Ethical practice NCLEX-RN Practice Questions

Ethical practice NCLEX-RN Practice Questions brings you a focused set of scenarios from the Management of Care domain to sharpen your decision-making around real-world dilemmas. Ethical nursing practice demands confident application of core principles—autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity—while navigating laws, policies, and interprofessional collaboration. In this topic-wise question set, you will confront issues such as informed consent, confidentiality and HIPAA, advance directives, end-of-life decisions, delegation ethics, cultural sensitivity, mandatory reporting, resource allocation, and moral distress. Each question is designed to simulate NCLEX-level complexity, emphasizing safety, patient rights, and legal-ethical standards. Use these items to assess your reasoning, clarify responsibilities, and prepare for ethical challenges that shape high-quality, patient-centered care.

Q1. A competent adult Jehovah’s Witness with a hemoglobin of 5.8 g/dL refuses a blood transfusion. What is the nurse’s most appropriate action?

• Seek a court order to override the refusal due to life-threatening anemia
• Honor the refusal after verifying decision-making capacity and discuss acceptable alternatives
• Document the refusal and proceed with transfusion under implied consent
• Ask family members to persuade the patient to accept the transfusion

Correct Answer: Honor the refusal after verifying decision-making capacity and discuss acceptable alternatives

Q2. A 16-year-old arrives with acute abdomen and signs of peritonitis. Parents cannot be reached, and emergent surgery is needed. What should the nurse anticipate?

• Await parental consent because the patient is a minor
• Proceed under implied consent for an emergency to prevent serious harm
• Ask the patient to sign informed consent as an emancipated minor
• Obtain consent from the school principal as a responsible adult

Correct Answer: Proceed under implied consent for an emergency to prevent serious harm

Q3. A patient with a comfort-care–only DNR develops respiratory distress postoperatively. Family demands intubation. What is the nurse’s best response?

• Initiate rapid sequence intubation to satisfy family wishes
• Clarify and honor the DNR order, provide symptom management, and notify the provider
• Delay interventions until the ethics committee meets
• Administer paralytics to reduce distress without intubation

Correct Answer: Clarify and honor the DNR order, provide symptom management, and notify the provider

Q4. A patient requests to review their medical record. What is the nurse’s most appropriate action?

• Refuse access because records are the property of the facility
• Provide immediate copies of all provider notes without documenting the request
• Facilitate access per facility policy and inform the patient of the process and timeline
• Allow access only if the provider approves content disclosure

Correct Answer: Facilitate access per facility policy and inform the patient of the process and timeline

Q5. The nurse observes a colleague removing opioids from the Pyxis for personal use. What is the ethical and legal first action?

• Confront the colleague privately and agree to keep it confidential
• Notify the nurse manager immediately and follow institutional reporting policies
• Ignore the behavior unless a patient is harmed
• Post an anonymous tip on the unit bulletin board

Correct Answer: Notify the nurse manager immediately and follow institutional reporting policies

Q6. Which action best demonstrates HIPAA-compliant communication?

• Discussing a patient’s diagnosis in a crowded elevator to update a team member
• Handing discharge paperwork to a friend who says they are the patient’s neighbor
• Using a private area to discuss patient information with the interprofessional team
• Leaving lab results on a patient’s voicemail without prior consent

Correct Answer: Using a private area to discuss patient information with the interprofessional team

Q7. Before witnessing an informed consent signature for a surgical procedure, the nurse’s priority is to verify that the patient:

• Received a full explanation of risks, benefits, and alternatives from the provider, is competent, and is not sedated
• Understands each step of the surgery in technical detail
• Has already paid for the procedure and transportation
• Has family approval for the surgery

Correct Answer: Received a full explanation of risks, benefits, and alternatives from the provider, is competent, and is not sedated

Q8. A patient’s living will declines artificial nutrition and hydration, but family members insist on starting a feeding tube. What is the nurse’s best action?

• Honor the family’s request to maintain harmony
• Follow the patient’s advance directive and notify the provider of the conflict
• Delay action until legal counsel arrives
• Ask the chaplain to persuade the family to retract their request

Correct Answer: Follow the patient’s advance directive and notify the provider of the conflict

Q9. A patient requests that only female staff provide personal care due to religious beliefs. What should the nurse do?

