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NCLEX legal and ethical practice questions

20 free NCLEX-style legal and ethical questions: autonomy, beneficence and the other principles the exam names, negligence, malpractice, assault, battery and false imprisonment, with rationales.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A 74-year-old client who is alert and makes her own decisions has a new diagnosis of pancreatic cancer, and the provider plans to discuss it with her today. Her two adult sons stop the nurse in the hallway and say, 'In our culture, the family hears bad news first. Please don't tell our mother. It would take away her hope.' What should the nurse do first?

  1. Ask the ethics committee to decide whether the diagnosis can be withheld
  2. Agree not to tell her, and ask the provider to give the diagnosis to the sons instead
  3. Ask the client privately how much she wants to know and whom to include
  4. Explain to the sons that their mother has a right to know and will be told today
Show the answer and rationale

Answer: C

A client with capacity decides how she receives information about her own health, and some clients prefer that family hear news first, so the nurse asks the client privately how much she wants to know and whom to include, then shares her answer with the provider. Telling the sons she will be told today is the strongest distractor, since it honors veracity, but it overrides her own preference before anyone has asked her. Agreeing to the sons' request lets the family decide for her, and an ethics referral is premature when one conversation with the client can settle the question.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 2 of 20

A competent client agreed to have a nasogastric tube inserted for decompression. As the nurse passes the tube into the nasopharynx, the client gags, pushes the nurse's hand away, and says, 'Stop! I don't want this anymore.' Which action should the nurse take?

  1. Keep the tube still and remind the client that he agreed to it to relieve his vomiting
  2. Stop advancing the tube, leave it in place, and call the provider to report the refusal
  3. Hold the tube where it is and coach slow breaths and sips of water until the gagging passes
  4. Stop, remove the tube, and ask the client what he is feeling and what worries him
Show the answer and rationale

Answer: D

A competent client can withdraw consent at any point, even partway through a procedure, so the nurse stops, removes the tube, explores what is behind the refusal, and informs the provider; going on would be battery. Stopping and calling the provider with the tube left in place is the runner-up because it halts the insertion and reports the refusal, but it leaves a tube he has refused in his nose and throat. Coaching slow breaths and sips of water is the right technique for a client who wants to go on, but this client has said no. Reminding him that he agreed earlier pressures him: that agreement no longer stands once he withdraws it, and the tube's benefits can be explained after it is out, as part of an informed refusal.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 3 of 20

A newly licensed nurse in her second week on a medical unit is about to start an IV on a 52-year-old client while her preceptor watches. It will be her first IV start on a client. The client asks, 'How many of these have you done?' Which response by the nurse is best?

  1. 'I've done plenty of these, so you're in very good hands with me today.'
  2. 'This is my first on a client, and my preceptor is here with me. Is that all right?'
  3. 'I've practiced many times in the lab, and my preceptor is here if I need help.'
  4. 'Starting IVs is a routine skill, so there's nothing for you to worry about.'
Show the answer and rationale

Answer: B

Veracity means not deceiving the client, and a client deciding whether to accept care from a new nurse is entitled to an honest answer, so the nurse says it is her first, notes that her preceptor is with her, and asks whether he agrees, honoring his autonomy if he would rather the preceptor do it. Citing lab practice is the strongest distractor, since every word of it is true, but it is chosen to leave a false impression of experience. Claiming many IV starts is a lie, and calling the skill routine dodges the question with false reassurance.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 4 of 20

An off-duty nurse stops at the scene of a car crash and controls a driver's bleeding with direct pressure. Which action by the nurse is most consistent with the protections of Good Samaritan laws?

