Ethics & Advocacy - 2026 Professional Nursing Standards

1. A client diagnosed with advanced stage lung cancer decides to refuse further chemotherapy treatments, preferring to focus on palliative comfort care. The client's family strongly objects and demands that the oncology team continue treatment. Which ethical principle is the nurse primarily protecting when supporting the client's decision? A. Beneficence B. Autonomy C. Non-maleficence D. Justice Correct Answer: B. Autonomy Rationale: Autonomy represents the client's right to self-determination and to make decisions about their own medical treatment, free from coercion. When a cognitively competent client decides to refuse chemotherapy, the nurse must respect and protect this choice, even if the family disagrees. Beneficence (acting to benefit the client) and non-maleficence (avoiding harm) are important, but the right of a competent individual to choose or refuse care is rooted in autonomy. 2. An elderly client who is unable to communicate due to a severe stroke is grimacing and groaning during repositioning. The nurse administers the ordered PRN intravenous pain medication. Which ethical principle is the nurse demonstrating? A. Autonomy B. Beneficence C. Veracity D. Fidelity Correct Answer: B. Beneficence Rationale: Beneficence is the ethical duty to do good, promote the well-being of others, and actively prevent or alleviate suffering. By recognizing signs of pain in a non-verbal client and administering pain medication to relieve that suffering, the nurse is acting in the client's best interest and demonstrating beneficence. 3. A nurse is reviewing a client's morning medications and notes that a newly ordered drug has a major interaction with the client's existing cardiac medication. The nurse holds the new drug and contacts the prescribing physician. Which ethical principle is the nurse prioritizing? A. Non-maleficence B. Fidelity C. Justice D. Autonomy Correct Answer: A. Non-maleficence Rationale: Non-maleficence is the foundational duty to "do no harm." By identifying a potentially dangerous drug- drug interaction, withholding the medication, and clarifying the order with the physician, the nurse actively prevents harm to the client. While fidelity involves duty to the client, the specific avoidance of clinical harm is the core of non-maleficence. 4. During a localized disaster, a triage nurse must allocate scarce emergency resources and beds based on objective clinical acuity scores rather than a client's social status, age, or ability to pay. Which ethical principle is the nurse applying? A. Beneficence B. Fidelity C. Justice D. Veracity Correct Answer: C. Justice Rationale: Justice in healthcare refers to fairness, equity, and the impartial distribution of resources. Allocating scarce beds and care based on objective, standardized clinical triage guidelines ensures that all clients are treated fairly and without bias, fulfilling the requirements of distributive justice. 5. A nurse tells a post-operative client, "I will return with your pain medication in 15 minutes. " The nurse is delayed by an emergency but ensures another nurse delivers the medication on time, and later checks in on the client. Which ethical principle did the nurse maintain? A. Veracity B. Fidelity C. Autonomy D. Beneficence Correct Answer: B. Fidelity Rationale: Fidelity refers to keeping promises, maintaining loyalty, and fulfilling professional commitments. By promising to return within a specific time and ensuring the promise is kept (even by delegating when a conflict arose), the nurse maintains the trust essential to the nurse-client relationship. Veracity is truthfulness, but keeping a commitment is specifically fidelity. 6. A client's family requests that the nurse withhold a diagnosis of terminal pancreatic cancer from the client, arguing that the news will cause the client to lose hope. The client asks the nurse directly, "Do I have cancer? Please tell me the truth. " Which ethical principle obligates the nurse to answer honestly? A. Beneficence B. Non-maleficence C. Veracity D. Fidelity Correct Answer: C. Veracity Rationale: Veracity is the obligation to tell the truth and avoid deception. A competent client has the right to honest information about their health status. The nurse must answer the client honestly, while providing supportive care, rather than participating in a conspiracy of silence requested by the family. 7. A client who is a Jehovah's Witness is admitted with severe gastrointestinal bleeding and a hemoglobin level of 5.2 g/dL. The physician orders a life-saving blood transfusion, but the client refuses, citing religious beliefs. The nurse supports the client's decision. This scenario represents a conflict between which two ethical principles? A. Justice and Fidelity B. Autonomy and Beneficence C. Veracity and Non-maleficence D. Autonomy and Veracity Correct Answer: B. Autonomy and Beneficence Rationale: This scenario highlights a classic conflict between autonomy (the client's right to refuse treatment based on personal beliefs) and beneficence (the medical goal to perform a life-saving transfusion to do good). Respect for autonomy takes priority when a competent adult makes an informed refusal. 8. A nurse decides to withhold information about a minor, non-critical lab variation from a highly anxious client, stating, "I did this for the client's own good to prevent unnecessary panic. " Which behavior is the nurse demonstrating? A. Beneficence B. Paternalism C. Veracity D. Advocacy Correct Answer: B. Paternalism Rationale: Paternalism occurs when a healthcare professional makes decisions for a client without their consent, under the assumption that they know what is best for the client. This restricts the client's autonomy and violates the principle of truth-telling (veracity). While the nurse's intent may be well-meaning (preventing anxiety), the act itself is paternalistic. 9. A nurse is assigned to care for an incarcerated client who is handcuffed to the bed under police guard. The nurse provides the same high-quality, compassionate, and attentive care to this client as she does to all others on the unit. Which ethical principle is the nurse upholding? A. Autonomy B. Justice C. Fidelity D. Paternalism Correct Answer: B. Justice Rationale: The ethical principle of justice demands that all individuals receive fair, equitable, and unbiased treatment, regardless of their social status, background, or legal standing. Providing equal care to an incarcerated individual reflects clinical justice. 