Pathophysiology
A patient reports chest tightness, wheezing, and coughing after visiting a friend with cats. Which pathophysiologic response is the nurse MOST likely observing?
A. Alveolar collapse
B. Chronic airway fibrosis
C. Bronchoconstriction from allergen exposure
D. Pulmonary embolism
Answer: C. Bronchoconstriction from allergen exposure
Rationale: Allergens trigger mast-cell activation → inflammation → bronchoconstriction.
A nurse is assessing a patient experiencing an acute asthma attack. Which lung sound is most commonly heard during an asthma exacerbation?
A. Crackles
B. Rhonchi
C. Wheezing
D. Pleural friction rub
Correct answer: C. Wheezing
Rationale: C — Wheezing is the hallmark lung sound of asthma, caused by airway narrowing from bronchospasm, inflammation, and mucus.
A- (crackles) typically occur with fluid in the alveoli (e.g., pneumonia, heart failure).
B- (rhonchi) suggests mucus in the large airways, not the narrowed bronchi seen in asthma.
D- (friction rub) indicates pleural inflammation, not asthma.
A patient taking an inhaled corticosteroid reports hoarseness and oral white patches. Which instruction is MOST appropriate?
A. “Increase the dose of your inhaler.”
B. “Rinse your mouth after each use.”
C. “Stop using the inhaler immediately.”
D. “Use your rescue inhaler first.”
Answer: B. "Rinse your mouth after each use.”
Rationale: Inhaled corticosteroids can cause oral candidiasis; rinsing the mouth prevents this.
A patient with asthma produces thick, gelatinous sputum during an acute attack. The provider orders a sputum culture. What is the purpose of this test?
A. To diagnose asthma
B. To detect bacterial infection contributing to symptoms
C. To evaluate airway remodeling
D. To measure eosinophil levels
Correct Answer: B. To detect bacterial infection contributing to symptoms
Rationale: Asthma is not diagnosed via sputum, but sputum cultures help detect superimposed bacterial infections, particularly with purulent sputum.
A patient with asthma reports using cleaning chemicals at work and feeling short of breath by the end of the day. What is the most appropriate nursing intervention?
A. Teach avoidance of all fragrances
B. Suggest the use of a mask or explore occupational changes
C. Encourage increasing fluid intake
D. Recommend OTC cough suppressants
Correct Answer: B. Suggest the use of a mask or explore occupational changes
Rationale: Occupational asthma requires avoidance of irritants or workplace modification.
A patient arrives in the emergency department with shortness of breath and suspected acute asthma. The nurse assesses the patient and notes: diminished breath sounds, prolonged expiration, wheezing on inspiration, and use of accessory muscles.
Which findings support the diagnosis of an acute asthma exacerbation?
Select all that apply.
A. Diminished breath sounds
B. Prolonged expiration
C. Wheezing on inspiration
D. Respiratory rate of 10/min
E. Moist crackles in the lung bases
Correct Answers: A. Diminished breath sounds, B. Prolonged expiration, C. Wheezing on inspiration
Rationale: A. Diminished breath sounds —CORRECT
Diminished or decreased breath sounds occur during severe bronchoconstriction when airflow is significantly limited.
This is a common finding in acute asthma exacerbations, especially moderate to severe attacks.
B. Prolonged expiration — CORRECT
Asthma is an expiratory airway obstruction.
Bronchoconstriction and air trapping make exhalation harder and longer, so prolonged expiration is a hallmark sign of asthma.
C. Wheezing on inspiration — CORRECT
Wheezing (especially inspiratory or expiratory wheezing) indicates airway narrowing.
Inspiratory wheezing often occurs in more severe asthma because it reflects tighter airways and increased turbulence during airflow.
D. Respiratory rate of 10/min — INCORRECT
A respiratory rate of 10/min (bradypnea) is not typical of asthma.
Asthma patients almost always present with tachypnea (↑ respiratory rate) due to the increased work of breathing.
A low RR would be more concerning for impending respiratory failure, not typical exacerbation.
E. Moist crackles in the lung bases — INCORRECT
Crackles are not characteristic of asthma.
Crackles suggest fluid in the lungs such as pneumonia, heart failure, or pulmonary edema.
Asthma is an airway obstruction disease, not a fluid overload condition.
