Advocacy NCLEX-RN Practice Questions

Advocacy NCLEX-RN Practice Questions

Advocacy is central to safe, ethical nursing practice within the NCLEX-RN Management of Care domain. These questions help you apply principles that protect patient rights, ensure informed decision-making, and secure equitable access to resources. You will navigate scenarios that require prioritizing autonomy, confidentiality, safety, and justice while collaborating with interprofessional teams. Expect questions on informed consent, use of interpreters, advance directives, discharge planning, mandatory reporting, impaired practice, HIPAA, ethical dilemmas, and chain-of-command escalation. Designed for advanced learners, including M. Pharma students preparing to work alongside nurses, these items emphasize real-world decisions at the bedside and systems level. Use them to sharpen critical thinking and reinforce the advocacy mindset essential for high-stakes clinical practice.

Q1. A patient scheduled for an elective endoscopy received 2 mg IV midazolam 20 minutes ago. The provider arrives to obtain informed consent. As the patient’s advocate, what should the nurse do?

• Witness the consent because the provider will explain the risks and benefits
• Proceed if the patient can still state name and procedure
• Delay consent and notify the provider that the patient is sedated
• Ask the spouse to sign consent on the patient’s behalf

Correct Answer: Delay consent and notify the provider that the patient is sedated

Q2. A 16-year-old requests STI testing and treatment without parental involvement. The nurse should first:

• Inform the teen that parental consent is required for all treatment
• Review state-specific minor consent laws and follow institutional policy
• Ask the parent by phone for verbal consent
• Recommend waiting until the teen is 18 years old

Correct Answer: Review state-specific minor consent laws and follow institutional policy

Q3. A patient with limited English proficiency is consenting for a central line. The daughter offers to interpret. The best advocacy action is to:

• Use the daughter to increase patient comfort
• Proceed if the provider speaks slowly and uses visual aids
• Obtain a certified medical interpreter immediately
• Ask the patient to sign and explain later

Correct Answer: Obtain a certified medical interpreter immediately

Q4. A patient insists on leaving against medical advice (AMA) after being informed of risks. The nurse determines the patient is alert, oriented, and understands the consequences. The nurse’s priority is to:

• Call security to prevent elopement
• Ask the provider to complete an involuntary hold
• Have the patient sign the AMA form and provide discharge teaching
• Refuse to provide the patient’s prescriptions

Correct Answer: Have the patient sign the AMA form and provide discharge teaching

Q5. A patient with a valid DNR order is in pulseless ventricular tachycardia. Family members demand resuscitation. As the patient’s advocate, the nurse should:

• Start CPR to honor family wishes
• Follow the DNR order and provide comfort measures
• Call the ethics committee before acting
• Ask the family to sign a rescindment form

Correct Answer: Follow the DNR order and provide comfort measures

Q6. During pre-op verification, the nurse discovers the patient’s advance directive refusing blood products, yet a transfusion is ordered intraoperatively. The best action is to:

• Ignore the directive because surgery takes precedence
• Place the advance directive in the record and notify the surgical team immediately
• Ask the family to override the directive
• Cancel the surgery independently

Correct Answer: Place the advance directive in the record and notify the surgical team immediately

Q7. A post-op patient in severe pain has an order to hold opioids if RR < 12/min. The patient’s RR is 10/min with grimacing and guarding. The nurse’s best advocacy action is to:

• Withhold analgesia and document refusal due to RR
• Administer the opioid and document “benefits outweigh risks”
• Call the provider to reassess pain management and request alternative strategies
• Increase IV fluids to distract from pain

Correct Answer: Call the provider to reassess pain management and request alternative strategies

Q8. A provider orders a potassium chloride IV push for a patient with hypokalemia. The nurse recognizes this is unsafe. As an advocate, the nurse should:

• Administer slowly over 5 minutes as a compromise
• Refuse the order and escalate via chain of command if needed
• Crush oral tablets and administer via NG tube
• Ask another nurse to give it

