NSG 423 POLICY, TRENDS, &
ETHICS IN NURSING
FINAL EXAM
Exam Elaborations Questions &
Answers
2026
,A 68-year-old man with newly diagnosed stage IV pancreatic cancer is admitted to
an oncology unit. The attending oncologist has spoken with the patient's adult
children before speaking with the patient, and the family requests that the nurse and
physician withhold the diagnosis from the patient because they believe the
information will cause him to "give up and die faster." The patient is alert, oriented,
fully competent, and has not assigned anyone as his healthcare proxy. During
morning care, the patient directly asks the nurse, "I know something serious is
happening. Please tell me honestly what my diagnosis is." Applying the ethical
principles of autonomy, veracity, and beneficence, which nursing action is most
ethically and legally defensible?
A. Honor the family's request and tell the patient that the physician will discuss all
details during rounds, effectively deferring and deflecting to avoid disclosing the
diagnosis
B. Notify the charge nurse of the family's request, document the conversation, and
avoid Answering the patient's direct question by changing the subject
C. Acknowledge the patient's right to receive truthful information about his own
medical condition, inform the attending physician immediately that the patient is
directly requesting his diagnosis, advocate clearly within the interdisciplinary team
that withholding information from a competent adult patient at the family's request
violates the ethical principle of veracity and the patient's autonomous right to
participate in his own care decisions, and facilitate a family meeting with social work
and palliative care support
D. Tell the patient his diagnosis directly and in full detail without first notifying the
physician, because the nurse's duty of veracity overrides all other considerations
Correct Answer: C
Rationale: The ethical principle of veracity obligates healthcare providers to
communicate truthfully with patients. The principle of autonomy establishes that a
competent adult patient has the absolute right to receive honest information about his
own diagnosis and prognosis so that he can make informed decisions about
treatment, advance care planning, and personal affairs. Family preferences about
disclosure, while emotionally understandable, have no legal or ethical authority to
override a competent patient's right to information. The practice of withholding a
diagnosis from a competent patient at the family's request, sometimes called
therapeutic privilege, is ethically indefensible under contemporary bioethical
standards except in the narrowest of documented circumstances where disclosure
would cause immediate, irreversible psychological harm. The nurse's role is to
advocate for the patient, escalate to the physician, and facilitate a structured family
meeting that addresses the family's fears while protecting the patient's rights. Option
2
,D, while motivated by veracity, bypasses the physician communication and chain of
accountability that is professionally appropriate in this situation.
---
A 17-year-old female presents to a Planned Parenthood clinic staffed by a
community health nurse seeking testing and treatment for a sexually transmitted
infection. She requests that her parents not be notified of her visit. The clinic nurse
reviews her state's minor consent law and confirms that the state permits minors to
independently consent to STI testing and treatment without parental notification. The
patient's parent telephones the clinic while the patient is present and asks to confirm
whether their daughter is a clinic patient and what she is being treated for. Which
legal and ethical principles govern the nurse's response?
A. Because the patient is a minor, the parent has absolute legal authority to access all
of her medical information and the nurse must confirm the visit and disclose the
diagnosis
B. The minor's right to confidentiality is legally protected under the state's minor
consent statute for STI-related care, and the parent's inquiry must be handled
consistent with HIPAA's Privacy Rule, which generally treats a minor who has the
legal authority to consent to her own care as the personal representative of her own
health information for that care; the nurse must neither confirm nor deny the patient's
presence or care without the patient's consent, and should inform the parent that the
clinic cannot discuss any individual's care without authorization
C. The nurse should place the parent on hold, ask the patient's permission, and if the
patient refuses, tell the parent that no information is available
D. The nurse should inform the parent that the clinic cannot disclose patient
information over the telephone but should mail a summary of the visit to the family
home to comply with standard communication practices
Correct Answer: B
Rationale: Minor consent laws exist in every U.S. state and create a legally protected
zone of confidentiality for minors seeking care for specific sensitive health issues
including sexually transmitted infections, contraception, substance use treatment, and
mental health services in most jurisdictions. HIPAA's Privacy Rule at 45 CFR
164.502(g) recognizes that when a minor has the legal right to consent to her own
care under state law, the minor (not the parent) is the personal representative of her
own health information for that episode of care. The nurse who confirms a minor's
presence at the clinic or discloses treatment information to a parent without the
minor's authorization is committing a HIPAA violation and breaching the minor's
legally protected confidentiality. Option C is dangerously inadequate because it
invites the patient into a coercive decision moment during a clinical visit. The correct
3
, response requires applying both state minor consent law and federal HIPAA
protections simultaneously.
