Ethics and legal questions test whether you know the boundaries of the nurse's role and can name the principle in play. Work through these 10 practice questions on ethical principles, advance directives, informed consent, HIPAA, mandatory reporting, negligence, and torts, each with a full rationale.
Nursing Ethics & Law: Principles, Consent & Liability
Ethics and legal content on the NCLEX rewards you for recognizing principles in action and knowing the boundaries of the nurse's role. Memorize the core ethical principles: autonomy (the client's right to self-determination, including refusing treatment), beneficence (doing good), nonmaleficence (do no harm), justice (fair, equal treatment and resource allocation), veracity (truthfulness), fidelity (keeping commitments), and confidentiality. The single most tested idea is that a competent adult's current wishes win. A competent client may refuse even life-sustaining treatment, and the nurse's job is to advocate for that choice, not to override it.
Know the legal scaffolding cold. Advance directives come in two flavors: a living will states the client's treatment wishes in writing, while a durable power of attorney for health care (health care proxy) names a decision-maker who acts ONLY once the client loses capacity. A competent client’s current wishes override any prior directive or family opinion, and a client with capacity can revoke a directive at any time; the Patient Self-Determination Act requires facilities to inform clients of their right to accept or refuse treatment and to create advance directives. For informed consent, the provider discloses risks, benefits, and alternatives; the nurse witnesses the signature and confirms understanding. HIPAA limits sharing of protected health information to the care team on a need-to-know basis, with exceptions for mandatory reporting, court orders, and duty to warn.
Finally, distinguish liability concepts. Malpractice/negligence requires four elements: duty, breach (below the standard of care), causation, and damages. Intentional torts include assault (threat), battery (unconsented touch), false imprisonment (improper confinement/restraint), invasion of privacy, and defamation. Nurses are mandated reporters of suspected child, elder, and vulnerable-adult abuse (reasonable suspicion is enough, and good-faith reports are protected). Incident reports are an internal quality-improvement tool: chart the facts objectively, never chart that a report was filed, and never place it in the medical record.
Nursing Ethics & Legal NCLEX Practice Questions
Question 1 · Ethical principles
A client with advanced lung cancer tells the nurse he has decided to stop chemotherapy and pursue comfort care, even though his family wants him to continue. The nurse supports the client's decision and helps arrange a palliative care consult. Which ethical principle is the nurse primarily upholding?
- A Beneficence
- B Justice
- C Autonomy
- D Fidelity
Show answer & rationale
Correct answer: C
Autonomy is the client's right to self-determination, including the right to make decisions about his own body and to refuse or discontinue treatment. A competent adult may stop chemotherapy even when family members disagree, and honoring that informed choice is the essence of autonomy and patient advocacy. Beneficence means acting for the client's good; while arranging palliative care is beneficent, the defining act here is respecting the client's self-chosen goal rather than deciding what is best for him. Justice concerns fair and equal treatment and the just allocation of resources among clients, which is not what this scenario turns on. Fidelity is faithfulness in keeping commitments and promises to the client, such as returning with pain medication when promised, and does not capture a client's right to choose. Clinical pearl: when a question centers on a client refusing, discontinuing, or choosing among treatments, the answer is almost always autonomy. Remember that the nurse's role is to advocate for the client's expressed wishes, not to persuade the client to accept what the family or team prefers. A competent client's current wishes override family opinion every time.
Question 2 · Ethical principles matching
The nurse manager is teaching new graduates to identify ethical principles in practice. Which statements correctly match an ethical principle to the nursing action? Select all that apply.
- A Fidelity: telling a client a comforting untruth to reduce anxiety
- B Veracity: disclosing a medication error to the affected client
- C Nonmaleficence: verifying a high-alert drug dose with a second nurse to prevent harm
- D Beneficence: refusing to answer a client's questions about the diagnosis
- E Autonomy: supporting a competent client's refusal of dialysis
- F Justice: providing the same standard of care to all clients regardless of ability to pay
Show answer & rationale
Correct answer: B, C, E, F
Veracity is truthfulness, so disclosing a medication error to the client is a correct match; clients have a right to honest information about their care. Nonmaleficence means do no harm, and independently double-checking a high-alert dose to prevent injury is a textbook example. Autonomy is self-determination, so supporting a competent client's refusal of dialysis correctly reflects the principle. Justice is fairness and equal treatment, so delivering the same standard of care regardless of ability to pay is properly matched. The pairing of fidelity with telling a comforting untruth is incorrect: lying violates veracity, and fidelity means keeping commitments and being faithful to the client, not deceiving them. Pairing beneficence with refusing to answer a client's questions is also incorrect; withholding information neither does good nor respects the client and actually undermines autonomy and veracity. Memory aid: link each principle to a one-word anchor. Autonomy equals choice, beneficence equals do good, nonmaleficence equals no harm, justice equals fairness, veracity equals truth, fidelity equals promises. When an option pairs a principle with an action that contradicts its anchor word, it is a distractor.
