ANCC IQ
DOMAIN 5: ETHICAL AND LEGAL
PRINCIPLES
FINAL ASSESSMENT REVIEW
2026
A patient with stable schizophrenia refuses to take their prescribed monthly long
acting injectable antipsychotic because they claim it makes their leg feel heavy. The
Psychiatric Nurse Practitioner knows the patient has a history of severe violence
when they are off medication. If the NP chooses to administer the injection against
the patient's will by using physical restraints, which ethical principle is primarily
being violated?
Multiple Choice: A. Beneficence; B. Non maleficence; C. Autonomy; D. Justice
Correct Answer: C. Autonomy
Rationale: Autonomy represents the patient's right to self determination and the
ability to make their own healthcare decisions. While the NP may believe they are
acting for the patient's benefit (beneficence) or the safety of others (non
maleficence), forcing a treatment on a capable adult who has not been legally
declared incompetent is a violation of autonomy.
A Nurse Practitioner is being sued for medical malpractice after a patient
experienced a severe lithium toxicity event. The plaintiff's attorney must prove four
distinct elements for the lawsuit to be successful. The first is "Duty," and the third is
"Causation." Identify the technical legal term for the second element.
Fill in the Blank: Breach of Duty
Correct Answer: Breach of Duty
Rationale: To succeed in a malpractice suit, the plaintiff must prove: 1. A duty was
owed to the patient. 2. A breach of that duty occurred (the NP failed to follow the
standard of care). 3. Causation (the breach directly caused the injury). 4. Damages
(actual harm occurred).
True or False: A Nurse Practitioner is legally permitted to share psychotherapy notes
with a patient's health insurance company for the purpose of processing payment
without obtaining a specific, separate authorization from the patient.
1
,Correct Answer: False
Rationale: Under HIPAA, psychotherapy notes receive special protection. While
general medical records can be shared for "TPO" (Treatment, Payment, Operations),
psychotherapy notes generally require a separate, specific authorization from the
patient before they can be released to a third party, including insurance companies.
A 28 year old male patient tells his Psychiatric Nurse Practitioner: "My boss is a
demon and I am going to wait for him in the parking lot tonight with my hunting
knife to prove he cannot bleed." Based on the landmark Tarasoff v. Regents of the
University of California ruling, what is the NP's immediate legal and ethical
obligation?
Multiple Choice: A. Maintain patient confidentiality at all costs; B. Discharge the
patient immediately for non compliance; C. Warn the intended victim and notify law
enforcement; D. Increase the dosage of antipsychotic medication.
Correct Answer: C. Warn the intended victim and notify law enforcement
Rationale: The "Duty to Warn" (or Duty to Protect) applies when a patient makes a
specific, credible threat against an identifiable victim. In such cases, the provider's
legal obligation to protect the public supersedes the patient's right to confidentiality.
While conducting an initial evaluation on an 82 year old patient who lives with their
daughter, a Nurse Practitioner notices several circular burns on the patient's back that
appear consistent with cigarette burns. The daughter claims the patient "bumped into
a hot stove." As a mandatory reporter, what is the NP's legal requirement?
Multiple Choice: A. Document the daughter's explanation and re evaluate in one
week; B. Confront the daughter and demand an apology; C. Report the suspected
abuse to Adult Protective Services; D. Respect the patient’s request not to involve
the police.
Correct Answer: C. Report the suspected abuse to Adult Protective Services
Rationale: Mandatory reporting laws require healthcare providers to report suspected
abuse of children, elders, or vulnerable adults to the appropriate authorities. The
provider does not need absolute proof; "reasonable suspicion" is sufficient to trigger
the report.
Before a Nurse Practitioner initiates a new clinical research study involving the use
of a novel ketamine protocol for treatment resistant depression, which oversight body
must review and approve the study to protect the rights and safety of human
subjects?
Fill in the Blank: Institutional Review Board (IRB)
Correct Answer: Institutional Review Board (IRB)
Rationale: The IRB is a committee established to review and approve research
involving human subjects. Its primary purpose is to ensure that all research is
conducted ethically and that the risks to participants are minimized and justified by
the benefits.
A clinic manager decides to stop accepting patients who only have Medicaid
coverage because the reimbursement rates are significantly lower than those of
2
, private insurance. Which ethical principle of bioethics is primarily called into
question by this decision?
Multiple Choice: A. Fidelity; B. Veracity; C. Justice; D. Paternalism
Correct Answer: C. Justice
Rationale: Justice refers to the fair and equitable distribution of healthcare resources.
