Ethical Principles in Nursing: What Every NCLEX Test-Taker must Know in 2025

Ethical principles in nursing — including respect for patient autonomy, beneficence, nonmaleficence, justice, fidelity, veracity, and accountability — provide a framework for clinical decision‑making, patient advocacy, and professional conduct across care settings.

Introduction

Nursing is a profession rooted in compassion, integrity, and unwavering commitment to patient welfare. As an NCLEX test-taker preparing to join this noble field, understanding the ethical principles that guide nursing practice is not only essential for passing your exam but also for shaping your future career as a responsible and empathetic healthcare provider. The National Council Licensure Examination (NCLEX) consistently assesses candidates’ grasp of ethical concepts, their ability to navigate complex moral dilemmas, and their readiness to uphold professional standards.

The Foundations of Nursing Ethics

Ethics in nursing is based on a framework of principles that safeguard the dignity, rights, and well-being of patients. These principles are not merely theoretical—they are woven into the fabric of daily nursing practice, influencing decisions, actions, and interactions with patients, families, and colleagues. The American Nurses Association (ANA) Code of Ethics, along with international standards, provides the foundation for ethical nursing practice. While the NCLEX is a US-based exam, Indian nursing curricula and other global standards also emphasise these universal ethical tenets.

Core Ethical Principles in Nursing

1.Autonomy

Autonomy refers to the patient’s right to make informed decisions about their own healthcare. Nurses are responsible for respecting these choices, even if they differ from medical recommendations or personal beliefs. This principle is especially relevant in scenarios involving informed consent, refusal of treatment, and end-of-life care.

2.Beneficence

Beneficence is the duty to act in the best interest of the patient, promoting well-being, and preventing harm. It requires nurses to provide competent care, advocate for patients, and intervene when necessary to protect their health and safety.

3.Nonmaleficence

Nonmaleficence means “do no harm.” Nurses must avoid causing injury or suffering, whether through action or inaction. This principle often comes into play when weighing the risks and benefits of treatments or procedures.

4.Justice

Justice in nursing entails fairness in the distribution of resources, care, and treatment. Nurses must ensure that all patients receive equitable care regardless of their background, socioeconomic status, or personal characteristics.

5.Fidelity

Fidelity refers to faithfulness to commitments and responsibilities. Nurses must honour promises made to patients, maintain confidentiality, and uphold professional standards.

6.Veracity

Veracity is the obligation to tell the truth. Nurses must communicate honestly with patients, families, and colleagues, providing accurate information and correcting misunderstandings.

Application of Ethical Principles in Nursing Practice

Ethical principles are not abstract concepts; they guide nurses through everyday challenges and complex dilemmas. Understanding how these principles apply in practice is crucial for both patient care and NCLEX success.

1. Autonomy in Action

Consider a scenario in which a patient refuses a recommended surgical procedure. As a nurse, your role is to respect the patient’s decision, provide all necessary information, and ensure that their choice is informed and voluntary. You may need to advocate for the patient’s wishes, even if they conflict with the healthcare provider’s opinion. On the NCLEX, questions may ask you to identify the appropriate response when a patient exercises autonomy, such as supporting their right to refuse treatment.

2. Beneficence and Advocacy

Beneficence often requires nurses to go beyond routine care, acting as advocates for patients. For example, if a patient requires a medication that is not readily available, the nurse should take steps to secure the medication, ensuring optimal care. Advocacy also involves recognising when a patient’s needs are being overlooked and taking steps to address those gaps.

3. Nonmaleficence and Risk Management

Nurses frequently encounter situations where they must balance potential benefits and harms. Administering a medication with known side effects, for instance, requires careful consideration of nonmaleficence. The nurse must monitor for adverse reactions and intervene promptly if harm occurs, documenting all actions and communicating with the healthcare team.

4. Justice in Resource Allocation

Justice is particularly relevant in settings where resources are limited, such as during natural disasters or pandemics. Nurses must allocate care based on need and urgency, avoiding discrimination or favouritism. In NCLEX scenarios, justice may be tested through questions about prioritising patients or managing waitlists.

5. Fidelity and Confidentiality

Fidelity is closely linked to maintaining patient trust. Nurses must protect patient confidentiality, sharing information only with authorised individuals. Breaching confidentiality, even unintentionally, can undermine trust and violate ethical standards. NCLEX questions may present scenarios in which confidentiality is at risk, requiring you to select the most ethical response.

6. Veracity and Communication

Honest communication is vital in nursing. Nurses must provide truthful information about diagnoses, treatments, and prognoses, even when the news is difficult. Veracity also involves correcting misinformation and clarifying misunderstandings. On the NCLEX, expect questions about how to respond when a patient or family member asks for information.

Ethical Dilemmas in Nursing

Ethical dilemmas arise when two or more principles conflict, and there is no clear “right” answer. Nurses must use critical thinking, professional guidelines, and empathy to navigate these situations. Common dilemmas include end-of-life decisions, allocation of scarce resources, and balancing patient autonomy with family wishes.

