一位因靜脈藥物濫用導致感染性心內膜炎的35歲男性正在接受 Vancomycin 治療。因為極端渴望抽菸，他粗暴扯下靜脈留置針將血滴在地板上，抓起外套大吼：「這家醫院簡直是監獄！我現在就要離院！」他的體溫為 38.6°C。護理師最恰當的一系列處置為何？
A 35-year-old male with infective endocarditis secondary to IV drug abuse is receiving Vancomycin. Anxious for a cigarette, he rips out his IV access, bleeding onto the floor, grabs his coat, and yells, "This hospital is a prison! I'm leaving right now!" His temperature is 38.6°C (101.5°F). Which sequence of actions by the nurse is the most appropriate?
- AAllow him to leave immediately without intervention because he possesses the right to refuse care, then chart the incident.允許其立即離開而不進行干預，因為他擁有拒絕治療的權利，然後記錄該事件。
- BTell the patient that leaving the hospital makes his insurance invalid, then attempt to insert a new IV.告訴病人離院將使其保險失效，然後嘗試重新插入靜脈留置針。
- CApply direct pressure to the bleeding site, call hospital security to restrain him to the bed, and page the attending physician.對出血部位施加直接壓力，呼叫醫院保全將其約束在床上，並通知主治醫師。
- DApply pressure to the bleeding site, calmly warn him that leaving may cause fatal stroke or sepsis, and ask him to sign an AMA form.✓ 正解對出血部位施加壓力，冷靜警告其離院可能導致致命性中風或敗血症，並要求其簽署自動出院（AMA）表單。
本題測驗病患人身自由權利與「未遵醫囑離院（Against Medical Advice, AMA）」的法律界線。若病患具備自主心智能力（即使行為粗魯、生氣），他擁有拒絕所有醫療並隨時離開醫院的絕對權利。護理團隊無權以醫療利益為由阻止他。選項C呼叫警衛將其束縛於病床構成嚴重的「非法拘禁（False Imprisonment）」與「醫療暴力（Battery）」，除非宣告其精神衰弱威脅生命，不從適。選項B是常見的恐嚇迷思，離開 AMA 並不代表保險自動作廢，更不該以謊言脅迫病患。選項A雖尊重了不治療權力，但護理師錯失了急救止血、告知潛在致命後果（Informed Refusal）的法律義務。正確作法（選項D）為：維持現有出血的急救（加壓止血），以平和口吻解釋心內膜炎中斷抗生素可能導致敗血症或腦栓塞的明確致命風險，若他仍堅持離開，即可請其簽署 AMA 同意書以保護院方免責。
This question tests patient autonomy and the legal boundary of AMA (Against Medical Advice) discharge. A competent client (even if rude or angry) has the absolute right to refuse care and leave at any time. Nursing staff cannot use medical benefit as justification to prevent departure. Option C (calling security to restrain) constitutes serious false imprisonment and battery and is unacceptable unless mental incapacity threatens life. Option B is a coercive myth—leaving AMA does not invalidate insurance. Option A respects refusal rights but the nurse misses the legal duty to provide first aid (control bleeding) and informed refusal. Option D correctly maintains hemostasis, explains specific lethal risks (sepsis, stroke), and obtains an AMA signature to protect institutional liability.
台美面臨 AMA 情況時，法規皆要求實行「Informed Refusal」（病患須充分了解強行出院的各種致命後果）。在台灣稱為 AAD（自動出院），同樣要求簽署切結書，且台灣護理師也絕對不能呼叫駐警強行拘留意識清楚的病患。