Free PMHNP board review · 10 practice questions
Informed Consent & Capacity Practice Questions
Assess capacity, informed refusal, emergency consent, and surrogate decisions.
Independent educational practice, not official ANCC exam items. Not affiliated with or endorsed by ANCC. Not legal advice. Apply current law, your scope of practice, and your organization’s procedures. Sources reviewed October 8, 2026.
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Question 1 of 10
Before starting a new medication, a patient signs the clinic form but cannot explain what the medication is for or what alternatives were discussed. What should the PMHNP do next?
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Correct answer: B. Pause and explain the treatment, relevant risks, benefits, alternatives, and option of no treatment, then check understanding
Informed consent is a communication process. A signature cannot substitute for meaningful disclosure, understanding, and a voluntary decision.
Why the other answers are less appropriate
- A. Treat the signature as proof of informed consent: A signature alone does not establish an informed decision.
- C. Ask a witness to sign and proceed: A witness cannot repair the missing discussion.
- D. Skip discussion because a prescription is not a procedure: Medication decisions also require an appropriate consent process.
Question 2 of 10
A patient can repeat the risks of untreated illness but insists those risks cannot apply to them because an implanted shield makes their body invulnerable. Which decision-making ability is most directly in question?
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Correct answer: C. Appreciating how the information applies to their own situation
Appreciation concerns personal application of the information. Repeating facts does not show that the patient recognizes their relevance. Assess all four abilities before reaching a decision-specific conclusion.
Why the other answers are less appropriate
- A. Communicating any choice: The patient can express a choice; that alone does not settle capacity.
- B. Remembering the clinician’s name: Name recall is not the core ability illustrated here.
- D. Signing a document legibly: Handwriting does not assess medical decision-making capacity.
Question 3 of 10
A PMHNP documents that a delirious patient currently cannot understand or weigh the proposed treatment. No court has considered the case. Which wording is most accurate?
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Correct answer: A. The patient lacks decision-making capacity for this treatment at this time
Clinical capacity concerns a particular decision at a particular time. Legal competence is a court determination; the clinical finding does not itself establish a global legal status.
Why the other answers are less appropriate
- B. The patient has been declared legally incompetent in all matters: A clinician’s assessment is not a court adjudication.
- C. The patient has permanently lost all decision-making rights: A time-limited clinical finding is not a permanent global loss of rights.
- D. The patient’s diagnosis automatically transfers all authority to the oldest relative: A diagnosis alone does not identify a legally authorized surrogate.
Question 4 of 10
A patient with mild cognitive impairment understands a simple medication choice but struggles to compare the consequences of a complex elective procedure. What is the best interpretation?
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Correct answer: D. Capacity should be assessed for each decision, with support appropriate to its complexity
Capacity is task-specific. Evaluate the abilities needed for the actual decision instead of assigning a single status from a diagnosis or screening result.
Why the other answers are less appropriate
- A. Capacity must be identical for both decisions: Different decisions can require different levels of understanding.
- B. Any cognitive impairment proves incapacity for all care: Cognitive impairment does not by itself establish global incapacity.
- C. A screening-test score alone decides both questions: A screen may inform assessment but does not replace the decision-specific evaluation.
Question 5 of 10
An adult explains a proposed treatment’s benefits, risks, and alternatives accurately, connects them to personal goals, and consistently declines. No emergency or other legal exception applies. The team considers the choice unwise. What is the best response?
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Correct answer: B. Respect the informed refusal, document the discussion, and discuss follow-up options
A capable adult can decline recommended care. The decision-making process and understanding matter; agreement with the clinician is not the test.
Why the other answers are less appropriate
- A. Ask family to override the refusal: Family preference does not override a capable adult’s decision.
- C. Declare incapacity because the patient disagrees: Disagreement alone is not incapacity.
- D. Proceed because clinicians believe treatment is beneficial: Expected benefit does not itself authorize treatment over objection.
Question 6 of 10
An unconscious patient needs immediate lifesaving treatment. No surrogate is available, delay would be dangerous, and no known prior refusal applies. Which action is most appropriate?
