NCLEX-RN practice › Management of Care
NCLEX question: a client with capacity leaving against advice
Management of Care · Multiple choice · Clinical judgment step: Take action
Client record
Assessment
Oriented ×4, explains the illness and the risks of leaving in own words, including death.
- CIWA-Ar
- 4
No hallucinations or suicidal thoughts
Plans to go to a sibling's home
Provider note
Recommends staying 2 more days for monitoring. Capacity: intact.
A client with alcohol-related liver disease wants to leave the hospital against medical advice. The nurse reviews the assessment. Which action is most appropriate?
- A. Tell the client insurance will not pay if they leave
- B. Respect the decision, inform the provider, explain the risks and follow-up plan, and document
- C. Hold the client until a psychiatric hold can be arranged
- D. Remove the IV and let the client leave without informing the provider
Show the answer and rationales
Answer: B
Clients with capacity have the right to leave against advice. The nurse informs the provider, explains risks, supports a safe plan and documents; restraint or coercion is not permitted.
- A. Incorrect. This is coercive and usually inaccurate.
- B. Correct. Correct. A client with decision-making capacity can refuse care. The nurse informs the provider, ensures the client understands the risks, offers prescriptions and follow-up, and documents.
- C. Incorrect. There are no grounds for an involuntary hold; detaining a capable client is false imprisonment.
- D. Incorrect. The provider must be informed, and the nurse should ensure a safe discharge plan.
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