Correct Answer: Refuse the order and escalate via chain of command if needed

Q9. A restrained ICU patient is calm, following commands, and redirectable. The nurse’s advocacy action is to:

• Maintain restraints until the next provider round
• Remove restraints as the least restrictive approach and continue close monitoring
• Double-secure restraints to prevent accidental removal
• Apply mittens in addition to wrist restraints

Correct Answer: Remove restraints as the least restrictive approach and continue close monitoring

Q10. A nurse hears another staff member discussing a patient’s diagnosis in a crowded elevator. The best advocacy response is to:

• Ignore it because no names were used
• Gently interrupt, remind about HIPAA, and move the conversation to a private area
• Post a reminder on social media about privacy
• Tell the patient what happened at discharge

Correct Answer: Gently interrupt, remind about HIPAA, and move the conversation to a private area

Q11. You receive an unsafe patient assignment that exceeds your competency. The advocacy-oriented first step is to:

• Refuse all patients immediately and go home
• Accept silently and try your best
• Communicate specific concerns to the charge nurse and request a modified assignment
• Call the state board during the shift

Correct Answer: Communicate specific concerns to the charge nurse and request a modified assignment

Q12. A homeless patient with insulin-dependent diabetes is being discharged with insulin that requires refrigeration. The nurse’s best advocacy intervention is to:

• Discharge as planned; teach to keep insulin “as cool as possible”
• Request case management, explore room-temperature insulin options, and coordinate community resources
• Instruct the patient to use ice from restaurants
• Advise the patient to return to the ED daily for insulin

Correct Answer: Request case management, explore room-temperature insulin options, and coordinate community resources

Q13. A competent adult refuses a life-saving blood transfusion for religious reasons. The nurse should:

• Administer the transfusion under implied consent
• Attempt to persuade the patient by describing death risk
• Honor refusal and discuss alternative treatments consistent with beliefs
• Seek a court order to override refusal

Correct Answer: Honor refusal and discuss alternative treatments consistent with beliefs

Q14. After a patient’s death, the nurse suspects eligibility for organ donation. The nurse’s appropriate advocacy action is to:

• Approach the family and ask for consent immediately
• Notify the organ procurement organization per policy
• Document “not a candidate” to avoid distressing the family
• Begin tissue recovery to preserve viability

Correct Answer: Notify the organ procurement organization per policy

Q15. A nurse suspects non-accidental trauma in a 4-year-old with inconsistent injury history. The preceptor says, “Don’t get involved.” The nurse should:

• Wait for more evidence before acting
• Confront the caregiver at the bedside
• Report the suspicion to child protective services per mandatory reporting laws
• Document concerns but take no further action

Correct Answer: Report the suspicion to child protective services per mandatory reporting laws

Q16. A nurse discovers an unopened opioid syringe missing from a controlled medication drawer and suspects a colleague. The nurse’s best action is to:

• Post about staff theft anonymously online
• Confront the colleague in front of the team
• Report immediately to the supervisor and follow diversion reporting policy
• Ignore it to avoid workplace conflict

Correct Answer: Report immediately to the supervisor and follow diversion reporting policy

Q17. A nurse considers posting a de-identified patient story on a private social media account. The advocacy-based guidance is to:

• Post if no names or photos are used
• Post only after the patient is discharged
• Avoid posting patient-related content to protect confidentiality
• Seek the manager’s permission and then post

Correct Answer: Avoid posting patient-related content to protect confidentiality

Q18. A patient cannot afford a newly prescribed anticoagulant. The nurse’s advocacy action should be to:

• Offer samples from another patient’s supply
• Collaborate with the provider about cost-effective alternatives and refer to financial assistance programs
• Tell the patient to skip doses on weekends
• Advise herbal alternatives without provider input

Correct Answer: Collaborate with the provider about cost-effective alternatives and refer to financial assistance programs

Q19. A nurse is advocating for a patient’s right to make informed choices even if the nurse disagrees with those choices. This exemplifies which ethical principle?

