Nursing Ethics CE Exam | Nursing Ethics Continuing
Education Study Guide & Exam Prep 2026/2027 |
Professional Nursing Ethics Review, Autonomy,
Beneficence, Nonmaleficence, Justice, Patient Rights &
Advocacy, Informed Consent, Confidentiality & HIPAA,
Ethical Decision-Making, Professional Boundaries, End-of-
Life Care, Cultural Competence, Legal Responsibilities,
Moral Dilemmas, Clinical Scenarios, Practice Questions,
Answers & Detailed Rationales
Question 1: A 72-year-old patient with terminal cancer and a Do Not
Resuscitate (DNR) order experiences sudden respiratory distress and becomes
unconscious. The patient's family, who are present, frantically demand that
you "do everything" to save the patient. What is the nurse's most appropriate
initial action?
A. Immediately initiate CPR and call a code blue, as the family has overruled the DNR.
B. Inform the family that the DNR order is a legal document and CPR cannot be
performed, while calmly explaining the patient's wishes.
C. Page the attending physician to come and speak with the family while you prepare
the crash cart.
D. Ask the family to leave the room so you can perform necessary life-saving
interventions without their interference.
CORRECT ANSWER: B. Inform the family that the DNR order is a legal
document and CPR cannot be performed, while calmly explaining the patient's
wishes.
Rationale: A valid DNR order is a legally binding physician's order that must be
followed. The nurse's primary responsibility is to advocate for the patient's autonomy
and previously expressed wishes. The nurse should provide compassionate, clear
communication to the family about the nature of the DNR and the patient's right to a
dignified, natural death.
Question 2: A nurse is caring for a patient who is a Jehovah's Witness and is
refusing a life-saving blood transfusion. The patient is unconscious, and no
advance directive exists. The patient's spouse requests the transfusion. What
principle should guide the nurse's action?
A. Beneficence, by overriding the patient's presumed wishes to preserve life.
B. Autonomy, by respecting the patient's religious beliefs, which are considered an
extension of their personhood.
C. Justice, by providing the same standard of care that any other unconscious patient
would receive.
D. Nonmaleficence, by doing everything possible to prevent the patient's death.
CORRECT ANSWER: B. Autonomy, by respecting the patient's religious beliefs,
which are considered an extension of their personhood.
,Rationale: The principle of autonomy dictates that a patient's religious and cultural
beliefs must be respected. If a patient has clearly articulated their beliefs as a Jehovah's
Witness, these beliefs must be honored even if the patient is unconscious. The nurse
must advocate for the patient's right to self-determination and explore alternative
treatments, even if this conflicts with the spouse's wishes.
Question 3: A nurse discovers that a colleague has been diverting narcotics by
replacing them with saline and falsifying the medication administration
record. What is the nurse's primary ethical and legal duty?
A. To confront the colleague privately and give them a chance to explain their actions.
B. To ignore the incident to avoid creating a hostile work environment.
C. To report the colleague's actions to the nursing supervisor and follow the facility's
protocol.
D. To anonymously document the findings in the patient's chart to protect oneself.
CORRECT ANSWER: C. To report the colleague's actions to the nursing
supervisor and follow the facility's protocol.
Rationale: The nurse has a professional and legal duty to report any suspected diversion
of controlled substances. This action is mandated by the state nurse practice act and
facility policy to ensure patient safety and uphold professional standards. Reporting to
the supervisor initiates an appropriate investigation and protects patients from potential
harm.
Question 4: A nurse is caring for a patient who has just been diagnosed with a
terminal illness. The patient asks the nurse, "How long do I have to live?"
Which response is the most ethically sound?
A. "Your doctor is the best person to answer that question; I will call them for you."
B. "I can't give you an exact timeline, but I can help you understand the stages of your
illness."
C. "I know this is difficult, but it's important to focus on your treatment plan."
D. "Everyone's journey is different, but you should prepare for the worst case."
CORRECT ANSWER: B. "I can't give you an exact timeline, but I can help you
understand the stages of your illness."
Rationale: This answer demonstrates honesty while maintaining the therapeutic
relationship. It avoids giving false hope or a definitive prognosis, which is beyond the
nurse's scope to provide. The nurse focuses on offering support and information about
the disease process, which respects the patient's right to know while fostering hope and
coping.
Question 5: An elderly patient with mild dementia is admitted for a procedure.
