NCLEX - National Council Licensure Examination NCLEX-RN 4 — Questions and Answers
Question 1: A nurse is caring for a patient who refuses a blood transfusion due to religious beliefs, even though the physician has determined it is medically necessary. Which ethical principle BEST supports the nurse's obligation to honor the patient's decision?
- Beneficence
- Autonomy (Correct answer)
- Justice
- Nonmaleficence
Correct answer: Autonomy
Autonomy recognizes the patient's right to make informed decisions about their own care, even when those decisions conflict with medical recommendations. The nurse's role is to ensure the patient is fully informed and then respect their choice.
Question 2: When a nurse witnesses a colleague administering the wrong medication dose but chooses not to report it to avoid conflict, this behavior MOST directly violates which professional obligation?
- The duty to maintain confidentiality
- The duty of fidelity
- The duty to advocate for patient safety (Correct answer)
- The duty to provide culturally competent care
Correct answer: The duty to advocate for patient safety
Nurses have a professional and ethical duty to advocate for patient safety. Failing to report a medication error, regardless of interpersonal concerns, directly compromises patient welfare and violates this core nursing obligation.
Question 3: A patient with terminal cancer asks the nurse not to tell his family about his prognosis. Which action by the nurse BEST upholds the patient's rights?
- Inform the family because they have a right to know
- Consult the ethics committee without telling the patient
- Honor the patient's request and maintain confidentiality (Correct answer)
- Document the request and then notify the attending physician to inform the family
Correct answer: Honor the patient's request and maintain confidentiality
Competent adult patients have the right to confidentiality regarding their own health information. Unless disclosure is legally required or the patient poses a danger to others, the nurse must honor the patient's explicit request.
Question 4: Which of the following BEST describes the concept of 'veracity' as it applies to nursing practice?
- Treating all patients fairly regardless of their background
- Providing equal distribution of healthcare resources
- Being truthful and honest with patients about their care and condition (Correct answer)
- Avoiding actions that cause harm to the patient
Correct answer: Being truthful and honest with patients about their care and condition
Veracity is the ethical principle of truthfulness. In nursing, it means providing patients with accurate, complete information about their diagnosis, treatment, and prognosis so they can make informed decisions.
Question 5: A nurse manager observes that one staff nurse consistently receives the highest patient satisfaction scores while another consistently receives the lowest. From a justice perspective, the manager should FIRST:
- Reward the high-performing nurse with extra time off
- Assign the low-performing nurse only the least complex patients
- Assess whether both nurses have equal access to resources and support (Correct answer)
- Terminate the low-performing nurse after a formal review
Correct answer: Assess whether both nurses have equal access to resources and support
Justice requires fair and equitable treatment. Before drawing conclusions about performance, the manager must determine whether systemic inequities — such as unequal access to training, staffing support, or patient assignments — are contributing to the disparity.
Question 6: Which of the following situations BEST represents a conflict between the ethical principles of beneficence and nonmaleficence?
- A patient refuses to take prescribed medication
- A nurse administers a high-dose opioid to relieve a dying patient's pain, knowing it may hasten death (Correct answer)
- A physician orders laboratory tests that the patient cannot afford
- A nurse discloses a patient's HIV status to a family member without consent
Correct answer: A nurse administers a high-dose opioid to relieve a dying patient's pain, knowing it may hasten death
This scenario illustrates the double effect — the nurse intends to do good (relieve suffering) but the action may also cause harm (hastening death). This tension between beneficence (doing good) and nonmaleficence (avoiding harm) is a classic ethical conflict in end-of-life care.
NCLEX - National Council Licensure Examination NCLEX-RN 4
A nurse is caring for a patient who refuses a blood transfusion due to religious beliefs, even though the physician has determined it is medically necessary.
Which ethical principle BEST supports the nurse's obligation to honor the patient's decision?