護理師正在照護一位因急性憂鬱症伴隨自殘命令式幻聽而自願入院 (voluntary status) 的 50 歲男性。大夜班時，該病患突然把行李收拾好且極具侵略性地衝出房間要求出院，宣稱：『我是自願入院的，你們在法律上不能違背我的意願扣留我！』護理師最恰當的行動為何？
The RN is caring for a 50-year-old male recently admitted voluntary for acute major depressive disorder with active command hallucinations directing self-harm. During the night shift, the client suddenly packs his bags, aggressively bursts out of his room, and demands to leave the facility immediately, stating, 'I am voluntary, you cannot hold me legally against my will!' What is the most appropriate action by the nurse?
- AAllow the client to leave immediately after securely obtaining his signature entirely on an Against Medical Advice (AMA) form.在安全取得其簽署完全對醫療建議反對（AMA）表格後，允許病人立即離開。
- BDetain the client firmly on the unit and instantly notify the primary healthcare provider to initiate an involuntary psychiatric hold protocol.✓ 正解堅定地扣留病人在病房內，並立即通知主要醫療提供者以啟動非自願精神科留置程序。
- CState calmly that voluntary clients explicitly possess absolute constitutional freedom to depart instantly without signing forms.冷靜地聲明自願病人明確擁有絕對的憲法自由，可在不簽署表格的情況下立即離開。
- DForcefully physically restrain the active client directly against the wall while simultaneously calling hospital security for an emergency takedown.在同時呼叫醫院保全進行緊急制服的同時，將活躍的病人強行物理約束抵在牆上。
本題測驗精神科病患權益與強制約束法規 (Mental Health Holds)。在美國與台灣護理法規中，即使是『自願入院』的精神科病患，他也不一定享有絕對自由。法律界線是：『他是否對自己或他人造成立即的生命威脅』。該病患有幻聽叫他去死，他具備極度高危險的自殺急迫性。如果護理師放他走（即使簽了 AMA），將構成嚴重的過失致死。合法的緊急處置是：將他留在封閉式病房內，並立刻聯絡醫師，啟動『非自願強制留院 (72-hour hold)』程序（選 B 正確）。
Because the client exhibits active command hallucinations directing self-harm, they pose an immediate danger to themselves and lose the right to leave voluntarily. The nurse must detain the client on the unit and notify the provider to initiate an involuntary psychiatric hold to ensure safety.
精神科最高強制力。只要有自殺/殺他傾向，自願病人也可以直接被通報強制扣留。