# The charge nurse reviews care for a client who wants to leave before evaluation is complete. Which actions require immediate follow-up? Highlight the actions that do not support an informed, voluntary refusal. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=497298&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question The charge nurse reviews care for a client who wants to leave before evaluation is complete. Which actions require immediate follow-up? Highlight the actions that do not support an informed, voluntary refusal. Nurses' Notes 1410: The client is alert after evaluation for intermittent chest discomfort and says, “I want to go home now.” The nurse documents that the client explains the choice and possible consequences in personal words after teach-back. The record then states that the adult child is asked to sign the refusal although the client has capacity. At 1418, the provider explains that myocardial injury has not been excluded and recommends repeat testing. The client listens and the nurse describes the specific risk of leaving before serial tests are complete in understandable words. The team offers an earlier clinic appointment and the client accepts a written alternative follow-up plan for the next-day clinic. At 1425, a staff member says that the client's clothing will be kept until the recommended testing is finished. The client remains calm and repeats the wish to leave. Before departure, the nurse removes the intravenous catheter and confirms the site is intact without bleeding. The discharge packet includes that the client receives written symptoms and instructions that require immediate emergency return. At 1432, the record shows that the note contains only “left AMA” without the risks, alternatives, or client response. The nurse also notifies the provider that the capable client continues to decline care and records the contact. A second staff member states that security should block the exit even though no emergency hold or legal restriction exists. The charge nurse pauses the process and reviews the client-rights response with the team. ## Explanation Substituting a relative, coercing the client, omitting the informed-refusal discussion, and blocking departure without legal authority require follow-up. A capable adult may refuse after receiving understandable risks, alternatives, and return precautions. ## In-depth explanation Quick answer Highlight asking the adult child to decide for a capable client, threatening to keep the client’s belongings, documenting only “left AMA,” and using security to prevent departure without legal authority. Each action undermines a voluntary informed refusal. Why this is correct A hospital must protect a client’s right to participate in care and request or refuse treatment. The nurse should assess decision-making capacity, explain material risks and alternatives in understandable terms, notify the provider, document the discussion, and preserve the client’s ability to return for care.[2] Easy analogy or mental picture Picture a clearly marked exit with a safety briefing beside it. The team cannot lock the door, but it must make sure the capable client understands the hazard, available routes, and when to come back; the picture does not replace a formal capacity assessment. Memory hook Check capacity, share information, respect the choice, document the discussion, and support a safe return. NCLEX decision rule When a capable adult refuses care, protect autonomy while reducing harm: verify capacity, give understandable risk and alternative information, avoid coercion, document, and provide return precautions. Why the other choices are wrong Teach-back, a specific risk discussion, an alternate follow-up plan, safe removal of the intravenous catheter, provider notification, and written return precautions support informed refusal. They do not force treatment or transfer the decision to someone else.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]CMS: Hospital Informed Consent RequirementsCenters for Medicare & Medicaid Services ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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