Nursing Ethics & Professional Practice
Competency Exam — Code: NUR-ETHICS
| 100-Question Advanced Practice Exam
2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A competent adult patient refuses a recommended blood transfusion
because of personal beliefs. The nurse believes the refusal will likely result
in serious harm. What is the nurse’s most appropriate action?
A. Ask the family to authorize the transfusion
B. Administer the transfusion because it is medically necessary
C. Respect the patient’s informed refusal and notify the provider
D. Request that the patient be sedated before treatment
Answer: C. Respect the patient’s informed refusal and notify the provider
Rationale: A competent adult has the ethical and legal right to refuse treatment,
even when the decision may result in serious harm or death. The nurse should
,ensure that the refusal is informed, document it, and communicate with the
healthcare team.
2. Which ethical principle is most directly demonstrated when a nurse
supports a patient's right to make independent healthcare decisions?
A. Beneficence
B. Justice
C. Fidelity
D. Autonomy
Answer: D. Autonomy
Rationale: Autonomy recognizes the patient’s right to make informed decisions
about their own healthcare, including accepting or refusing treatment.
3. A nurse discovers that a colleague documented administration of a
medication that was never given. What should the nurse do first?
A. Ignore the error if the patient is stable
B. Alter the colleague’s documentation
C. Report the discrepancy through the appropriate chain of command
D. Discuss the issue with other nurses before reporting it
Answer: C. Report the discrepancy through the appropriate chain of command
Rationale: Falsification of clinical documentation is a serious professional
concern. The nurse should protect the patient and follow organizational
reporting procedures without altering another clinician’s record.
4. A nurse is asked to perform a procedure for which the nurse has never
been trained or validated as competent. What is the best response?
A. Perform the procedure while asking another nurse for assistance
B. Refuse the assignment and immediately leave the unit
C. Explain the competency limitation and request appropriate assistance or
reassignment
D. Perform the procedure if the physician is present
,Answer: C. Explain the competency limitation and request appropriate
assistance or reassignment
Rationale: Nurses have a professional obligation to practice within their
education, training, competence, and scope of practice. Accepting an
assignment beyond competency can place the patient at risk.
5. A nurse receives a verbal prescription that appears inconsistent with the
patient’s condition. What is the nurse’s priority?
A. Carry out the order because the provider prescribed it
B. Clarify the order with the prescribing provider
C. Ask another nurse to administer it
D. Document the concern after administering the medication
Answer: B. Clarify the order with the prescribing provider
Rationale: Nurses have an independent professional responsibility to question
prescriptions that appear unsafe, incomplete, or inconsistent with the patient’s
clinical condition.
6. Which situation best illustrates the ethical principle of justice?
A. Providing pain medication to a patient in severe pain
B. Allowing a patient to refuse surgery
C. Distributing limited critical-care resources according to clinically relevant
criteria
D. Maintaining confidentiality of patient information
Answer: C. Distributing limited critical-care resources according to clinically
relevant criteria
Rationale: Justice concerns fairness and equitable distribution of benefits,
burdens, resources, and opportunities.
7. A nurse accidentally administers a medication to the wrong patient but
recognizes the error immediately. What is the most ethical response?
, A. Document only if symptoms develop
B. Notify the appropriate provider and follow the organization’s disclosure and
safety procedures
C. Ask the patient not to mention the error
D. Correct the medication administration record without reporting the incident
Answer: B. Notify the appropriate provider and follow the organization’s
disclosure and safety procedures
Rationale: Patient safety requires prompt assessment, disclosure through
appropriate channels, documentation, and implementation of measures to
reduce harm. Concealing an error is unethical and potentially unlawful.
8. A patient asks a nurse to keep a serious diagnosis secret from the patient’s
adult children. What should the nurse do?
A. Tell the children because they are family
B. Respect the patient’s confidentiality unless disclosure is otherwise legally
required
C. Ask the children whether they want to know
D. Place the diagnosis in the family waiting-room record
Answer: B. Respect the patient’s confidentiality unless disclosure is otherwise
legally required
Rationale: Patient information is confidential. Family members do not
automatically have a right to protected health information simply because they
are relatives.
