NCLEX-RN Quiz: Legal And Ethical Practice And Confidentiality
20 questions · exam conditions
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Legal And Ethical Practice And ConfidentialityQuestion 1 of 20

A 76-year-old client (female) is admitted with a urinary tract infection; the RN notices her caregiver frequently withholds her phone and the client whispers that money is missing. The RN suspects exploitation and knows suspected elder abuse must be reported per law and policy. Which action by the nurse is legally required?

Ask the caregiver to leave and then call Adult Protective Services (or the designated reporting agency) through the facility process, documenting objective findings and statements.
Contact the local news with the client's story so that public attention pressures the family to stop the suspected exploitation and ensures the client's safety at home.
Wait until the client is discharged and then observe whether the situation at home actually improves before deciding to report the suspected exploitation to a supervisor.
Report the suspected exploitation only if the client signs a written request giving consent, because reporting without that permission would violate the client's right to confidentiality and privacy.
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NCLEX-RN Quiz

NCLEX-RN Quiz: Legal And Ethical Practice And Confidentiality

Practice Legal And Ethical Practice And Confidentiality in NCLEX-RN with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Legal And Ethical Practice And Confidentiality, giving you a quick way to practice the rules, question types, and explanations that matter most for NCLEX-RN.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A 76-year-old client (female) is admitted with a urinary tract infection; the RN notices her caregiver frequently withholds her phone and the client whispers that money is missing. The RN suspects exploitation and knows suspected elder abuse must be reported per law and policy. Which action by the nurse is legally required?

  1. Ask the caregiver to leave and then call Adult Protective Services (or the designated reporting agency) through the facility process, documenting objective findings and statements. (correct answer)
  2. Contact the local news with the client's story so that public attention pressures the family to stop the suspected exploitation and ensures the client's safety at home.
  3. Wait until the client is discharged and then observe whether the situation at home actually improves before deciding to report the suspected exploitation to a supervisor.
  4. Report the suspected exploitation only if the client signs a written request giving consent, because reporting without that permission would violate the client's right to confidentiality and privacy.
Explanation: The legal duty for suspected elder abuse or exploitation is mandatory reporting—nurses must report reasonable suspicion to Adult Protective Services or the designated agency, regardless of consent. The correct action removes the caregiver to allow a private interview and documents findings, then reports promptly. Contacting the news breaches confidentiality and does not trigger the official investigation; it also fails the legal requirement to report through proper channels. Waiting to see if home conditions improve unlawfully delays a report that must be made on suspicion alone. Requiring the client's written consent misunderstands the law: reporting suspected abuse is an exception to confidentiality, and consent is not needed. Therefore, the only action that fulfills the legal mandate is the one that follows facility protocol, protects the client from interference, and documents objectively.

Question 2

A 38-year-old client (male) is admitted for alcohol withdrawal; in a public corridor, a staff member tells another, "He's detoxing again—he's a frequent flyer." The RN knows confidentiality includes limiting unnecessary disclosures and maintaining respectful communication. Which statement reflects appropriate confidentiality practices?

  1. "It's okay to talk about frequent admissions as long as we don't mention his diagnosis."
  2. "If you use his initials, it's not confidential anymore."
  3. "Please don't discuss client information in the corridor; let's move to a private area and keep the discussion limited to care needs." (correct answer)
  4. "Continue, but speak more quietly so visitors won't be able to hear."
Explanation: Confidentiality under HIPAA requires both limiting disclosures to what is necessary for care and controlling where those discussions happen, so a corridor conversation about a client's admission history is a breach regardless of the words chosen. Asking the staff member to stop discussing client information in the corridor, move to a private area, and keep the discussion limited to care needs is correct because it fixes the setting and the scope at the same time, and it also removes stigmatizing language that undermines the client's dignity and the team's therapeutic stance. Claiming it is acceptable to mention frequent admissions as long as the diagnosis is omitted misunderstands protected health information: the fact of admission is itself protected, and in a corridor near the client's unit he is easily identifiable. Believing that using initials removes confidentiality obligations is a common myth, since initials combined with location, timing, and context readily identify a client. Simply lowering the voice and continuing keeps the conversation in a public space where visitors and other clients may still overhear, so it reduces volume without removing the breach. Protected information is defined by identifiability and setting, not by whether the diagnosis is spoken aloud — move the conversation, then limit it to what care requires.

