On the morning of a planned hysterectomy, a client who signed the consent form yesterday says, 'I'm still not sure whether they're taking my ovaries too.' What should the nurse do first?

Hold the preoperative routine and notify the surgeon

Reassure her that the signed form covers the operation

Explain the extent of the surgery to the client in detail

Ask the charge nurse to witness a new consent form

A client who speaks only Vietnamese needs to give consent for a cardiac catheterization. Who should interpret the provider's explanation?

A qualified medical interpreter

The client's bilingual 14-year-old son

A free translation app on a phone

A bilingual housekeeper on the unit

An alert client admitted with chest pain says he is leaving now against medical advice. What should the nurse do?

Notify the provider and explain the risks of leaving

Remove the IV and let him leave without informing anyone

Ask security to keep the client on the unit until he is seen

Tell him his insurance will refuse to pay if he leaves now

In a systematic approach to an ethical dilemma, the nurse's first step is to:

Gather the relevant facts of the situation

Choose the action that helps the most people

List the options available to the team

Evaluate the outcome of the chosen action

An 82-year-old woman with a gangrenous foot refuses a below-knee amputation. She is oriented to person, place and time and tells the nurse, 'I know I may die without it, but I won't live without my leg.' Her daughter says, 'She's confused; you have to make her have it.' What is the nurse's best action?

