A nurse is caring for a client in an inpatient mental health facility who has anorexia nervosa. The client declines treatment and reports wanting to be discharged. After notifying the provider, which of the following actions should the nurse take?

Choice A reason: Having the client sign a form to acknowledge they are leaving against medical advice (AMA) is the correct action. Involuntary treatment is only permitted under specific legal circumstances, such as when the client poses an imminent danger to themselves or others, or is unable to meet basic needs due to their condition. If the client is deemed competent to make decisions, they retain the right to refuse treatment and leave the facility. The AMA form serves as documentation that the client has been informed of the risks of leaving and is choosing to do so against medical advice. This protects both the client’s autonomy and the nurse/provider legally and ethically. Choice B reason: Telling the client that requests are not granted until case management approves is incorrect. Case management does not have the authority to override a competent client’s decision to leave. This response would be misleading and could be considered coercive, violating the client’s right to autonomy. Nurses must respect the client’s legal rights and avoid imposing unnecessary barriers to discharge. Choice C reason: Placing the client in restraints is inappropriate and unethical in this scenario. Restraints are only indicated when a client poses an immediate risk of harm to themselves or others, and even then, they must be used as a last resort with strict legal and ethical guidelines. Using restraints to prevent a competent client from leaving would constitute false imprisonment and a violation of patient rights. It could also cause psychological trauma and worsen the client’s mental health condition. Choice D reason: Notifying the client’s family members is not the correct immediate action. While family involvement can be beneficial in treatment planning, the nurse must prioritize the client’s autonomy and confidentiality. Unless the client consents or there is a legal requirement (such as the client being a minor), family members cannot be notified without violating privacy laws. The nurse’s responsibility is to document the client’s decision and ensure proper AMA procedures are followed, not to involve family without consent.