Question 3

A 57-year-old client (female) is scheduled for a blood transfusion and appears confused after receiving opioid pain medication; she cannot describe why she needs blood and keeps asking unrelated questions. The provider is ready to start the transfusion; consent must be informed and voluntary. What should the nurse do to ensure informed consent?

  1. Have the client sign now because transfusions are routine and the risks are minimal.
  2. Ask the client's roommate to explain the transfusion and co-sign the consent as a witness.
  3. Delay the transfusion and notify the provider that the client may not have capacity at this time; reassess when alert and involve the legally authorized representative if required. (correct answer)
  4. Ask a second nurse to witness the client's signature to make the consent valid despite confusion.
Explanation: Informed consent requires capacity, and capacity is a here-and-now assessment: the client must be able to receive the information, understand the reason for the procedure, and voluntarily decide. A client who is confused after opioids and cannot say why she needs blood does not currently meet that standard, so the correct action is to delay the transfusion, notify the provider that capacity is in question, reassess when she is alert, and involve the legally authorized representative if she does not regain capacity. Having her sign because transfusions are routine treats the signature as the goal instead of the understanding it is supposed to document, and calling risks minimal is false reassurance. Adding a second nurse to witness the signature only verifies that the client signed, not that she comprehended, so a witness cannot cure incapacity; asking a roommate to explain the procedure and co-sign breaches confidentiality and delegates provider-level disclosure to someone with no authority or knowledge. A signature is only valid if the person signing has capacity right now; when medication clouds understanding, the nurse stops the process and notifies the provider rather than finding a workaround.

Question 4

A 73-year-old client (female) with end-stage renal disease has a completed Physician Orders for Life-Sustaining Treatment (POLST) indicating no intubation and comfort-focused care; her sister insists the client "would want everything," while the client's designated healthcare proxy agrees with the POLST. The team is preparing for possible respiratory failure. What is the nurse's ethical obligation in this scenario?

  1. Advocate for following the documented orders and communicate the proxy's decision to the provider while supporting the sister with clear, compassionate explanations. (correct answer)
  2. Ask the sister to sign a form overriding the POLST because family disagreements require a new decision.
  3. Prepare for intubation because preventing death is always the priority regardless of prior directives.
  4. Avoid discussing the POLST with anyone to prevent conflict and wait for a crisis to occur.
Explanation: This question tests legal and ethical practice and confidentiality in nursing. The relevant framework is the legal binding nature of Physician Orders for Life-Sustaining Treatment (POLST) forms, which reflect client wishes and must be followed unless revoked. Option A reflects appropriate practice because it advocates for the POLST, communicates the proxy's decision, and supports the sister compassionately. Option B seeks unnecessary overrides; C prioritizes life extension over directives; D avoids discussion, risking unpreparedness. Key legal principles include honoring POLST to respect autonomy and involving proxies. Ethically, nurses facilitate beneficence by aligning care with client goals. A strategy for applying these principles is to review advance directives upon admission and engage in proactive family discussions with the team.

Question 5

A 45-year-old client (male) is hospitalized for gastrointestinal bleeding; in the visitor elevator, an RN overhears two staff members discussing his endoscopy results and joking about his "noncompliance." Which action by the RN reflects appropriate confidentiality practice?

