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HURST REVIEW NCLEX-RN READINESS
EXAM 1 ## COMPLETE Q&A WITH
RATIONALES (2026 EDITION) ## ALIGNED
WITH 2026-2027 NCLEX-RN TEST PLAN
STANDARDS
itsjereguides
# UNIT 1: MANAGEMENT OF CARE (15-21%)
## 1.1 Legal & Ethical Issues
### Question 1
A newly licensed nurse is caring for a client who refuses a prescribed blood transfusion due to
religious beliefs. The client's family requests that the transfusion be administered without the
client's knowledge. Which action should the nurse take?
A. Administer the transfusion as prescribed, as the family has decision-making authority
B. Contact the healthcare provider to discuss the client's refusal and explore alternative
treatments
C. Explain to the family that the client's wishes must be respected and document the refusal
D. Ask the family to leave the room while the transfusion is administered quietly
**Correct Answer: C**
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**Rationale:** The client has the right to refuse treatment based on informed consent and
autonomy. When a client is alert and oriented, their wishes take precedence over family requests.
The nurse must respect the client's decision, document the refusal, and notify the healthcare
provider. The nurse should also explore alternative treatments if available, but the primary
obligation is to honor the client's autonomous decision.
**Why A is incorrect:** Administering the transfusion without consent constitutes battery and
violates the client's right to self-determination. The family does not have legal authority to
override a competent adult's decision.
**Why B is incorrect:** While notifying the provider is appropriate, the nurse's immediate
priority is to respect and document the client's refusal. The statement implies the nurse should
seek to override the refusal rather than honor it.
**Why D is incorrect:** Administering the transfusion surreptitiously is deceitful, unethical, and
illegal. This action violates the client's autonomy and constitutes fraud.
---
### Question 2
A nurse overhears two colleagues discussing a client's diagnosis in the hospital cafeteria. What is
the nurse's best response?
A. Join the conversation to ensure accuracy of the information
B. Ignore the conversation as it does not involve the nurse's assigned clients
C. Remind the colleagues that client information should not be discussed in public areas
D. Report the colleagues to the nursing supervisor immediately
**Correct Answer: C**
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**Rationale:** The nurse has a duty to protect client confidentiality under HIPAA regulations
and professional ethical standards. Discussing client information in public places where it can be
overheard violates privacy rights. The nurse should first address the colleagues directly and
remind them of their confidentiality obligations.
**Why A is incorrect:** Joining the conversation perpetuates the violation of confidentiality and
does not address the breach appropriately.
**Why B is incorrect:** Ignoring the violation is a passive response that fails to uphold
professional standards and patient rights. All nurses share responsibility for protecting client
confidentiality.
**Why D is incorrect:** Reporting to the supervisor may be necessary if the behavior continues,
but the initial response should be to address the colleagues directly. Immediate reporting without
first addressing the issue may be overly punitive and bypasses professional accountability.
---
### Question 3
A client with end-stage renal disease has a valid advance directive indicating a desire for comfort
measures only. The client's adult child insists that "everything possible" be done. What should
the nurse do?
A. Follow the child's wishes to avoid family conflict
B. Initiate full resuscitation measures as requested by the family
C. Honor the client's advance directive and continue comfort measures
D. Contact the ethics committee for a formal decision
**Correct Answer: C**
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**Rationale:** Advance directives are legal documents that express a client's wishes regarding
medical treatment. When a client has a valid advance directive, healthcare providers must honor
those wishes, even if family members disagree. The nurse should advocate for the client's
autonomy and ensure comfort measures are provided.
**Why A is incorrect:** Following the family's wishes would violate the client's legally
expressed preferences and the principle of autonomy.
**Why B is incorrect:** Initiating resuscitation against the client's documented wishes is
unethical and illegal. The advance directive is legally binding.
**Why D is incorrect:** While the ethics committee can provide guidance in complex situations,
there is no need for formal consultation when a valid advance directive clearly states the client's
wishes.
---
### Question 4
A nurse suspects that a colleague is impaired by alcohol while on duty. What is the nurse's
priority action?
A. Confront the colleague privately about the suspicion
B. Report the concern to the nursing supervisor immediately
C. Monitor the colleague's behavior for additional evidence
D. Ignore the concern to avoid damaging the colleague's career
**Correct Answer: B**
**Rationale:** Client safety is the nurse's primary responsibility. When a nurse suspects
impairment in a colleague, they have a duty to report the concern to the supervisor immediately.
