# Stage 2 — Analyze cues. For each reassessment finding, identify the conclusion it supports. More than one column may apply to a finding.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568571&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

Stage 2 — Analyze cues. For each reassessment finding, identify the conclusion it supports. More than one column may apply to a finding.

|  | Supports severe airflow obstruction | Supports impending ventilatory failure | Can be an expected beta-agonist effect |
| --- | --- | --- | --- |
| SpO2 89% on oxygen and peak flow 32% of personal best |  |  |  |
| Minimal air movement and increasing drowsiness |  |  |  |
| Heart rate 136/min after repeated albuterol |  |  |  |
| Unable to complete a sentence without pausing |  |  |  |

## Explanation

Persistent hypoxemia and very low peak flow show severe obstruction. Minimal air movement with increasing drowsiness also indicates impending ventilatory failure. Tachycardia after albuterol can be an expected medication effect and does not by itself prove worsening obstruction.

## In-depth explanation

Quick answer
Separate evidence of obstruction from evidence that the child is tiring; drowsiness plus minimal air movement supports both.

Why this is correct
Low oxygen saturation, a peak flow near one-third of personal best, and interrupted speech reflect severe obstruction. Declining alertness and minimal air movement raise the additional concern that respiratory muscles are failing.

Easy analogy or mental picture
Use two warning gauges: one shows how narrow the airway is, and the other shows whether the child can keep breathing against that resistance. A fast pulse after albuterol is a medication-effect clue, not either gauge by itself.

Memory hook
Obstruction is tight; failure is tired.

NCLEX decision rule
When asthma findings stay severe after initial treatment, check both airflow and mental status; reduced breath sounds with drowsiness demands escalation.

Why the other choices are wrong
A beta-agonist-related pulse increase is expected in context and cannot independently establish treatment failure or ventilatory collapse.

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
First reassessment — Oxygen and repeated inhaled albuterol with ipratropium have been started. The child remains unable to speak in full sentences.

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