  1. Ask the staff members to lower their voices so visitors cannot hear details.
  2. Tell the staff members to stop discussing client information in public and report the incident per facility policy. (correct answer)
  3. Join the conversation briefly to redirect it toward education about noncompliance.
  4. Wait until the end of the shift and send an anonymous email reminder about privacy to the whole unit.
Explanation: This question tests legal and ethical practice and confidentiality in nursing. The relevant framework is professional standards and HIPAA, which require client information to be discussed only in private with involved parties, prohibiting public discussions. Option B reflects appropriate practice because it stops the breach immediately and reports it, promoting accountability. Option A only lowers the volume and does not stop the breach; C joins inappropriately; D minimizes but does not stop the breach. Key legal principles include preventing unauthorized disclosures in public spaces. Ethically, nurses maintain professionalism and respect for clients. A strategy for applying these principles is to intervene in overheard breaches and use secure communication methods like handoff reports in private areas.

Question 6

A 66-year-old client (female) with advanced heart failure has an advance directive requesting no cardiopulmonary resuscitation; her brother argues the document is "old" and demands resuscitation if she arrests. The RN is caring for the client and notes the DNR order is active in the chart. What is the nurse's ethical obligation in this scenario?

  1. Follow the active DNR order and promptly notify the provider of the family's concerns while maintaining a calm, supportive approach. (correct answer)
  2. Plan to start resuscitation if the brother is present to avoid conflict, then stop once the provider arrives.
  3. Remove the DNR wristband to prevent upsetting the brother and revisit the decision later.
  4. Tell the brother he has no rights and refuse to speak with him further even if he is the designated contact person.
Explanation: This question tests legal and ethical practice and confidentiality in nursing. The relevant framework is the ethical and legal obligation to follow active DNR orders from advance directives unless revoked. Option A reflects appropriate practice because it honors the order, notifies the provider, and supports the family. Option B removes identifiers inappropriately; C refuses communication; D plans inconsistent actions. Key legal principles include upholding directives for autonomy. Ethically, nurses provide compassionate care amid conflicts. A strategy for applying these principles is to verify DNR status at shift start and engage in open dialogues with families about directives.

Question 7

A 90-year-old client (male) is admitted with a hip fracture; the RN notes the client is fearful and has poor hygiene, and the caregiver answers all questions and refuses to leave the room. The RN suspects neglect and knows mandatory reporting laws apply to suspected elder abuse/neglect. Which action by the nurse is legally required?

  1. Ask the caregiver for a written statement explaining the situation and file it in the chart instead of reporting.
  2. Report the suspicion using the facility's mandated process and document objective findings; do not wait for proof before reporting. (correct answer)
  3. Discharge the client to a different caregiver without reporting to avoid legal involvement.
  4. Honor the caregiver's request not to report because reporting could worsen the home situation.
Explanation: This question tests legal and ethical practice and confidentiality in nursing. The relevant legal guideline is mandatory reporting laws for suspected elder neglect, requiring reports based on reasonable suspicion without independent investigation. Option A reflects appropriate practice because it initiates reporting per protocol and documents findings, ensuring legal compliance. Option B discharges without reporting; C substitutes a statement for reporting; D honors requests against law. Key legal principles include protecting vulnerable adults through prompt reporting. Ethically, nurses uphold justice and nonmaleficence by intervening in neglect. A strategy for applying these principles is to assess for neglect indicators like poor hygiene during admissions and follow up with required reports while coordinating support services.

Question 8

A 26-year-old client (female) is treated for pelvic inflammatory disease; in a public waiting area, an RN overhears a colleague telling another staff member, "She probably got it from multiple partners." Ethical practice requires respect and confidentiality, including avoiding unnecessary disclosure and stigmatizing comments. Which statement reflects appropriate confidentiality practices?