  1. Moving the driver out of the car to lie flat on the grass while waiting
  2. Giving the driver two aspirin from the nurse's bag for the pain
  3. Leaving once a police officer arrives and offers to take over
  4. Staying with the driver until emergency medical services take over care
Show the answer and rationale

Answer: D

Good Samaritan laws generally protect people who give emergency care in good faith, without expecting payment, and within the limits of their training, and a nurse who starts care stays until someone with equal or greater training, such as emergency medical services, takes over. Leaving when a police officer arrives is the runner-up because the officer seems to be an official taking charge, but an officer's first-aid training is usually less than a nurse's, so leaving can be considered abandonment. Moving a crash victim when there is no immediate danger such as fire risks worsening a spinal injury and is not what a reasonably prudent nurse would do, and aspirin slows clotting in a client who is already bleeding and is not part of first aid for trauma.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 5 of 20

A 27-year-old client is being discharged after treatment for an abscess at an injection site on his forearm. He says, 'I'm not ready to stop using heroin, but my friend almost died last month. Where can I get naloxone?' Which response by the nurse is best?

  1. 'I'll need to let the police know about your drug use before you leave.'
  2. 'You can buy it without a prescription. Let me show you how to use it.'
  3. 'I can give you information about treatment programs once you're ready to stop.'
  4. 'Having naloxone around may make it easier to keep using, so treatment is safer.'
Show the answer and rationale

Answer: B

Beneficence and nonmaleficence support meeting the client where he is: naloxone can reverse an opioid overdose, nasal naloxone is sold without a prescription, and teaching him to use it can prevent a death, while the nurse also offers treatment resources. Offering treatment information only is the strongest distractor, since recovery is the goal, but making help wait until he quits withholds a tool that could save his life now. Steering him away from naloxone puts the nurse's judgment of his choices ahead of his safety, and drug use is not something the nurse reports to police.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 6 of 20

An assistive personnel (AP) tells the nurse, 'The IV pump in room 412 kept alarming, so I turned the rate down from 100 mL/h to 50 mL/h, and it stopped beeping.' Which action should the nurse take first?

  1. Check the client, the IV site, and the infusion right away
  2. Explain to the AP that changing IV pump settings is outside the AP's role
  3. Report the AP's action to the charge nurse so it can be addressed
  4. Complete an incident report describing what the AP did to the pump
Show the answer and rationale

Answer: A

The client's safety comes first: the nurse assesses the client and the IV site, finds the cause of the alarm, and restores the prescribed rate. Telling the AP that adjusting an IV pump is outside the AP's role is the runner-up, because it must happen soon to prevent a repeat, but the client may be getting the wrong dose right now. Reporting to the charge nurse and completing an incident report are appropriate follow-up once the client is safe.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 7 of 20

The evening before his first surgery, a 45-year-old client grips the nurse's hand and says, 'Promise me you'll be there when I wake up in recovery.' The nurse is not scheduled to work tomorrow. Which response by the nurse is best?

  1. 'You'll be asleep for most of it, so you won't notice who is there with you.'
  2. 'I promise I'll be right there beside you when you open your eyes.'
  3. 'I'm off tomorrow, but a recovery nurse will be with you as you wake up.'
  4. 'I'll do my best to stop by and see you in recovery if I can get away.'
Show the answer and rationale

Answer: C

Fidelity means making only the promises one can keep, and veracity rules out a comforting falsehood, so the nurse is truthful about her schedule and tells the client that a recovery nurse will be at his side, which speaks to the fear behind the request. Promising to try is the strongest distractor, since it sounds kind and noncommittal, but the nurse knows she will not be there, so it sets up a broken promise. A flat promise is a lie, and saying he won't notice dismisses his fear.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 8 of 20

A nurse forgets to give a client's scheduled 0900 dose of oral cephalexin for cellulitis. At 1300 the client, who walks independently and steadily, trips over a visitor's bag in the hallway and sprains an ankle. The client later sues the nurse, claiming the missed dose led to the injury. Which element of malpractice would be hardest for the client to prove?

