Which statement best describes a patient with RASS +4?

• A. They pose immediate danger to self or others
• B. They are calm and cooperative
• C. They are drowsy but responsive
• D. They require sedation

Answer: (A)

In the Richmond Agitation-Sedation Scale (RASS), higher positive numbers mean more agitation. A RASS of +4 is the most agitated level and is described as combative or violent, with the patient posing an immediate danger to staff or others. That is why the statement that best describes this patient is that they pose immediate danger to self or others. They are not calm, cooperative, or merely drowsy; while sedation may be needed, the defining feature at +4 is the dangerous level of agitation requiring urgent safety measures.