Question 3 · Advance directives
A newly admitted client asks the nurse to explain what a durable power of attorney for health care does. Which response by the nurse is most accurate?
- A It states in writing which specific treatments you do and do not want near the end of life.
- B It names a person to make your health care decisions if you become unable to make them yourself.
- C It gives the physician the authority to make all of your medical decisions for you.
- D It automatically makes your spouse responsible for your finances and medical bills.
Show answer & rationale
Correct answer: B
A durable power of attorney for health care (also called a health care proxy or surrogate) names a specific decision-maker who acts on the client's behalf, but only when the client loses decision-making capacity. That is the defining feature the nurse should teach. The description of a document that states in writing which specific treatments the client does or does not want describes a living will, a different type of advance directive, not a durable power of attorney. Saying it gives the physician authority to make all decisions is wrong; the proxy is a person the client chooses, and even then the surrogate follows the client's known wishes rather than transferring blanket authority to a provider. The statement about making a spouse responsible for finances and bills confuses a health care proxy with a financial power of attorney and adds an incorrect liability claim. Clinical pearl: living will equals wishes on paper; durable power of attorney equals a named person. Both are advance directives protected under the Patient Self-Determination Act, which requires facilities to inform clients of their right to create them. Also remember the proxy has no authority while the client still has capacity, and a competent client can revoke or change any directive at any time.
Question 4 · Informed consent
A client scheduled for a laparoscopic cholecystectomy is holding the surgical consent form and tells the nurse, "I signed it, but honestly I'm not sure what they're actually going to do or what could go wrong." What is the nurse's most appropriate action?
- A Reassure the client that the surgeon is highly skilled and proceed with transport.
- B Explain the surgical procedure, its risks, and alternatives to the client.
- C Witness the signature and document that teaching was completed.
- D Notify the surgeon that the client needs more information before surgery proceeds.
Show answer & rationale
Correct answer: D
Informed consent is a legal responsibility of the provider performing the procedure. The surgeon must disclose the nature of the surgery, its risks, benefits, and alternatives. When the client states he does not understand what will be done or what the risks are, valid informed consent is in question, so the nurse must notify the surgeon to return and complete the disclosure before the client proceeds. Simply reassuring the client about the surgeon's skill and transporting him ignores the deficit in understanding and could result in an invalid consent. Explaining the procedure, risks, and alternatives yourself oversteps the nurse's role; the nurse reinforces and clarifies teaching but is not responsible for the primary disclosure of surgical risks and alternatives. Witnessing the signature and documenting that teaching was completed would be false documentation, because the client has just told you he does not understand. The nurse's legal role in informed consent is to witness the signature and confirm that the client appears to understand and is signing voluntarily. Clinical pearl: if a client cannot describe the procedure and its risks in his own words, stop and call the provider. A competent adult may refuse even life-sustaining treatment, but consent is only valid when it is truly informed and voluntary.
Question 5 · Confidentiality / HIPAA
Which action by a nurse best protects a client's protected health information and complies with HIPAA?
- A Discussing the client's condition only with members of the client's care team
- B Sharing lab results with the client's coworker who is listed as an emergency contact
- C Reviewing the chart of a neighbor admitted to another unit out of personal concern
- D Discussing the client's case by name with colleagues in the hospital elevator
Show answer & rationale
Correct answer: A
HIPAA expects protected health information to be accessed and shared on a need-to-know basis, such as with care team members who are directly involved in that client’s treatment. Limiting discussion to members of the client's care team is the correct, compliant practice. Sharing lab results with a coworker listed as an emergency contact is a violation; an emergency contact is not automatically authorized to receive clinical information, and disclosure requires the client's consent unless a legal exception applies. Reviewing the chart of a neighbor admitted to another unit out of personal concern is unauthorized access, a common and serious HIPAA violation, because the nurse has no treatment relationship with that person. Discussing a client by name in an elevator exposes information in a public area where others can overhear, another classic breach. Clinical pearl: before accessing or sharing information, ask two questions. Am I part of this client's care team, and is there a treatment, payment, or operations reason to know? If not, stay out of the chart. Remember the limited exceptions where disclosure is required or permitted without consent: mandatory reporting, a valid court order, and the duty to warn an identifiable third party of a serious threat. Curiosity and personal relationships are never valid reasons to access a record.
