NCLEX-RN Practice Questions: Legal & Ethical Issues in Nursing
Introduction
Navigating the ethical and legal aspects of nursing can be just as difficult as mastering the clinical skills. Nurses must be prepared for situations involving real people, real emotions, and real consequences even before they start their practice. The purpose of this set of NCLEX practice questions is to help you think like a nurse in the moment: calmly, clearly, and with a solid grasp of professional standards. These practice questions include some of the most prevalent problems that nurses encounter. Learn effectively with Tiju’s NCLEX-RN exam preparation.
1. A nurse is caring for a 78-year-old client with dementia who has a DNR order but becomes unresponsive during a routine dressing change. The family, who arrived unexpectedly, insists on full resuscitation, claiming the client "wouldn't want to die like this." The nurse's immediate legal priority is:
A. Proceed with CPR to avoid a potential lawsuit from the family.
B. Honor the DNR and document the family's objection.
C. Consult the ethics committee before acting.
D. Transfer care to another nurse to avoid liability.
ANSWER: B. Honor the DNR and document the family's objection.
2. During a busy shift, a nurse delegates medication administration to an unlicensed assistive personnel (UAP) for a client on warfarin. The UAP reports the dose was given, but later lab results show supratherapeutic INR. The client develops a bleed. Which legal principle is the nurse most at risk of violating?
A. Assault and battery.
B. Breach of duty in delegation.
C. Invasion of privacy.
D. False imprisonment.
ANSWER : B. Breach of duty in delegation.
3. A client with HIV discloses status to the nurse and begs confidentiality, stating, "Don't tell my partner—he'll leave me." The nurse learns the partner is also a client on the unit and unaware. Select all that apply (SATA) regarding the nurse's legal obligations:
A. Report to public health for partner notification.
B. Document the disclosure in the client's chart only.
C. Inform the partner directly to prevent harm.
D. Consult the facility's risk management team
E. Maintain absolute confidentiality per HIPAA.
ANSWER: A. Report to public health for partner notification.
D. Consult the facility's risk management team.
4. A postoperative client sues the nurse for negligence after a retained sponge is discovered during follow-up. The nurse had counted instruments correctly but noted a discrepancy in the sponge tally that was overridden by the surgeon. To defend against malpractice, the nurse must prove:
A. The sponge was not visible during the count.
B. Adherence to facility policy and reasonable care.
C. The surgeon's override absolves all liability.
D. No prior incidents of similar errors.
ANSWER: B. Adherence to facility policy and reasonable care.
5. A nurse overhears two colleagues discussing a client's psychiatric history in the elevator, including details from the chart. This violates which legal standard?
A. Informed consent.
C. Confidentiality under HIPAA.
D. Advance directive enforcement.
E. Right to refuse treatment.
ANSWER : B. Confidentiality under HIPAA.
6. A client with capacity refuses a blood transfusion due to religious beliefs during an emergency C-section with postpartum hemorrhage. The nurse believes the refusal endangers the fetus. The most legally defensible action is:
A. Administer the transfusion covertly to save both lives.
B. Seek an emergency court order for treatment.
C. Honor the refusal and prepare for conservative management.
D. Notify child protective services immediately.
ANSWER : C. Honor the refusal and prepare for conservative management.
7. In a staffing shortage, a charge nurse assigns a new graduate RN to triage in the ED without orientation. A client with chest pain is triaged low, delaying care and resulting in MI. This scenario exemplifies:
A. Respondeat superior.
B. Contributory negligence by the client.
C. Vicarious liability for improper delegation.
D. Statute of limitations expiration.
ANSWER : C. Vicarious liability for improper delegation.
8. A nurse documents a medication error (wrong dose given) but alters the entry 2 hours later to "correct" it without noting the change. This action risks:
A. HIPAA violation for unauthorized access.
B. Tampering with medical records, invalidating evidence.
C. Breach of informed consent process.
D. Failure to report abuse.
ANSWER : B. Tampering with medical records, invalidating evidence.
9. A terminally ill client asks the nurse to assist in ending life via overdose, citing unbearable pain. The nurse's ethical-legal response is to:
A. Provide the medication discreetly to alleviate suffering.
B. Refer to palliative care and ethics consultation.
C. Document the request and ignore it as non-reportable.
D. Report to authorities as a suicide threat.
ANSWER : B. Refer to palliative care and ethics consultation.
