Asthma — NCLEX Cheat Sheet
Reversible airway narrowingAlso known as: asthma attack · reactive airway disease · wheezing attack · bronchospasm
Use this quick-reference guide to spot, treat, and prevent Asthma on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
🩺 Signs
- Wheeze, cough, chest tight
- Prolonged expiration, dyspnea
- ↓ peak flow, accessory muscles
🚩 Report
- Silent chest = no air movement
- Status asthmaticus, ↓ O₂
🧪 Meds
- Rescue: SABA (albuterol) first
- Maintenance: inhaled steroid
- Bronchodilator before steroid
🎓 Teach
- Avoid triggers, rinse after steroid
📚 Asthma — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- Expiratory wheezing, chest tightness, dyspnea, and a nonproductive cough are hallmark signs.
- Air trapping during an attack prolongs the expiratory phase and can cause a barrel chest over time.
- Use of accessory muscles, nasal flaring, and tripod positioning indicate increasing respiratory effort.
- A silent chest (absence of wheezing) with severe distress signals impending respiratory failure, not improvement.
- Early in an attack respiratory alkalosis develops from hyperventilation; a rising CO2 with normalizing pH signals fatigue.
- Status asthmaticus is a severe attack unresponsive to standard bronchodilators and requires emergency care.
Nursing priorities
What to do, in order- Position the patient upright (high Fowler's) to maximize lung expansion.
- Administer short-acting beta-2 agonists (albuterol) first for acute bronchospasm, then corticosteroids for inflammation.
- Apply oxygen and continuously monitor pulse oximetry and respiratory status.
- Encourage pursed-lip breathing and keep the patient calm to reduce oxygen demand.
- Monitor peak expiratory flow rate and prepare for possible intubation if the patient deteriorates.
Red flags — report now
Escalate immediately- A silent chest with no audible wheezing plus rising PaCO2 indicates impending respiratory arrest, escalate immediately.
- Cyanosis, drowsiness, or a drop in respiratory rate with worsening distress signals decompensation.
- SpO2 below 90 percent that does not improve with oxygen and bronchodilators requires rapid intervention.
- Never give beta-blockers, which can trigger or worsen bronchospasm.
Labs & values
Numbers to know- ABG early attack: respiratory alkalosis (pH >7.45, PaCO2 <35)
- Normal PaCO2 (35-45) during a severe attack is an ominous sign of fatigue
- SpO2 normal 95-100%; treat if <90%
Patient teaching
What patients must know- Use the bronchodilator (rescue) inhaler before the corticosteroid (controller) inhaler, and rinse the mouth after steroids to prevent thrush.
- Identify and avoid personal triggers such as smoke, allergens, and cold air.
- Use a peak flow meter daily and follow the green-yellow-red zone action plan to catch worsening early.
❓ Asthma: NCLEX FAQs
What are the priority nursing interventions for Asthma?
Position the patient upright (high Fowler's) to maximize lung expansion. Administer short-acting beta-2 agonists (albuterol) first for acute bronchospasm, then corticosteroids for inflammation. Apply oxygen and continuously monitor pulse oximetry and respiratory status. Encourage pursed-lip breathing and keep the patient calm to reduce oxygen demand.
What are the warning signs of Asthma a nurse must report?
A silent chest with no audible wheezing plus rising PaCO2 indicates impending respiratory arrest, escalate immediately. Cyanosis, drowsiness, or a drop in respiratory rate with worsening distress signals decompensation. SpO2 below 90 percent that does not improve with oxygen and bronchodilators requires rapid intervention. Never give beta-blockers, which can trigger or worsen bronchospasm.
What do I need to know about Asthma for the NCLEX?
Expiratory wheezing, chest tightness, dyspnea, and a nonproductive cough are hallmark signs. Air trapping during an attack prolongs the expiratory phase and can cause a barrel chest over time. Use of accessory muscles, nasal flaring, and tripod positioning indicate increasing respiratory effort. A silent chest (absence of wheezing) with severe distress signals impending respiratory failure, not improvement.
What patient teaching is important for Asthma?
Use the bronchodilator (rescue) inhaler before the corticosteroid (controller) inhaler, and rinse the mouth after steroids to prevent thrush. Identify and avoid personal triggers such as smoke, allergens, and cold air. Use a peak flow meter daily and follow the green-yellow-red zone action plan to catch worsening early.
Quick Tip
Expiratory wheezing, chest tightness, dyspnea, and a nonproductive cough are hallmark signs.
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