Study topic
Ethics and care coordination
NCLEX ethics chapter: autonomy beneficence veracity, informed consent and refusal, DNR with comfort needs, ABC prioritization, and discharge referrals.
Ethics and coordination items ask whether you will protect a client’s informed choice, tell the truth, and still pick the crashing airway over the stable wound check.
Ethical principles in one table
| Principle | Exam picture |
|---|---|
| Autonomy | Honor refusal of transfusion or surgery after informed discussion |
| Beneficence | Act for the client’s benefit |
| Nonmaleficence | Avoid preventable harm |
| Justice | Fair allocation of time and resources |
| Veracity | Answer truthfully about results within your role |
| Fidelity | Keep promises and follow through |
Informed consent and refusal
- Provider gives the procedure explanation and obtains consent.
- Nurse confirms the client can explain the plan in their own words.
- If understanding is missing, notify the provider before the procedure.
- Honor revocation of consent before the start of the procedure.
- Emancipated or legally independent minors may consent for themselves when the stem establishes that status.
- Never coerce a competent adult into care they refuse after informed discussion. Document and notify.
Safety
DNR does not mean neglect. Treat pain, dyspnea, and dignity. Give oxygen for hypoxia unless a separate comfort-only order limits it.
Prioritization and referrals
After report, hunt for airway compromise, new breathing failure, unstable circulation, and sudden mental-status change. Stable chronic problems and routine teaching wait.
| Discharge need | Likely referral |
|---|---|
| Ongoing wound care, bathing help, PT at home | Home health |
| New dysphagia + lives alone / stairs | Home health + swallow therapy / PT as ordered |
| Unsafe alone with complex meds | Home health or higher level of care discussion |
Priority map
| Picture | First move |
|---|---|
| Signed consent, still confused about surgery | Stop; provider re-explains |
| Competent refusal of transfusion | Honor autonomy; document; notify |
| DNR + SpO2 84% + “can’t breathe” | Oxygen/comfort; not abandonment |
| Four clients after report | ABC / most unstable first |
| Stroke d/c, alone, new deficits | Home health and therapy referrals |
Must know
- 1Autonomy: respect informed choices, including refusal of recommended care.
- 2Beneficence / nonmaleficence: help and do no harm. Justice: fair resource use. Veracity: truthfulness. Fidelity: keep commitments.
- 3Informed consent: provider explains procedure/risks/benefits/alternatives. Nurse witnesses signature, verifies understanding, and advocates if the client is unsure.
- 4Client who signed but does not understand: do not quietly proceed — notify the provider to re-explain. Client may revoke consent before the procedure.
- 5Emancipated / legally independent minors may consent for their own care per jurisdiction rules tested as “married/independent/self-supporting.”
- 6DNR is not “do not treat.” A dyspneic DNR client still gets oxygen and comfort measures.
- 7Prioritize with ABCs and acute unstable over chronic stable. See the airway/breathing threat first.
- 8Complex discharge (stroke + dysphagia + lives alone): home health / PT / appropriate rehab referrals.
Memory hooks
Signed ≠ understood
A signature on the permit is worthless if the client cannot say what is being done. Stop and get the provider back.
DNR still breathes
Do-not-resuscitate is about CPR, not about withholding oxygen for acute dyspnea.
Airway before paperwork
When four clients compete, the one who cannot protect the airway or oxygenate wins the first assessment.
How it's tested
Stems map an action to an ethical principle, catch a client who signed without understanding, or ask who to see first after report. Distractors force a transfusion after refusal, hide a cancer result, or treat DNR as no oxygen.