WGU D439 Foundations of Nursing | Objective Assessment
Practice Questions with Verified Answers (2026/2027
Edition)
SECTION 1: Professionalism, Ethics, and Legal Foundations
1. Which nursing leader is credited with establishing the first nursing philosophy based
on health maintenance and restoration, and is widely recognized as the founder of
modern nursing?
A. Clara Barton
B. Dorothea Dix
C. Florence Nightingale
D. Lillian Wald
Correct Answer: C. Florence Nightingale
Rationale: Florence Nightingale (1820–1910) established the first nursing philosophy
emphasizing environmental influences on health, founded the first secular nursing
school, and is universally recognized as the founder of modern nursing. Clara Barton
founded the American Red Cross; Dorothea Dix was a mental health reform advocate;
Lillian Wald established public health nursing and the Henry Street Settlement.
2. A nurse is caring for a patient who refuses a blood transfusion based on religious
beliefs. The patient's condition is critical, and the family demands the transfusion be
administered. What is the nurse's most appropriate action?
,A. Administer the transfusion because the family has the legal authority to override the
patient's decision
B. Honor the patient's refusal and notify the healthcare provider to discuss alternative
treatment options
C. Obtain a court order to administer the transfusion against the patient's wishes
D. Ask the hospital chaplain to convince the patient to accept the transfusion
Correct Answer: B. Honor the patient's refusal and notify the healthcare provider to
discuss alternative treatment options
Rationale: The ANA Code of Ethics upholds patient autonomy and the right to
self-determination. A competent adult has the legal right to refuse treatment, even if the
decision may result in death. The nurse must respect this refusal, document it, and
collaborate with the healthcare provider to explore alternatives. Family members cannot
override a competent patient's decision, and court orders are only sought in specific
circumstances (e.g., minors, incompetent patients).
3. Under HIPAA regulations, when may a nurse legally disclose a patient's protected
health information (PHI) without the patient's written authorization?
A. When the patient's family calls to check on the patient's condition
B. When discussing the case with nursing colleagues in the hospital cafeteria
C. When reporting a suspected case of child abuse to the appropriate state authorities
D. When a law enforcement officer requests information about a minor traffic violation
,Correct Answer: C. When reporting a suspected case of child abuse to the appropriate
state authorities
Rationale: HIPAA permits disclosure without patient authorization for mandatory
reporting of abuse, neglect, or domestic violence as required by state law. Disclosing
PHI to family without patient consent violates privacy rules unless the patient has
authorized it. Discussing patients in public areas violates the minimum necessary
standard, and law enforcement requests require specific legal documentation or
imminent threat circumstances.
4. A nurse witnesses a colleague administering a medication via the wrong route. The
colleague asks the nurse not to report it because the patient appears fine. What is the
nurse's ethical obligation?
A. Respect the colleague's request to maintain team cohesion
B. Report the medication error through the appropriate institutional channels
C. Confront the colleague and demand they self-report, but take no further action if they
refuse
D. Document the error in the patient's medical record but do not notify the charge nurse
Correct Answer: B. Report the medication error through the appropriate institutional
channels
Rationale: The ANA Code of Ethics requires nurses to promote patient safety by
reporting errors, near-misses, and unsafe practices. Failing to report violates the ethical
principles of nonmaleficence (do no harm) and fidelity. Even if the patient appears fine,
medication errors must be reported to enable monitoring, prevent recurrence, and fulfill
institutional quality improvement processes.
, 5. Which element is NOT required for a valid informed consent?
A. Disclosure of the nature and purpose of the procedure
B. Explanation of risks, benefits, and alternatives
C. A guarantee of successful outcome from the healthcare provider
D. The patient's voluntary agreement without coercion
Correct Answer: C. A guarantee of successful outcome from the healthcare provider
Rationale: Informed consent requires disclosure, comprehension, voluntariness, and
competence. Healthcare providers must explain the procedure, risks, benefits, and
alternatives, but they cannot guarantee outcomes. Such a guarantee would be
unrealistic and potentially fraudulent. The patient must voluntarily agree after
understanding the information provided.
6. A nurse is reviewing a patient's advance directive, which states the patient does not
want mechanical ventilation. The patient is now unconscious and in respiratory failure.
The patient's adult child demands that the healthcare provider intubate the patient
immediately. What is the nurse's most appropriate action?
