Four adults with asthma arrive at the urgent care. Which presentation indicates the MOST severe exacerbation r…

Question

Four adults with asthma arrive at the urgent care. Which presentation indicates the MOST severe exacerbation requiring immediate transfer to the ED for high-acuity management?

Accepted Answer

Option 4: Patient drowsy, leaning back, "silent chest" with minimal air movement on auscultation, SpO2 84%, paradoxical breathing.

Choice 4 represents life-threatening status asthmaticus: a "silent chest" means so little air is moving that wheezing is no longer audible — this is more dangerous than loud wheezing. Combined with drowsiness, paradoxical breathing, and severe hypoxemia, this patient is approaching respiratory failure and requires emergent ED transfer with possible intubation. Choice 1 is mild, Choice 2 is moderate, Choice 3 is severe but not yet life-threatening (still has audible wheeze and is awake). Less wheezing in asthma is NOT improvement — it is alarm.

Answer

Option 1: Patient awake and able to speak in full sentences, RR 20, SpO2 95% on room air, mild end-expiratory wheeze.

Answer

Option 2: Patient speaks in short phrases, RR 26, SpO2 92%, scattered expiratory wheezes, accessory muscle use, peak flow 60% predicted.

Answer

Option 3: Patient sitting forward, can only speak single words, RR 32, SpO2 86% on room air, peak flow < 50% predicted, reports anxiety and chest tightness.

Four adults with asthma arrive at the urgent care. Which presentation indicates the MOST severe exacerbation requiring immediate transfer to the ED for high-acuity management?

In-depth explanation

Clinical scenario

Key concepts

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Four adults with asthma arrive at the urgent care. Which presentation indicates the MOST severe exacerbation requiring immediate transfer to the ED for high-acuity management?

In-depth explanation

Clinical scenario

Key concepts

Master the NCLEX-RN with MyMerci