  1. "It's okay to discuss as long as you don't say her full name."
  2. "Say it in code words so visitors won't understand what you mean."
  3. "Stop—this is not an appropriate place or need-to-know discussion. Let's focus on clinical facts in a private area and follow policy for any concerns." (correct answer)
  4. "Continue, but speak softly; the waiting room is noisy anyway."
Explanation: Confidentiality has two components: limiting disclosure to those with a need to know, and avoiding stigmatizing speech that harms a client's dignity, and speculation about a client's sexual history in a public waiting area breaches both. Saying stop, naming the setting as neither appropriate nor a need-to-know discussion, and redirecting to clinical facts in a private area with a path to follow policy for concerns is correct because it interrupts the disclosure immediately, corrects the judgmental framing, and stays professional rather than punitive. Saying it is acceptable as long as her full name is omitted misunderstands identifiability, since a client in that same waiting area is easily recognized from context. Suggesting code words so visitors will not understand is still a discussion of protected information in public and rests on the assumption that bystanders cannot decode it. Telling the colleague to continue but speak softly because the room is noisy permits the breach to go on and treats ambient noise as a privacy control. Intervene at the moment of the breach and move the conversation to a private space; partial concealment through omitted names, code words, or lowered voices is never a substitute for not having the conversation in public.

Question 9

A 69-year-old client (male) with cataracts is asked to sign a consent for a bronchoscopy; he states, "I can't see what I'm signing and I don't understand the sedation." The provider is occupied, and the procedure time is approaching; informed consent requires adequate disclosure and comprehension. What should the nurse do to ensure informed consent?

  1. Provide accommodations (such as reading the form in full and using teach-back), and notify the provider to answer questions before the client signs. (correct answer)
  2. Ask the unit clerk to obtain the signature because the nurse is not required for consent.
  3. Explain the sedation briefly and have the client sign with an "X" to keep the schedule on time.
  4. Have the client's spouse sign the consent because vision problems mean the client lacks capacity.
Explanation: This question tests legal and ethical practice and confidentiality in nursing. The relevant guideline is informed consent accommodations for disabilities, ensuring comprehension through full disclosure. Option B reflects appropriate practice because it provides reading and teach-back, involving the provider. Option A simplifies inappropriately; C delegates wrongly; D assumes incapacity. Key legal principles include voluntary understanding. Ethically, nurses ensure equitable access. A strategy for applying these principles is to anticipate needs like audio aids and confirm understanding before consents.

Question 10

A 72-year-old client (male) with advanced dementia is hospitalized with aspiration pneumonia; his advance directive indicates no feeding tube, but two family members disagree and argue at the bedside. The RN collaborates with the provider and case manager and wants to respect client autonomy and reduce harm. What is the nurse's ethical obligation in this scenario?

  1. Encourage the family to vote on the feeding tube decision because majority preference is ethically fair and honors the family's collective judgment.
  2. Tell the family the decision is primarily medical and their participation is not needed because the provider will apply the advance directive.
  3. Proceed with feeding tube preparation until the family reaches agreement to avoid delaying essential nutrition while the conflict is resolved.
  4. Advocate for honoring the advance directive and facilitate communication with the provider to clarify goals of care and available supports. (correct answer)
Explanation: The correct action is to advocate for honoring the advance directive while also addressing the family's conflict through communication. The advance directive is the client's own voice and must be respected. Among the wrong options, having the family vote treats the directive as if it were a popularity contest, because the client's written wishes take precedence over family majority. Telling the family that the decision is primarily medical and that they cannot participate ignores the nurse's role in providing support and may intensify the conflict, even if it acknowledges the directive. Proceeding with feeding tube preparation before the family agrees actually violates the advance directive by starting an intervention the client refused, and it delays appropriate care. Only the correct option honors the client's autonomy while also engaging the provider and family to clarify goals and supports, addressing both the ethical and interpersonal aspects of the situation.

Question 11

A 29-year-old client (female) is admitted for pyelonephritis; at the nurses' station within earshot of visitors, a colleague says, "She's the one with a history of sexually transmitted infections." Confidentiality standards require minimizing incidental disclosures and discussing protected health information privately. Which statement reflects appropriate confidentiality practices?