Support her decision and report her stated understanding

Ask the daughter to sign consent, since the client is elderly and unwell

Tell the client that she will die without the surgery, so she must have it

Delay any action until a psychiatrist declares the client incompetent

Client rights, consent, advance directives and ethics

58 NCLEX-RN practice questions on Client rights, consent, advance directives and ethics, part of Management of Care. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
On the morning of a planned hysterectomy, a client who signed the consent form yesterday says, 'I'm still not sure whether they're taking my ovaries too.' What should the nurse do first?
1. AReassure her that the signed form covers the operation
2. BExplain the extent of the surgery to the client in detail
3. CHold the preoperative routine and notify the surgeon
4. DAsk the charge nurse to witness a new consent form
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Answer: C · Hold the preoperative routine and notify the surgeon
Informed consent requires that the client understands what will be done, and this client does not know the extent of her surgery. The nurse is an advocate: she stops the process and informs the surgeon, who must explain the procedure again. A signature does not make consent valid if understanding is missing. This item tests analysing cues and taking action.
- A: A signed form is not valid consent when the client does not understand the procedure.
- B: Explaining the operation is the surgeon's duty; the nurse may reinforce but not supply it.
- D: A new form is useless until the surgeon has given the missing information.
Question 2 · Medium
A client who speaks only Vietnamese needs to give consent for a cardiac catheterization. Who should interpret the provider's explanation?
1. AA qualified medical interpreter
2. BThe client's bilingual 14-year-old son
3. CA free translation app on a phone
4. DA bilingual housekeeper on the unit
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Answer: A · A qualified medical interpreter
Clients with limited English proficiency have the right to a qualified medical interpreter, in person, by video or by phone, at no cost. Family members, especially children, and untrained staff may omit or change information and can compromise privacy. The interpreter's name or ID is recorded with the consent. This item tests taking action to protect valid consent.
- B: Children should not interpret; they may filter content and it burdens them.
- C: Consumer apps are not reliable for consent-level medical information.
- D: Untrained staff may not know medical terms and are not accountable for accuracy.
Question 3 · Medium
An alert client admitted with chest pain says he is leaving now against medical advice. What should the nurse do?
1. ARemove the IV and let him leave without informing anyone
2. BAsk security to keep the client on the unit until he is seen
3. CNotify the provider and explain the risks of leaving
4. DTell him his insurance will refuse to pay if he leaves now
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Answer: C · Notify the provider and explain the risks of leaving
A competent adult may leave the hospital, and holding him against his will would be false imprisonment. The nurse informs the provider, makes sure the client hears the risks, asks him to sign the against-medical-advice form, and documents what was explained. If he refuses to sign, that is documented too. This item tests taking action that respects autonomy and safety.
- A: The IV is removed, but the provider must be told and the risks explained first.
- B: Restraining a competent adult who wants to leave is false imprisonment.
- D: This is a common myth and is a form of coercion, not informed choice.
Question 4 · Medium
In a systematic approach to an ethical dilemma, the nurse's first step is to:
1. AChoose the action that helps the most people
2. BList the options available to the team
3. CGather the relevant facts of the situation
4. DEvaluate the outcome of the chosen action
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Answer: C · Gather the relevant facts of the situation
Ethical decision-making follows a process like the nursing process: first gather the facts (medical, client wishes, who is involved), then identify the conflict and values, list options, act, and evaluate. Acting before the facts are clear risks solving the wrong problem. Facts often show that the 'dilemma' is a communication gap. This item tests recognising cues as the first step of clinical judgment.
- A: Choosing an action comes later and is not always about the greatest number.
- B: Options are listed after the facts and the conflict are clear.
- D: Evaluation is the last step.
Question 5 · Hard
An 82-year-old woman with a gangrenous foot refuses a below-knee amputation. She is oriented to person, place and time and tells the nurse, 'I know I may die without it, but I won't live without my leg.' Her daughter says, 'She's confused; you have to make her have it.' What is the nurse's best action?
1. AAsk the daughter to sign consent, since the client is elderly and unwell
2. BTell the client that she will die without the surgery, so she must have it
3. CSupport her decision and report her stated understanding
4. DDelay any action until a psychiatrist declares the client incompetent
Show answerHide answer
Answer: C · Support her decision and report her stated understanding
The client shows the elements of capacity: she understands her condition, the risk of refusing and the consequence, and she gives a reason consistent with her values. The nurse advocates by documenting her words and telling the provider, who confirms capacity and discusses options; the daughter has no authority while her mother can decide. Age and illness are not proof of incapacity. This item tests analysing cues to judge capacity.
- A: The daughter cannot consent for a mother who has capacity.
- B: Pressuring the client ignores her informed decision.
- D: A capacity concern is assessed by the provider; no psychiatric ruling is needed when the cues show capacity.
Question 6 · Medium
An alert, oriented client named his daughter as his health care proxy. He now declines a cardiac catheterization that his daughter wants him to have. Whose decision should the team follow?
1. AThe daughter's, but only after an ethics committee review
2. BThe provider's, because the client and his proxy disagree
3. CThe client's, because the proxy acts only if he cannot decide
4. DThe daughter's, because she holds the signed proxy document
Answer and explanation in LearnFree account
Question 7 · Easy
Which document legally defines the scope of practice of a registered nurse in a US state?
1. AThe ANA Code of Ethics for Nurses
2. BThe employing hospital's policy manual
3. CThe state's nurse practice act
4. DThe NCSBN NCLEX-RN Test Plan
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Question 8 · Hard
A client who had a large stroke 3 days ago cannot swallow or communicate. His living will states, 'No artificial nutrition by tube.' A new admitting provider orders a nasogastric tube for feeding, and the client's daughter, his health care proxy, objects. What should the nurse do?
1. AInsert the tube and let the ethics committee decide later on
2. BAsk the daughter to put her objection in writing before acting
3. CInsert the tube, since nutrition is a basic need, not a treatment
4. DHold the insertion and tell the provider about the directive and the proxy
Answer and explanation in LearnFree account
Question 9 · Medium
