Ethics & Legal

Ethics & Legal accounts for approximately 5% of the ANCC exam. Like Professional Practice, these questions are often more straightforward than clinical domains — they test whether you know the rules, not whether you can reason through complex clinical scenarios. Solid preparation here means reliable points on exam day.

Core topics include informed consent (what it requires and when capacity must be assessed), confidentiality and HIPAA (including the exceptions — duty to warn, mandatory reporting, emergency disclosures), involuntary commitment criteria (danger to self, danger to others, grave disability), and boundary management in therapeutic relationships.

The exam also tests the Tarasoff duty to warn and protect, mandatory reporting obligations (child abuse, elder abuse), competency vs. capacity distinctions, the 21st Century Cures Act (patient access to records including psychotherapy notes), and ethical principles (autonomy, beneficence, nonmaleficence, justice). Expect scenarios that require you to balance competing ethical obligations.

• ✕Confusing competency and capacity. Competency is a legal determination made by a court. Capacity is a clinical assessment made by the treating clinician. The exam tests this distinction directly — a patient can lack capacity (clinical judgment) while still being legally competent until a court rules otherwise.
• ✕Applying Tarasoff duty too broadly or too narrowly. Tarasoff requires a specific, identifiable threat to a specific, identifiable person. Generalized statements about wanting to hurt people do not trigger Tarasoff — they may trigger other interventions (safety planning, hospitalization), but the duty to warn a specific third party requires specificity.
• ✕Not knowing when HIPAA allows disclosure without patient consent. Emergencies, mandatory reporting situations, and duty-to-warn scenarios all permit disclosure. The exam tests your ability to identify when confidentiality can be breached and what the minimum necessary standard requires.
• ✕Treating boundary crossings and boundary violations as the same thing. A boundary crossing (accepting a small gift, attending a patient's graduation) may be clinically appropriate in context. A boundary violation (sexual contact, financial exploitation) is always unethical. The distinction matters on the exam.
• ✕Forgetting that involuntary commitment criteria vary by state, but the exam tests the general principle: imminent danger to self, danger to others, or grave disability (inability to care for basic needs). All three pathways should be familiar.