A nurse is caring for a patient experiencing a severe asthma exacerbation. Which assessment finding is considered an ominous sign indicating severe airway obstruction and possible impending respiratory failure?
A. Loud expiratory wheezing
B. Prolonged expiration
C. Diminished breath sounds with a “silent chest”
D. Increased use of accessory muscles
Correct answer: C. Diminished breath sounds with a “silent chest”
Rationale: C — Silent chest indicates extremely limited airflow due to critical airway obstruction and is a late, life-threatening sign of impending respiratory failure.
A- Wheezing, even loud, suggests airflow still present.
B- Prolonged expiration is typical of asthma but not an imminent danger sign.
D- Accessory muscle use indicates distress, but the “silent chest” is far more dangerous.
Which medication is appropriate for acute bronchospasm?
A. Budesonide/formoterol (Symbicort)
B. Fluticasone (Flovent)
C. Albuterol (ProAir)
D. Montelukast (Singulair)
Correct Answer: C. Albuterol (ProAir)
Rationale: Albuterol is the only medication listed that provides rapid bronchodilation for immediate relief.
A patient with suspected allergic asthma undergoes skin testing, which shows several positive reactions. What is the nurse’s best interpretation?
A. The allergens identified definitely cause the patient’s symptoms
B. A positive test indicates exposure only
C. Positive tests indicate sensitization, which may contribute to asthma symptoms
D. The patient must avoid all allergens tested
Correct Answer: C. Positive tests indicate sensitization, which may contribute to asthma symptoms
Rationale: A positive allergy skin test means the patient is sensitized, but does not confirm that exposure always triggers asthma.
A patient is experiencing mild shortness of breath during an asthma attack. Which action should the nurse take FIRST?
A. Prepare for intubation
B. Apply high-flow oxygen
C. Administer an inhaled short-acting beta agonist (SABA)
D. Perform chest physiotherapy
Answer: C. Administer an inhaled short-acting beta agonist (SABA)
Rationale: SABAs (albuterol) are first-line therapy for acute bronchospasm.
A nurse is teaching a patient about common triggers for asthma exacerbations. The nurse explains that viral respiratory infections commonly trigger which type of asthma?
A. Exercise-induced asthma
B. Occupational asthma
C. Intrinsic (non-allergic) asthma
D. Allergic (extrinsic) asthma
Correct Answer: C. Intrinsic (non-allergic) asthma
Rationale: Intrinsic (non-allergic) asthma is frequently triggered by viral respiratory infections, irritation, or stress rather than allergens. Exercise-induced asthma is triggered by physical activity. Occupational asthma is triggered by workplace exposures. Allergic (extrinsic) asthma is triggered by allergens such as dust, pollen, and pet dander.
A patient arrives at the clinic reporting cough at night, episodic dyspnea, and chest tightness. Which assessment finding is most characteristic of an asthma exacerbation?
A. Fine crackles in bilateral lower lobes
B. Expiratory wheezing
C. Pleural friction rub
D. Decreased tactile fremitus
Correct Answer: B. Expiratory wheezing
Rationale: Wheezing—especially on expiration—is the hallmark of airway obstruction caused by bronchospasm in asthma. Crackles indicate fluid; friction rub indicates inflammation of pleura; fremitus changes are not typical.
A nurse is assessing a 32-year-old patient admitted with an acute asthma exacerbation. The patient appears anxious, is sitting upright, and says, “I can’t get the air out.” The nurse notes the following assessment findings:
Respiratory rate: 32/min
Pulse: 118/min
Oxygen saturation: 89% on room air
Accessory muscle use
Markedly decreased breath sounds with no audible wheezing
The patient can only speak in single words
Which assessment findings indicate the patient is at high risk for impending respiratory failure?
Select all that apply.
A. Respiratory rate of 32/min
B. Inability to speak in full sentences
C. Markedly decreased breath sounds with no audible wheezing
D. Tachycardia at 118/min
E. Oxygen saturation of 89% on room air
Correct Answers: B. Inability to speak in full sentences, C. Markedly decreased breath sounds with no audible wheezing, E. Oxygen saturation of 89% on room air
Rationale: B. Inability to speak in full sentences → Indicates severe respiratory distress.
C. Markedly decreased breath sounds (“silent chest”) → Ominous sign of severely reduced airflow and impending respiratory failure.
