Quick answerThe client's escalating CIWA-Ar score, autonomic hyperactivity, hallucinations, and seizure indicate severe alcohol withdrawal requiring immediate benzodiazepine administration, seizure precautions, and respiratory monitoring.
Why this is correctAlcohol withdrawal can progress rapidly from mild symptoms to life-threatening delirium tremens and seizures. The trend shows worsening severity despite initial interventions, necessitating prompt escalation of care.
Clinical pictureCIWA-Ar scores above 15 indicate severe withdrawal. Hallucinations and seizures are red flags for delirium tremens. Benzodiazepines are first-line for symptom control and seizure prevention. Seizure precautions and respiratory monitoring are essential due to risk of aspiration and respiratory depression.
Memory hookCIWA-Ar ≥15 = severe withdrawal; hallucinations + seizure = high risk for delirium tremens; treat with benzodiazepines and monitor airway.
NCLEX decision ruleIn severe alcohol withdrawal, prioritize medication administration, safety precautions, and respiratory assessment.
Why the alternatives are wrongDelaying medication or withholding benzodiazepines due to absence of seizure history is unsafe; leaving the client alone or offering caffeine is contraindicated; reassessing after medication is appropriate but not the first action.
Sources
1NCSBN 2026 NCLEX-RN Test Plan
2ASAM Clinical Practice Guideline on Alcohol Withdrawal Management