When using the Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-A), what should the nurse realize that the use of medication for clinically significant symptoms is based upon?

Question

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1. Vital signs are monitored and treated with appropriate medications and fluids to maintain hemodynamic stability.
2. Response to treatment is an evaluation of therapy given. Treatment with further medication would be based on that evaluation and the patient's level of consciousness. Medication should not be automatically administered without further assessment.
3. Patients are medicated with benzodiazepines when they cross a designated threshold of severity. Frequency of assessments will be determined by the severity, treatment, response to treatment, and overall acuity.
4. Physiologic and behavioral symptoms determine intervention as opposed to the amount of observation time required to monitor the patient.

When Using the Clinical Institute Withdrawal Assessment for Alcohol Scale