  1. We don't need to move because visitors near the nurses' station should not be listening to our current conversation.
  2. Let's step into a private area to discuss client care, and please avoid sharing nonessential history where others can hear. (correct answer)
  3. I'll confirm the sexually transmitted infection history from the chart and then share the relevant details with you later in the cafeteria.
  4. Let's speak a little quieter and use her initials, because that makes the information less obvious to people nearby.
Explanation: Protected health information is not made confidential by using a lower voice or initials; the nurse must take active steps to avoid incidental disclosure. The response about visitors should not be listening places the privacy burden on the visitor rather than on the healthcare team. Confirming the sexually transmitted infection history from the chart and sharing relevant details in a cafeteria keeps the disclosure in a public setting, so it is not private. Speaking quietly and using initials still occurs at the nurses' station and may still be overheard, so it does not satisfy confidentiality standards. The correct response is the one that moves the discussion to a private area and avoids sharing nonessential history.

Question 12

A 90-year-old client (female) with advanced dementia is admitted with aspiration pneumonia. The chart includes a valid advance directive indicating comfort-focused care and no feeding tube; two adult children disagree at the bedside, with one demanding a feeding tube "to keep her alive" and the other supporting the directive. What is the nurse's ethical obligation in this scenario?

  1. Support implementation of the documented advance directive and notify the provider/case management to address family conflict. (correct answer)
  2. Proceed with feeding-tube preparation because providing nutrition is always required regardless of directives.
  3. Ask both children to sign a new consent form and proceed with whichever option has two signatures.
  4. Withhold all information from the family to avoid escalating conflict and focus only on tasks.
Explanation: This question tests legal and ethical practice and confidentiality, specifically addressing advance directive implementation and family conflicts in end-of-life care. The Patient Self-Determination Act establishes that valid advance directives legally guide care decisions when patients lack capacity, superseding family member preferences that contradict documented wishes. The correct answer (A) reflects appropriate practice by supporting directive implementation and engaging appropriate resources to address family conflict while honoring patient autonomy. Option B is incorrect because it violates the patient's documented wishes for comfort care only; option C inappropriately suggests family voting when legal directives exist; option D fails to support families during difficult decisions and abandons advocacy responsibilities. Key legal and ethical principles include respecting patient autonomy through advance directives, providing comfort-focused care as directed, and facilitating family understanding while maintaining ethical obligations. Nurses should apply these principles by reviewing advance directives carefully, advocating for patient wishes, and collaborating with interdisciplinary teams to support families through end-of-life decisions.

Question 13

A 61-year-old client (male) with severe sepsis is intermittently confused and is scheduled for central venous catheter insertion. He repeatedly asks, "Is this going to cure me today?" and cannot explain back the purpose of the procedure; the provider requests that the nurse obtain the signature quickly because the unit is busy. What should the nurse do to ensure informed consent?

  1. Have the client sign now and reassess understanding after the procedure since it is urgent.
  2. Determine whether the client has decision-making capacity at this time, notify the provider of the lack of understanding, and involve the legally authorized representative if needed before signing. (correct answer)
  3. Ask another nurse to witness the signature to reduce liability and proceed with the insertion.
  4. Explain that refusal could lead to death and obtain the signature to ensure the client chooses the safest option.
Explanation: This question tests legal and ethical practice and confidentiality, specifically addressing informed consent requirements when capacity is questionable. Legal standards for informed consent require that patients have decision-making capacity and understand the procedure's nature, risks, and benefits before consenting. The correct answer (B) reflects appropriate practice by assessing capacity, notifying the provider about comprehension issues, and involving legally authorized representatives if the patient lacks capacity. Option A is incorrect because proceeding without understanding violates informed consent; option C inappropriately uses witnessing to avoid addressing capacity issues; option D uses coercion and fear tactics rather than ensuring informed choice. Key legal and ethical principles include assessing decision-making capacity, ensuring voluntary consent without coercion, and involving appropriate surrogates when patients cannot consent. Nurses should apply these principles by recognizing signs of impaired capacity, advocating for proper consent processes even under time pressure, and collaborating with providers to ensure legal and ethical standards are met before procedures.