The patient's son presents a Power of Attorney for Healthcare document. The
patient repeatedly refuses to sign the consent form, stating, "I don't want this."
What should the nurse do?
,A. Have the son sign the consent form as the legal decision-maker.
B. Document the patient's refusal and proceed with the procedure as it is medically
necessary.
C. Notify the physician and the ethics committee of the conflict between the patient's
wishes and the surrogate's authority.
D. Explain to the patient that the son has legal authority and that the refusal is not valid.
CORRECT ANSWER: C. Notify the physician and the ethics committee of the
conflict between the patient's wishes and the surrogate's authority.
Rationale: A patient with mild dementia may still have decisional capacity, especially for
a procedure. If the patient expresses a clear refusal, the nurse must advocate for the
patient's autonomy. The situation presents an ethical dilemma requiring a formal review
to determine the patient's capacity and the validity of the surrogate decision-maker's
authority in this specific context.
Question 6: A nurse is assigned to care for a patient who is an inmate. The
correctional officer demands that the nurse reveal the patient's HIV status.
What is the nurse's best response?
A. Share the information with the officer to ensure the safety of the prison staff.
B. Share the information only if the inmate gives verbal permission.
C. Respect patient confidentiality and inform the officer that this information cannot be
disclosed without the patient's consent.
D. Report the request to the hospital security for further handling.
CORRECT ANSWER: C. Respect patient confidentiality and inform the officer
that this information cannot be disclosed without the patient's consent.
Rationale: The nurse-patient relationship is governed by strict confidentiality, protected
by HIPAA. An inmate's health information is protected under the same laws as any other
patient. The nurse's duty is to advocate for the patient's privacy rights. Any exceptions to
confidentiality must be outlined by law, such as in cases of public health threats, which
do not apply here.
Question 7: A patient with a history of substance use disorder is in severe pain
post-operatively and is requesting a specific narcotic. The nurse suspects the
patient is drug-seeking. What is the nurse's most ethical course of action?
A. Refuse to administer the medication and report the patient's behavior to security.
B. Administer a placebo to assess the patient's true level of pain.
C. Perform a comprehensive pain assessment and administer an appropriate analgesic
according to the ordered protocol.
D. Ignore the patient's requests and only administer the medication when vital signs are
elevated.
CORRECT ANSWER: C. Perform a comprehensive pain assessment and
administer an appropriate analgesic according to the ordered protocol.
, Rationale: The principle of beneficence requires the nurse to treat the patient's pain. A
history of substance abuse should not prevent a patient from receiving adequate pain
management. The nurse must assess the patient's pain using a validated tool and
administer prescribed medication. Unmanaged pain is an ethical failure; a prejudgment
of drug-seeking behavior is unethical.
Question 8: A nurse is caring for a patient who is a minor. The patient's
parents refuse a medically necessary blood transfusion due to religious beliefs.
The physician has obtained a court order for the transfusion. What is the
nurse's role?
A. To delay the transfusion while attempting to educate the parents further.
B. To respect the parents' religious beliefs and refuse to participate in the transfusion.
C. To prepare the patient for the transfusion as ordered, as the court has intervened to
protect the child's welfare.
D. To call a meeting with the parents and the hospital administration to find a
compromise.
CORRECT ANSWER: C. To prepare the patient for the transfusion as ordered,
as the court has intervened to protect the child's welfare.
Rationale: In cases where a minor's life is at immediate risk and the parents' religious
beliefs conflict with necessary treatment, the state has the authority to intervene via the
courts to protect the child's welfare (the principle of "parens patriae"). The nurse must
comply with the court order and prepare the patient for the transfusion.
Question 9: A nurse is asked to participate in a research study involving
vulnerable patients. Which of the following is a critical component of ethical
research that the nurse must ensure is in place?
A. That the research will provide financial compensation to the participants.
B. That the research protocol has been approved by the Institutional Review Board
(IRB).
C. That the principal investigator has full authority over patient care decisions.
D. That the study will be published in a prominent medical journal.
CORRECT ANSWER: B. That the research protocol has been approved by the
Institutional Review Board (IRB).
Rationale: IRB approval is a fundamental ethical requirement for any research involving
human subjects. The IRB ensures that the study protects the rights and welfare of
participants, that risks are minimized, and that informed consent is appropriately
obtained. The nurse's role in research includes advocating for patient safety and ethical
conduct.
Question 10: A patient confides in a nurse that they plan to commit suicide by
overdosing on their insulin when they get home. What is the nurse's primary
responsibility?
