1
Comprehensive Nursing Practice & Leadership: Ethics, Delegation & Evidence-Based Care
Study Guide & Practice Questions 2026–2027
Study Guide Note: This practice exam is aligned with the 2026 NCLEX-RN Test Plan (effective
April 1, 2026 through March 31, 2029) and covers high-yield content in ethics, delegation,
leadership, and evidence-based practice. Each question includes the correct answer with a
detailed rationale grounded in current nursing standards and the NCSBN Clinical Judgment
Measurement Model .
Section 1: Nursing Ethics & Ethical Decision-Making (Questions 1–20)
1. A patient with decision-making capacity refuses a life-saving blood transfusion due to
religious beliefs. The nurse respects this decision. Which ethical principle is being upheld?
A. Beneficence
B. Autonomy
C. Justice
D. Nonmaleficence
add Autonomy refers to the patient's right to self-determination and to make informed
decisions about their own care. Respecting a competent patient's right to refuse treatment,
even if it is life-saving, is a cornerstone of the principle of autonomy .
2. A nurse administers a medication that causes severe harm because they failed to check
for allergies. Which core ethical principle has been breached?
A. Veracity
B. Nonmaleficence
C. Autonomy
D. Justice
Answer: B. Nonmaleficence is the ethical obligation to "do no harm." By neglecting to verify
a critical safety step like allergy status, the nurse failed in their duty to avoid causing harm .
3. In a situation where ICU beds are scarce, which ethical principle should primarily guide
the fair allocation of these resources?
A. Autonomy
B. Beneficence
C. Justice
D. Fidelity
Answer: C. Justice in nursing ethics pertains to fairness and equity in the distribution of
resources, risks, and benefits. When allocating scarce resources like ICU beds, decisions
should be made based on fair and objective criteria .
,2
4. Which ethical principle is most directly violated when a nurse fails to obtain informed
consent before performing a non-emergent procedure?
A. Nonmaleficence
B. Autonomy
C. Beneficence
D. Veracity
Answer: B. Autonomy refers to the patient's right to self-determination. Performing a
procedure without the patient's informed consent disregards this fundamental right .
5. A nurse feels intense psychological distress because they know the ethically correct
action for a dying patient but are prevented from acting by a physician's orders. This
experience is best described as:
A. Moral uncertainty
B. Ethical dilemma
C. Moral distress
D. Professional burnout
Answer: C. Moral distress occurs when a healthcare professional knows the morally right
action to take but feels powerless to act due to institutional, hierarchical, or other external
constraints .
6. What is the primary ethical concern when a nurse discusses a patient's case in a public
hospital elevator?
A. Violation of veracity
B. Breach of confidentiality
C. Failure of beneficence
D. Conflict of interest
Answer: B. Discussing identifiable patient information in a public space where others may
overhear is a clear breach of confidentiality, mandated by ethical standards and HIPAA
regulations .
7. Which action by a nurse best exemplifies the principle of fidelity?
A. Reporting a colleague for a medication error
B. Keeping a promise to sit with a frightened patient
C. Advocating for a patient's request to see a specialist
D. Documenting a patient's refusal of treatment accurately
Answer: B. Fidelity is the ethical principle of faithfulness and keeping promises. Keeping a
promise to sit with a frightened patient demonstrates fidelity .
, 3
8. A patient tells the nurse, "I don't want any more chemotherapy. I want to go home on
hospice." The family insists on continuing treatment. The nurse should:
A. Follow the family's wishes to avoid conflict
B. Respect the patient's autonomous decision and notify the provider
C. Delay action until the ethics committee meets
D. Ask the family to convince the patient to continue
Answer: B. Competent adult patients have the right to refuse treatment. Autonomy
overrides family wishes. The nurse advocates for the patient's decision and notifies the
provider .
9. A patient who is intubated and cannot state their wishes regarding comfort care is
represented by their daughter, who indicates the patient would not want aggressive
treatment. This decision-making process is called:
A. Substituted judgment
B. Distributive justice
C. Ethical parity
D. Nonmaleficence
Answer: A. Substituted judgment involves using a family member who is more likely to
understand the patient's desires to make decisions on their behalf when the patient cannot
speak for themselves .
10. A 67-year-old man with potentially resectable colon cancer declines operative therapy
and chemotherapy after a lengthy discussion. Which principle is being utilized in his
decision?
A. Beneficence
B. Autonomy
C. Justice
D. Paternalism
Answer: B. Autonomy preserves a patient's ability to engage in self-determination regarding
goals of therapy. If the physician believes the patient has appropriate decisional capacity,
respecting their informed decision to decline therapy is appropriate .
11. Which provision of the ANA Code of Ethics addresses a nurse's duty to self, including
the responsibility to preserve integrity and promote safety?
