BAYLOR UNIVERSITY NURSING PAPER 1 (2026-2027) |
REVISION QUESTIONS AND DETAILED ANSWERS |
EXAM - 150 Questions
Section 1: Professional Nursing Practice and Ethics (Questions 1-15)
1 A staff nurse on a medical-surgical unit discovers that a colleague has been documenting vital signs for a patient
without actually taking them. The colleague has been under significant personal stress and asks the nurse not to
report the incident, stating it was a one-time lapse. The nurse is torn between loyalty to the colleague and
professional integrity. Which ethical principle is most directly challenged in this scenario?
A) Nonmaleficence
B) Fidelity
C) Beneficence
D) Autonomy
Answer: B
Rationale: Fidelity involves keeping promises and being faithful to professional commitments, including accurate
documentation. The nurse's duty to report falsified records is rooted in fidelity to the patient and the profession.
Nonmaleficence (avoiding harm) is relevant but secondary; beneficence (doing good) and autonomy (patient
self-determination) are less directly implicated.
2 A nurse is caring for a patient who has been diagnosed with terminal cancer. The patient's family requests that
the patient not be told the diagnosis, fearing it will cause emotional distress. The patient has not explicitly stated
any preference about information disclosure. According to the ANA Code of Ethics, what is the nurse's primary
obligation?
A) Respect the family's request to protect the patient from harm
B) Disclose the diagnosis to the patient to uphold veracity
C) Withhold information until the patient asks directly
D) Refer the ethical dilemma to the hospital ethics committee
Answer: B
Rationale: The ANA Code of Ethics Provision 1 emphasizes respect for human dignity, which includes the patient's
right to self-determination and truthful information. Veracity (truth-telling) is a core ethical duty; the nurse should
not deceive the patient. While considering family concerns is important, the patient's right to know their diagnosis
takes precedence. Referring to an ethics committee is appropriate for complex cases but does not absolve the nurse
of the duty to be truthful.
3 A nurse is a member of an institutional review board (IRB) reviewing a clinical trial that involves a vulnerable
population of prisoners. The study aims to test a new medication for hepatitis C. Which of the following ethical
considerations is most critical for the IRB to evaluate?
A) The potential for therapeutic misconception among participants
B) The adequacy of the informed consent process to ensure voluntariness
C) The financial compensation offered to participants
D) The scientific validity of the research hypothesis
Answer: B
Rationale: Prisoners are a vulnerable population because their autonomy may be compromised by coercive
environments. The IRB must ensure that consent is truly voluntary, free from undue influence or coercion.
,Therapeutic misconception (confusing research with treatment) is important but secondary to voluntariness.
Compensation and scientific validity are relevant but not the most critical ethical issue for this population.
4 A nurse manager is implementing a new policy that requires all staff to report any medication errors within 24
hours, regardless of patient outcome. Some nurses resist, fearing disciplinary action. Which ethical framework
best supports the implementation of this policy?
A) Utilitarianism, because it promotes the greatest good for the greatest number
B) Deontology, because it upholds the duty to report errors
C) Virtue ethics, because it cultivates the virtue of honesty
D) Principlism, because it balances autonomy and justice
Answer: B
Rationale: Deontology focuses on moral duties and rules; reporting errors is a duty to patients and the profession,
regardless of consequences. Utilitarianism might consider the overall benefit but could allow exceptions if
reporting causes more harm. Virtue ethics emphasizes character but does not provide a clear rule. Principlism is a
framework but deontology most directly supports the obligation to report.
5 A nurse is assigned to care for a patient who is a known member of a religious group that refuses blood
transfusions. The patient is unconscious and requires an emergency transfusion to survive. The patient's advance
directive clearly states refusal of blood products. The surgeon insists on transfusing, citing the principle of
beneficence. The nurse should:
A) Administer the transfusion to save the patient's life
B) Refuse to administer the transfusion and notify the ethics committee
C) Ask the patient's family to override the advance directive
D) Transfer care to another nurse who will follow the surgeon's order
Answer: B
Rationale: The patient's advance directive is a legally binding expression of autonomy. The nurse has an ethical duty
to respect the patient's wishes even when they conflict with beneficence. Refusing to participate and involving the
ethics committee is appropriate to uphold the patient's autonomy and the nurse's integrity. Transferring care does
not resolve the ethical conflict.