9. Which action most clearly violates professional boundaries?
A. Providing therapeutic communication
B. Accepting a small institutional holiday gift available to all patients
C. Developing a personal financial relationship with a current patient
D. Explaining a treatment procedure
Answer: C. Developing a personal financial relationship with a current patient
Competency Exam — Code: NUR-ETHICS
| 100-Question Advanced Practice Exam
2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A competent adult patient refuses a recommended blood transfusion
because of personal beliefs. The nurse believes the refusal will likely result
in serious harm. What is the nurse’s most appropriate action?
A. Ask the family to authorize the transfusion
B. Administer the transfusion because it is medically necessary
C. Respect the patient’s informed refusal and notify the provider
D. Request that the patient be sedated before treatment
Answer: C. Respect the patient’s informed refusal and notify the provider
Rationale: A competent adult has the ethical and legal right to refuse treatment,
even when the decision may result in serious harm or death. The nurse should
,ensure that the refusal is informed, document it, and communicate with the
healthcare team.
2. Which ethical principle is most directly demonstrated when a nurse
supports a patient's right to make independent healthcare decisions?
A. Beneficence
B. Justice
C. Fidelity
D. Autonomy
Answer: D. Autonomy
Rationale: Autonomy recognizes the patient’s right to make informed decisions
about their own healthcare, including accepting or refusing treatment.
3. A nurse discovers that a colleague documented administration of a
medication that was never given. What should the nurse do first?
A. Ignore the error if the patient is stable
B. Alter the colleague’s documentation
C. Report the discrepancy through the appropriate chain of command
D. Discuss the issue with other nurses before reporting it
Answer: C. Report the discrepancy through the appropriate chain of command
Rationale: Falsification of clinical documentation is a serious professional
concern. The nurse should protect the patient and follow organizational
reporting procedures without altering another clinician’s record.
4. A nurse is asked to perform a procedure for which the nurse has never
been trained or validated as competent. What is the best response?
A. Perform the procedure while asking another nurse for assistance
B. Refuse the assignment and immediately leave the unit
C. Explain the competency limitation and request appropriate assistance or
reassignment
D. Perform the procedure if the physician is present
,Answer: C. Explain the competency limitation and request appropriate
assistance or reassignment
Rationale: Nurses have a professional obligation to practice within their
education, training, competence, and scope of practice. Accepting an
assignment beyond competency can place the patient at risk.
5. A nurse receives a verbal prescription that appears inconsistent with the
patient’s condition. What is the nurse’s priority?
A. Carry out the order because the provider prescribed it
B. Clarify the order with the prescribing provider
C. Ask another nurse to administer it
D. Document the concern after administering the medication
Answer: B. Clarify the order with the prescribing provider
Rationale: Nurses have an independent professional responsibility to question
prescriptions that appear unsafe, incomplete, or inconsistent with the patient’s
clinical condition.
6. Which situation best illustrates the ethical principle of justice?
A. Providing pain medication to a patient in severe pain
B. Allowing a patient to refuse surgery
C. Distributing limited critical-care resources according to clinically relevant
criteria
D. Maintaining confidentiality of patient information
Answer: C. Distributing limited critical-care resources according to clinically
relevant criteria
Rationale: Justice concerns fairness and equitable distribution of benefits,
burdens, resources, and opportunities.
7. A nurse accidentally administers a medication to the wrong patient but
recognizes the error immediately. What is the most ethical response?
, A. Document only if symptoms develop
B. Notify the appropriate provider and follow the organization’s disclosure and
safety procedures
C. Ask the patient not to mention the error
D. Correct the medication administration record without reporting the incident
Answer: B. Notify the appropriate provider and follow the organization’s
disclosure and safety procedures
Rationale: Patient safety requires prompt assessment, disclosure through
appropriate channels, documentation, and implementation of measures to
reduce harm. Concealing an error is unethical and potentially unlawful.
8. A patient asks a nurse to keep a serious diagnosis secret from the patient’s
adult children. What should the nurse do?
A. Tell the children because they are family
B. Respect the patient’s confidentiality unless disclosure is otherwise legally
required
C. Ask the children whether they want to know
D. Place the diagnosis in the family waiting-room record
Answer: B. Respect the patient’s confidentiality unless disclosure is otherwise
legally required
Rationale: Patient information is confidential. Family members do not
automatically have a right to protected health information simply because they
are relatives.
9. Which action most clearly violates professional boundaries?
A. Providing therapeutic communication
B. Accepting a small institutional holiday gift available to all patients
C. Developing a personal financial relationship with a current patient
D. Explaining a treatment procedure
Answer: C. Developing a personal financial relationship with a current patient