Question 6 · Negligence / malpractice
A nurse fails to reposition and monitor a high-fall-risk client per the facility's protocol. The client climbs out of bed unassisted, falls, and sustains a fractured hip requiring surgery. In analyzing this event for the four elements of malpractice, which element does the fractured hip represent?
- A Duty
- B Breach of duty
- C Damages
- D Causation
Show answer & rationale
Correct answer: C
Malpractice (professional negligence) requires four elements: duty, breach, causation, and damages. Damages are the actual harm the client suffers, so the fractured hip requiring surgery is the damages element. Duty refers to the nurse-client relationship that obligated the nurse to provide care meeting the standard; that existed but is not what the fracture represents. Breach of duty is the failure to meet the standard of care, which here is failing to reposition and monitor per protocol; the breach is the nurse's action or omission, not the injury itself. Causation is the link showing that the breach directly led to the harm, connecting the missed monitoring to the fall; causation is the relationship between the two, not the harm on its own. Memory aid: think of the four Ds in order as a chain, Duty, Deviation (breach), Direct cause (causation), and Damages. All four must be present to prove malpractice. If a client is angry about substandard care but suffered no actual harm, the damages element is missing and a malpractice claim fails. In this scenario every element is met: a duty existed, the standard was breached, the breach caused the fall, and the fracture is the measurable damage.
Question 7 · Incident reports
A client slips in the bathroom and is uninjured but shaken. Which nursing action related to the incident report is correct?
- A Chart in the client's medical record that an incident report was completed.
- B Place a copy of the completed incident report inside the client's medical record.
- C Record a subjective opinion in the incident report about who was at fault.
- D Objectively chart the facts of the fall and complete a separate incident report.
Show answer & rationale
Correct answer: D
An incident (occurrence) report is an internal quality-improvement and risk-management tool. The nurse should objectively document the facts of the fall, such as where the client was found, the client's statements, the assessment, and interventions, in the medical record, and then complete a separate incident report kept outside the chart. Charting in the medical record that an incident report was completed is incorrect; referencing the report in the chart can make the internal document discoverable and blurs the line between the legal record and the quality-improvement process. Placing a copy of the completed incident report in the client's chart defeats its purpose and exposes it legally, so it is never filed in the medical record. Recording a subjective opinion in the incident report about who was at fault is wrong because incident reports must be factual and objective, avoiding blame, speculation, and conclusions. Clinical pearl: document facts, not fault, and never mention the incident report in the chart. Think of two parallel tracks. The medical record gets an objective narrative of what happened to the client and the care provided; the incident report, filed separately, helps the facility identify and prevent system problems. Keeping these separate protects both the client's record integrity and the quality-improvement process.
Question 8 · Intentional torts
A competent adult client states he wants to leave the hospital against medical advice. The nurse tells him he is not allowed to leave and warns that security will physically restrain him if he tries, and the client remains out of fear. Which intentional tort has the nurse most clearly committed?
- A Assault
- B False imprisonment
- C Battery
- D Invasion of privacy
Show answer & rationale
Correct answer: B
False imprisonment is the unjustified confinement or restraint of a person against their will, including using threats of restraint to prevent a competent client from leaving. A competent adult has the right to leave against medical advice, so preventing his departure through intimidation is false imprisonment. Assault is a threat or attempt that makes a person fear imminent harmful or offensive contact; the nurse's warning has an assault-like quality, but the tort most clearly completed here is the wrongful confinement itself, because the client was actually kept from leaving. Battery is harmful or offensive touching without consent, such as physically restraining or treating the client, which has not yet occurred in this scenario. Invasion of privacy involves improperly exposing or intruding on the client's private information or person, which is unrelated here. Clinical pearl: a competent client may leave AMA even against clinical advice; the appropriate nursing response is to notify the provider, explain the risks, ask the client to sign an AMA form, and document, never to threaten or confine. Distinguish the torts by remembering assault equals the threat, battery equals the unconsented touch, and false imprisonment equals blocking someone's freedom to leave.
Question 9 · Mandatory reporting
A nurse is reviewing situations from a busy shift. Which situations legally require the nurse to make a report? Select all that apply.
