NCLEX-RN cheat sheet · Management of care
Legal, ethical and client rights
Scope and malpractice, informed consent and refusal, confidentiality, ethical principles, mandatory reporting
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The practice act sets your scope. A capable adult can refuse. Share only for a permitted purpose. Report suspected child abuse on reasonable suspicion, not proof; follow state law for adults.
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At a glance
Who sets your scope
- Every state has a nurse practice act: license qualifications, titles and scope of practice. The board of nursing enforces it to protect the public.
- Compact license: the rules of the state where the client is located when you give the care.
- Hospital policy can be stricter than the law, never looser. A provider's order doesn't widen your scope.
- Only the board of nursing can act on a license; a lawsuit can't take it.
- Good Samaritan laws protect good-faith emergency aid off duty, though the details vary.
Allowed isn't the same as ready
- Scope: what any nurse at your level may do. Competence: whether you, today, can do it safely.
- Is it allowed, covered by policy, am I competent, will I accept accountability? A single no means you don't do it.
- Not prepared: don't start it, tell the charge nurse, and ask for training, help or reassignment.
- Keep giving the care you can. Leaving accepted clients without a handoff is patient abandonment.
Legal wrongs
| Term | Means |
|---|---|
| Assault | Threatening unwanted contact, like "we'll have to hold you down" |
| Battery | Touching a client without consent, even with no injury |
| Fraud | Charting care you didn't give |
| Negligence | Unintentional: not giving the care a reasonable person would |
| Malpractice | Negligence by a licensed professional, measured against a reasonably prudent nurse |
Malpractice: all four elements
| Element | Numbness under a new cast, charted, never reported |
|---|---|
| Duty | A nurse-client relationship: it began when she took report |
| Breach | Below the standard: a reasonably prudent nurse reports it promptly |
| Causation | The delay led to the damage |
| Harm | Real damages: permanent nerve damage |
Watch: She documented the finding, but documenting isn't acting.
Informed consent: who does what
| Task | Whose job |
|---|---|
| Explain the procedure, risks and alternatives; answer detailed questions | Provider doing it |
| Witness the signature: it confirms this person signed, not that you explained the procedure | Nurse |
| Check the client seems to understand. If not, stop and call the provider | Nurse |
| Confirm a valid, signed consent is on the chart before the procedure | Nurse |
Also: Nursing care needs consent too: a bath, a medication, an IV. Consent can be withdrawn at any time, even after signing.
Who can consent?
- An alert adult who can decide: the client, even if family disagrees.
- Competence is legal, decided by a judge. Capacity is this decision, right now; it can come and go, as with delirium or intoxication.
- No capacity: an activated health care power of attorney, a guardian, or next of kin where law allows.
- Minors need a parent or guardian unless state law says otherwise; some minors consent for certain care, varying by state.
- True emergency: the client can't decide and no authorized person is available. Treatment can go ahead; document why.
Refusal, advocacy and interpreters
- A capable adult can refuse any treatment, even life-saving. Make it informed, tell the provider, document it in the client's words, and offer again later.
- Never pressure, trick or threaten.
- Advocacy: inform, don't decide. A capable adult's choice is theirs.
- A qualified interpreter, free, accurate and timely. Never a child, except for a moment in an emergency.
Six ethical principles
| Principle | The nurse... |
|---|---|
| Autonomy | Respects a capable client's refusal |
| Beneficence | Sits with a dying client so she isn't alone |
| Nonmaleficence | Double-checks a high-alert drug |
| Justice | Same care whatever a client can pay; ranks by need |
| Fidelity | Comes back in an hour, as promised |
| Veracity | Explains a side effect honestly |
Paternalism: Overriding a choice for the client's own good. Explain the risks, document, and keep offering.
Can you share it?
| Who's asking | Share? |
|---|---|
| A nurse taking over her care | Yes: treatment |
| Her husband, whom she asked to be involved | What's relevant to his part |
| A caller who says he's her brother | No: can't be verified; follow policy |
| The health department, reportable disease | Yes, what the law requires |
| A curious coworker on another unit | No permitted reason |
Rules: Share the minimum necessary, except treatment disclosures to providers; other exceptions exist. Staff access stays role-based. Records request: the provider acts within 30 calendar days of receipt.
Privacy and social media
- Open only a chart your role gives you a permitted reason to open; a few seconds is still a breach.
- Never post anything that could identify a client: a room number and an event can. No client photos on your own phone.
- Private groups aren't private, and deleting doesn't undo a disclosure. Report any breach promptly.
Mandatory reporting
- Child abuse: nurses are mandated reporters in every state. Report on reasonable suspicion; no proof needed, and you don't investigate.
- In many states, policy doesn't replace your own duty to report.
- Adult Protective Services: abuse, neglect, self-neglect, financial exploitation.
- Document objectively, the client's words in quotes; don't confront the suspect.
After an error: chart or incident report?
| Detail | Goes in |
|---|---|
| What happened, the client's condition, the provider notified and when, the care given | Chart |
| The words "incident report filed" | Never the chart |
| What else was going on, like an interruption or a look-alike vial | Incident report |
First: Check the client and give any care needed, then tell the provider, follow policy, and complete an incident report. Near misses get reported too.
Priority and safety calls
- ★ About to sign, the client asks what exactly they're going to do: hold the signing and ask the surgeon to talk with her.
- A capable adult refuses a transfusion the family wants: respect the refusal, make sure it's informed, tell the provider, document.
- ★ A colleague often off the unit, making errors, giving others' clients their opioids: report your observations to the charge nurse or manager. Impaired on duty now: keep them away from clients.
- ★ A capable client declines more chemotherapy and her family pushes back: support her decision; request an ethics consult if the conflict continues.
- ★ Bruises that don't fit the story: report the suspicion, following state law and policy.
How the NCLEX tests it
- Scope distractors: the provider said it was fine, learn as you go, refuse everything and leave.
- Consent traps: the nurse explaining the surgery, a child interpreting, overriding a capable adult.
- Confidentiality traps: she's family, I didn't use the name, I deleted it, it was a private group.
- Ethics traps: beneficence mistaken for paternalism, deciding for the client, staying silent.
- Reporting traps: waiting for proof, confronting the abuser, charting incident report filed, keeping a colleague's secret.
Practice it next
This sheet comes from Scope of practice and legal responsibilities and Client rights, advocacy and informed consent and Confidentiality, privacy and social media and Ethics and ethical dilemmas and Mandatory reporting, errors and unsafe practice in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- Touching without consent, even with no injury, is ___.
Show answer
battery - Malpractice needs duty, breach, causation and ___.
Show answer
harm - Witnessing the signature confirms this person ___ the form.
Show answer
signed - Knowing the right action but being blocked from it is moral ___.
Show answer
distress - Report suspected child abuse on reasonable ___.
Show answer
suspicion
Sources
- Open RN, NMPC 2e, 5.6 Other Legal Issues
- HHS, Minimum Necessary Requirement
- NCSBN, A Nurse's Guide to the Use of Social Media
- Open RN, NMPC 2e, 6.2 Basic Ethical Concepts
- Child Welfare Information Gateway, Mandatory Reporting
More management of care cheat sheets
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.