Question 14

A 61-year-old client (male) who speaks limited English is scheduled for a cardiac catheterization; he nods but cannot explain the procedure back, and his adult daughter offers to translate. The facility policy requires a qualified medical interpreter for informed consent discussions. What should the nurse do to ensure informed consent?

  1. Explain only the risks in English and have the client sign so the consent is legally valid.
  2. Use the daughter to interpret because she knows the client best and it is faster than calling an interpreter.
  3. Request a qualified medical interpreter and notify the provider that the client has not demonstrated understanding before the procedure proceeds. (correct answer)
  4. Proceed because the provider already obtained consent and the client nodded in agreement.
Explanation: Informed consent is valid only when the client actually understands the procedure, its risks, and the alternatives, and a nod is not evidence of understanding when the client cannot explain the procedure back. Requesting a qualified medical interpreter and notifying the provider that understanding has not been demonstrated is correct because it both restores the client's access to the information and returns the consent discussion to the provider, who owns it; the nurse's role is to verify comprehension, witness, and escalate, not to obtain or repair the consent alone. Letting the daughter interpret violates facility policy and the language-access standard for consent discussions, and family interpreters risk omission, filtering, and loss of privacy — convenience does not make consent informed. Explaining only the risks in English produces a signature without comprehension, which is exactly the defect that makes consent legally and ethically void, and proceeding because the provider already obtained consent and the client nodded accepts that same defect while ignoring the evidence in front of the nurse. When a client cannot teach the procedure back, consent is incomplete: stop the process, get a qualified interpreter, and notify the provider before the procedure moves forward.

Question 15

A 70-year-old client (male) with severe stroke is nonverbal and has an advance directive declining artificial nutrition; his spouse agrees, but an adult child demands feeding tube placement and threatens to sue. The RN is present during a care conference with the provider and case manager. What is the nurse's ethical obligation in this scenario?

  1. Encourage the spouse to change the directive to avoid conflict and speed discharge planning.
  2. Proceed with tube feeding because family requests override written directives when emotions are high.
  3. Tell the child that the hospital will not discuss any information with them and end the meeting immediately.
  4. Advocate for honoring the advance directive and support a structured family meeting with the provider to explain goals of care and address concerns. (correct answer)
Explanation: An advance directive is the nonverbal client's own voice and remains legally binding unless he revokes it while he has capacity; family distress, disagreement, or threats of litigation do not override it. The nurse's ethical obligation is therefore to advocate for honoring the directive while supporting a structured family meeting with the provider so goals of care can be explained and the adult child's grief and concerns can be addressed, which protects autonomy without abandoning the family. Proceeding with tube feeding because the family demands it substitutes surrogate wishes for a valid written directive and is both an ethical and a legal violation. Encouraging the spouse to change the directive to smooth discharge planning pressures a surrogate to overturn the client's documented wishes for the team's convenience. Shutting the adult child out of all discussion misapplies confidentiality, since the conflict calls for facilitated communication and, if it persists, an ethics consult rather than a closed door. A valid advance directive governs care, and the nurse's role in family conflict is to uphold it while facilitating communication, not to renegotiate it.

Question 16

A 34-year-old client (female) is admitted for new-onset seizures; in a crowded hallway, a nurse from another unit asks the RN, "Is she the one who tested positive for drugs?" The RN has not been involved in that nurse's care and confidentiality standards limit sharing to those with a need-to-know. Which statement reflects appropriate confidentiality practices?