Denying access to care based solely on a patient's socioeconomic status or insurance
type creates an ethical dilemma regarding the fair treatment of all individuals in
society.
True or False: The legal "Scope of Practice" for a Psychiatric Mental Health Nurse
Practitioner is a national standard that remains identical regardless of the state in
which the NP is licensed.
Correct Answer: False
Rationale: While national certification boards set standards for education and
competency, the actual legal scope of practice (including prescriptive authority and
level of independence) is governed by individual state Nurse Practice Acts and State
Boards of Nursing.
A Nurse Practitioner is explaining a new treatment plan involving Clozapine to a
patient. The NP discusses the potential benefits for treatment resistant symptoms and
the requirement for frequent blood monitoring for agranulocytosis. To fulfill the
legal requirements of "Informed Consent," the NP must also explain:
Multiple Choice: A. The cost of the medication; B. The NP's personal opinion of the
pharmaceutical company; C. Alternative treatment options and the risk of refusing
treatment; D. The history of the medication's development.
Correct Answer: C. Alternative treatment options and the risk of refusing treatment
Rationale: Informed consent is a legal and ethical process that requires the provider
to explain the nature of the treatment, the risks and benefits, reasonable alternatives,
and the potential consequences of refusing the intervention.
An NP realizes they prescribed a dosage of a medication that is ten times higher than
intended. Fortunately, the pharmacist caught the error and the patient never received
the dose. Which ethical obligation requires the NP to disclose this "near miss" to the
patient or the organization's quality committee?
Multiple Choice: A. Veracity; B. Paternalism; C. Utilitarianism; D. Fidelity
Correct Answer: A. Veracity
Rationale: Veracity is the duty to be honest and tell the truth. Disclosing errors (even
near misses) is essential for maintaining trust in the provider patient relationship and
for the system to learn and prevent future errors.
A Nurse Practitioner is working in a state with "Restricted Practice" laws. The legal
document that defines the specific tasks the NP can perform and the required
oversight by a physician is known as a:
Fill in the Blank: Collaborative Practice Agreement (CPA)
Correct Answer: Collaborative Practice Agreement (CPA)
Rationale: In states without full practice authority, NPs must often sign a CPA with a
physician. This document outlines the clinical relationship, supervision requirements,
3
DOMAIN 5: ETHICAL AND LEGAL
PRINCIPLES
FINAL ASSESSMENT REVIEW
2026
A patient with stable schizophrenia refuses to take their prescribed monthly long
acting injectable antipsychotic because they claim it makes their leg feel heavy. The
Psychiatric Nurse Practitioner knows the patient has a history of severe violence
when they are off medication. If the NP chooses to administer the injection against
the patient's will by using physical restraints, which ethical principle is primarily
being violated?
Multiple Choice: A. Beneficence; B. Non maleficence; C. Autonomy; D. Justice
Correct Answer: C. Autonomy
Rationale: Autonomy represents the patient's right to self determination and the
ability to make their own healthcare decisions. While the NP may believe they are
acting for the patient's benefit (beneficence) or the safety of others (non
maleficence), forcing a treatment on a capable adult who has not been legally
declared incompetent is a violation of autonomy.
A Nurse Practitioner is being sued for medical malpractice after a patient
experienced a severe lithium toxicity event. The plaintiff's attorney must prove four
distinct elements for the lawsuit to be successful. The first is "Duty," and the third is
"Causation." Identify the technical legal term for the second element.
Fill in the Blank: Breach of Duty
Correct Answer: Breach of Duty
Rationale: To succeed in a malpractice suit, the plaintiff must prove: 1. A duty was
owed to the patient. 2. A breach of that duty occurred (the NP failed to follow the
standard of care). 3. Causation (the breach directly caused the injury). 4. Damages
(actual harm occurred).
True or False: A Nurse Practitioner is legally permitted to share psychotherapy notes
with a patient's health insurance company for the purpose of processing payment
without obtaining a specific, separate authorization from the patient.
1
,Correct Answer: False
Rationale: Under HIPAA, psychotherapy notes receive special protection. While
general medical records can be shared for "TPO" (Treatment, Payment, Operations),
psychotherapy notes generally require a separate, specific authorization from the
patient before they can be released to a third party, including insurance companies.
A 28 year old male patient tells his Psychiatric Nurse Practitioner: "My boss is a
demon and I am going to wait for him in the parking lot tonight with my hunting
knife to prove he cannot bleed." Based on the landmark Tarasoff v. Regents of the
University of California ruling, what is the NP's immediate legal and ethical
obligation?