  1. That missing the dose fell below the standard of care
  2. That the client suffered an actual injury
  3. That the nurse owed the client a duty of care
  4. That the missed dose caused the sprained ankle
Show the answer and rationale

Answer: D

Malpractice requires duty, breach, causation, and damages, and causation links the nurse's breach directly to the injury. Damages is the runner-up because the missed dose itself did no visible harm, but damages refers to the client's injury, and the sprained ankle is real; what is missing is any connection between a missed antibiotic dose and tripping over a bag. The nurse's assignment to the client creates the duty, and omitting a prescribed dose is a breach of the standard of care.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 9 of 20

A client with Down syndrome who lives in a group home and makes his own health care decisions is admitted for planned surgery. The surgeon directs every question to the group home staff member, although the client is answering for himself. What should the nurse do?

  1. Report the surgeon's conduct to the charge nurse after the visit
  2. Let the staff member answer, since staff know the client's history well
  3. Encourage the surgeon to speak directly to the client in plain language
  4. Check with the client after the visit to see what he understood
Show the answer and rationale

Answer: C

Advocacy includes making sure clients with disabilities take part in decisions about their own care, so the nurse prompts the surgeon to speak with the client in plain language, check his understanding, and include the support person only as the client wishes. Checking with the client after the visit is the strongest distractor, since confirming understanding matters, but it leaves him shut out of the discussion while it happens. Reporting the surgeon later skips speaking up in the moment, and letting staff answer disregards his right to decide; capacity depends on whether a person understands the specific decision, not on a diagnosis.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 10 of 20

A client at high risk for falls has gotten out of bed alone three times tonight despite reminders to call for help. Which action by the nurse meets the legal definition of assault?

  1. Gripping the client's arm and leading him back to bed after he refuses help
  2. Placing a lap tray he cannot remove on his wheelchair
  3. Telling his roommate's visitor that the client is confused and keeps wandering
  4. Telling the client, 'Get up once more and I'm strapping you to the bed.'
Show the answer and rationale

Answer: D

Assault is a threat or attempt that makes a person fear harmful or offensive contact, and no touching is needed, so threatening to strap the client down is assault. Gripping the client's arm after he refuses help is the runner-up, but actual contact without consent is battery, not assault. A lap tray the client cannot remove restricts his movement like a restraint and could be false imprisonment without a prescription and a clear need, and telling a visitor about his condition violates his privacy.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Practice 10 more Legal & ethical questions free โ†’

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Question 11 of 20

At 0800, a nurse notices that a coworker who arrived 30 minutes late has slurred speech, an unsteady gait, and the smell of alcohol on her breath. The coworker has four clients due for 0900 medications. Which action should the nurse take first?

  1. Give the 0900 medications for her and quietly check on her clients
  2. Report the coworker to the state board of nursing before the shift ends
  3. Tell the charge nurse now so the coworker is removed from client care
  4. Talk with the coworker privately at break and urge her to get help
Show the answer and rationale

Answer: C

A nurse who appears impaired cannot safely care for clients, so the nurse reports the observations to the charge nurse or manager right away, and the manager removes the coworker from client care and follows policy. Reporting to the state board of nursing is the runner-up: it may be required later under state law and policy, but it does not stop the coworker from giving medications in the next hour. A private talk at break leaves clients at risk until then, and quietly covering her work hides the problem and enables it.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 12 of 20

A client admitted voluntarily to a mental health unit 4 days ago tells the nurse, 'I've decided I want to leave today.' The client denies any thoughts of harming self or others. Which action should the nurse take?

  1. Ask about the client's reasons for wanting to leave, and document them
  2. Explain the process for a written request to leave, and notify the provider
  3. Encourage the client to stay until the treatment team agrees the client is ready
  4. Place the client on an emergency hold until the provider can complete an evaluation
Show the answer and rationale

Answer: B

A client admitted voluntarily keeps the right to request discharge, and facilities usually ask for the request in writing so the provider can evaluate the client before release, often within a time limit set by state law. If the evaluation found that the client met criteria for involuntary admission, such as danger to self or others, the provider could start that process; otherwise the client is discharged. Asking about the client's reasons is good therapeutic communication, but on its own it leaves the request unanswered and the provider unaware. Urging the client to stay until the team agrees does not act on the request, and an emergency hold for a client who denies any thoughts of harm restricts the client's freedom without legal justification and can be false imprisonment.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 13 of 20

A nurse questions a prescription for a medication dose that is double the maximum recommended dose. The provider replies, 'I know the range. Just give it.' What should the nurse do next?

