NCLEX-RNManagement of CareEasy
A client with a substance use disorder insists on leaving the hospital before treatment is complete, against medical advice. The client is alert, oriented, and demonstrates understanding of the risks of leaving. What is the nurse's most appropriate action?
- AHave the client sign an against-medical-advice (AMA) form and document the discussion
- BCall security to physically prevent the client from leaving the unit
- CRefuse to remove the IV line until the physician arrives to stop the client
- DTell the client that insurance will not cover any future hospital visits
Show answer & explanationAnswer & explanation
Correct answer: A. Have the client sign an against-medical-advice (AMA) form and document the discussion
A competent adult client has the right to refuse treatment and leave the hospital even against medical advice. The nurse's role is to ensure the client understands the risks, document the informed refusal, and have the client sign an AMA form if willing, while allowing the client to leave without coercion.
Why the other options are wrong
- B. Using security to physically restrain a competent client is unlawful and violates client rights.
- C. Detaining a competent client is false imprisonment; the nurse cannot forcibly stop discharge.
- D. This is coercive, inaccurate, and inappropriate; it pressures the client with false information.
Against Medical Advice (AMA) Discharge
A competent client has the legal right to refuse treatment and leave the facility even if it is medically unwise, as long as they understand the risks.
- Client must be alert, oriented, and informed of risks
- AMA form documents informed refusal, not consent
- Nurse cannot restrain or coerce a competent adult
- Document teaching, risks explained, and client's response
Memory trick: Can't cage a competent client—document, don't detain.