Education Study Guide & Exam Prep 2026/2027 |
Professional Nursing Ethics Review, Autonomy,
Beneficence, Nonmaleficence, Justice, Patient Rights &
Advocacy, Informed Consent, Confidentiality & HIPAA,
Ethical Decision-Making, Professional Boundaries, End-of-
Life Care, Cultural Competence, Legal Responsibilities,
Moral Dilemmas, Clinical Scenarios, Practice Questions,
Answers & Detailed Rationales
Question 1: A 72-year-old patient with terminal cancer and a Do Not
Resuscitate (DNR) order experiences sudden respiratory distress and becomes
unconscious. The patient's family, who are present, frantically demand that
you "do everything" to save the patient. What is the nurse's most appropriate
initial action?
A. Immediately initiate CPR and call a code blue, as the family has overruled the DNR.
B. Inform the family that the DNR order is a legal document and CPR cannot be
performed, while calmly explaining the patient's wishes.
C. Page the attending physician to come and speak with the family while you prepare
the crash cart.
D. Ask the family to leave the room so you can perform necessary life-saving
interventions without their interference.
CORRECT ANSWER: B. Inform the family that the DNR order is a legal
document and CPR cannot be performed, while calmly explaining the patient's
wishes.
Rationale: A valid DNR order is a legally binding physician's order that must be
followed. The nurse's primary responsibility is to advocate for the patient's autonomy
and previously expressed wishes. The nurse should provide compassionate, clear
communication to the family about the nature of the DNR and the patient's right to a
dignified, natural death.
Question 2: A nurse is caring for a patient who is a Jehovah's Witness and is
refusing a life-saving blood transfusion. The patient is unconscious, and no
advance directive exists. The patient's spouse requests the transfusion. What
principle should guide the nurse's action?
A. Beneficence, by overriding the patient's presumed wishes to preserve life.
B. Autonomy, by respecting the patient's religious beliefs, which are considered an
extension of their personhood.
C. Justice, by providing the same standard of care that any other unconscious patient
would receive.
D. Nonmaleficence, by doing everything possible to prevent the patient's death.
CORRECT ANSWER: B. Autonomy, by respecting the patient's religious beliefs,
which are considered an extension of their personhood.
,Rationale: The principle of autonomy dictates that a patient's religious and cultural
beliefs must be respected. If a patient has clearly articulated their beliefs as a Jehovah's
Witness, these beliefs must be honored even if the patient is unconscious. The nurse
must advocate for the patient's right to self-determination and explore alternative
treatments, even if this conflicts with the spouse's wishes.
Question 3: A nurse discovers that a colleague has been diverting narcotics by
replacing them with saline and falsifying the medication administration
record. What is the nurse's primary ethical and legal duty?
A. To confront the colleague privately and give them a chance to explain their actions.
B. To ignore the incident to avoid creating a hostile work environment.
C. To report the colleague's actions to the nursing supervisor and follow the facility's
protocol.
D. To anonymously document the findings in the patient's chart to protect oneself.
CORRECT ANSWER: C. To report the colleague's actions to the nursing
supervisor and follow the facility's protocol.
Rationale: The nurse has a professional and legal duty to report any suspected diversion
of controlled substances. This action is mandated by the state nurse practice act and
facility policy to ensure patient safety and uphold professional standards. Reporting to
the supervisor initiates an appropriate investigation and protects patients from potential
harm.
Question 4: A nurse is caring for a patient who has just been diagnosed with a
terminal illness. The patient asks the nurse, "How long do I have to live?"
Which response is the most ethically sound?
A. "Your doctor is the best person to answer that question; I will call them for you."
B. "I can't give you an exact timeline, but I can help you understand the stages of your
illness."
C. "I know this is difficult, but it's important to focus on your treatment plan."
D. "Everyone's journey is different, but you should prepare for the worst case."
CORRECT ANSWER: B. "I can't give you an exact timeline, but I can help you
understand the stages of your illness."
Rationale: This answer demonstrates honesty while maintaining the therapeutic
relationship. It avoids giving false hope or a definitive prognosis, which is beyond the
nurse's scope to provide. The nurse focuses on offering support and information about
the disease process, which respects the patient's right to know while fostering hope and
coping.
Question 5: An elderly patient with mild dementia is admitted for a procedure.
The patient's son presents a Power of Attorney for Healthcare document. The
patient repeatedly refuses to sign the consent form, stating, "I don't want this."