  1. "Yes, but don't repeat it—she doesn't want anyone to know."
  2. "I'm not sure, but you can look it up in the electronic record when you have time."
  3. "I can't discuss her information unless you are directly involved in her care; please speak with her primary nurse or the provider if needed." (correct answer)
  4. "I'll tell you in the break room so no one else hears."
Explanation: Confidentiality limits access to protected health information to those directly involved in the client's care, so a nurse from another unit with no care relationship has no need-to-know and no right to the information. Stating that the information cannot be discussed unless the other nurse is directly involved in the client's care, and redirecting them to the primary nurse or provider, is correct because it declines the disclosure while remaining professional and offering a legitimate route if a genuine care need exists. Confirming the drug screen result while asking the other nurse to keep it quiet is a full breach; asking for discretion afterward does not undo the disclosure, and it happens in a crowded hallway where others can overhear. Suggesting the other nurse look it up in the electronic record invites unauthorized chart access, which is an independent violation that is auditable and traceable. Offering to share the information in the break room only changes the location of the breach, since privacy is determined by who is entitled to the information, not by how quiet the room is. Need-to-know is about the listener's role in the client's care, not about how the conversation is packaged or where it takes place.

Question 17

A 52-year-old client (male) is admitted for acute pancreatitis; while waiting for the elevator near the hospital cafeteria, an RN overhears a nursing assistant telling a friend, "He's the one with pancreatitis from heavy drinking—his labs are terrible." The unit policy and professional standards require protection of protected health information (need-to-know only). Which statement reflects appropriate confidentiality practices?

  1. Tell the friend the client's room number so the friend can avoid that area and prevent further gossip.
  2. Ignore the comment because the nursing assistant did not mention the client's name and the friend is not a hospital employee.
  3. Immediately ask the nursing assistant to stop and move the discussion to a private area, then report the breach to the charge nurse per policy. (correct answer)
  4. Post a reminder about privacy on the unit bulletin board without addressing the nursing assistant directly to avoid conflict.
Explanation: Protected health information may be shared only with those who have a need to know for the client's care, and a nursing assistant discussing a client's diagnosis and alcohol use with a friend in a public area violates that standard whether or not a name is spoken. Immediately asking the nursing assistant to stop and move the discussion to a private area, then reporting the breach to the charge nurse per policy, is correct because it does both required things: it halts the disclosure in progress and escalates through the chain of command so the event is addressed rather than repeated. Ignoring the comment because no name was used and the friend is not an employee misreads identifiability, since a client described by diagnosis, cause, and location is readily identifiable, and inaction makes the nurse complicit. Posting a general privacy reminder on the bulletin board avoids the conflict but leaves the specific breach unaddressed and unreported. Telling the friend the client's room number discloses additional protected information to an unauthorized person, compounding the original violation. Stop the disclosure at the moment you witness it and then report it through policy; silence, indirect hints, and any response that reveals more information are all failures.

Question 18

A 79-year-old client (female) with moderate dementia is scheduled for a central venous catheter insertion; she repeatedly asks, "Why are they doing this to me?" and cannot restate risks/benefits. The provider is ready to proceed and the client's adult son is in the waiting room. What should the nurse do to ensure informed consent?

  1. Ask the son to sign the consent form and tell him to explain the procedure to the client later.
  2. Witness the client's signature because the provider already explained the procedure and the form is complete.
  3. Explain only the benefits in simple terms to reduce anxiety and obtain the client's signature quickly before she forgets.
  4. Hold the procedure and notify the provider that the client is not demonstrating understanding; request evaluation of decision-making capacity and contact the legally authorized representative as indicated. (correct answer)
Explanation: Valid informed consent requires decision-making capacity, and capacity is judged by whether the client can understand and restate the risks, benefits, and alternatives, not by a diagnosis and not by whether a form is complete. This client repeatedly asks why the procedure is being done and cannot restate risks or benefits, so the correct action is to hold the catheter insertion, notify the provider that understanding is not demonstrated, request an evaluation of decision-making capacity, and contact the legally authorized representative as indicated. Witnessing her signature because the provider already explained the procedure would attest to an understanding that visibly does not exist, which is the exact error the nurse is positioned to catch. Asking the son to sign and explain the procedure to her later assumes surrogate authority that has not been established, since being an adult child does not by itself make someone the legally authorized representative. Explaining only the benefits in simple terms and obtaining her signature quickly before she forgets withholds required risk disclosure and exploits her impairment, which is coercion rather than consent. Consent rests on demonstrated understanding, so when a client cannot restate the plan, stop the procedure and have capacity determined before any signature is obtained.