E. O2 saturation of 89% → Indicates hypoxemia requiring intervention.
A and D (tachypnea and tachycardia) are expected in an asthma attack but are not the most critical indicators of impending respiratory failure.
Which diagnostic result supports a diagnosis of asthma?
A. FEV1 improves by 15% after bronchodilator
B. Chest x-ray reveals hyperinflation
C. ABG shows metabolic acidosis
D. PaO2 60 mm Hg
Answer: A. FEV1 improves by 15% after bronchodilator
Rationale: Reversibility of airway obstruction after bronchodilator is diagnostic for asthma.
A patient wants to reduce asthma triggers at home.
Which recommendations should the nurse include? Select all that apply.
A. Use a HEPA filter in the bedroom.
B. Wash bedding weekly in hot water.
C. Keep humidity levels between 60–70%.
D. Remove carpets and heavy drapes.
E. Avoid wood-burning stoves or fireplaces.
Correct Answers: A. Use a HEPA filter in the bedroom, B. Wash bedding weekly in hot water, D. Remove carpets and heavy drapes, E. Avoid wood-burning stoves or fireplaces.
Rationale:
HEPA filters remove allergens.
Hot-water washing kills dust mites.
Carpets and drapes harbor allergens.
Wood smoke worsens asthma.
Humidity should not be >50%.
A patient with a history of asthma reports increased coughing and wheezing, especially at night. The nurse reviews the patient’s medical history and notes symptoms of frequent heartburn and regurgitation. Which chronic condition does the nurse suspect may be worsening the patient’s asthma?
A. Peptic ulcer disease (PUD)
B. Gastroesophageal reflux disease (GERD)
C. Irritable bowel syndrome (IBS)
D. Ulcerative colitis
Correct Answer: B. Gastroesophageal reflux disease (GERD)
Rationale: GERD can worsen asthma by allowing stomach acid to reflux into the esophagus, triggering bronchoconstriction through vagal stimulation and airway irritation. This often leads to nighttime asthma symptoms. The other conditions do not directly contribute to bronchospasm.
The nurse assesses a patient experiencing an asthma attack. Which finding requires immediate intervention?
A. Loud inspiratory and expiratory wheezes
B. Diminished breath sounds with no wheezing
C. Prolonged expiration
D. Use of accessory muscles
Correct Answer: B. Diminished breath sounds with no wheezing
Rationale: The absence of wheezing (“silent chest”) suggests severe airway obstruction and can precede respiratory failure.
A patient with aspirin-sensitive asthma reports recent worsening of wheezing and chest tightness. The nurse reviews the patient’s home medications. Which type of medication should the nurse identify as unsafe for this patient?
A. Acetaminophen
B. Nonsteroidal anti-inflammatory drugs (NSAIDs)
C. Opioid analgesics
D. Muscle relaxants
Correct answer: B. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Rationale: Patients with aspirin-sensitive asthma may develop severe bronchospasm when taking NSAIDs—including ibuprofen, naproxen, and aspirin-containing products. Acetaminophen is generally safe when used appropriately. Opioids and muscle relaxants do not trigger aspirin-sensitive asthma.
A nurse is reviewing arterial blood gases for a patient during an acute asthma attack. Which findings indicate the attack is worsening?
Select all that apply.
A. pH 7.52
B. PaCO₂ 30 mm Hg
C. SpO₂ dropping from 95% to 88%
D. PaCO₂ rising from 32 mm Hg to 50 mm Hg
E. pH 7.28
Correct Answer: C. SpO₂ dropping from 95% to 88%, D. PaCO₂ rising from 32 mm Hg to 50 mm Hg, E. pH 7.28
Rationale: C. O₂ saturation falling = worsening gas exchange.
D. Rising CO₂ = patient is tiring → impending respiratory failure.
E. Low pH = respiratory acidosis from CO₂ retention → late, dangerous sign.
Incorrect choices:
A & B: Show respiratory alkalosis from hyperventilation — early signs, not worsening ones.
A nurse is caring for a patient experiencing moderate asthma symptoms. Which nursing interventions are appropriate?
Select all that apply.
