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Difficulty: HardLegal Rights and Responsibilities

An adult client is receiving continuous intravenous (IV) antibiotics for severe cellulitis. The client, who is alert, oriented, and demonstrates clear decision-making capacity, abruptly disconnects the IV tubing and states, "I am tired of this hospital. I am leaving right now." The client's adult child privately approaches the nurse and says, "Please give my parent the PRN lorazepam that was ordered for anxiety. If they fall asleep, they will stay and finish the treatment. They are just overwhelmed."

Which of the following is the most appropriate, legally sound action for the nurse to take?

  1. Inform the adult child that using medication to detain a competent client is unlawful, and initiate the against medical advice (AMA) discharge process.Answer
  2. B
    Administer the prescribed PRN lorazepam to manage the client's acute distress, utilizing the adult child's substituted consent.
  3. C
    Instruct the unlicensed assistive personnel (UAP) to sit by the doorway and educate the client about the severe risks of untreated cellulitis.
  4. D
    Contact Adult Protective Services (APS) immediately to report the adult child's request as an incident of intentional elder abuse.

Answer

The correct action is to inform the adult child that using medication to detain a competent client is unlawful, and to initiate the against medical advice (AMA) discharge process directly with the client.
The correct action upholds the legal principle of autonomy. A competent client has the absolute right to refuse treatment and leave a healthcare facility against medical advice (AMA). Administering a medication specifically to sedate a client and prevent them from leaving is legally defined as a chemical restraint and false imprisonment. The nurse must firmly explain this legal boundary to the family member and proceed with standard AMA protocols, which includes having the RN directly explain the risks of leaving to the client.

Step-by-Step Solution

1
Assess the client's decision-making capacity and legal rights.
The client is alert, oriented, and competent, granting them the legal right to refuse treatment and leave the hospital.
Competent adults have the right to self-determination regarding their healthcare, even if their decisions pose a risk to their health.
2
Evaluate the adult child's request to administer a sedative.
The request violates the client's legal rights, as using medication to prevent a competent client from leaving constitutes a chemical restraint and false imprisonment.
Medications cannot be used for the convenience of staff or family to restrict a client's freedom of movement or alter their behavior to force compliance.
3
Determine the legally sound nursing intervention.
The nurse must educate the family member about legal boundaries and proceed with the AMA protocol, ensuring the RN personally explains the medical risks to the client.
The nurse's legal and ethical duty is to advocate for the client's autonomy while ensuring they are fully informed of the consequences of their actions.

Key Concept

Client Autonomy, Chemical Restraints, and AMA Protocols
Estimated Time:1m 30s
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Topics

Legal Rights and Responsibilities

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