NCLEX-PN Test #18 1 — Questions and Answers
Question 1: A competent adult patient refuses a blood transfusion based on religious beliefs, despite knowing it may result in death. What is the nurse's most appropriate action?
- Proceed with the transfusion to save the patient's life
- Contact the hospital ethics committee to override the decision
- Respect the patient's decision, document it, and notify the physician (Correct answer)
- Ask the family to convince the patient to accept treatment
Correct answer: Respect the patient's decision, document it, and notify the physician
Competent adults have the legal and ethical right to refuse any treatment, including life-saving interventions, based on informed decision-making. The nurse must respect patient autonomy, document the refusal and the patient's understanding of the consequences, and notify the provider.
Question 2: A nurse overhears a colleague discussing a patient's HIV status in the hospital elevator with non-care team members. The nurse should take which action first?
- Ignore it — the colleague may have had a valid reason
- Speak to the colleague privately about the confidentiality violation (Correct answer)
- Report the conversation directly to hospital administration
- Ask the patient for permission to discuss the breach
Correct answer: Speak to the colleague privately about the confidentiality violation
The initial action is to address the colleague directly and privately. HIPAA regulations protect patient health information. Discussing a patient's diagnosis in public areas with unauthorized individuals is a confidentiality violation. If the behavior continues, escalation to management is appropriate.
Question 3: A nurse discovers a medication error made by another nurse earlier in the shift. The medication did not cause patient harm. What is the nurse's ethical and professional obligation?
- Say nothing — the patient was not harmed
- Tell the patient what happened without documenting
- Complete an incident report, notify the charge nurse and physician, and document in the patient record (Correct answer)
- Correct the medication administration record only
Correct answer: Complete an incident report, notify the charge nurse and physician, and document in the patient record
All medication errors, whether or not harm occurred, must be reported via an incident (variance) report, disclosed to the provider, and documented objectively in the medical record. Transparency and accurate reporting are essential for patient safety, quality improvement, and legal protection.
Question 4: A patient is scheduled for surgery and the nurse learns the patient does not understand the risks explained by the surgeon. The nurse should take which action?
- Witness the consent form signature as long as the patient is willing to sign
- Explain the surgical procedure in detail to satisfy the consent requirement
- Refuse to witness the consent and notify the surgeon that the patient needs further explanation (Correct answer)
- Postpone the surgery indefinitely until the patient fully understands
Correct answer: Refuse to witness the consent and notify the surgeon that the patient needs further explanation
Obtaining informed consent is the physician's (or surgeon's) legal responsibility. The nurse's role is to witness that the signature is voluntary and the patient appears competent. If the patient does not understand the procedure or risks, the nurse must notify the surgeon for clarification before witnessing the consent.
Question 5: A patient is admitted to the emergency department unconscious with no identification. Emergency surgery is needed to save the patient's life. Which type of consent applies?
- Implied consent (Correct answer)
- Informed consent
- Substituted consent
- No consent is required in a hospital setting
Correct answer: Implied consent
Implied consent allows healthcare providers to treat an unconscious patient in a life-threatening emergency when the patient is incapable of giving consent and there is no time to locate a surrogate decision-maker. The law implies that a reasonable person in this situation would consent to life-saving treatment.
Question 6: A nurse is caring for a patient who is being discharged against medical advice (AMA). What is the nurse's primary responsibility?
- Physically prevent the patient from leaving to protect them from harm
- Ensure the patient signs the AMA form and provide discharge instructions and medications (Correct answer)
- Withhold the patient's belongings until they agree to stay
- Call law enforcement to detain the patient
Correct answer: Ensure the patient signs the AMA form and provide discharge instructions and medications
A competent patient has the right to leave the hospital at any time. The nurse should ensure the patient signs the AMA form (documenting informed refusal), provide any medications, discharge education, and follow-up information to promote safety. Physically restraining the patient without legal authority constitutes false imprisonment.
NCLEX-PN Test #18 1
A competent adult patient refuses a blood transfusion based on religious beliefs, despite knowing it may result in death.
What is the nurse's most appropriate action?