HURST REVIEW NCLEX-RN READINESS
EXAM 1 ## COMPLETE Q&A WITH
RATIONALES (2026 EDITION) ## ALIGNED
WITH 2026-2027 NCLEX-RN TEST PLAN
STANDARDS
itsjereguides
# UNIT 1: MANAGEMENT OF CARE (15-21%)
## 1.1 Legal & Ethical Issues
### Question 1
A newly licensed nurse is caring for a client who refuses a prescribed blood transfusion due to
religious beliefs. The client's family requests that the transfusion be administered without the
client's knowledge. Which action should the nurse take?
A. Administer the transfusion as prescribed, as the family has decision-making authority
B. Contact the healthcare provider to discuss the client's refusal and explore alternative
treatments
C. Explain to the family that the client's wishes must be respected and document the refusal
D. Ask the family to leave the room while the transfusion is administered quietly
**Correct Answer: C**
,2|Page
**Rationale:** The client has the right to refuse treatment based on informed consent and
autonomy. When a client is alert and oriented, their wishes take precedence over family requests.
The nurse must respect the client's decision, document the refusal, and notify the healthcare
provider. The nurse should also explore alternative treatments if available, but the primary
obligation is to honor the client's autonomous decision.
**Why A is incorrect:** Administering the transfusion without consent constitutes battery and
violates the client's right to self-determination. The family does not have legal authority to
override a competent adult's decision.
**Why B is incorrect:** While notifying the provider is appropriate, the nurse's immediate
priority is to respect and document the client's refusal. The statement implies the nurse should
seek to override the refusal rather than honor it.
**Why D is incorrect:** Administering the transfusion surreptitiously is deceitful, unethical, and
illegal. This action violates the client's autonomy and constitutes fraud.
---
### Question 2
A nurse overhears two colleagues discussing a client's diagnosis in the hospital cafeteria. What is
the nurse's best response?
A. Join the conversation to ensure accuracy of the information
B. Ignore the conversation as it does not involve the nurse's assigned clients
C. Remind the colleagues that client information should not be discussed in public areas
D. Report the colleagues to the nursing supervisor immediately
**Correct Answer: C**
,3|Page
**Rationale:** The nurse has a duty to protect client confidentiality under HIPAA regulations
and professional ethical standards. Discussing client information in public places where it can be
overheard violates privacy rights. The nurse should first address the colleagues directly and
remind them of their confidentiality obligations.
**Why A is incorrect:** Joining the conversation perpetuates the violation of confidentiality and
does not address the breach appropriately.
**Why B is incorrect:** Ignoring the violation is a passive response that fails to uphold
professional standards and patient rights. All nurses share responsibility for protecting client
confidentiality.
**Why D is incorrect:** Reporting to the supervisor may be necessary if the behavior continues,
but the initial response should be to address the colleagues directly. Immediate reporting without
first addressing the issue may be overly punitive and bypasses professional accountability.
---
### Question 3
A client with end-stage renal disease has a valid advance directive indicating a desire for comfort
measures only. The client's adult child insists that "everything possible" be done. What should
the nurse do?
A. Follow the child's wishes to avoid family conflict
B. Initiate full resuscitation measures as requested by the family
C. Honor the client's advance directive and continue comfort measures
D. Contact the ethics committee for a formal decision
**Correct Answer: C**
, 4|Page
**Rationale:** Advance directives are legal documents that express a client's wishes regarding
medical treatment. When a client has a valid advance directive, healthcare providers must honor
those wishes, even if family members disagree. The nurse should advocate for the client's
autonomy and ensure comfort measures are provided.
**Why A is incorrect:** Following the family's wishes would violate the client's legally
expressed preferences and the principle of autonomy.
**Why B is incorrect:** Initiating resuscitation against the client's documented wishes is
unethical and illegal. The advance directive is legally binding.
**Why D is incorrect:** While the ethics committee can provide guidance in complex situations,
there is no need for formal consultation when a valid advance directive clearly states the client's
wishes.
---
### Question 4
A nurse suspects that a colleague is impaired by alcohol while on duty. What is the nurse's
priority action?
A. Confront the colleague privately about the suspicion
B. Report the concern to the nursing supervisor immediately
C. Monitor the colleague's behavior for additional evidence
D. Ignore the concern to avoid damaging the colleague's career
**Correct Answer: B**
**Rationale:** Client safety is the nurse's primary responsibility. When a nurse suspects
impairment in a colleague, they have a duty to report the concern to the supervisor immediately.
