# The emergency nurse reviews serial findings for clients with acute asthma. Which findings require immediate follow-up? Highlight the findings associated with impending respiratory failure.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=494275&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

The emergency nurse reviews serial findings for clients with acute asthma. Which findings require immediate follow-up? Highlight the findings associated with impending respiratory failure.

| Response to treatment | Current finding |
| --- | --- |
| One hour has passed since the prescribed albuterol treatment. | Expiratory wheezing is softer, and the client reports less tightness. |
| The client now speaks in full sentences without pausing. | Peak flow increased from 55% to 75% of the personal best value. |
| The client remains upright and uses accessory muscles to breathe. | Breath sounds are nearly absent despite marked chest retractions. |
| Respirations are 22/min, and air movement is heard bilaterally. | Oxygen saturation is 95% on room air after bronchodilator therapy. |
| Breathing effort has become shallow after prolonged distress. | The client becomes drowsy and gives confused one-word answers. |
| Heart rate is 104/min, and breathing is otherwise improving. | A mild hand tremor occurs after repeated albuterol treatment. |
| Nebulized treatment has not relieved the severe breathlessness. | Oxygen saturation remains 88% while oxygen flows at 4 L/min. |
| Breath sounds remain diminished but are improving on reassessment. | Retractions are decreasing, and the client can drink small sips. |
| The client cannot complete a sentence without stopping for breath. | Peak flow remains at 28% of personal best after three treatments. |

## Explanation

A silent chest, declining alertness, persistent hypoxemia despite oxygen, and a peak flow of 28% after treatment indicate severe airflow obstruction and possible respiratory failure. Improvement after bronchodilator therapy is less urgent.

## In-depth explanation

Quick answer
Escalate immediately for a silent chest despite visible effort, new drowsiness and confusion, oxygen saturation of 88% despite supplemental oxygen, and peak flow at 28% of personal best after repeated treatment.

Why this is correct
Severe asthma can progress to hypoxemia, exhaustion, reduced mental alertness, minimal air movement, and respiratory failure. A silent chest is not reassuring when work of breathing remains high; it can mean airflow is too low to produce wheezing.[2]

Easy analogy or mental picture
Wheezing is like sound through a narrowed whistle. If the sound disappears while the person is still struggling, almost no air may be crossing the whistle. Quiet plus distress is more dangerous, not calmer.

Memory hook
Silent, sleepy, still hypoxic, still below half: escalate.

NCLEX decision rule
Judge respiratory status by air movement, oxygenation, mental status, speech, effort, and response to treatment together. Do not use the loudness of wheezing as the sole measure of severity.

Why the other choices are wrong
Improved speech, decreasing retractions, oxygen saturation recovery, peak flow improvement, and a mild tremor after albuterol need continued monitoring but show a response rather than impending failure.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]NCBI Bookshelf: Respiratory AlterationsNational Library of Medicine

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