NCLEX-PN® ExaminationPhysiological AdaptationEasy
A client is experiencing an exacerbation of asthma. The nurse notes expiratory wheezing, productive cough, and uses of accessory muscles. The peak expiratory flow rate (PEFR) is 60% of the client's personal best. Which medication should the nurse anticipate administering FIRST?
- AInhaled fluticasone
- BNebulized albuterol
- CIntravenous magnesium sulfate
- DOral prednisone
Show answer & explanationAnswer & explanation
Correct answer: B. Nebulized albuterol
The client's symptoms (wheezing, cough, accessory muscle use) and PEFR of 60% of personal best indicate an acute asthma exacerbation. Short-acting beta-agonists (SABAs) like albuterol are the first-line treatment for acute bronchospasm, as they rapidly relax bronchial smooth muscle, improving airflow. Nebulized administration provides quick and effective delivery.
Why the other options are wrong
- A. Fluticasone (inhaled corticosteroid) is a long-term controller medication, not for acute exacerbations.
- C. Magnesium sulfate may be used in severe, refractory asthma, but it is not the first-line treatment for an acute exacerbation.
- D. Prednisone (systemic corticosteroid) is used for inflammation but has a delayed onset and is not for immediate bronchodilation.
Acute Asthma Exacerbation Treatment
A worsening of asthma symptoms (wheezing, cough, dyspnea, chest tightness) requiring immediate intervention to relieve bronchospasm and inflammation.
- First-line treatment: Short-acting beta-agonists (SABAs) like albuterol.
- SABAs provide rapid bronchodilation.
- Systemic corticosteroids (e.g., prednisone) are used to reduce inflammation in moderate to severe exacerbations.
- Oxygen therapy may be needed to maintain adequate saturation.
Memory trick: Asthma Attack: Albuterol First, Breathe Better Fast!