# An alert adult can understand the relevant information, appreciate the consequences, reason about the options, and communicate a choice but refuses recommended surgery for newly diagnosed lung cancer. The adult children ask the team to proceed anyway and to conceal the prognosis. Which nursing actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372446&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

An alert adult can understand the relevant information, appreciate the consequences, reason about the options, and communicate a choice but refuses recommended surgery for newly diagnosed lung cancer. The adult children ask the team to proceed anyway and to conceal the prognosis. Which nursing actions are appropriate? Select all that apply.

1

Weigh autonomy, beneficence, nonmaleficence, and justice while identifying the client's values and information preferences

2

Let the family authorize surgery over the refusal because relatives determine what is best for an adult with cancer

3

Document the client's decision, the ethical concern, communication, and escalation through the appropriate chain of command

4

Conceal the diagnosis and prognosis solely at the family's request without asking what information the client wants

5

Respect the informed refusal of an adult with decision-making capacity even when the family or nurse disagrees

6

Request an ethics consultation when conflict persists despite clarification, communication, and attempts to resolve it at the bedside

## Explanation

Ethical reasoning balances respect for autonomy with beneficence, nonmaleficence, and justice and begins with the client's values and preferences for receiving information (Choice 1). An adult with decision-making capacity may provide informed consent or informed refusal, and family disagreement does not override that decision (Choice 5). Document the decision, relevant communication, advocacy, and escalation through organizational channels (Choice 3). When conflict remains unresolved, an ethics consultation can provide structured multidisciplinary support (Choice 6). Family members cannot authorize unwanted surgery for an adult who has capacity (Choice 2). The team should ask what the client wants to know and whom the client authorizes to receive information; concealing information solely because relatives request it violates autonomy and truthful communication (Choice 4).

## In-depth explanation

Clinical Judgment
The nurse uses the four-principle framework for every ethical question: Autonomy (right to choose), Beneficence (do good), Nonmaleficence (do no harm), Justice (fair distribution). When principles conflict, the autonomy of a competent adult typically prevails.

Memory Tip
Ethics quick scan = A-B-N-J. Add veracity (truth) and fidelity (keep promises) for everyday practice. Escalate complex cases to the ethics committee.

KR vs US
In Korea, families often direct medical decisions and may prefer to withhold a serious diagnosis from an older adult. NCLEX-RN aligns with US legal and ethical norms: the competent client decides, and concealment requested by the family is not ethically permitted.

## Clinical scenario

Clinical Practice Guide
ANA Code of Ethics for Nurses, Beauchamp and Childress Principles of Biomedical Ethics, and ASBH Core Competencies for Health Care Ethics Consultation: assess capacity, identify the principles in tension, gather perspectives from the client, family, and team, and consult the ethics committee for unresolved dilemmas. Document the process. Provide truthful, compassionate disclosure with appropriate timing and support.

Caution
Common NCLEX traps: deferring to family judgment over a competent client, agreeing to conceal a diagnosis, and skipping ethics-committee consultation. Remember: a competent client decides for themselves — the nurse advocates and supports, but does not override.

## Key concepts

- **Four Principles of Biomedical Ethics** — Beauchamp and Childress framework: Autonomy (respect for self-determination), Beneficence (act for the benefit of the client), Nonmaleficence (do no harm), and Justice (fair distribution of benefits and burdens). NCLEX exam tip: when principles conflict, the autonomy of a competent adult typically takes priority unless overridden by clear harm to others or legal requirements.
- **Ethics Committee Consultation** — Multidisciplinary institutional resource — usually including ethicists, clinicians, social work, chaplaincy, and legal counsel — that helps analyze complex cases and offer non-binding recommendations. Triggered by unresolved dilemmas around capacity, end-of-life choices, family conflict, resource allocation, and conscience-based refusals. NCLEX exam tip: an option that escalates an unresolved ethical dilemma to the ethics committee is almost always correct.
- **Veracity** — The ethical principle of truth-telling. Nurses provide complete and accurate information appropriate to the role of the nurse, support clients during difficult disclosures, and avoid deception even when family members request concealment. Veracity is closely linked to autonomy because clients need true information to make informed choices. NCLEX exam tip: an option that asks the nurse to lie to or hide information from a competent client is wrong.

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