Which emergency department clients cannot be allowed to sign out against medical advice? Select all that apply.

Question

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To leave against medical advice (AMA), the client must be legally competent to make an educated decision to stop treatment. Disqualifications for legal competency include altered consciousness, mental illness (ie, a danger to self or others), and being under chemical influence (eg, drugs or alcohol). The client who drank a 1 L bottle of vodka is intoxicated (Option B). The client who hears voices has psychotic symptoms and is potentially homicidal (Option C). The manic client who has not eaten in 5 days is a potential danger to self and cannot leave AMA (Option D). For a competent client to leave AMA, the health care provider must explain the risks of discontinuing treatment. The nurse must witness and document the discussion on risks of leaving AMA and the client's understanding of these risks ("informed refusal"). A client leaving AMA can, and should, receive discharge instructions and the option to return at any time. (Options A and E) Clients have the right to leave AMA, even if it is not in their best interests to leave (eg, even if potentially life-threatening). Not allowing a competent client to leave AMA is a form of false imprisonment, a legally liable action by the nurse. Educational objective: The client must be legally competent to leave against medical advice. Disqualifications for legal competency include impairment by drugs or alcohol, altered consciousness, and mental illness (ie, a danger to self or others).

Which Emergency Department Clients Cannot Be Allowed to Sign Out