# Stage 1 — Recognize cues. Review the emergency-department note and highlight the five findings that most strongly indicate a severe asthma exacerbation with risk of respiratory failure.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568570&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

Stage 1 — Recognize cues. Review the emergency-department note and highlight the five findings that most strongly indicate a severe asthma exacerbation with risk of respiratory failure.

Emergency note
The child sits forward and speaks only one or two words at a time. Heart rate is 132/min. Respiratory rate is 38/min. Oxygen saturation is 88% on room air. Peak expiratory flow is 30% of personal best. Auscultation reveals markedly diminished breath sounds with minimal wheeze. The child is becoming drowsy during the assessment. Temperature is 37.0 C. Blood pressure is 108/68 mm Hg. Capillary refill is 2 seconds.

## Explanation

One- or two-word speech, hypoxemia, a peak flow of 30% of personal best, markedly diminished air movement, and increasing drowsiness identify severe obstruction and possible fatigue. Tachycardia can occur with distress or beta-agonist use but is less specific than the selected cues.

## In-depth explanation

Quick answer
The five priority cues show severe airflow obstruction, hypoxemia, and emerging fatigue; the quieter chest and drowsiness are deterioration, not reassurance.

Why this is correct
Asthma narrows the airways and limits exhalation. Very short speech, low oxygen saturation, markedly reduced peak flow, minimal air movement, and declining alertness show that the child may no longer move enough air to sustain ventilation.

Easy analogy or mental picture
Picture airflow through a pinched straw: less sound can mean less air is moving, not that the pinch has opened. The image explains airflow only and does not replace respiratory assessment.

Memory hook
Quiet chest plus tired child equals louder danger.

NCLEX decision rule
When a child with asthma becomes hypoxemic, unable to speak normally, or less alert, think severe obstruction and fatigue; call for advanced respiratory help while continuing emergency therapy.

Why the other choices are wrong
Tachycardia and tachypnea support distress but are less specific, while normal temperature, blood pressure, and capillary refill do not cancel the respiratory red flags.

References
1GINA 2025 Strategy ReportRecognition and emergency management of severe asthma exacerbations
2NHLBI: Asthma AttacksEmergency warning signs, reliever use, oxygen, and ventilatory support

## Clinical scenario

Case update
Initial presentation — A 10-year-old with persistent asthma has worsening respiratory distress despite two home albuterol treatments.

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