• Beneficence
• Autonomy
• Nonmaleficence
• Justice

Correct Answer: Autonomy

Q20. A patient lacks decision-making capacity and has no advance directive. The appropriate next step for consent is to:

• Ask the nurse to sign as witness and surrogate
• Identify the legal surrogate per state hierarchy and policy
• Proceed without consent for all procedures
• Have the most involved family member sign regardless of legal status

Correct Answer: Identify the legal surrogate per state hierarchy and policy

Q21. An alert patient asks to review their medical record. The nurse should:

• Refuse because records are the hospital’s property
• Allow access per policy and facilitate the request
• Require a court order first
• Permit access only after discharge

Correct Answer: Allow access per policy and facilitate the request

Q22. A medication error occurred with no immediate harm. The nurse’s advocacy role includes:

• Documenting only in the incident report, not the chart
• Notifying the provider, monitoring the patient, disclosing to the patient, and completing an incident report
• Waiting to see if symptoms develop before telling anyone
• Changing the MAR to hide the error

Correct Answer: Notifying the provider, monitoring the patient, disclosing to the patient, and completing an incident report

Q23. A patient with limited English proficiency nods “yes” during a complex chemotherapy consent explanation delivered without an interpreter. The nurse should:

• Witness the consent because the patient nodded
• Use teach-back via a certified interpreter to confirm understanding
• Ask a bilingual family member to summarize
• Proceed and provide education after the first dose

Correct Answer: Use teach-back via a certified interpreter to confirm understanding

Q24. A patient is being recruited for a clinical trial by their oncologist. The nurse’s primary advocacy focus is to ensure:

• Enrollment proceeds to access cutting-edge therapy
• The patient understands voluntariness, risks, benefits, alternatives, and the right to withdraw
• Family members decide because the patient is overwhelmed
• Insurance coverage is guaranteed before consent

Correct Answer: The patient understands voluntariness, risks, benefits, alternatives, and the right to withdraw

Q25. A patient on the behavioral unit states, “I have a plan to kill myself when I get home.” As an advocate, the nurse should first:

• Tell the patient that’s their choice
• Ensure immediate safety by initiating suicide precautions and notifying the provider
• Ignore the comment because the patient seeks attention
• Discharge as planned with a hotline number

Correct Answer: Ensure immediate safety by initiating suicide precautions and notifying the provider

Q26. A patient reports a nurse made a racially insensitive remark. Advocacy requires the nurse receiving the complaint to:

• Tell the patient to ignore it
• Apologize on behalf of the hospital and report through the grievance process
• Defend the colleague’s intentions
• Delay action until discharge

Correct Answer: Apologize on behalf of the hospital and report through the grievance process

Q27. A new nurse has a high-acuity assignment and cannot complete time-sensitive care. The best advocacy action for patient safety is to:

• Skip breaks and work unpaid overtime
• Request assistance and consider redistribution of tasks with the charge nurse
• Prioritize only documentation
• Avoid telling anyone to appear competent

Correct Answer: Request assistance and consider redistribution of tasks with the charge nurse

Q28. A patient’s adult sibling demands access to the patient’s chart. The patient is competent and has not provided authorization. The nurse should:

• Provide access because they are family
• Decline access and explain HIPAA restrictions
• Print only the lab results for the sibling
• Allow access if the sibling promises confidentiality

Correct Answer: Decline access and explain HIPAA restrictions

Q29. A patient with a court-appointed guardian needs consent for non-emergent surgery. The nurse advocates by:

• Obtaining consent from the patient directly
• Securing consent from the legal guardian and ensuring the patient’s preferences are communicated
• Asking any family member to sign
• Proceeding under implied consent

Correct Answer: Securing consent from the legal guardian and ensuring the patient’s preferences are communicated

Q30. A terminally ill patient requests palliative sedation for refractory suffering. The family objects. The nurse’s advocacy action is to:

• Deny the request to honor family wishes
• Support the patient’s informed decision, notify the provider, and consider ethics consultation
• Initiate sedation without an order due to distress
• Ask the chaplain to convince the patient otherwise

Correct Answer: Support the patient’s informed decision, notify the provider, and consider ethics consultation

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