A client being evaluated for intermittent chest pain says, "I need to leave now." The client is alert and oriented, and the evaluation is incomplete. Which action should the nurse take first?
1Call security and prevent the client from leaving until the cardiac evaluation is complete
2Ask the client to sign an against-medical-advice form before discussing concerns
3Remove the IV catheter and provide routine discharge instructions without further assessment
4Assess decision-making capacity, explore the concern, and explain risks and alternatives✓ Correct answer
Explanation
The nurse should first assess the client's ability to make the decision and identify the reason for leaving, then provide understandable risks and alternatives. A capable adult is not detained or coerced into signing a form.
Quick answer Assess decision-making capacity, explore why the client wants to leave, and explain the risks and available alternatives. This protects autonomy while reducing preventable harm.
Why this is correct Leaving before evaluation is complete does not automatically remove the client's right to decide. The team should confirm that the client can understand, appreciate, reason about, and communicate the choice, then discuss consequences, safer alternatives, follow-up, and return precautions.
Easy analogy or mental picture Picture an exit beside a safety briefing rather than a locked door. The team cannot force a capable adult to stay, but it should make the hazards, alternatives, and route back clear; the image does not replace a formal capacity assessment when capacity is uncertain.
Memory hook Check capacity, ask why, explain risk and alternatives, document, and make return safer.
NCLEX decision rule When a client wants to leave, assess capacity and the reason before focusing on the form. Respect a capable refusal, avoid coercion, notify the provider, document the discussion, and give follow-up and emergency return instructions.
Why the other choices are wrong Security detention lacks justification when no legal hold exists. A signature is not a substitute for informed discussion, and immediate routine discharge without assessing capacity or concerns misses opportunities to reduce risk and arrange safer follow-up.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
AHRQ PSNet: Discharge Against Medical AdviceAgency for Healthcare Research and Quality