A. Support the adult child's decision because family members have the right to override
advance directives
B. Notify the healthcare provider of the advance directive and facilitate a family
conference to review the patient's documented wishes
C. Refuse to participate in care and request to be reassigned
Practice Questions with Verified Answers (2026/2027
Edition)
SECTION 1: Professionalism, Ethics, and Legal Foundations
1. Which nursing leader is credited with establishing the first nursing philosophy based
on health maintenance and restoration, and is widely recognized as the founder of
modern nursing?
A. Clara Barton
B. Dorothea Dix
C. Florence Nightingale
D. Lillian Wald
Correct Answer: C. Florence Nightingale
Rationale: Florence Nightingale (1820–1910) established the first nursing philosophy
emphasizing environmental influences on health, founded the first secular nursing
school, and is universally recognized as the founder of modern nursing. Clara Barton
founded the American Red Cross; Dorothea Dix was a mental health reform advocate;
Lillian Wald established public health nursing and the Henry Street Settlement.
2. A nurse is caring for a patient who refuses a blood transfusion based on religious
beliefs. The patient's condition is critical, and the family demands the transfusion be
administered. What is the nurse's most appropriate action?
,A. Administer the transfusion because the family has the legal authority to override the
patient's decision
B. Honor the patient's refusal and notify the healthcare provider to discuss alternative
treatment options
C. Obtain a court order to administer the transfusion against the patient's wishes
D. Ask the hospital chaplain to convince the patient to accept the transfusion
Correct Answer: B. Honor the patient's refusal and notify the healthcare provider to
discuss alternative treatment options
Rationale: The ANA Code of Ethics upholds patient autonomy and the right to
self-determination. A competent adult has the legal right to refuse treatment, even if the
decision may result in death. The nurse must respect this refusal, document it, and
collaborate with the healthcare provider to explore alternatives. Family members cannot
override a competent patient's decision, and court orders are only sought in specific
circumstances (e.g., minors, incompetent patients).
3. Under HIPAA regulations, when may a nurse legally disclose a patient's protected
health information (PHI) without the patient's written authorization?
A. When the patient's family calls to check on the patient's condition
B. When discussing the case with nursing colleagues in the hospital cafeteria
C. When reporting a suspected case of child abuse to the appropriate state authorities
D. When a law enforcement officer requests information about a minor traffic violation
,Correct Answer: C. When reporting a suspected case of child abuse to the appropriate
state authorities
Rationale: HIPAA permits disclosure without patient authorization for mandatory
reporting of abuse, neglect, or domestic violence as required by state law. Disclosing
PHI to family without patient consent violates privacy rules unless the patient has
authorized it. Discussing patients in public areas violates the minimum necessary
standard, and law enforcement requests require specific legal documentation or
imminent threat circumstances.
4. A nurse witnesses a colleague administering a medication via the wrong route. The
colleague asks the nurse not to report it because the patient appears fine. What is the
nurse's ethical obligation?
A. Respect the colleague's request to maintain team cohesion
B. Report the medication error through the appropriate institutional channels
C. Confront the colleague and demand they self-report, but take no further action if they
refuse
D. Document the error in the patient's medical record but do not notify the charge nurse
Correct Answer: B. Report the medication error through the appropriate institutional
channels
Rationale: The ANA Code of Ethics requires nurses to promote patient safety by
reporting errors, near-misses, and unsafe practices. Failing to report violates the ethical
principles of nonmaleficence (do no harm) and fidelity. Even if the patient appears fine,
medication errors must be reported to enable monitoring, prevent recurrence, and fulfill
institutional quality improvement processes.
, 5. Which element is NOT required for a valid informed consent?
A. Disclosure of the nature and purpose of the procedure
B. Explanation of risks, benefits, and alternatives
C. A guarantee of successful outcome from the healthcare provider
D. The patient's voluntary agreement without coercion
Correct Answer: C. A guarantee of successful outcome from the healthcare provider
Rationale: Informed consent requires disclosure, comprehension, voluntariness, and
competence. Healthcare providers must explain the procedure, risks, benefits, and
alternatives, but they cannot guarantee outcomes. Such a guarantee would be
unrealistic and potentially fraudulent. The patient must voluntarily agree after
understanding the information provided.
6. A nurse is reviewing a patient's advance directive, which states the patient does not
want mechanical ventilation. The patient is now unconscious and in respiratory failure.
The patient's adult child demands that the healthcare provider intubate the patient
immediately. What is the nurse's most appropriate action?
A. Support the adult child's decision because family members have the right to override
advance directives
B. Notify the healthcare provider of the advance directive and facilitate a family
conference to review the patient's documented wishes
C. Refuse to participate in care and request to be reassigned