- A Suspected physical abuse of a 4-year-old with multiple unexplained bruises
- B A competent adult client's decision to refuse recommended cancer treatment
- C A gunshot wound in an adult client presenting to the emergency department
- D Suspected neglect of an older adult who is fully dependent on a caregiver
- E A client's request that his employer not be told about his hospitalization
- F A new laboratory-confirmed diagnosis of active tuberculosis
Show answer & rationale
Correct answer: A, C, D, F
Nurses are mandated reporters. Suspected physical abuse of a young child must be reported; reasonable suspicion is enough and proof is not required, and good-faith reports are legally protected. Gunshot (and stab) wounds are reportable to law enforcement in essentially every jurisdiction. Suspected neglect of a dependent older adult falls under elder and vulnerable-adult abuse reporting laws and must be reported on suspicion. A laboratory-confirmed case of active tuberculosis is a reportable communicable disease that must be reported to public health authorities. A competent adult's decision to refuse recommended cancer treatment is not reportable; it is an exercise of autonomy that the nurse should support and document, not report. A client's request that his employer not be told about his hospitalization is a routine confidentiality preference the nurse should honor, not a reportable event. Clinical pearl: report reasonable suspicion of abuse or neglect of children, elders, and vulnerable adults; you do not investigate or wait for proof, and you are shielded from liability when you report in good faith. Other mandatory reports include certain communicable diseases and gunshot or stab wounds. Autonomous, lawful choices by competent adults and ordinary privacy requests are never mandatory reports.
Question 10 · Advance directives
A nurse is providing education about advance directives during admission. Which statements about advance directives are accurate? Select all that apply.
- A Once signed, an advance directive can never be changed.
- B A living will describes the treatments a client would or would not want if unable to speak for themselves.
- C Federal law requires providers to make treatment decisions for clients who have no advance directive.
- D A health care proxy makes decisions only after the client loses decision-making capacity.
- E A competent client's current spoken wishes override a previously written advance directive.
- F An advance directive can be revoked or changed by the client at any time.
Show answer & rationale
Correct answer: B, D, E, F
A living will is a written statement of the treatments a client would or would not want if the client can no longer communicate, so that statement is accurate. A health care proxy (durable power of attorney for health care) has authority only after the client loses decision-making capacity, which correctly describes when a surrogate acts. A competent client's current spoken wishes always override any previously written directive, because the client's present, informed choice controls; this is a heavily tested point. Advance directives can be revoked or changed at any time by a client with capacity, so that statement is accurate. The claim that a signed directive can never be changed is false and contradicts the client's ongoing right to revise it. The statement about federal law is incorrect: the Patient Self-Determination Act requires facilities to inform clients of their right to create advance directives and to accept or refuse treatment; it does not authorize providers to make decisions for clients who lack a directive. Clinical pearl: the current wishes of a competent client trump both prior paperwork and family opinion. When a client with capacity says something different from an old directive, follow the client. Directives guide care only when the client can no longer speak for themselves.
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Nursing Ethics & Legal FAQ
What is the difference between a living will and a durable power of attorney for health care?
A living will is a written document stating which treatments you do or do not want if you cannot speak for yourself. A durable power of attorney for health care (health care proxy or surrogate) names a specific person to make decisions for you, but only after you lose decision-making capacity. Both are advance directives protected under the Patient Self-Determination Act. On the NCLEX, remember: living will equals wishes on paper, durable power of attorney equals a named person, and a competent client's current wishes always override either one.
What is the nurse's role in informed consent?
The provider performing the procedure is legally responsible for disclosing the risks, benefits, and alternatives. The nurse's role is to witness the client's signature and confirm that the client appears to understand and is signing voluntarily. If the client cannot describe the procedure or its risks in their own words, the nurse must stop and notify the provider to complete the disclosure before the client proceeds. The nurse does not provide the primary explanation of surgical risks. Remember that a competent adult can refuse even life-sustaining treatment.
When is a nurse legally required to report something, even without the client's permission?
Nurses are mandated reporters. You must report reasonable suspicion of child, elder, or vulnerable-adult abuse or neglect; proof is not required, and good-faith reports are legally protected. Other mandatory reports include certain communicable diseases and gunshot or stab wounds. A valid court order and the duty to warn an identifiable person of a serious threat are additional exceptions to confidentiality. A competent adult's lawful refusal of treatment and ordinary privacy requests are not reportable.
How should a nurse handle an incident report after a client fall?
Document the facts of the fall objectively in the client's medical record, including what happened, the client's statements, your assessment, and interventions. Then complete a separate incident report as an internal quality-improvement tool. Do not chart that an incident report was filed, do not place the report in the medical record, and do not record opinions about who was at fault. Keep the objective clinical narrative and the internal report on two separate tracks. This protects the integrity of the record and the quality-improvement process.