

Question 9

When does CPR stop during a code?

Answer 9

When the physician determines it is futile

Question 10

How are advanced directives useful during codes?

Answer 10

Guide decisions prior to emergencies

Question 11

What is a full code?

Answer 11

All life-saving measures including CPR, intubation, meds, and shocks

Question 12

What does DNI mean?

Answer 12

Do Not Intubate — allow CPR but no invasive airway

Question 13

What is a partial code?

Answer 13

Limited CPR — patient chooses specific interventions (e.g., CPR but no epinephrine or no defibrillation)

Question 14

What is Full Active Treatment DNR?

Answer 14

Patient receives all treatments, but if pulseless → CPR only

Question 15

What treatments continue under Full Active Treatment DNR?

Answer 15

Antibiotics, fluids, feeding tubes, and all non-code care

Question 16

What is life support?

Answer 16

Medical treatments/technology sustaining vital functions when the body can’t

Question 17

Examples of life support technologies?

Answer 17

Mechanical ventilation, CPR, defibrillation, artificial nutrition/hydration, TPN, vasopressors, dialysis, pacemakers, VADs

Question 18

What is the purpose of life support?

Answer 18

Temporarily sustain life while treating the underlying condition

Question 19

What is medical futility?

Answer 19

Treatments unlikely to provide meaningful benefit or improve survival/quality of life

Question 20

What is quantitative futility?

Answer 20

Likelihood of success is extremely low

Question 21

What is qualitative futility?

Answer 21

Treatment works physically but won’t result in meaningful recovery or quality of life

Question 22

Which ethical principles guide futility discussions?

Answer 22

Beneficence and nonmaleficence

Question 23

What is required to address futility ethically?

Answer 23

Clear communication with patient, family, and care team

Question 24

Who may be consulted when disagreements occur about futility?

Answer 24

Ethics committee