Question 19

An 82-year-old client (male) with end-stage chronic obstructive pulmonary disease is hospitalized with worsening respiratory failure. His chart includes a valid do-not-resuscitate (DNR) order and an advance directive naming his spouse as healthcare proxy; at the bedside, the adult son insists, "Do everything, start CPR if he stops breathing," while the spouse states the client previously refused resuscitation. What is the nurse's ethical obligation in this scenario?

  1. Follow the adult son's request to start CPR because the closest blood relative has priority over the healthcare proxy during emergencies.
  2. Initiate a new consent discussion with family members present and have them vote to determine the plan of care for end-of-life treatment.
  3. Clarify the documented advance directive and DNR status, support the healthcare proxy's role, and notify the provider of the conflict. (correct answer)
  4. Cancel the DNR order until a court order is obtained to prevent legal risk to staff from any future resuscitation attempts.
Explanation: The correct response is to clarify the documented advance directive and DNR status, support the healthcare proxy's role, and notify the provider of the conflict. A valid advance directive and a designated healthcare proxy carry legal authority when the client cannot decide; the spouse, as proxy, stands in for the client's previously expressed wishes. The son's request does not supersede that authority, so following the adult son's request to start CPR because the closest blood relative has priority is incorrect—blood relation does not override a named proxy. Initiating a new consent discussion and having family members vote wrongly treats end-of-life decisions as a majority vote, ignoring the proxy's legal role. Canceling the DNR order until a court order is obtained is also wrong: a nurse cannot unilaterally cancel a valid DNR, and the conflict should be escalated to the provider, not resolved by suspending the order. The nurse's duty is to honor the client's documented wishes, support the legitimate surrogate, and communicate the disagreement for prompt ethical and legal review.

Question 20

A 24-year-old client (female) is admitted for complications of type 1 diabetes. In the hospital cafeteria, a nurse overhears two staff members discussing the client's recent pregnancy loss and blood glucose values; several people nearby appear to be listening. Which statement reflects appropriate confidentiality practices?

  1. Report the incident to the media relations department so the hospital can prepare a public statement before the privacy breach becomes widely known outside the hospital.
  2. Approach the staff members, stop the discussion, move to a private area if patient-care communication is needed, and follow the facility's privacy reporting process. (correct answer)
  3. Ask the client whether she wants the staff members disciplined, and wait for her response before filing a privacy report or beginning next steps.
  4. Assume the cafeteria is acceptable because it is inside the hospital, the staff members are colleagues, and they do not identify the client by full name.
Explanation: Confidentiality does not stop at a hospital's entrance. A cafeteria is a public area, and the pregnancy loss and blood glucose values are specific health details that can identify the client even without a full name. The appropriate response is to stop the discussion immediately, move needed patient-care communication to a private area, and report the incident through the facility's privacy reporting process. Reporting to the media relations department is about protecting the hospital's public image, not protecting client privacy or following the required reporting process. Asking the client whether the staff should be disciplined and waiting for her response before filing a privacy report improperly delegates a staff and facility reporting responsibility to the client and delays the nurse's duty to act. Assuming the cafeteria is acceptable because it is inside the hospital and the full name was not used ignores that public areas and identifiable clinical details still create a privacy risk. The correct action combines immediate intervention, continuation in private when needed, and facility-based privacy reporting.