6 A nurse is precepting a new graduate who confides that they made a medication error but did not report it
because the patient was unharmed. The preceptor knows that reporting is required by hospital policy and state
law. Which action best demonstrates the preceptor's ethical responsibility?
A) Report the error to the nurse manager without naming the new graduate
B) Advise the new graduate to self-report and explain the ethical and legal obligations
C) Ignore the issue since the patient was not harmed
D) Document the incident in the new graduate's personnel file
Answer: B
Rationale: The preceptor has a duty to mentor and uphold professional standards. Advising self-reporting respects
the new graduate's autonomy while reinforcing accountability. Reporting anonymously undermines transparency.
Ignoring the error violates the duty to protect patients and promote a culture of safety. Documenting in personnel
files is punitive and not the first step.
7 A nurse is caring for a patient who is a Jehovah's Witness and refuses a blood transfusion. The patient is
bleeding profusely and will die without blood. The nurse respects the refusal but feels moral distress. Which
action would be most appropriate to address the nurse's moral distress?
A) Request a different assignment to avoid the conflict
,B) Discuss feelings with a colleague or ethics consultant
C) Persuade the patient to accept the transfusion
D) Document the distress in the patient's chart
Answer: B
Rationale: Moral distress arises when one knows the right action but is constrained from performing it. Discussing
feelings with a trusted colleague or ethics consultant can provide support and validation. Avoiding the assignment
does not resolve the distress. Persuading the patient violates autonomy. Documenting in the chart is not appropriate
for personal feelings.
8 A nurse is part of an interprofessional team that is deciding whether to continue aggressive treatment for a
patient with advanced dementia who is unable to communicate. The family disagrees with the medical
recommendation to transition to comfort care. Which ethical principle should guide the team's decision-making
process?
A) Justice, to ensure fair allocation of resources
B) Beneficence, to act in the patient's best interest
C) Nonmaleficence, to avoid causing harm
D) Autonomy, to respect the patient's previously expressed wishes
Answer: D
Rationale: For patients who lack decision-making capacity, autonomy is respected through advance directives or
substituted judgment based on previously expressed wishes. The patient's prior values and preferences should guide
care. Beneficence and nonmaleficence are important but are secondary to honoring the patient's autonomy. Justice
is less directly relevant in this individual case.
9 A nurse discovers that a colleague has been diverting opioid medications for personal use. The nurse reports the
colleague to the state board of nursing. Which ethical principle primarily supports this action?
A) Veracity
B) Fidelity
C) Justice
D) Nonmaleficence
Answer: B
Rationale: Fidelity includes the duty to protect patients from harm and uphold professional standards. Reporting a
colleague who is impaired fulfills the nurse's obligation to the public and the profession. Veracity (truthfulness) is
involved but is not the primary principle. Justice (fairness) and nonmaleficence (avoiding harm) are relevant but
secondary to the duty of fidelity.
10 A nurse is asked by a physician to administer a medication that the nurse believes is not in the patient's best
interest because the dose is higher than recommended. The physician insists and states that the nurse must
follow orders. Based on the ANA Code of Ethics and nursing scope of practice, what should the nurse do?
A) Administer the medication as ordered and document the concern
B) Refuse to administer and request a written order from the physician
C) Administer the medication but reduce the dose
D) Ask another nurse to administer the medication
Answer: B
Rationale: The nurse has an ethical and legal duty to advocate for the patient and refuse to carry out orders that
could cause harm. Requesting a written order ensures accountability and allows the nurse to formally challenge the
order. Administering and documenting does not protect the patient. Reducing the dose is practicing outside scope.
Delegating to another nurse is inappropriate.
, 11 A nurse is caring for a patient who is a minor and whose parents refuse a life-saving blood transfusion based on
religious beliefs. The healthcare team believes the transfusion is medically necessary. Which legal and ethical
action should the nurse anticipate?