---
A 45-year-old Jehovah's Witness patient is admitted to the ICU following a motor
vehicle accident with a hemoglobin of 5.8 g/dL and active internal hemorrhage. He is
alert, oriented, and decisionally competent. He presents a signed advance directive
and personally refuses blood transfusion on religious grounds, stating clearly that he
understands the refusal may result in his death. His wife is pleading with the
healthcare team to administer blood over his objection. The trauma surgeon asks the
nurse what the legal and ethical framework is for proceeding. Which analysis most
accurately reflects the controlling principles?
A. The physician should administer blood over the patient's objection because the
duty to preserve life under beneficence overrides patient autonomy when the patient's
decision will result in death
B. The wife's consent as next of kin supersedes the patient's refusal when the patient
is at imminent risk of death, because surrogate decision-makers can override patient
preferences in emergencies
C. A competent adult patient's informed refusal of a specific medical treatment,
including a blood transfusion, is a legally and constitutionally protected exercise of
bodily autonomy and religious freedom; administering blood over a competent
patient's explicit, informed, and persistent refusal constitutes battery under both civil
and criminal law regardless of the medical necessity or the family's wishes, and the
healthcare team's obligation is to respect the refusal, provide all other possible
clinical interventions consistent with the patient's values, document the refusal
comprehensively, ensure ongoing competency assessment, and involve ethics
consultation and legal counsel if institutional uncertainty exists
D. The hospital ethics committee must convene and vote before any clinical decision
can be made, during which time blood may be administered as a life-saving
emergency measure
Correct Answer: C
Rationale: This scenario represents one of the most clinically and emotionally
challenging intersections of law, ethics, and clinical practice in professional nursing.
The legal framework is unambiguous: in Cruzan v. Director, Missouri Dept. of
Health (1990), the U.S. Supreme Court affirmed that competent individuals have a
constitutionally protected liberty interest in refusing unwanted medical treatment,
including life-sustaining treatment. This protection is reinforced by the First
Amendment's free exercise of religion clause. Battery in tort law is defined as
intentional, unpermitted touching, which includes administering a medical treatment
4
ETHICS IN NURSING
FINAL EXAM
Exam Elaborations Questions &
Answers
2026
,A 68-year-old man with newly diagnosed stage IV pancreatic cancer is admitted to
an oncology unit. The attending oncologist has spoken with the patient's adult
children before speaking with the patient, and the family requests that the nurse and
physician withhold the diagnosis from the patient because they believe the
information will cause him to "give up and die faster." The patient is alert, oriented,
fully competent, and has not assigned anyone as his healthcare proxy. During
morning care, the patient directly asks the nurse, "I know something serious is
happening. Please tell me honestly what my diagnosis is." Applying the ethical
principles of autonomy, veracity, and beneficence, which nursing action is most
ethically and legally defensible?
A. Honor the family's request and tell the patient that the physician will discuss all
details during rounds, effectively deferring and deflecting to avoid disclosing the
diagnosis
B. Notify the charge nurse of the family's request, document the conversation, and
avoid Answering the patient's direct question by changing the subject
C. Acknowledge the patient's right to receive truthful information about his own
medical condition, inform the attending physician immediately that the patient is
directly requesting his diagnosis, advocate clearly within the interdisciplinary team
that withholding information from a competent adult patient at the family's request
violates the ethical principle of veracity and the patient's autonomous right to
participate in his own care decisions, and facilitate a family meeting with social work
and palliative care support
D. Tell the patient his diagnosis directly and in full detail without first notifying the
physician, because the nurse's duty of veracity overrides all other considerations
Correct Answer: C
Rationale: The ethical principle of veracity obligates healthcare providers to
communicate truthfully with patients. The principle of autonomy establishes that a
competent adult patient has the absolute right to receive honest information about his
own diagnosis and prognosis so that he can make informed decisions about
treatment, advance care planning, and personal affairs. Family preferences about
disclosure, while emotionally understandable, have no legal or ethical authority to
override a competent patient's right to information. The practice of withholding a
diagnosis from a competent patient at the family's request, sometimes called
therapeutic privilege, is ethically indefensible under contemporary bioethical
standards except in the narrowest of documented circumstances where disclosure
would cause immediate, irreversible psychological harm. The nurse's role is to
advocate for the patient, escalate to the physician, and facilitate a structured family
meeting that addresses the family's fears while protecting the patient's rights. Option
2
,D, while motivated by veracity, bypasses the physician communication and chain of
accountability that is professionally appropriate in this situation.