  1. Hold the dose and complete an incident report about the provider's reply
  2. Hold the dose and notify the charge nurse or nursing supervisor now
  3. Give the dose and document the provider's reply word for word
  4. Give the dose once the provider writes a note confirming it in the record
Show the answer and rationale

Answer: B

A nurse who gives a medication known to be unsafe shares liability for the harm, so the nurse withholds the dose and uses the chain of command, starting with the charge nurse or nursing supervisor, and documents the communication factually. Holding the dose and filing an incident report sounds safe, but a report reviews the event later and does not settle the order now. A confirming note from the provider and a word-for-word chart entry do not make an unsafe dose safe or remove the nurse's liability.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 14 of 20

A client with Medicare who is scheduled for discharge tomorrow tells the nurse, 'I don't feel ready to go home. I think they're rushing me out.' Which response by the nurse is accurate?

  1. 'You can ask the Medicare quality improvement organization for a fast review.'
  2. 'You can ask the hospital's billing office to extend your covered stay by 2 days.'
  3. 'You can appeal to Medicare, but the review will not begin until after discharge.'
  4. 'You can ask the quality improvement organization to review next month's bills.'
Show the answer and rationale

Answer: A

Medicare clients receive An Important Message from Medicare About Your Rights, which explains the right to a fast appeal through the Beneficiary and Family Centered Care Quality Improvement Organization, requested before discharge. The runner-up is appealing to Medicare after discharge; that route exists for other disputes, but it loses the fast review and the protections that come with requesting it before leaving. The billing office cannot extend a covered stay, and a review of next month's bills does not address a discharge the client believes is premature.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 15 of 20

A client who was admitted involuntarily to a mental health unit yesterday asks the nurse for a phone to call an attorney about the hold. Which response by the nurse is appropriate?

  1. 'I'll ask the social worker to call your attorney and pass on your concerns.'
  2. 'I'll take you to a private phone so you can make that call now.'
  3. 'You can call after your treatment team sees you tomorrow.'
  4. 'Your provider has to approve any calls you make while you're here.'
Show the answer and rationale

Answer: B

Clients admitted involuntarily keep their civil rights, including the right to communicate with an attorney and to challenge the hold at a legal hearing, so the nurse helps the client reach counsel privately and promptly. Having a social worker relay the message is the strongest distractor, since it sounds helpful, but it replaces the client's own private conversation with counsel. Waiting for the treatment team or requiring the provider's approval would delay or block a legal right that cannot be restricted as part of treatment.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 16 of 20

A 45-year-old client admitted 2 days ago with cellulitis of the leg is receiving IV antibiotics through a peripheral IV catheter in the forearm. The client is alert and oriented and says, 'I'm done with this place. I'm going home.' The provider has explained the risks of leaving, and the client still chooses to go. Which action should the nurse take?

  1. Flush and cap the IV catheter so antibiotics can restart quickly if the client returns
  2. Leave the catheter in place and teach the client how to flush it at home each day
  3. Remove the catheter once the provider has signed the against-advice form first
  4. Remove the IV catheter, then apply pressure and a dressing before the client leaves
Show the answer and rationale

Answer: D

A client leaving against medical advice must not go home with a vascular access device, which can infect, dislodge, bleed, or be misused, so the nurse removes the catheter and dresses the site. The runner-up is flushing and capping it so antibiotics could restart if he returns; it sounds efficient, but it leaves an open route to the bloodstream outside the hospital. Teaching him to flush it at home has the same problem, and waiting for a signed form before removal delays a safety step for paperwork. He still receives written warning-sign and follow-up instructions.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 17 of 20

Four nurses give emergency care outside a hospital. Which nurse is least likely to be protected by a Good Samaritan law?