A) Respect the parents' decision and provide supportive care
B) Seek a court order to override parental refusal
C) Administer the transfusion without consent
D) Transfer the patient to another facility
Answer: B
Rationale: In cases where parental refusal places a child at risk of serious harm or death, the state may intervene
under parens patriae to protect the child. Seeking a court order is the appropriate legal mechanism to override
refusal. Administering without consent could lead to legal liability. Transferring may delay necessary care.
12 A nurse is participating in a research study as a co-investigator. The study involves a placebo-controlled trial
for a new antidepressant. A participant in the placebo group is experiencing worsening depression and
expresses suicidal ideation. What is the nurse's primary ethical obligation?
A) Maintain the integrity of the study by not unblinding the participant
B) Ensure the participant receives appropriate clinical care, even if it means unblinding
C) Refer the participant to a mental health provider outside the study
D) Withdraw the participant from the study without explanation
Answer: B
Rationale: The nurse's duty to protect participant welfare supersedes research goals. Unblinding may be necessary to
ensure the participant receives appropriate treatment. Maintaining the study integrity is secondary to preventing
harm. Referring externally may delay care. Withdrawing without explanation violates the participant's right to
know.
13 A nurse is a member of a hospital ethics committee reviewing a case of a patient with end-stage renal disease
who refuses dialysis. The patient is competent and has made an informed decision. The attending physician is
uncomfortable with the decision and wants to override it. Which ethical principle should the committee
emphasize?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Answer: C
Rationale: A competent adult patient has the right to refuse even life-sustaining treatment under the principle of
autonomy. The physician's discomfort does not justify overriding the patient's decision. Beneficence cannot
override autonomy in this context. Nonmaleficence and justice are less central.
14 A nurse is precepting a student nurse who is observed documenting care that was not provided. The student
says they were busy and intended to do it later. Which action by the preceptor is most ethically sound?
A) Report the student to the nursing program immediately
B) Counsel the student about the importance of veracity and inform the clinical instructor
C) Ignore the incident to avoid damaging the student's confidence
D) Document the incident in the student's evaluation
Answer: B
Rationale: The preceptor has a duty to educate and correct behavior while maintaining patient safety. Counseling the
student addresses the ethical breach and allows for learning. Reporting immediately without counseling may be
REVISION QUESTIONS AND DETAILED ANSWERS |
EXAM - 150 Questions
Section 1: Professional Nursing Practice and Ethics (Questions 1-15)
1 A staff nurse on a medical-surgical unit discovers that a colleague has been documenting vital signs for a patient
without actually taking them. The colleague has been under significant personal stress and asks the nurse not to
report the incident, stating it was a one-time lapse. The nurse is torn between loyalty to the colleague and
professional integrity. Which ethical principle is most directly challenged in this scenario?
A) Nonmaleficence
B) Fidelity
C) Beneficence
D) Autonomy
Answer: B
Rationale: Fidelity involves keeping promises and being faithful to professional commitments, including accurate
documentation. The nurse's duty to report falsified records is rooted in fidelity to the patient and the profession.
Nonmaleficence (avoiding harm) is relevant but secondary; beneficence (doing good) and autonomy (patient
self-determination) are less directly implicated.
2 A nurse is caring for a patient who has been diagnosed with terminal cancer. The patient's family requests that
the patient not be told the diagnosis, fearing it will cause emotional distress. The patient has not explicitly stated
any preference about information disclosure. According to the ANA Code of Ethics, what is the nurse's primary
obligation?
A) Respect the family's request to protect the patient from harm
B) Disclose the diagnosis to the patient to uphold veracity
C) Withhold information until the patient asks directly
D) Refer the ethical dilemma to the hospital ethics committee
Answer: B
Rationale: The ANA Code of Ethics Provision 1 emphasizes respect for human dignity, which includes the patient's
right to self-determination and truthful information. Veracity (truth-telling) is a core ethical duty; the nurse should
not deceive the patient. While considering family concerns is important, the patient's right to know their diagnosis
takes precedence. Referring to an ethics committee is appropriate for complex cases but does not absolve the nurse
of the duty to be truthful.
3 A nurse is a member of an institutional review board (IRB) reviewing a clinical trial that involves a vulnerable
population of prisoners. The study aims to test a new medication for hepatitis C. Which of the following ethical
considerations is most critical for the IRB to evaluate?