---
A 17-year-old female presents to a Planned Parenthood clinic staffed by a
community health nurse seeking testing and treatment for a sexually transmitted
infection. She requests that her parents not be notified of her visit. The clinic nurse
reviews her state's minor consent law and confirms that the state permits minors to
independently consent to STI testing and treatment without parental notification. The
patient's parent telephones the clinic while the patient is present and asks to confirm
whether their daughter is a clinic patient and what she is being treated for. Which
legal and ethical principles govern the nurse's response?
A. Because the patient is a minor, the parent has absolute legal authority to access all
of her medical information and the nurse must confirm the visit and disclose the
diagnosis
B. The minor's right to confidentiality is legally protected under the state's minor
consent statute for STI-related care, and the parent's inquiry must be handled
consistent with HIPAA's Privacy Rule, which generally treats a minor who has the
legal authority to consent to her own care as the personal representative of her own
health information for that care; the nurse must neither confirm nor deny the patient's
presence or care without the patient's consent, and should inform the parent that the
clinic cannot discuss any individual's care without authorization
C. The nurse should place the parent on hold, ask the patient's permission, and if the
patient refuses, tell the parent that no information is available
D. The nurse should inform the parent that the clinic cannot disclose patient
information over the telephone but should mail a summary of the visit to the family
home to comply with standard communication practices
Correct Answer: B
Rationale: Minor consent laws exist in every U.S. state and create a legally protected
zone of confidentiality for minors seeking care for specific sensitive health issues
including sexually transmitted infections, contraception, substance use treatment, and
mental health services in most jurisdictions. HIPAA's Privacy Rule at 45 CFR
164.502(g) recognizes that when a minor has the legal right to consent to her own
care under state law, the minor (not the parent) is the personal representative of her
own health information for that episode of care. The nurse who confirms a minor's
presence at the clinic or discloses treatment information to a parent without the
minor's authorization is committing a HIPAA violation and breaching the minor's
legally protected confidentiality. Option C is dangerously inadequate because it
invites the patient into a coercive decision moment during a clinical visit. The correct
3
, response requires applying both state minor consent law and federal HIPAA
protections simultaneously.
---
A 45-year-old Jehovah's Witness patient is admitted to the ICU following a motor
vehicle accident with a hemoglobin of 5.8 g/dL and active internal hemorrhage. He is
alert, oriented, and decisionally competent. He presents a signed advance directive
and personally refuses blood transfusion on religious grounds, stating clearly that he
understands the refusal may result in his death. His wife is pleading with the
healthcare team to administer blood over his objection. The trauma surgeon asks the
nurse what the legal and ethical framework is for proceeding. Which analysis most
accurately reflects the controlling principles?
A. The physician should administer blood over the patient's objection because the
duty to preserve life under beneficence overrides patient autonomy when the patient's
decision will result in death
B. The wife's consent as next of kin supersedes the patient's refusal when the patient
is at imminent risk of death, because surrogate decision-makers can override patient
preferences in emergencies
C. A competent adult patient's informed refusal of a specific medical treatment,
including a blood transfusion, is a legally and constitutionally protected exercise of
bodily autonomy and religious freedom; administering blood over a competent
patient's explicit, informed, and persistent refusal constitutes battery under both civil
and criminal law regardless of the medical necessity or the family's wishes, and the
healthcare team's obligation is to respect the refusal, provide all other possible
clinical interventions consistent with the patient's values, document the refusal
comprehensively, ensure ongoing competency assessment, and involve ethics
consultation and legal counsel if institutional uncertainty exists
D. The hospital ethics committee must convene and vote before any clinical decision
can be made, during which time blood may be administered as a life-saving
emergency measure
Correct Answer: C
Rationale: This scenario represents one of the most clinically and emotionally
challenging intersections of law, ethics, and clinical practice in professional nursing.
The legal framework is unambiguous: in Cruzan v. Director, Missouri Dept. of
Health (1990), the U.S. Supreme Court affirmed that competent individuals have a
constitutionally protected liberty interest in refusing unwanted medical treatment,
including life-sustaining treatment. This protection is reinforced by the First
Amendment's free exercise of religion clause. Battery in tort law is defined as
intentional, unpermitted touching, which includes administering a medical treatment
4