• End-of-Life Care: Decisions about withdrawing life support or administering palliative sedation require careful consideration of autonomy, beneficence, and nonmaleficence.
• Resource Allocation: During crises, nurses may need to decide which patients receive limited treatments, balancing justice and beneficence.
• Confidentiality vs. Safety: When a patient’s confidentiality conflicts with the need to protect others (e.g., reporting communicable diseases), nurses must weigh fidelity against beneficence and justice.

Ethical Decision-Making Models

To approach ethical dilemmas systematically, nurses can use decision-making models such as:

1. Moral Model: Identify the problem, gather information, consider alternatives, make a decision, act, and evaluate outcomes.
2. Four-Box Method: Examine medical indications, patient preferences, quality of life, and contextual features.
3. Ethical Principles Approach: Analyse the dilemma through the lens of the six core principles, balancing competing interests.

On the NCLEX, ethical decision-making questions often require you to identify the best course of action based on the principles involved. Practise using these models to enhance your critical thinking skills.

Legal and Regulatory Considerations

Ethics and law are closely intertwined in nursing. Nurses must adhere to legal standards, including patient rights, consent procedures, and mandated reporting. Violating ethical principles can have legal consequences, such as disciplinary action or loss of licensure. The NCLEX frequently tests knowledge of legal requirements related to ethical practice, such as documentation, informed consent, and confidentiality.

• Informed Consent: Nurses must ensure that patients understand the risks, benefits, and alternatives before agreeing to treatment.
• Documentation: Accurate and timely documentation is both an ethical and legal obligation.
• Reporting: Nurses are legally required to report abuse, neglect, and certain communicable diseases, even if it conflicts with confidentiality.

Cultural Sensitivity and Ethical Practice

India is a diverse country, and nurses must be sensitive to cultural differences while upholding ethical principles. Respecting religious beliefs, dietary practices, and family traditions is part of providing holistic and ethical care. On the NCLEX, questions may address cultural competence, requiring you to balance ethical principles with respect for cultural values.

Strategies for NCLEX Success: Ethical Principles

Ethical principles are a recurring theme on the NCLEX. To excel, you must be able to:

1. Identify Ethical Issues: Read each question carefully, noting any ethical dilemmas or conflicts between principles.
2. Apply Principles: Use your knowledge of autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity to select the best response.
3. Prioritise Patient Welfare: Patient safety, dignity, and rights should guide your decisions.
4. Understand Legal Implications: Recognise when legal requirements overlap with ethical obligations.
5. Practise Cultural Competence: Consider cultural factors in ethical decision-making.

Practise with NCLEX-style questions focusing on ethical scenarios. Review rationales for both correct and incorrect answers to deepen your understanding.

Sample NCLEX Ethical Questions

1. A patient refuses life-saving treatment. What should the nurse do?
2. Respect the patient’s autonomy, provide information about consequences, and document the refusal.
3. A nurse discovers a colleague has made a medication error but has not reported it. What is the most ethical action?
4. Encourage the colleague to report the error, and if necessary, report it to ensure patient safety and uphold fidelity and veracity.
5. A patient asks the nurse not to tell their family about a diagnosis. What should the nurse do?
6. Maintain confidentiality unless there is a legal requirement to disclose.
7. During a disaster, resources are scarce. How should the nurse allocate care?
8. Distribute resources based on urgency and need, upholding justice.

Professional Conduct and Ethical Leadership

Nurses are expected to demonstrate professionalism and ethical leadership at all times. This includes maintaining boundaries, managing conflicts of interest, and acting as role models for ethical behaviour. The NCLEX tests your understanding of professional conduct, including scenarios involving unprofessional behaviour, bullying, or breaches of ethics.

Ethical Challenges in Modern Nursing (2025)

With advances in technology, changing healthcare systems, and evolving societal values, new ethical challenges are emerging. These include:

• Telemedicine: Ensuring confidentiality, informed consent, and equitable access to care in virtual settings.
• Genetic Testing: Balancing patient autonomy with potential implications for families and communities.
• Artificial Intelligence in Healthcare: Addressing issues of bias, transparency, and accountability.
• Global Health Crises: Navigating resource allocation, vaccination policies, and public health ethics.

As a future nurse, staying informed about these developments and their ethical implications will be essential for responsible practice.

Conclusion

Ethical principles form the backbone of nursing practice, shaping every decision, interaction, and intervention. For NCLEX test-takers, mastering these principles is vital—not only for exam success but for becoming compassionate, competent, and trustworthy professionals. Remember to approach each ethical scenario with empathy, critical thinking, and a commitment to upholding the highest standards of care. As you prepare for the NCLEX in 2025, let these ethical tenets guide you towards a fulfilling and impactful career in nursing.

REFERENCES

1. Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 6 – Ethical Practice. Available from: https://www.ncbi.nlm.nih.gov/books/NBK598377/
2. Haddad LM, Geiger RA. Nursing Ethical Considerations. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526054/

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