  1. A nurse hired to staff a concert's first-aid tent who treats a fan for heat exhaustion
  2. A nurse flying home from vacation who answers a flight attendant's call for help during the flight
  3. An emergency nurse on her way to work who gives first aid at a crash near her hospital
  4. A nurse at a grocery store who gives first aid to a man she cared for on her unit last week
Show the answer and rationale

Answer: A

Good Samaritan laws generally protect people who give emergency care in good faith, without expecting payment, and within the limits of their training. A nurse hired to staff a first-aid tent has a job duty to care for the fans, so the usual standard of care applies rather than Good Samaritan protection. The nurse on the flight is the runner-up because state laws may seem not to reach a plane, but the federal Aviation Medical Assistance Act shields anyone who helps in an in-flight emergency unless grossly negligent. The emergency nurse on her way to work is not yet on duty, and having cared for the man last week creates no duty at the store, since that nurse-client relationship ended with his care.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 18 of 20

At 0200 a nurse calls the provider because a client cannot sleep. The provider says, 'Just give her whatever sleeping pill you think is best,' and starts to hang up. Which response by the nurse is best?

  1. 'I'll give her the melatonin we stock on the unit, since it's the safest choice.'
  2. 'Please name the drug, dose, route, and frequency so I can read the order back.'
  3. 'I'll ask the pharmacist to choose one and enter it under your name.'
  4. 'I'll check her home medication list and give the sleep aid she takes at home.'
Show the answer and rationale

Answer: B

Choosing a drug is prescribing, which is outside the RN's scope, so the nurse asks the provider for a complete order with the drug, dose, route, and frequency and reads it back to confirm it. Giving the sleep aid the client takes at home is the runner-up because it seems individualized and familiar, but the nurse would still be choosing the medication and dose without a prescription. Picking the stocked melatonin is the same scope problem, and a pharmacist entering an order the provider never gave does not create a valid prescription.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 19 of 20

An alert, oriented client refuses the scheduled dose of an oral antihypertensive medication. Which action by the nurse is most appropriate?

  1. Ask about the reason for refusing and notify the provider of the refusal
  2. Document the refusal and offer the next dose when it is due
  3. Explain the risks of hypertension and reoffer the tablet in 30 minutes
  4. Ask a family member to encourage the client to take the tablet
Show the answer and rationale

Answer: A

A competent client has the right to refuse any treatment, so the nurse explores the reason, explains the possible consequences, respects the decision, documents the refusal, and informs the provider. Explaining the risks and offering the tablet again sounds caring, but without asking why, the nurse may miss a side effect or other problem, and the provider still does not know a dose was missed. Documenting and simply waiting for the next dose leaves the provider uninformed, and asking family to push the client is coercion and shares information without the client's permission.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 20 of 20

A nurse educator is reviewing side rail use on a medical unit. In which situation does the use of side rails meet the definition of a restraint, requiring a prescription and monitoring?

  1. Raising all four side rails for a client with quadriplegia who cannot move out of bed
  2. Raising the side rails on a stretcher while transporting a client to radiology
  3. Raising the two upper rails that a client uses to turn and push herself up to stand
  4. Raising all four side rails so an alert client at risk for falls cannot get up alone
Show the answer and rationale

Answer: D

Side rails are a restraint when they keep a client from leaving the bed voluntarily, so raising all four rails to stop an alert client from getting up needs a prescription, monitoring, and a trial of less restrictive measures first. Raising all four rails for a client with quadriplegia is the runner-up, but rails do not limit the movement of someone who cannot get out of bed, so they are not a restraint. Stretcher rails during transport prevent an accidental fall, and partial rails the client uses to turn and stand help mobility rather than limit it.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Practice 10 more Legal & ethical questions free โ†’

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