10. During a code, a nurse performs chest compressions on a client with known rib fragility from osteoporosis, resulting in fractures. The family later claims battery. The nurse's best defense is:
A. The fractures were unavoidable in resuscitation.
B. Obtaining implied consent from the code team.
C. Documenting the osteoporosis in the chart pre-code.
D. Blaming the delay in family arrival.
ANSWER : A. The fractures were unavoidable in resuscitation.
11. A nurse shares a de-identified client story on a nursing forum for advice, but omits key details that could identify the client via context (e.g., rare diagnosis in small town). This potentially breaches:
A. Nothing, as it's de-identified
B. HIPAA's safe harbor rules for re-identification risk.
C. Scope of practice limits.
D. Duty to report errors.
ANSWER : B. HIPAA's safe harbor rules for re-identification risk.
12. An elderly client with mild cognitive impairment signs a surgical consent form after the nurse explains risks, but the family later claims the client lacked capacity. To strengthen legal validity, the nurse should have:
A. Obtained family co-signature on the form.
B. Assessed and documented capacity via mini-mental exam.
C. Skipped explanation due to time constraints.
D.Let the surgeon handle all consents.
ANSWER : B. Assessed and documented capacity via mini-mental exam.
13. A UAP reports witnessing a colleague verbally abusing a client. The nurse, fearing retaliation, decides not to report. This inaction exposes the facility to:
A. Corporate liability for negligent supervision.
B. No risk, as it's interpersonal.
C. Only the abuser's personal liability.
D.HIPAA fines for the report.
ANSWER : A. Corporate liability for negligent supervision.
14. A client refuses chemotherapy and requests discharge against medical advice (AMA). The nurse's legal documentation must include:
A. Only the refusal, without risks discussed.
B. Discussion of risks/benefits, capacity assessment, and signature.
C. Forcing the client to stay until stable.
D. Notifying law enforcement for endangerment.
ANSWER: B. Discussion of risks/benefits, capacity assessment, and signature.
15. In a research study, a nurse enrolls a non-English-speaking client without an interpreter, using family translation. This violates:
A. Institutional Review Board (IRB) consent standards.
B. Right to privacy only.
C. Medication administration rights.
D. Advance directive laws.
ANSWER : A. Institutional Review Board (IRB) consent standards.
17. A nurse is subpoenaed for a malpractice trial involving a former client. During deposition, the nurse's attorney advises invoking privilege for client communications. This applies to:
A. All medical records shared.
B. Psychotherapeutic notes under HIPAA psychotherapy notes rule.
C. Routine vital sign entries.
D. Delegation logs only.
ANSWER: B. Psychotherapeutic notes under HIPAA psychotherapy notes rule.
17. A floating nurse unfamiliar with the unit's protocols administers a high-alert med without double-checking, causing an adverse reaction. The legal recourse for the nurse is:
A. Blame the float policy entirely.
B. Claim ignorance as a new employee.
C. Demonstrate adherence to general standards of care.
D. Refuse to testify in any suit.
ANSWER: C. Demonstrate adherence to general standards of care.
18. Select all that apply (SATA): A nurse suspects elder abuse in a client with unexplained bruises but notes the family is influential donors. Legal actions include:
- Mandatory reporting to APS within 24 hours.
- Confronting the family privately first.
- Documenting suspicions objectively.
- Delaying report until confirmed.
- Informing the client's physician only. |
ANSWER: A. Mandatory reporting to APS within 24 hours.
C. Documenting suspicions objectively.
19. A client with a history of violence threatens the nurse during rounds, saying, "I'll find you after shift." The nurse's immediate legal-ethical step is:
- Ignore it as venting.
- Restrain the client for safety.
- Document, notify security, and request a care plan adjustment.
- Discharge the client on the spot.
ANSWER: C. Document, notify security, and request a care plan adjustment.
20. After a sentinel event (wrong-site surgery), the nurse participates in root cause analysis (RCA) but is later disciplined for "contributing factors." This raises concerns of:
A. Whistleblower retaliation under OSHA.
B. Breach of peer review immunity.
C. HIPAA violation in the RCA.
D. Informed consent failure.
ANSWER: A. Whistleblower retaliation under OSHA.
Conclusion
Understanding legal and ethical issues is part of what makes nursing such a reputable and trustworthy profession. You can improve your exam readiness and gain the self-assurance to deal with challenging situations in actual clinical settings by practicing these scenarios. Practicing thoroughly with our experienced trainers and updated NCLEX-RN syllabus makes your exam ready. With expert NCLEX-RN coaching from Tiju’s Academy, you will become confident to crack the exam in your first try. Join now at the best NCLEX-RN coaching centre in Kerala!