A. Positioning the patient in high-Fowler’s
B. Encouraging pursed-lip breathing
C. Delaying bronchodilator treatment until ABGs return
D. Applying oxygen to maintain SpO₂ > 90%
E. Reviewing the patient’s asthma action plan
Correct Answers: A. Positioning the patient in high-Fowler’s, B. Encouraging pursed-lip breathing, D. Applying oxygen to maintain SpO₂ > 90%, E. Reviewing the patient’s asthma action plan
Rationale:
A. Positioning the patient in high-Fowler’s — CORRECT
High-Fowler’s position helps expand the lungs, decreases the work of breathing, and improves ventilation.
This is a key initial intervention during an asthma exacerbation.
B. Encouraging pursed-lip breathing — CORRECT
Pursed-lip breathing helps keep airways open longer, reduces air trapping, and promotes controlled exhalation.
It is appropriate for moderate asthma symptoms.
C. Delaying bronchodilator treatment until ABGs return — INCORRECT
Bronchodilators (e.g., albuterol) must be administered immediately during an asthma episode.
Waiting for ABGs would delay life-saving treatment and worsen the patient’s condition.
D. Applying oxygen to maintain SpO₂ > 90% — CORRECT
Supplemental oxygen is appropriate for asthma patients who are symptomatic or hypoxic.
Maintaining SpO₂ > 90% is consistent with standard asthma management guidelines.
E. Reviewing the patient’s asthma action plan — CORRECT
Reviewing the action plan helps guide treatment, reinforces education, and ensures the patient knows the appropriate steps during an exacerbation.
It is appropriate once the patient is stable and able to participate.
A patient with a history of asthma arrives in the emergency department during an acute attack. After several minutes of escalating wheezing, the nurse suddenly notes that breath sounds are now markedly diminished. What is the nurse’s priority interpretation?
A. The bronchodilator medication is starting to work
B. The patient is experiencing severe airway obstruction
C. The patient is hyperventilating and tiring out
D. The patient’s lungs are clearing as mucus is expelled
Correct Answer: B. The patient is experiencing severe airway obstruction
Rationale: A sudden decrease or absence of breath sounds during an asthma attack indicates severe airflow obstruction, often called a silent chest. This is a life-threatening sign of impending respiratory failure and requires immediate intervention.
A. is incorrect — bronchodilators cause improvement, not sudden silence.
C. is partially true but not the primary interpretation.
D. is incorrect — mucus clearing would improve breath sounds, not eliminate them.
During an asthma assessment, the nurse notes pulsus paradoxus. This finding indicates:
A. Early infection
B. Increased intrathoracic pressure during inspiration
C. Overhydration
D. Normal physiologic response
Correct Answer: B. Increased intrathoracic pressure during inspiration
Rationale: In severe asthma, air trapping increases intrathoracic pressure, causing systolic BP to drop >10 mmHg on inspiration.
A patient in the ED has a severe asthma exacerbation unresponsive to repeated SABA and corticosteroid therapy. The provider orders IV magnesium sulfate.
Which expected effect should the nurse monitor for?
A. Rapid sputum expectoration
B. Smooth muscle relaxation improving airway diameter
C. Immediate decrease in inflammatory markers
D. Reversal of hypoxemia within seconds
Correct Answer: B. Smooth muscle relaxation improving airway diameter
Rationale: Magnesium sulfate acts as a bronchial smooth muscle relaxant, used for severe, refractory asthma exacerbations.
Which instruction should the nurse give the patient before scheduled spirometry?
A. “Do not eat for 8 hours before the test.”
B. “Avoid bronchodilators for 6–12 hours before the test.”
C. “Wear tight clothing during the test.”
D. “Stop all asthma medications for 24 hours.”
Correct Answer: B. “Avoid bronchodilators for 6–12 hours before the test.”
Rationale: Bronchodilators must be withheld to accurately measure baseline lung function.
A patient with an acute asthma attack has ABG results showing:
pH 7.48, PaCO₂ 30 mmHg, PaO₂ 72 mmHg.
Which nursing interpretation is correct?
A. The patient is tiring and developing respiratory acidosis
B. The patient is hyperventilating early in the attack
C. The patient’s ABG is normal for asthma
D. The patient is experiencing metabolic alkalosis
Correct Answer: B. The patient is hyperventilating early in the attack
Rationale: Early in an asthma attack, patients hyperventilate, causing respiratory alkalosis (↑pH, ↓CO₂). A shift to acidosis would indicate severe fatigue.