• Explain that staffing cannot accommodate personal preferences
• Make reasonable efforts to honor the request and coordinate care within safety and staffing limits
• Ask the family to provide all personal care
• Document the request but take no action

Correct Answer: Make reasonable efforts to honor the request and coordinate care within safety and staffing limits

Q10. During a mass-casualty incident with limited ventilators, which allocation approach best aligns with ethical triage principles?

• First-come, first-served regardless of prognosis
• Allocate based on patient age
• Prioritize those with the highest likelihood of survival and expected benefit from ventilation
• Prioritize individuals of higher socioeconomic status

Correct Answer: Prioritize those with the highest likelihood of survival and expected benefit from ventilation

Q11. A patient’s family asks the nurse not to tell the patient about a new cancer diagnosis. The patient later asks, “Do I have cancer?” What should the nurse do first?

• Defer and tell the patient to ask the family
• Assess the patient’s preferences for receiving information and then provide truthful information sensitively
• Respect the family’s wishes and change the topic
• Provide false reassurance to maintain hope

Correct Answer: Assess the patient’s preferences for receiving information and then provide truthful information sensitively

Q12. An acutely agitated patient with delirium is a danger to self and others. De-escalation fails. What is the ethical use of restraints?

• Apply the most restrictive restraints and keep indefinitely
• Use the least restrictive option, obtain a provider order, and perform ongoing monitoring and reassessment
• Restrain only if family consents
• Place in four-point restraints without documentation because of urgency

Correct Answer: Use the least restrictive option, obtain a provider order, and perform ongoing monitoring and reassessment

Q13. A patient is considering enrollment in a clinical trial. What is the nurse’s primary ethical responsibility?

• Explain all study procedures and obtain consent on behalf of the investigator
• Ensure the patient understands participation is voluntary, can withdraw anytime without penalty, and refer questions to the investigator
• Encourage participation to help advance science
• Obtain consent from the patient’s family

Correct Answer: Ensure the patient understands participation is voluntary, can withdraw anytime without penalty, and refer questions to the investigator

Q14. A patient with uncontrolled seizures insists on continuing to drive. What is the nurse’s best action?

• Maintain confidentiality and take no further action
• Notify the provider and follow state-mandated reporting requirements while counseling the patient on safety
• Inform the patient’s employer without consent
• Confiscate the patient’s car keys

Correct Answer: Notify the provider and follow state-mandated reporting requirements while counseling the patient on safety

Q15. Which social media behavior is ethical and compliant with professional standards?

• Posting de-identified patient stories in a private group
• Sharing a photo of a healed wound with the patient’s first name only
• Never posting patient-related information or images online
• Posting a celebratory discharge photo with verbal patient consent only

Correct Answer: Never posting patient-related information or images online

Q16. A competent patient with pneumonia refuses antibiotics after education about risks and benefits. What is the most appropriate nursing action?

• Administer antibiotics covertly in food
• Respect the refusal, document the discussion, notify the provider, and offer supportive care
• Discharge the patient for noncompliance
• Obtain consent from family to override the decision

Correct Answer: Respect the refusal, document the discussion, notify the provider, and offer supportive care

Q17. A brain-dead patient is a potential organ donor. What is the nurse’s role?

• Approach the family to request organ donation
• Contact the organ procurement organization per policy and avoid initiating donation discussions
• Wait for the family to raise the topic
• Begin organ-specific testing without notifying anyone

Correct Answer: Contact the organ procurement organization per policy and avoid initiating donation discussions

Q18. The nurse faces an ethical dilemma about continuing nonbeneficial treatment. What is the first step in ethical decision-making?

• Immediately contact hospital legal counsel
• Clarify the problem by gathering relevant facts, values, and stakeholders’ perspectives
• Refuse to participate in care
• Transfer the patient to another hospital

Correct Answer: Clarify the problem by gathering relevant facts, values, and stakeholders’ perspectives

Q19. Which delegation decision is ethically appropriate regarding a patient with recent stroke and dysphagia?

• Delegate initial feeding to an unlicensed assistive personnel (UAP) to save time
• Assign the nurse to perform first feeding and request a speech-language evaluation
• Allow family to feed without instruction
• Delegate to a novice nurse without supervision

Correct Answer: Assign the nurse to perform first feeding and request a speech-language evaluation

Q20. The nurse suspects child abuse based on injury patterns and inconsistent history. What is the priority action?