What should the nurse do?
,A. Have the son sign the consent form as the legal decision-maker.
B. Document the patient's refusal and proceed with the procedure as it is medically
necessary.
C. Notify the physician and the ethics committee of the conflict between the patient's
wishes and the surrogate's authority.
D. Explain to the patient that the son has legal authority and that the refusal is not valid.
CORRECT ANSWER: C. Notify the physician and the ethics committee of the
conflict between the patient's wishes and the surrogate's authority.
Rationale: A patient with mild dementia may still have decisional capacity, especially for
a procedure. If the patient expresses a clear refusal, the nurse must advocate for the
patient's autonomy. The situation presents an ethical dilemma requiring a formal review
to determine the patient's capacity and the validity of the surrogate decision-maker's
authority in this specific context.
Question 6: A nurse is assigned to care for a patient who is an inmate. The
correctional officer demands that the nurse reveal the patient's HIV status.
What is the nurse's best response?
A. Share the information with the officer to ensure the safety of the prison staff.
B. Share the information only if the inmate gives verbal permission.
C. Respect patient confidentiality and inform the officer that this information cannot be
disclosed without the patient's consent.
D. Report the request to the hospital security for further handling.
CORRECT ANSWER: C. Respect patient confidentiality and inform the officer
that this information cannot be disclosed without the patient's consent.
Rationale: The nurse-patient relationship is governed by strict confidentiality, protected
by HIPAA. An inmate's health information is protected under the same laws as any other
patient. The nurse's duty is to advocate for the patient's privacy rights. Any exceptions to
confidentiality must be outlined by law, such as in cases of public health threats, which
do not apply here.
Question 7: A patient with a history of substance use disorder is in severe pain
post-operatively and is requesting a specific narcotic. The nurse suspects the
patient is drug-seeking. What is the nurse's most ethical course of action?
A. Refuse to administer the medication and report the patient's behavior to security.
B. Administer a placebo to assess the patient's true level of pain.
C. Perform a comprehensive pain assessment and administer an appropriate analgesic
according to the ordered protocol.
D. Ignore the patient's requests and only administer the medication when vital signs are
elevated.
CORRECT ANSWER: C. Perform a comprehensive pain assessment and
administer an appropriate analgesic according to the ordered protocol.
, Rationale: The principle of beneficence requires the nurse to treat the patient's pain. A
history of substance abuse should not prevent a patient from receiving adequate pain
management. The nurse must assess the patient's pain using a validated tool and
administer prescribed medication. Unmanaged pain is an ethical failure; a prejudgment
of drug-seeking behavior is unethical.
Question 8: A nurse is caring for a patient who is a minor. The patient's
parents refuse a medically necessary blood transfusion due to religious beliefs.
The physician has obtained a court order for the transfusion. What is the
nurse's role?
A. To delay the transfusion while attempting to educate the parents further.
B. To respect the parents' religious beliefs and refuse to participate in the transfusion.
C. To prepare the patient for the transfusion as ordered, as the court has intervened to
protect the child's welfare.
D. To call a meeting with the parents and the hospital administration to find a
compromise.
CORRECT ANSWER: C. To prepare the patient for the transfusion as ordered,
as the court has intervened to protect the child's welfare.
Rationale: In cases where a minor's life is at immediate risk and the parents' religious
beliefs conflict with necessary treatment, the state has the authority to intervene via the
courts to protect the child's welfare (the principle of "parens patriae"). The nurse must
comply with the court order and prepare the patient for the transfusion.
Question 9: A nurse is asked to participate in a research study involving
vulnerable patients. Which of the following is a critical component of ethical
research that the nurse must ensure is in place?
A. That the research will provide financial compensation to the participants.
B. That the research protocol has been approved by the Institutional Review Board
(IRB).
C. That the principal investigator has full authority over patient care decisions.
D. That the study will be published in a prominent medical journal.
CORRECT ANSWER: B. That the research protocol has been approved by the
Institutional Review Board (IRB).
Rationale: IRB approval is a fundamental ethical requirement for any research involving
human subjects. The IRB ensures that the study protects the rights and welfare of
participants, that risks are minimized, and that informed consent is appropriately
obtained. The nurse's role in research includes advocating for patient safety and ethical
conduct.
Question 10: A patient confides in a nurse that they plan to commit suicide by
overdosing on their insulin when they get home. What is the nurse's primary
responsibility?
