# Stage 6 — Evaluate outcomes. Review the 12-hour trend after monitored, protocol-guided treatment and select the best interpretation and next plan.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372482&lang=en  
> language: en  
> subject: Chemical/Substance Use Disorder  
> category: PSI

## Question

Stage 6 — Evaluate outcomes. Review the 12-hour trend after monitored, protocol-guided treatment and select the best interpretation and next plan.

| Time | Data |
| --- | --- |
| Recognition | RASS +2; CAM-ICU positive; BP 168/96; HR 124; RR 22; SpO2 95 percent; visual hallucinations; oriented to person only |
| After initial protocol-guided IV treatment | RASS 0 to -1; BP 150/86; HR 104; RR 16; SpO2 97 percent; hallucinations stop; awakens to voice |
| Hour 4 | RASS 0; BP 142/84; HR 96; RR 16; SpO2 97 percent; calm; attention still fluctuates; oriented to person and place |
| Hour 12 | RASS 0; BP 132/80; HR 86; RR 16; SpO2 98 percent; no hallucinations; attention sustained during conversation; oriented to person, place, and time |

Q1. How is the client responding to treatment?

Clinically improving without current evidence of respiratory oversedation
Still severely agitated with worsening autonomic hyperactivity
Deteriorating from progressive hypoxemia after treatment

Q2. What is the best next plan?

Continue monitored objective reassessment; transition therapy only as protocol permits; revisit alternative causes if delirium persists; arrange a warm AUD-treatment handoff when cognition permits
Stop monitoring and discharge immediately because hallucinations have resolved
Increase IV benzodiazepine until the client remains unresponsive to voice
Stop thiamine and cancel follow-up because the medication response proves the diagnosis

## Explanation

Trend interpretation
Controlled agitation, resolution of hallucinations and autonomic hyperactivity, improving orientation, and stable respiration show clinical improvement without current oversedation. Continue monitored reassessment, transition medication only as the protocol and clinical response permit, revisit alternative causes if delirium persists or returns, and begin a warm handoff to ongoing AUD treatment when cognition permits.

## In-depth explanation

Step 1 — Read efficacy and safety together
RASS moves from agitation toward calm wakefulness, hallucinations stop, attention and orientation improve, and BP and HR fall. Stable respiratory rate and oxygen saturation argue against current medication-induced respiratory compromise.

Step 2 — Avoid diagnostic overclaim
Improvement with benzodiazepine supports the working hypothesis but does not prove that every postoperative alternative has been excluded. Persistent or recurrent delirium requires renewed medical and neurologic assessment.

Step 3 — De-escalate safely
Continue close monitoring. Once calm and cooperative, a protocol may transition IV treatment to oral symptom-triggered therapy. Do not abruptly stop treatment or discharge solely because one score improved.

Step 4 — Connect withdrawal care to AUD treatment
Withdrawal management alone is not long-term treatment. As cognitive status permits, engage the client in evidence-based AUD treatment and arrange a warm handoff rather than offering a medication list without assessment.

NCLEX rule
Evaluate response, medication safety, residual delirium, and continuity needs together.

## Clinical scenario

Scenario (Stage 6 — Evaluate outcomes)
Assess both therapeutic response and respiratory safety over 12 hours of monitored treatment.

Clinical judgment target
De-escalate from trajectory without treating response as diagnostic proof or immediate discharge readiness.

## Key concepts

- **RASS trajectory** — Serial agitation and sedation findings used with respiratory and clinical assessment to judge response and medication safety.
- **Warm handoff** — A direct, coordinated connection from withdrawal management to a clinician or program providing ongoing AUD treatment.
- **Residual delirium** — Persistent or recurrent inattention or altered awareness that requires continued monitoring and renewed evaluation for causes.

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