A client revoked part of his living will yesterday by telling the nurse he now wants full resuscitation. What should the nurse do?
1. AAsk the client's health care proxy to approve the change
2. BFollow the written living will until he signs a new one
3. CNotify the provider and document the client's exact words
4. DTell him that a living will can only be changed by a lawyer
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Question 10 · Medium
Which of these nursing actions shows advocacy on the client's behalf?
1. ACompleting the client's admission assessment within the first hour
2. BGiving the client's ordered medications on the scheduled times
3. CExplaining the hospital's visiting policy to the client's family
4. DRelaying to the provider a client's wish to stop chemotherapy
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Question 11 · Medium
An alert adult with pneumonia tells the nurse, 'I don't want that IV antibiotic anymore.' What is the nurse's best first action?
1. AExplain that the antibiotic is needed to cure him
2. BDocument the refusal and remove the IV antibiotic
3. CAsk the client what is behind the decision to refuse
4. DNotify the health care provider of the refusal at once
Answer and explanation in LearnFree account
Question 12 · Medium
Which action by a nurse best demonstrates the ethical principle of fidelity?
1. AGiving an honest answer about a poor prognosis
2. BReturning at the time promised to help a client walk
3. CSupporting a client's choice to decline surgery
4. DGiving equal care to clients without insurance
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Question 13 · Medium
During admission, a client hands the nurse a copy of her living will. What is the nurse's best action?
1. AApply a do-not-resuscitate wristband to the client
2. BReturn it, since a living will applies only at home
3. CPlace a copy in the record and tell the provider
4. DAsk the family to confirm that it reflects her wishes
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Question 14 · Easy
Before giving a high-alert dose of insulin, a nurse asks a second nurse to check the dose independently so that no harm reaches the client. This action applies the ethical principle of:
1. ANonmaleficence
2. BFidelity
3. CBeneficence
4. DRespect for autonomy
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Question 15 · Medium
Which statement about a client's decision-making capacity is accurate?
1. AOnly a court can find that a client lacks this capacity
2. BOnce lost during a hospital stay, it cannot be regained
3. CA diagnosis of dementia removes the right to give consent
4. DIt is judged for each decision, at the time it is made
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Question 16 · Hard
A client enrolled in a drug trial tells the nurse she wants to stop taking part, but the research coordinator told her she would 'lose her place in the clinic.' What should the nurse tell her?
1. AShe should wait until the next study visit to decide on it
2. BShe may withdraw at any time without losing her usual care
3. CShe needs the provider's permission before she can withdraw
4. DShe must finish the trial because she signed the consent form
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Question 17 · Hard
A provider writes 'Soft wrist restraints PRN for agitation' for a client who keeps pulling at his nasogastric tube. What should the nurse do?
1. AAsk the family to sign consent before using the restraints
2. BApply the restraints whenever the client becomes agitated
3. CContact the provider, as a restraint order cannot be written PRN
4. DApply the restraints now and renew the order in 7 days
Answer and explanation in LearnFree account
Question 18 · Medium
An unconscious adult with internal bleeding from a car crash needs emergency surgery. No family can be reached. How can surgery proceed?
1. AOnce the charge nurse signs on the client's behalf
2. BAfter hospital security locates the next of kin
3. CUnder the emergency, or implied, consent exception
4. DOnly after a court appoints a temporary guardian
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Question 19 · Hard
A client with severe anoxic brain injury is on a ventilator. His wife is his named health care proxy and, citing his written wishes, asks that the ventilator be withdrawn. His two adult children object. Whose decision should guide the team?
1. AThe provider's, because the family members disagree
2. BThe ethics committee's, as it holds the final authority
3. CThe wife's, as the named proxy following his known wishes
4. DThe children's, because they outnumber the client's wife
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Question 20 · Medium
A client who signed consent for an elective knee replacement says in the holding area, 'I've changed my mind. I don't want this.' What should the nurse do?
1. AStop the preparation and notify the surgeon
2. BRemind him that he signed the form and it is now binding
3. CGive the ordered preoperative sedative to ease his anxiety
4. DAsk his wife to talk him into going ahead with the surgery
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Question 21 · Hard
A competent client with advanced ALS asks to have his ventilator withdrawn, and the provider writes the orders. The assigned nurse believes that withdrawing it is morally wrong. Which action is most appropriate for the nurse?
1. ARefuse the assignment and leave the client to the charge nurse to cover
2. BCarry out the withdrawal anyway so as not to delay the client
3. CAsk the client to reconsider, as the nurse cannot support it
4. DTell the charge nurse so care is reassigned, and stay until relieved
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Question 22 · Medium
A client with a do-not-resuscitate order develops a fever of 102.6°F (39.2°C). His daughter asks, 'Does DNR mean you won't treat this?' Which response by the nurse is accurate?
1. A'DNR means he can no longer be given antibiotics.'
2. B'DNR means no CPR if his heart stops; other care goes on.'
3. C'DNR means we will only give him comfort measures from now on.'
4. D'DNR means he will be moved to the hospice unit.'
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Question 23 · Medium
The family of a competent client with a new cancer diagnosis asks the nurse not to tell him, saying it will 'destroy him.' What is the nurse's best response?
1. ARefer the request straight to the ethics committee for a ruling
2. BExplore their fears and explain that he has a right to know
3. CAgree, and avoid discussing the diagnosis with the client
4. DTell the client the diagnosis now, before the family can object
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Question 24 · Hard
The nurse is present while a surgeon obtains consent for a laparoscopic cholecystectomy. The surgeon says, 'There are really no risks at all,' and the client signs. What should the nurse do?
1. AAsk the surgeon privately to discuss the real risks first
2. BComplete an incident report after the surgery is over
3. CWitness the form, since the surgeon has explained the procedure
4. DExplain the risks of the operation to the client herself afterward
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Question 25 · Easy
Under the federal Patient Self-Determination Act, a hospital admitting an adult client must:
1. ARequire every adult client to complete a living will
2. BAssign a health care proxy to clients who lack one
3. CObtain a code status decision of do-not-resuscitate
4. DAsk each client about advance directives and rights
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33 more Client rights, consent, advance directives and ethics questions