A) The potential for therapeutic misconception among participants
B) The adequacy of the informed consent process to ensure voluntariness
C) The financial compensation offered to participants
D) The scientific validity of the research hypothesis
Answer: B
Rationale: Prisoners are a vulnerable population because their autonomy may be compromised by coercive
environments. The IRB must ensure that consent is truly voluntary, free from undue influence or coercion.
,Therapeutic misconception (confusing research with treatment) is important but secondary to voluntariness.
Compensation and scientific validity are relevant but not the most critical ethical issue for this population.
4 A nurse manager is implementing a new policy that requires all staff to report any medication errors within 24
hours, regardless of patient outcome. Some nurses resist, fearing disciplinary action. Which ethical framework
best supports the implementation of this policy?
A) Utilitarianism, because it promotes the greatest good for the greatest number
B) Deontology, because it upholds the duty to report errors
C) Virtue ethics, because it cultivates the virtue of honesty
D) Principlism, because it balances autonomy and justice
Answer: B
Rationale: Deontology focuses on moral duties and rules; reporting errors is a duty to patients and the profession,
regardless of consequences. Utilitarianism might consider the overall benefit but could allow exceptions if
reporting causes more harm. Virtue ethics emphasizes character but does not provide a clear rule. Principlism is a
framework but deontology most directly supports the obligation to report.
5 A nurse is assigned to care for a patient who is a known member of a religious group that refuses blood
transfusions. The patient is unconscious and requires an emergency transfusion to survive. The patient's advance
directive clearly states refusal of blood products. The surgeon insists on transfusing, citing the principle of
beneficence. The nurse should:
A) Administer the transfusion to save the patient's life
B) Refuse to administer the transfusion and notify the ethics committee
C) Ask the patient's family to override the advance directive
D) Transfer care to another nurse who will follow the surgeon's order
Answer: B
Rationale: The patient's advance directive is a legally binding expression of autonomy. The nurse has an ethical duty
to respect the patient's wishes even when they conflict with beneficence. Refusing to participate and involving the
ethics committee is appropriate to uphold the patient's autonomy and the nurse's integrity. Transferring care does
not resolve the ethical conflict.
6 A nurse is precepting a new graduate who confides that they made a medication error but did not report it
because the patient was unharmed. The preceptor knows that reporting is required by hospital policy and state
law. Which action best demonstrates the preceptor's ethical responsibility?
A) Report the error to the nurse manager without naming the new graduate
B) Advise the new graduate to self-report and explain the ethical and legal obligations
C) Ignore the issue since the patient was not harmed
D) Document the incident in the new graduate's personnel file
Answer: B
Rationale: The preceptor has a duty to mentor and uphold professional standards. Advising self-reporting respects
the new graduate's autonomy while reinforcing accountability. Reporting anonymously undermines transparency.
Ignoring the error violates the duty to protect patients and promote a culture of safety. Documenting in personnel
files is punitive and not the first step.
7 A nurse is caring for a patient who is a Jehovah's Witness and refuses a blood transfusion. The patient is
bleeding profusely and will die without blood. The nurse respects the refusal but feels moral distress. Which
action would be most appropriate to address the nurse's moral distress?
A) Request a different assignment to avoid the conflict
,B) Discuss feelings with a colleague or ethics consultant
C) Persuade the patient to accept the transfusion
D) Document the distress in the patient's chart
Answer: B
Rationale: Moral distress arises when one knows the right action but is constrained from performing it. Discussing
feelings with a trusted colleague or ethics consultant can provide support and validation. Avoiding the assignment
does not resolve the distress. Persuading the patient violates autonomy. Documenting in the chart is not appropriate
for personal feelings.
8 A nurse is part of an interprofessional team that is deciding whether to continue aggressive treatment for a
patient with advanced dementia who is unable to communicate. The family disagrees with the medical
recommendation to transition to comfort care. Which ethical principle should guide the team's decision-making
process?