A. Provision 1
B. Provision 3
C. Provision 5
D. Provision 9
Comprehensive Nursing Practice & Leadership: Ethics, Delegation & Evidence-Based Care
Study Guide & Practice Questions 2026–2027
Study Guide Note: This practice exam is aligned with the 2026 NCLEX-RN Test Plan (effective
April 1, 2026 through March 31, 2029) and covers high-yield content in ethics, delegation,
leadership, and evidence-based practice. Each question includes the correct answer with a
detailed rationale grounded in current nursing standards and the NCSBN Clinical Judgment
Measurement Model .
Section 1: Nursing Ethics & Ethical Decision-Making (Questions 1–20)
1. A patient with decision-making capacity refuses a life-saving blood transfusion due to
religious beliefs. The nurse respects this decision. Which ethical principle is being upheld?
A. Beneficence
B. Autonomy
C. Justice
D. Nonmaleficence
add Autonomy refers to the patient's right to self-determination and to make informed
decisions about their own care. Respecting a competent patient's right to refuse treatment,
even if it is life-saving, is a cornerstone of the principle of autonomy .
2. A nurse administers a medication that causes severe harm because they failed to check
for allergies. Which core ethical principle has been breached?
A. Veracity
B. Nonmaleficence
C. Autonomy
D. Justice
Answer: B. Nonmaleficence is the ethical obligation to "do no harm." By neglecting to verify
a critical safety step like allergy status, the nurse failed in their duty to avoid causing harm .
3. In a situation where ICU beds are scarce, which ethical principle should primarily guide
the fair allocation of these resources?
A. Autonomy
B. Beneficence
C. Justice
D. Fidelity
Answer: C. Justice in nursing ethics pertains to fairness and equity in the distribution of
resources, risks, and benefits. When allocating scarce resources like ICU beds, decisions
should be made based on fair and objective criteria .
,2
4. Which ethical principle is most directly violated when a nurse fails to obtain informed
consent before performing a non-emergent procedure?
A. Nonmaleficence
B. Autonomy
C. Beneficence
D. Veracity
Answer: B. Autonomy refers to the patient's right to self-determination. Performing a
procedure without the patient's informed consent disregards this fundamental right .
5. A nurse feels intense psychological distress because they know the ethically correct
action for a dying patient but are prevented from acting by a physician's orders. This
experience is best described as:
A. Moral uncertainty
B. Ethical dilemma
C. Moral distress
D. Professional burnout
Answer: C. Moral distress occurs when a healthcare professional knows the morally right
action to take but feels powerless to act due to institutional, hierarchical, or other external
constraints .
6. What is the primary ethical concern when a nurse discusses a patient's case in a public
hospital elevator?
A. Violation of veracity
B. Breach of confidentiality
C. Failure of beneficence
D. Conflict of interest
Answer: B. Discussing identifiable patient information in a public space where others may
overhear is a clear breach of confidentiality, mandated by ethical standards and HIPAA
regulations .
7. Which action by a nurse best exemplifies the principle of fidelity?
A. Reporting a colleague for a medication error
B. Keeping a promise to sit with a frightened patient
C. Advocating for a patient's request to see a specialist
D. Documenting a patient's refusal of treatment accurately
Answer: B. Fidelity is the ethical principle of faithfulness and keeping promises. Keeping a
promise to sit with a frightened patient demonstrates fidelity .
, 3
8. A patient tells the nurse, "I don't want any more chemotherapy. I want to go home on
hospice." The family insists on continuing treatment. The nurse should:
A. Follow the family's wishes to avoid conflict
B. Respect the patient's autonomous decision and notify the provider
C. Delay action until the ethics committee meets
D. Ask the family to convince the patient to continue
Answer: B. Competent adult patients have the right to refuse treatment. Autonomy
overrides family wishes. The nurse advocates for the patient's decision and notifies the
provider .
9. A patient who is intubated and cannot state their wishes regarding comfort care is
represented by their daughter, who indicates the patient would not want aggressive
treatment. This decision-making process is called:
A. Substituted judgment
B. Distributive justice
C. Ethical parity
D. Nonmaleficence
Answer: A. Substituted judgment involves using a family member who is more likely to
understand the patient's desires to make decisions on their behalf when the patient cannot
speak for themselves .
10. A 67-year-old man with potentially resectable colon cancer declines operative therapy
and chemotherapy after a lengthy discussion. Which principle is being utilized in his
decision?
A. Beneficence
B. Autonomy
C. Justice
D. Paternalism
Answer: B. Autonomy preserves a patient's ability to engage in self-determination regarding
goals of therapy. If the physician believes the patient has appropriate decisional capacity,
respecting their informed decision to decline therapy is appropriate .
11. Which provision of the ANA Code of Ethics addresses a nurse's duty to self, including
the responsibility to preserve integrity and promote safety?
A. Provision 1
B. Provision 3
C. Provision 5
D. Provision 9