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Correct answer: A. Provide necessary emergency treatment and seek consent for ongoing care as soon as possible
An urgent emergency can permit treatment without prior consent when the patient cannot participate and a surrogate is unavailable. Inform the patient or surrogate promptly and obtain consent for continuing care.
Why the other answers are less appropriate
- B. Wait indefinitely for a signature: Dangerous delay is not required in this scenario.
- C. Assume the emergency authorizes all future elective treatment: The emergency basis is limited; it is not blanket future consent.
- D. Ask an unrelated visitor to consent: An unrelated visitor has no established authority.
Question 7 of 10
A patient loses capacity for a nonemergency decision. A valid health care agent is available and knows the patient’s previously expressed values. Which approach should guide the discussion?
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Correct answer: C. Use the patient’s known preferences and values through substituted judgment
Help the authorized surrogate make the decision the patient would make, using reliable wishes and values. Continue involving the patient as much as possible.
Why the other answers are less appropriate
- A. Ask the agent to choose the least expensive option regardless of wishes: Cost alone does not replace the patient’s preferences.
- B. Let whichever relative speaks first decide: Authority must be established rather than assigned by who speaks first.
- D. Use only the clinician’s personal view of quality of life: The clinician’s personal values should not displace the patient’s.
Question 8 of 10
An adult who lacks capacity has no available record of treatment preferences, and the authorized surrogate cannot reasonably infer them. What standard is most appropriate?
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Correct answer: D. The patient’s best interests, weighing likely benefits and burdens
When preferences cannot be known or reasonably inferred, best-interest reasoning weighs what the intervention is likely to mean for the patient. Seek ethics support for unresolved conflicts.
Why the other answers are less appropriate
- A. The surrogate’s personal convenience: Convenience is not the governing ethical standard.
- B. Automatic refusal of every intervention: Unknown wishes do not establish a refusal of all care.
- C. Automatic use of the most invasive intervention: More intervention is not automatically more beneficial.
Question 9 of 10
A patient cannot follow a consent discussion conducted in English. Their adult child offers to summarize, but the proposed treatment has complex risks and the patient requests language assistance. What is the best next step?
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Correct answer: B. Arrange a qualified interpreter and reassess understanding in the patient’s preferred language
Provide effective language access before judging understanding. A qualified interpreter can communicate specialized information accurately and impartially; a language barrier does not establish incapacity.
Why the other answers are less appropriate
- A. Assess capacity only in English: English-only testing confounds language access with capacity.
- C. Have the child sign instead of the patient: The child does not acquire decision-making authority through interpretation.
- D. Label the language barrier as cognitive impairment: Difficulty understanding a second language does not establish cognitive impairment.
Question 10 of 10
A PMHNP recruiting for a research study tells a patient that declining enrollment will end their access to the clinic’s otherwise available treatment. What is the main consent problem?
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Correct answer: A. Coercion undermines voluntary research participation
Threatening loss of needed care improperly pressures research participation. Explain the voluntary choice and applicable alternatives without threatening access to otherwise available services.
Why the other answers are less appropriate
- B. The consent form needs a larger font only: Formatting alone does not resolve the threat.
- C. Patients receiving psychiatric care cannot consent to research: Psychiatric treatment does not automatically eliminate research-consent capacity.
- D. Research consent is unnecessary when the intervention may help: Potential benefit does not remove research-consent requirements.
Turn missed questions into focused review
Identify the clue that supports the best answer, then explain why the closest alternative is less appropriate. Return to the linked article to revisit a missed concept. This short practice set does not predict certification performance.
Frequently asked questions
Does a psychiatric diagnosis establish incapacity?
No. Assess the abilities needed for the particular decision at that time. Clinical capacity and a court’s legal determination are different concepts.
Can a patient with capacity refuse recommended care?
Generally, yes. The scenarios separate an informed refusal from situations involving an applicable emergency or other legal exception. Real cases require jurisdiction-specific review.