A) Justice, to ensure fair allocation of resources
B) Beneficence, to act in the patient's best interest
C) Nonmaleficence, to avoid causing harm
D) Autonomy, to respect the patient's previously expressed wishes
Answer: D
Rationale: For patients who lack decision-making capacity, autonomy is respected through advance directives or
substituted judgment based on previously expressed wishes. The patient's prior values and preferences should guide
care. Beneficence and nonmaleficence are important but are secondary to honoring the patient's autonomy. Justice
is less directly relevant in this individual case.
9 A nurse discovers that a colleague has been diverting opioid medications for personal use. The nurse reports the
colleague to the state board of nursing. Which ethical principle primarily supports this action?
A) Veracity
B) Fidelity
C) Justice
D) Nonmaleficence
Answer: B
Rationale: Fidelity includes the duty to protect patients from harm and uphold professional standards. Reporting a
colleague who is impaired fulfills the nurse's obligation to the public and the profession. Veracity (truthfulness) is
involved but is not the primary principle. Justice (fairness) and nonmaleficence (avoiding harm) are relevant but
secondary to the duty of fidelity.
10 A nurse is asked by a physician to administer a medication that the nurse believes is not in the patient's best
interest because the dose is higher than recommended. The physician insists and states that the nurse must
follow orders. Based on the ANA Code of Ethics and nursing scope of practice, what should the nurse do?
A) Administer the medication as ordered and document the concern
B) Refuse to administer and request a written order from the physician
C) Administer the medication but reduce the dose
D) Ask another nurse to administer the medication
Answer: B
Rationale: The nurse has an ethical and legal duty to advocate for the patient and refuse to carry out orders that
could cause harm. Requesting a written order ensures accountability and allows the nurse to formally challenge the
order. Administering and documenting does not protect the patient. Reducing the dose is practicing outside scope.
Delegating to another nurse is inappropriate.
, 11 A nurse is caring for a patient who is a minor and whose parents refuse a life-saving blood transfusion based on
religious beliefs. The healthcare team believes the transfusion is medically necessary. Which legal and ethical
action should the nurse anticipate?
A) Respect the parents' decision and provide supportive care
B) Seek a court order to override parental refusal
C) Administer the transfusion without consent
D) Transfer the patient to another facility
Answer: B
Rationale: In cases where parental refusal places a child at risk of serious harm or death, the state may intervene
under parens patriae to protect the child. Seeking a court order is the appropriate legal mechanism to override
refusal. Administering without consent could lead to legal liability. Transferring may delay necessary care.
12 A nurse is participating in a research study as a co-investigator. The study involves a placebo-controlled trial
for a new antidepressant. A participant in the placebo group is experiencing worsening depression and
expresses suicidal ideation. What is the nurse's primary ethical obligation?
A) Maintain the integrity of the study by not unblinding the participant
B) Ensure the participant receives appropriate clinical care, even if it means unblinding
C) Refer the participant to a mental health provider outside the study
D) Withdraw the participant from the study without explanation
Answer: B
Rationale: The nurse's duty to protect participant welfare supersedes research goals. Unblinding may be necessary to
ensure the participant receives appropriate treatment. Maintaining the study integrity is secondary to preventing
harm. Referring externally may delay care. Withdrawing without explanation violates the participant's right to
know.
13 A nurse is a member of a hospital ethics committee reviewing a case of a patient with end-stage renal disease
who refuses dialysis. The patient is competent and has made an informed decision. The attending physician is
uncomfortable with the decision and wants to override it. Which ethical principle should the committee
emphasize?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Answer: C
Rationale: A competent adult patient has the right to refuse even life-sustaining treatment under the principle of
autonomy. The physician's discomfort does not justify overriding the patient's decision. Beneficence cannot
override autonomy in this context. Nonmaleficence and justice are less central.
14 A nurse is precepting a student nurse who is observed documenting care that was not provided. The student
says they were busy and intended to do it later. Which action by the preceptor is most ethically sound?
A) Report the student to the nursing program immediately
B) Counsel the student about the importance of veracity and inform the clinical instructor
C) Ignore the incident to avoid damaging the student's confidence
D) Document the incident in the student's evaluation
Answer: B
Rationale: The preceptor has a duty to educate and correct behavior while maintaining patient safety. Counseling the
student addresses the ethical breach and allows for learning. Reporting immediately without counseling may be
