Professional Nursing Practice and Ethics
Core concepts
Professional practice rests on scope of practice, standards of care, informed consent, confidentiality, advocacy, and the ethical principles of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Know the difference between an ethical dilemma (two defensible moral claims) and an ethical distress situation (you know the right action but an obstacle blocks it). Delegation follows the five rights: right task, circumstance, person, direction/communication, and supervision; the RN retains accountability and cannot delegate assessment, teaching, or evaluation.
Traps in questions
Questions often place the nurse between a physician order and patient preference. The defensible answer protects patient autonomy and follows the chain of command, not blind obedience. Watch for answer choices that say "do nothing and document" or "ask the family to decide" when the patient is competent. Another trap: confusing confidentiality with mandatory reporting; suspected abuse, certain communicable diseases, and imminent threat to an identifiable person override ordinary confidentiality.
Worked example
A competent adult refuses a blood transfusion after surgery. The surgeon insists. Rule of thumb: a competent adult's informed refusal is binding; the nurse validates understanding, documents the refusal, ensures the provider discusses risks, and continues to monitor. Escalation is for disagreements about capacity, not for overriding a capable patient.
Study strategy
Practice sorting interventions into independent nursing actions, collaborative actions, and actions requiring a new order. Review nurse practice act language for your jurisdiction and remember that institutional policy can be stricter than law but never looser.