• Document findings and wait for more evidence
• Confront the caregivers and demand an explanation
• Report the suspicion immediately to child protective services per mandatory reporting laws
• Ask the child to confirm abuse privately, then decide

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

Q21. A patient with active tuberculosis refuses isolation and plans to return to a crowded shelter. What should the nurse do?

• Respect the patient’s decision to leave and maintain confidentiality
• Notify public health authorities as required and collaborate to ensure safe isolation and treatment
• Share the patient’s full medical record with the shelter staff
• Physically prevent the patient from leaving without a court order

Correct Answer: Notify public health authorities as required and collaborate to ensure safe isolation and treatment

Q22. A patient offers the nurse an expensive gift to show gratitude. What is the most ethical response?

• Accept the gift to avoid offending the patient
• Politely decline the expensive gift, explain policy, and express appreciation for the sentiment
• Offer to share the gift with the unit
• Suggest the patient gift cash instead

Correct Answer: Politely decline the expensive gift, explain policy, and express appreciation for the sentiment

Q23. A patient lacks capacity and has a legally designated healthcare proxy. Other family members disagree with the proxy’s decisions. What is the nurse’s best action?

• Follow the family majority to avoid conflict
• Support the proxy’s decisions that reflect the patient’s known values and wishes
• Transfer decision-making to the eldest child
• Delay care until the conflict is resolved

Correct Answer: Support the proxy’s decisions that reflect the patient’s known values and wishes

Q24. The nurse administers the wrong dose of a medication; the patient has no apparent harm. What is the ethical duty?

• Say nothing since there was no harm
• Inform the patient and provider, complete an incident report, and monitor the patient
• Document only in the incident report, not in the medical record
• Blame the pharmacy for the error

Correct Answer: Inform the patient and provider, complete an incident report, and monitor the patient

Q25. A patient requests integration of a traditional healer’s visit during hospitalization. What is the most ethical nursing response?

• Decline because it is not evidence-based
• Coordinate culturally congruent care that is safe and does not interfere with essential treatments
• Allow only if the healer signs a liability waiver
• Permit visits only after discharge

Correct Answer: Coordinate culturally congruent care that is safe and does not interfere with essential treatments

Q26. A patient learns they carry a pathogenic BRCA mutation and does not want family informed. What is the nurse’s best action?

• Notify at-risk relatives to protect them
• Respect confidentiality, encourage the patient to share results, and offer resources for family communication
• Document the result in a separate, hidden record
• Post a general warning in the patient’s social chart

Correct Answer: Respect confidentiality, encourage the patient to share results, and offer resources for family communication

Q27. A nurse experiences moral distress when providing aggressive treatments perceived as futile. What is the most appropriate first step?

• Refuse to care for the patient immediately
• Seek a clinical ethics consultation and discuss concerns with the interprofessional team
• Vent frustrations on social media
• Continue care and ignore feelings

Correct Answer: Seek a clinical ethics consultation and discuss concerns with the interprofessional team

Q28. When conducting telehealth visits from the unit, which practice best protects patient privacy?

• Using a shared nursing station with speakers on low volume
• Conducting visits in a private room with a secure platform and headset
• Using a personal smartphone over public Wi-Fi
• Recording visits for later reference without consent

Correct Answer: Conducting visits in a private room with a secure platform and headset

Q29. A restrained incarcerated patient asks that health information remain confidential. A law enforcement officer requests details of the diagnosis. What should the nurse do?

• Disclose all details to the officer because the patient is in custody
• Provide only the minimum necessary information for safety and security or as required by law, otherwise maintain confidentiality
• Give the officer full access to the medical record
• Refuse all communication with law enforcement

Correct Answer: Provide only the minimum necessary information for safety and security or as required by law, otherwise maintain confidentiality

Q30. A competent ventilated patient communicates the wish to withdraw life support. Which statement reflects correct ethical practice?

• Withdrawing life support upon informed request allows natural death and is ethically and legally distinct from euthanasia
• Withdrawal is illegal if death is likely
• Family consent is required to honor the patient’s request
• Care should be stopped immediately without symptom management

Correct Answer: Withdrawing life support upon informed request allows natural death and is ethically and legally distinct from euthanasia

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