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Client rights, consent, advance directives and ethics

On the morning of a planned hysterectomy, a client who signed the consent form yesterday says, 'I'm still not sure whether they're taking my ovaries too.' What should the nurse do first?

A client who speaks only Vietnamese needs to give consent for a cardiac catheterization. Who should interpret the provider's explanation?

An alert client admitted with chest pain says he is leaving now against medical advice. What should the nurse do?

In a systematic approach to an ethical dilemma, the nurse's first step is to:

An alert, oriented client named his daughter as his health care proxy. He now declines a cardiac catheterization that his daughter wants him to have. Whose decision should the team follow?

Which document legally defines the scope of practice of a registered nurse in a US state?

A client who had a large stroke 3 days ago cannot swallow or communicate. His living will states, 'No artificial nutrition by tube.' A new admitting provider orders a nasogastric tube for feeding, and the client's daughter, his health care proxy, objects. What should the nurse do?

A client revoked part of his living will yesterday by telling the nurse he now wants full resuscitation. What should the nurse do?

Which of these nursing actions shows advocacy on the client's behalf?

An alert adult with pneumonia tells the nurse, 'I don't want that IV antibiotic anymore.' What is the nurse's best first action?

Which action by a nurse best demonstrates the ethical principle of fidelity?

During admission, a client hands the nurse a copy of her living will. What is the nurse's best action?

Before giving a high-alert dose of insulin, a nurse asks a second nurse to check the dose independently so that no harm reaches the client. This action applies the ethical principle of:

Which statement about a client's decision-making capacity is accurate?

A client enrolled in a drug trial tells the nurse she wants to stop taking part, but the research coordinator told her she would 'lose her place in the clinic.' What should the nurse tell her?

A provider writes 'Soft wrist restraints PRN for agitation' for a client who keeps pulling at his nasogastric tube. What should the nurse do?

An unconscious adult with internal bleeding from a car crash needs emergency surgery. No family can be reached. How can surgery proceed?

A client with severe anoxic brain injury is on a ventilator. His wife is his named health care proxy and, citing his written wishes, asks that the ventilator be withdrawn. His two adult children object. Whose decision should guide the team?

A client who signed consent for an elective knee replacement says in the holding area, 'I've changed my mind. I don't want this.' What should the nurse do?

A competent client with advanced ALS asks to have his ventilator withdrawn, and the provider writes the orders. The assigned nurse believes that withdrawing it is morally wrong. Which action is most appropriate for the nurse?

A client with a do-not-resuscitate order develops a fever of 102.6°F (39.2°C). His daughter asks, 'Does DNR mean you won't treat this?' Which response by the nurse is accurate?

The family of a competent client with a new cancer diagnosis asks the nurse not to tell him, saying it will 'destroy him.' What is the nurse's best response?

The nurse is present while a surgeon obtains consent for a laparoscopic cholecystectomy. The surgeon says, 'There are really no risks at all,' and the client signs. What should the nurse do?

Under the federal Patient Self-Determination Act, a hospital admitting an adult client must: