Examkin

Question

Difficulty: HardLegal Rights and Responsibilities

A client receiving a continuous intravenous heparin infusion for a pulmonary embolism becomes intensely frustrated with the hospital environment. The client gathers their personal belongings and firmly states, 'I am done with this place; I am leaving immediately.' Arrange the nurse's legal and professional actions in the correct sequence. (Place the first action at the top and the final action at the bottom.)

  1. 1Determine the exact cause of the client's frustration and attempt to implement comfort measures or compromises.
  2. 2Notify the primary healthcare provider of the client's demand to leave the facility against medical advice.
  3. 3Ensure the client receives an explicit explanation of the risks of fatal complications from stopping anticoagulation.
  4. 4Ask the client to formally acknowledge their informed refusal by signing the Against Medical Advice (AMA) form.
  5. 5Discontinue the intravenous access device and provide written information on when to seek emergency care.

Answer

The correct sequence is: Assess the cause of frustration, notify the provider, ensure risks are explained, request the AMA signature, and finally discontinue the IV and provide discharge instructions.
The correct chronological sequence prioritizes the nursing process and legal client rights. Assessment of the client's concern is the primary action. If unresolved, the provider must be notified to participate in care and explain the medical risks, satisfying the requirement for informed refusal. The AMA document is then presented to legally record this informed decision. Finally, all invasive devices must be removed to prevent battery and false imprisonment, ensuring a safe physical departure even if the client refuses to sign the form.

Step-by-Step Solution

1
Determine the exact cause of the client's frustration and attempt to implement comfort measures or compromises.
The nurse identifies the root cause of the client's distress.
Applying the nursing process, assessment always comes first. The nurse may be able to resolve the issue (e.g., offering a quieter room, addressing pain) and prevent the client from leaving.
2
Notify the primary healthcare provider of the client's demand to leave the facility against medical advice.
The medical team is alerted to the client's impending departure.
Once it is clear the client still intends to leave, the provider must be informed immediately to evaluate the client's capacity and participate in the clinical intervention.
3
Ensure the client receives an explicit explanation of the risks of fatal complications from stopping anticoagulation.
The client understands the severe consequences of their decision.
Legal informed refusal requires that the client is fully aware of the specific medical risks (such as a fatal pulmonary embolism) before finalizing their decision to leave.
4
Ask the client to formally acknowledge their informed refusal by signing the Against Medical Advice (AMA) form.
The client's informed refusal is legally documented.
The AMA form protects the facility and healthcare provider from liability by serving as written proof that the client understood the risks and chose to leave anyway.
5
Discontinue the intravenous access device and provide written information on when to seek emergency care.
The client is physically discharged safely without being unlawfully detained.
The nurse cannot physically detain the client or force an invasive device to remain in place, as this constitutes battery and false imprisonment. Discharge instructions must be provided regardless of AMA status.

Key Concept

Handling Against Medical Advice (AMA) discharges requires adherence to the nursing process and protection of the client's legal right to informed refusal and freedom from false imprisonment.
Estimated Time:2m 0s
Rate this question

Topics

Legal Rights and Responsibilities

More questions from this topic