10. A physician orders a medication dosage that is three times the normal recommended limit. The nurse recognizes the potential danger, refuses to administer the dose, and contacts the physician to change the order. Which ethical principle is the nurse primarily enacting? A. Non-maleficence B. Veracity C. Justice D. Autonomy Correct Answer: A. Non-maleficence Rationale: The primary duty of the nurse when identifying an unsafe medication dosage is to prevent injury or death, which directly aligns with non-maleficence (avoiding harm). Giving a known toxic or excessive dose would violate this core duty. 11. A nurse is caring for a famous local politician. A colleague who is not involved in the client's care asks the nurse for details about the politician's diagnosis. The nurse refuses to share any details, citing confidentiality. Which ethical principle is the nurse demonstrating? A. Justice B. Fidelity C. Autonomy D. Veracity Correct Answer: B. Fidelity Rationale: Fidelity involves honoring commitments and professional obligations, which includes safeguarding client privacy and maintaining strict confidentiality of medical records as promised by professional codes of conduct. Sharing this information would violate trust and fidelity. 12. A 15-year-old client with leukemia agrees to participate in a clinical trial after the nurse explains the study in age-appropriate terms. While the parents provide the legal consent, the nurse ensures the adolescent provides written agreement as well. What is the adolescent's agreement called? A. Informed Consent B. Assent C. Advocacy D. Paternalism Correct Answer: B. Assent Rationale: Assent is the voluntary agreement to participate in treatment or research by a minor or an individual who is not legally competent to give consent, but is old enough to understand the situation. Obtaining assent respects the client's emerging autonomy, while legal consent must still be obtained from parents or guardians. 13. The nurse accidentally administers a medication to the wrong client. Upon realizing the error, the nurse immediately assesses the client, notifies the charge nurse and provider, and completes an incident report. Which ethical principle is demonstrated by the nurse's honesty? A. Beneficence B. Justice C. Veracity D. Paternalism Correct Answer: C. Veracity Rationale: Veracity is the moral duty to tell the truth. Admitting a medication error immediately to the client and clinical team, rather than concealing it, is a direct application of veracity, ensuring transparency and facilitating immediate corrective care. 14. A client post-appendectomy is receiving a low dose of pain medication that is failing to relieve their pain, leaving them unable to deep breathe or ambulate. The nurse contacts the physician, presents the client's clinical findings, and requests an adjusted pain management plan. Which ethical duty is the nurse fulfilling? A. Beneficence B. Paternalism C. Justice D. Autonomy Correct Answer: A. Beneficence Rationale: Beneficence involves taking positive action to help others and alleviate their distress. Advocating for effective pain management to allow the client to recover and avoid complications (like pneumonia) is a key expression of beneficence. 15. A nurse is managing a heavy workload on a medical-surgical floor. Instead of prioritizing care based on which clients are friendly or have high social influence, the nurse organizes care according to the clients' urgent physiological needs. This behavior aligns with which ethical principle? A. Veracity B. Justice C. Autonomy D. Paternalism Correct Answer: B. Justice Rationale: Justice requires that resources, time, and attention are distributed fairly based on objective need, ensuring that all clients receive equitable care regardless of personal preferences or socio-economic background. 16. The nurse is facing an ethical dilemma involving a family who wants to withdraw life support from a client who has no advance directives, while the medical team believes recovery is possible. What is the nurse's first step in resolving this ethical dilemma? A. Contact the hospital ethics committee for a final decision. B. Gather all relevant clinical, social, and legal facts surrounding the situation. C. Advise the family to consult an attorney. D. Support the medical team's plan and ignore the family's wishes. Correct Answer: B. Gather all relevant clinical, social, and legal facts surrounding the situation. Rationale: The first step in any ethical decision-making process is to collect all relevant data and clarify the facts of the case (who is involved, the client's medical prognosis, family dynamics, legal surrogacy). Calling the committee (A) or taking sides (D) occurs after the problem is fully assessed and defined. 17. A competent client with chronic obstructive pulmonary disease (COPD) decides to leave the hospital against medical advice (AMA) because they want to attend their grandson's wedding. The nurse explains the risks of leaving without completing treatment, but the client insists. What should the nurse do next to respect the client's autonomy? A. Lock the client's room door to prevent departure. B. Notify security to physically detain the client. C. Have the client sign the Against Medical Advice (AMA) form, remove any IV catheters, and provide discharge education and prescriptions. D. Call the client's family to convince them to stay. Correct Answer: C. Have the client sign the Against Medical Advice (AMA) form, remove any IV catheters, and provide discharge education and prescriptions. Rationale: Respecting autonomy means allowing a competent client to make decisions, even if they conflict with medical recommendations. The nurse must ensure the client understands the risks (discharge education), document their decision (AMA form), remove medical devices (IV lines) to prevent harm, and facilitate safe transition. Detaining the client (A, B) is illegal and constitutes false imprisonment.