DrillRNDownload

Management of Care

NCLEX Ethical and Legal Practice Questions

Quick answer

Ethical and legal questions test whether you know where the nurse's authority starts and stops: what you may do, what you must do, and what you must never do. They sit inside Management of Care, the biggest section of the exam at 15 to 21 percent, and most test takers see several of them.

  • 10 practice questions
  • Full rationales
  • Free

These questions feel easy until you read the options, and then two of them look right. A client refuses a blood transfusion that will probably save his life. A daughter calls the unit and asks how her father's surgery went. A coworker smells of alcohol at 7 AM. There is no lab value to fall back on, only the law and the nursing code of ethics. The trap on this topic is answering with what a kind person would do instead of what a licensed nurse is required to do. Kind people call the daughter back with an update. Licensed nurses check whether the client has given permission. Keep that line in your head on every question below: the client's rights come first, your license comes second, and your feelings come last.

Practice questions

1

A client is scheduled for a laparoscopic cholecystectomy in the morning. The surgeon has left a consent form on the chart, and the client tells the nurse, "I will sign whatever you give me, but I still do not really understand what they are going to take out." Which action should the nurse take?

  1. AExplain the procedure to the client and then witness the signature
  2. BHave the client sign the form now and ask the surgeon to answer questions in the morning
  3. CHold the consent form and notify the surgeon that the client needs more information
  4. DAsk the client's spouse to sign the form instead
Show answer

Answer: C

Informed consent means the client understands the procedure, its risks, its benefits and the alternatives. The provider doing the procedure is responsible for that explanation, so when a client says he does not understand, the nurse stops the signing and gets the surgeon back to the bedside.

Why the others are wrong

The nurse can clarify and reinforce what the surgeon said, but explaining the surgery herself (A) puts the legal duty on the wrong person. Signing first and explaining later (B) is a consent in name only and would not hold up. The spouse (D) has no right to sign for a competent adult.

2

A nurse is asked to witness a client's signature on a surgical consent form. Which statement correctly describes the nurse's role as a witness?

  1. AThe nurse is confirming that the surgery is medically necessary
  2. BThe nurse is confirming that the client signed voluntarily and appeared competent
  3. CThe nurse is confirming that all risks were disclosed in full
  4. DThe nurse is taking legal responsibility if a complication occurs
Show answer

Answer: B

When the nurse signs as a witness she is attesting to three things: the signature is the client's, the client signed of his own free will, and the client appeared alert and competent at the time. That is the whole job.

Why the others are wrong

Medical necessity (A) and full disclosure of risks (C) are the provider's responsibility, and the nurse's signature does not vouch for either. Witnessing a form does not shift liability for surgical outcomes onto the nurse (D).

3

A 78 year old client with end stage heart failure has a signed do not resuscitate order and a living will in the chart. During the night the client becomes unresponsive and pulseless. The client's son, who is at the bedside, begs the nurse to "do something." Which action should the nurse take?

  1. ABegin chest compressions because the son is requesting it
  2. BCall the provider to ask whether the DNR order still applies
  3. CDo not begin resuscitation, stay with the son, and provide support
  4. DBegin bag mask ventilation but withhold chest compressions
Show answer

Answer: C

A valid DNR order is a medical order written from the client's own documented wishes. A family member cannot override it at the bedside. The nurse honors the order, confirms death per protocol, and gives the son the support he needs.

Why the others are wrong

Starting compressions (A) goes against both the order and the client's living will and could be considered battery. There is no reason to call and ask whether a current, signed order applies (B); that delay only serves to pressure the nurse into acting. A partial code (D) is not a thing that exists; the order is either followed or it is not.

4

A client with pneumonia is alert, oriented, and able to explain the risks of leaving. He tells the nurse he is going home now even though the provider has recommended two more days of IV antibiotics. Which action should the nurse take first?

  1. ATell the client the hospital cannot let him leave until the provider sees him
  2. BNotify the provider and ask the client to sign the against medical advice form after the risks are reviewed
  3. CRemove the IV catheter and let the client leave without documentation
  4. DCall security to keep the client on the unit until the family arrives
Show answer

Answer: B

A competent adult can leave at any time. The nurse's job is to make sure the decision is informed: notify the provider, make sure the client has heard the risks, ask him to sign the AMA form, and document everything including a refusal to sign. The IV is removed before he goes.