Multiple Choice: A. Maintain patient confidentiality at all costs; B. Discharge the
patient immediately for non compliance; C. Warn the intended victim and notify law
enforcement; D. Increase the dosage of antipsychotic medication.
Correct Answer: C. Warn the intended victim and notify law enforcement
Rationale: The "Duty to Warn" (or Duty to Protect) applies when a patient makes a
specific, credible threat against an identifiable victim. In such cases, the provider's
legal obligation to protect the public supersedes the patient's right to confidentiality.
While conducting an initial evaluation on an 82 year old patient who lives with their
daughter, a Nurse Practitioner notices several circular burns on the patient's back that
appear consistent with cigarette burns. The daughter claims the patient "bumped into
a hot stove." As a mandatory reporter, what is the NP's legal requirement?
Multiple Choice: A. Document the daughter's explanation and re evaluate in one
week; B. Confront the daughter and demand an apology; C. Report the suspected
abuse to Adult Protective Services; D. Respect the patient’s request not to involve
the police.
Correct Answer: C. Report the suspected abuse to Adult Protective Services
Rationale: Mandatory reporting laws require healthcare providers to report suspected
abuse of children, elders, or vulnerable adults to the appropriate authorities. The
provider does not need absolute proof; "reasonable suspicion" is sufficient to trigger
the report.
Before a Nurse Practitioner initiates a new clinical research study involving the use
of a novel ketamine protocol for treatment resistant depression, which oversight body
must review and approve the study to protect the rights and safety of human
subjects?
Fill in the Blank: Institutional Review Board (IRB)
Correct Answer: Institutional Review Board (IRB)
Rationale: The IRB is a committee established to review and approve research
involving human subjects. Its primary purpose is to ensure that all research is
conducted ethically and that the risks to participants are minimized and justified by
the benefits.
A clinic manager decides to stop accepting patients who only have Medicaid
coverage because the reimbursement rates are significantly lower than those of
2
, private insurance. Which ethical principle of bioethics is primarily called into
question by this decision?
Multiple Choice: A. Fidelity; B. Veracity; C. Justice; D. Paternalism
Correct Answer: C. Justice
Rationale: Justice refers to the fair and equitable distribution of healthcare resources.
Denying access to care based solely on a patient's socioeconomic status or insurance
type creates an ethical dilemma regarding the fair treatment of all individuals in
society.
True or False: The legal "Scope of Practice" for a Psychiatric Mental Health Nurse
Practitioner is a national standard that remains identical regardless of the state in
which the NP is licensed.
Correct Answer: False
Rationale: While national certification boards set standards for education and
competency, the actual legal scope of practice (including prescriptive authority and
level of independence) is governed by individual state Nurse Practice Acts and State
Boards of Nursing.
A Nurse Practitioner is explaining a new treatment plan involving Clozapine to a
patient. The NP discusses the potential benefits for treatment resistant symptoms and
the requirement for frequent blood monitoring for agranulocytosis. To fulfill the
legal requirements of "Informed Consent," the NP must also explain:
Multiple Choice: A. The cost of the medication; B. The NP's personal opinion of the
pharmaceutical company; C. Alternative treatment options and the risk of refusing
treatment; D. The history of the medication's development.
Correct Answer: C. Alternative treatment options and the risk of refusing treatment
Rationale: Informed consent is a legal and ethical process that requires the provider
to explain the nature of the treatment, the risks and benefits, reasonable alternatives,
and the potential consequences of refusing the intervention.
An NP realizes they prescribed a dosage of a medication that is ten times higher than
intended. Fortunately, the pharmacist caught the error and the patient never received
the dose. Which ethical obligation requires the NP to disclose this "near miss" to the
patient or the organization's quality committee?
Multiple Choice: A. Veracity; B. Paternalism; C. Utilitarianism; D. Fidelity
Correct Answer: A. Veracity
Rationale: Veracity is the duty to be honest and tell the truth. Disclosing errors (even
near misses) is essential for maintaining trust in the provider patient relationship and
for the system to learn and prevent future errors.
A Nurse Practitioner is working in a state with "Restricted Practice" laws. The legal
document that defines the specific tasks the NP can perform and the required
oversight by a physician is known as a:
Fill in the Blank: Collaborative Practice Agreement (CPA)
Correct Answer: Collaborative Practice Agreement (CPA)
Rationale: In states without full practice authority, NPs must often sign a CPA with a
physician. This document outlines the clinical relationship, supervision requirements,
3
