# Stage 6 — Evaluate outcomes. Review the respiratory trend and answer both questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568575&lang=en  
> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

Stage 6 — Evaluate outcomes. Review the respiratory trend and answer both questions.

| Time | Data |
| --- | --- |
| Arrival | SpO2 88% room air; PEF 30% personal best; one- to two-word speech; alert |
| 1 hour | SpO2 90% on oxygen; minimal air movement; increasingly drowsy |
| 4 hours | SpO2 96% on low-flow oxygen; awake; improved air movement; speaks in sentences |
| Next day | SpO2 97% room air; PEF 68% personal best; no accessory-muscle use |

Q1. Which finding best shows that the acute respiratory threat is resolving?

Heart rate remained elevated after albuterol
The child had no fever at arrival
Alertness, air movement, oxygenation, speech, and peak flow all improved
The child received several medications

Q2. Which plan is most important before discharge?

Use only a reliever whenever symptoms recur
Verify a written action plan, controller adherence, inhaler-spacer technique, follow-up, and emergency return cues
Avoid all physical activity indefinitely
Stop controller therapy when peak flow improves

## Explanation

Improved speech, oxygenation, air movement, alertness, and peak flow demonstrate recovery. Discharge readiness also requires a written action plan, correct inhaler-spacer technique, controller adherence, follow-up, and return precautions.

## In-depth explanation

Quick answer
The respiratory trend shows recovery, and safe discharge requires both medication-skill verification and a written plan for worsening symptoms.

Why this is correct
Recovery is supported by several independent measures rather than one number: the child is alert, speaks normally, moves more air, oxygenates on less support, and has a higher peak flow. Future risk falls when the family can carry out the controller and action plans.

Easy analogy or mental picture
A safe landing needs the aircraft stable and the ground plan ready. Here the stable vital trend is the landing, and the asthma action plan is the route home.

Memory hook
Better breathing plus a better plan.

NCLEX decision rule
When evaluating asthma recovery, trend symptoms, function, oxygenation, and airflow together; before discharge, verify the plan and technique, not just symptom relief.

Why the other choices are wrong
Medication receipt alone does not prove recovery. Reliever-only use, indefinite activity restriction, and stopping controller therapy invite preventable relapse.

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
The child received critical-care respiratory support and improved without cardiac arrest. The team is assessing recovery and future-risk reduction.

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