Why the others are wrong

Telling a competent client he cannot leave (A) or holding him with security (D) is false imprisonment. Pulling the IV and letting him walk out without a word in the chart (C) skips the risk discussion and leaves the nurse with no record of what was said.

5

A nurse answers the phone on a medical unit. The caller says she is the daughter of a client who was admitted that morning and asks what his diagnosis is and when he will be discharged. The client has not completed a release of information form. Which response by the nurse is best?

  1. A"He was admitted with chest pain and will probably go home tomorrow."
  2. B"I cannot confirm or deny that a person by that name is on this unit."
  3. C"I can only give that information to his wife."
  4. D"Let me check with him and see whether he wants me to share that with you."
Show answer

Answer: D

The client owns his health information. Without a signed release or a verbal okay from the client, the nurse shares nothing, but she also does not have to shut the daughter out. Asking the client whether he wants his daughter updated respects both the law and the family.

Why the others are wrong

Giving the diagnosis and discharge plan to an unverified caller (A) is a HIPAA violation. Refusing to confirm the client is even there (B) is the right script for a client who asked to be kept confidential, but this client has not asked for that, so it is heavier than needed. Spouses have no automatic right to information either (C).

6

A nursing student posts a photo on social media of a decorated hospital room with the caption, "Long night with my favorite little leukemia patient, room 412." The child's face is not visible. Which statement about this post is correct?

  1. AThe post is acceptable because the client's face and name are not shown
  2. BThe post violates client confidentiality because the room number and diagnosis can identify the client
  3. CThe post is acceptable because the student is not a licensed nurse yet
  4. DThe post is acceptable if the student's account is set to private
Show answer

Answer: B

Protected health information includes anything that could identify a person, not just a name or face. A room number plus a diagnosis plus a date narrows it down to one child. Students are held to the same confidentiality standard as licensed staff and can be dismissed from a program for a post like this.

Why the others are wrong

No face and no name (A) is not the test; identifiability is. Student status (C) does not exempt anyone from HIPAA. A private account (D) still shares the information with other people, and screenshots travel.

7

A nurse in a pediatric clinic examines a 4 year old who has bruises in various stages of healing on the back and thighs. The mother says the child "falls a lot." The bruises do not match that explanation. Which action is the nurse legally required to take?

  1. AConfront the mother and ask whether she is hurting the child
  2. BReport the suspicion to the state child protective services agency
  3. CWait until the next visit to see whether new bruises appear
  4. DDocument the findings and take no further action unless the child discloses abuse
Show answer

Answer: B

Nurses are mandatory reporters. The duty is triggered by reasonable suspicion, not by proof. The nurse reports to the designated agency (or through the facility's reporting process) and documents the objective findings. Reporting in good faith protects the nurse from liability even if abuse is later ruled out.

Why the others are wrong

Confronting the parent (A) is not the nurse's role and can put the child at greater risk at home. Waiting for more evidence (C) or for the child to disclose (D) leaves a 4 year old in danger and is a failure of the legal duty to report.

8

A nurse gives a client the wrong dose of metoprolol. The client's blood pressure stays stable and the provider is notified. Which action regarding documentation is correct?

  1. AWrite "incident report completed" in the nursing notes
  2. BDocument the medication given, the client's response, and the provider notification in the chart, and complete a separate incident report
  3. CDocument only in the incident report so the error is not visible in the legal record
  4. DDocument the error in the chart with the nurse's opinion of why the pharmacy label was confusing
Show answer

Answer: B

The chart gets the facts: what was given, when, what the client's vital signs and symptoms were, and who was notified. The incident report is a separate quality improvement document that is filed with risk management and is never mentioned in the chart. Both are completed.

Why the others are wrong

Referencing the incident report in the nursing notes (A) makes it discoverable in a lawsuit and defeats its purpose. Leaving the error out of the chart (C) is falsification of the medical record. Opinions and blame (D) do not belong in either document; both stick to objective facts.

9

A confused client on a medical unit keeps pulling at a central line. The provider writes an order for soft wrist restraints. Which statement by a newly licensed nurse shows a correct understanding of restraint use?

