Ethical, Legal, and Professional Practices
What you must know
This domain tests ethical principles (autonomy, beneficence, nonmaleficence, justice, veracity, fidelity), informed consent, confidentiality and its limits, involuntary commitment criteria, duty to warn/protect, mandated reporting, and documentation. Know the scope of practice for the PMHNP, supervision/collaboration requirements, prescribing authority, and professional boundaries. Understand HIPAA basics, minor consent rules, guardianship, competence vs. capacity, and advance directives. Recognize ethical dilemmas such as dual roles, gifts, and conflicts of interest, and know how to use ethics consultation and organizational policy.
Traps
Questions test the exception: confidentiality yields to imminent danger (duty to warn/protect), suspected abuse/neglect (mandated reporting), and certain legal orders. Another trap is confusing competence (legal determination) with capacity (clinical assessment). Watch for stems where autonomy conflicts with safety-e.g., a patient refusing treatment who lacks decision-making capacity. Boundary questions often bait with "helpful" overinvolvement.
Rule of thumb
When safety and confidentiality collide, safety prevails-act to protect, document reasoning, and disclose only what is necessary. For capacity, assess understanding, appreciation, reasoning, and ability to express a choice.
Worked example: A patient discloses a credible, specific plan to harm an identified person. The PMHNP acts on duty to protect (warn the intended victim, notify authorities per state law, consider hospitalization), documents the steps, and discloses only the minimum necessary information.