Study Tips

NCLEX® QOTD: Worsening asthma

Osmosis Team
Published on Feb 14, 2024. Updated on Feb 1, 2024.

Today's NCLEX-RN® question of the day focuses on a nurse in the emergency department is planning care for a 9-year-old patient experiencing an exacerbation of asthma. The nurse has already applied a non-rebreather mask to administer humidified oxygen. What are the sequential steps the nurse should take, in order from first to last, after reviewing the information in the chart? Can you figure it out?

The nurse in the emergency department is planning care for a 9-year-old patient experiencing an exacerbation of asthma. The nurse has already applied a non-rebreather mask to administer humidified oxygen.




Review the information in the chart and arrange the next steps the nurse should take in order from first to last. All options must be used.


Options down left side

A

B

C

D

Provide emotional support to the patient



X


Administer prescribed β2-agonists and corticosteroids via nebulizer 


X



Elevate the head of the bed 

X




Review asthma action plan with patient and caregiver to help prevent future asthma exacerbations




X


Scroll down for the correct answer!

The correct answer to today's NCLEX-RN® Question is...

A. Elevate the head of the bed

Rationale: The nurse should elevate the head of the bed to promote lung expansion and to facilitate breathing and oxygenation first. Opening the patient’s airway will allow for the inhalation of medications and oxygen needed to treat the exacerbation. Using the ABC priorities of care model (airway, breathing, circulation), elevating the head of the bed should be completed before other interventions. 

B. Administer prescribed β2-agonists and corticosteroids via nebulizer

Rationale: Administering β2-agonists and corticosteroids via nebulizer is the next priority, to reduce bronchoconstriction and airway inflammation during the asthma exacerbation. Using the ABC priorities of care model (airway, breathing, circulation), administering medications that promote breathing is the next highest priority after managing patency of the airway.

C. Provide emotional support to the patient

Rationale: Providing reassurance is important to help reduce anxiety in both the patient and their family members during an asthma exacerbation. While this can typically be carried out simultaneously with other actions, there are other options that take higher priority.

D. Review asthma action plan with patient and caregiver to help prevent future asthma exacerbations

Rationale: Patient and family education about preventing future asthma exacerbations should take place prior to discharge from the emergency department. However, the patient should be stabilized and no longer experiencing an acute emergency before this takes place to promote comprehension and understanding. Other options take higher priority over this intervention.

Major Takeaway

The nurse should use clinical judgment to take action and implement solutions that address the highest priorities. For a pediatric patient with an exacerbation of asthma, the highest priority is to promote airway patency. According to the airway, breathing, and circulation (ABC) model, problems with the airway should always be addressed first, followed by breathing and circulation. Next, the patient’s breathing should be supported by elevating the head of the bed, and then the patient and family should be reassured by the nurse by explaining procedures and answering questions. Finally, once the acute episode has subsided, the patient and family should be educated on best practices to prevent future asthma exacerbations.

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