  1. A"The restraint order is good for 24 hours, and I will check the client every 4 hours."
  2. B"I should try a bed alarm, a sitter, or covering the line first, and if restraints are needed I need a new order every 24 hours for a nonviolent client."
  3. C"I can apply the restraints now and get the order signed at the end of my shift."
  4. D"Once the restraints are on, I should keep them on until the line is removed."
Show answer

Answer: B

Restraints are a last resort after less restrictive measures have been tried and documented. For a nonviolent, non self destructive client, an order must be renewed at least every 24 hours (for violent behavior the limits are 4 hours for adults, 2 hours for ages 9 to 17, 1 hour under 9), and a PRN restraint order is never allowed.

Why the others are wrong

Checks are done at least every 2 hours, not every 4 (A), with circulation, skin, and range of motion documented, and restraints are released to offer toileting and movement. In a true emergency the nurse can apply restraints before the order, but the order must be obtained within minutes, not at end of shift (C). Restraints are removed as soon as the behavior that required them stops, not kept on for convenience (D).

10

The nurse notices that a coworker on the night shift has slurred speech, smells of alcohol, and has twice drawn up the wrong dose of morphine in the past hour. Which action should the nurse take?

  1. ACover the coworker's medication passes for the rest of the shift and talk to her privately in the morning
  2. BReport the observations to the charge nurse or nursing supervisor immediately
  3. CAsk the other nurses on the unit whether they have noticed anything
  4. DSend an anonymous message to the state board of nursing after the shift ends
Show answer

Answer: B

An impaired nurse is an immediate client safety problem, so the report goes up the chain of command right now, before another dose is given. The supervisor removes the coworker from client care and starts the facility process, which usually includes a confidential assistance program.

Why the others are wrong

Covering for the coworker (A) leaves clients at risk and makes the nurse who stayed quiet legally responsible too. Polling the unit (C) spreads gossip and delays action. The board of nursing may eventually be notified, but anonymous outside reporting after the shift (D) does nothing to protect tonight's clients.

Quick tips

  • Who explains the procedure and who gets the signature: the provider. Who witnesses, reinforces, and stops the process when the client is confused: the nurse. If a question asks who "obtains" consent, the answer is never the nurse.
  • Learn the four torts by their key word. Negligence is carelessness without intent (forgot to raise the side rails). Malpractice is negligence by a professional acting in that role. Assault is a threat (saying "if you do not hold still I will restrain you"). Battery is touching without consent (giving an injection the client refused). Threatening to stop a competent client from leaving is false imprisonment.
  • A competent adult can refuse anything, including the treatment that will save her life, and a family member cannot overrule her. Advance directives speak for the client only once she can no longer speak for herself.
  • Incident reports and the chart never meet. Facts go in the chart, the whole story goes to risk management, and the words "incident report" never appear in the nursing notes.
  • Restraint questions almost always want "least restrictive first." If an option mentions a bed alarm, a sitter, reorientation, or covering a line, it is probably the answer over the restraint.

Related topics

FAQ

What is the difference between negligence and malpractice on the NCLEX?

Negligence is failing to act the way a reasonable person would, and anyone can be negligent. Malpractice is negligence by a licensed professional while doing professional work. On the exam, a nurse who forgets to check an armband before a transfusion is committing malpractice, because the standard is what a reasonable nurse would do.

Can a nurse get informed consent from a client?

No. The nurse can witness the signature, reinforce the provider's explanation, and answer questions about nursing care, but the provider who will perform the procedure is responsible for explaining it and obtaining consent. If the client does not understand, the nurse holds the form and calls the provider.

How long is a restraint order good for on the NCLEX?

For a nonviolent client (pulling at lines, trying to climb out of bed) the order is renewed at least every 24 hours. For violent or self destructive behavior the limits are 4 hours for adults, 2 hours for ages 9 to 17 and 1 hour for children under 9. Checks are done at least every 2 hours and PRN restraint orders are never allowed.

Practice 10 free NCLEX questions every day in the DrillRN app

Every question comes with a full rationale that explains the right answer and why each wrong option is wrong.

Download on the App Store