Asthma Nursing Care Plan | NCLEX Practice Questions

Asthma is a chronic inflammatory disorder of the airways that leads to episodes of wheezing, breathlessness, chest tightness, and coughing. As a nurse, creating an effective asthma care plan is essential for managing acute exacerbations and promoting long-term control. This article will guide nursing students and professionals through a complete nursing care plan for asthma, including assessment data, nursing diagnoses, interventions, rationales, and NCLEX-style practice questions to reinforce learning.

Understanding Asthma: Definition and Pathophysiology

Asthma is characterized by airway hyperresponsiveness, inflammation, and reversible airflow obstruction. Triggers such as allergens, exercise, cold air, or stress cause the bronchial muscles to tighten, the airway to swell, and excessive mucus production to occur.

Common Symptoms:

• Shortness of breath

• Wheezing

• Chest tightness

• Persistent coughing (especially at night)

Assessment for Asthma in Nursing Practice

Subjective Data:

• Reports of difficulty breathing

• Chest tightness or pressure

• History of asthma attacks or allergies

• Fatigue with physical activity

Objective Data:

• Audible wheezing

• Use of accessory muscles to breathe

• Increased respiratory rate

• Decreased oxygen saturation (SpO₂)

• Peak expiratory flow rate (PEFR) below normal

Nursing Diagnosis for Asthma

Below are the common NANDA-approved nursing diagnoses associated with asthma:

1. Ineffective Airway Clearance

2. Impaired Gas Exchange

3. Ineffective Breathing Pattern

4. Anxiety

5. Activity Intolerance

6. Deficient Knowledge

Nursing Care Plan for Asthma

1. Ineffective Airway Clearance

Related to: bronchospasm, increased mucus production
As evidenced by: wheezing, coughing, use of accessory muscles, abnormal lung sounds

Goals:

Patient will maintain a clear airway as evidenced by normal breath sounds and improved respiratory rate.

Nursing Interventions and Rationales:

• Position patient in high Fowler’s position: Promotes lung expansion and easier breathing.

• Administer bronchodilators as prescribed: Reduces bronchospasm and opens airways.

• Encourage fluid intake (if not contraindicated): Helps thin mucus secretions.

• Monitor breath sounds and respiratory effort: Early detection of worsening condition.

• Suction as needed: Removes secretions and prevents airway blockage.

2. Impaired Gas Exchange

Related to: alveolar-capillary membrane changes, bronchial edema
As evidenced by: low SpO₂, cyanosis, restlessness

Goals:

Patient will maintain oxygen saturation > 94% on room air.

Nursing Interventions and Rationales:

• Administer oxygen therapy as prescribed: Improves oxygenation and reduces hypoxia.

• Monitor ABG and SpO₂ levels: Assesses the extent of gas exchange impairment.

• Instruct in pursed-lip breathing: Prevents airway collapse and improves CO₂ exhalation.

• Avoid environmental allergens or triggers: Prevents further respiratory compromise.

3. Ineffective Breathing Pattern

Related to: bronchoconstriction, anxiety, respiratory muscle fatigue
As evidenced by: use of accessory muscles, abnormal respiratory rate, nasal flaring

Goals:

Patient will demonstrate effective breathing pattern with normal respiratory rate and rhythm.

Nursing Interventions and Rationales:

• Teach relaxation and breathing techniques: Helps control panic and breathing rhythm.

• Monitor respiratory rate and depth regularly: Detects early signs of deterioration.

• Encourage rest periods between activities: Prevents fatigue and oxygen depletion.

4. Anxiety

Related to: difficulty breathing, unfamiliar hospital environment
As evidenced by: restlessness, verbal expression of fear

Goals:

Patient will verbalize decreased anxiety and participate in care routines.

Nursing Interventions and Rationales:

• Provide emotional support and reassurance: Reduces fear and improves trust.

• Explain all procedures and equipment: Reduces fear of the unknown.

• Use calming voice and environment: Minimizes external stressors.

5. Activity Intolerance

Related to: imbalance between oxygen supply and demand
As evidenced by: fatigue, dyspnea on exertion

Goals:

Patient will perform ADLs with minimal assistance and no signs of respiratory distress.

Nursing Interventions and Rationales:

• Gradually increase activity level: Enhances endurance without causing respiratory strain.

• Monitor vital signs during activity: Ensures safety and tolerance to exercise.

• Encourage energy-conservation techniques: Helps maintain strength while reducing stress.

6. Deficient Knowledge

Related to: lack of understanding about asthma management
As evidenced by: improper use of inhaler, frequent ER visits

Goals:

Patient will verbalize understanding of asthma triggers, medications, and emergency response.

Nursing Interventions and Rationales:

• Educate about trigger avoidance: Empowers self-management and reduces episodes.

• Demonstrate proper inhaler use: Improves medication effectiveness.

• Create an asthma action plan with the patient: Supports autonomy and readiness for emergencies.

• Provide written materials and videos for reinforcement: Enhances retention.

Case Study: Asthma Nursing Care Plan Example

Patient: 14-year-old male
Chief Complaint: Shortness of breath and wheezing after gym class

Assessment Findings:

• Respiratory rate: 28/min

• SpO₂: 91% on room air

• Wheezing heard in all lung fields

• Peak flow meter: 60% of baseline

Nursing Diagnoses:

• Ineffective Airway Clearance

• Impaired Gas Exchange

• Anxiety

Interventions:

• Administered prescribed short-acting bronchodilator

• Positioned in high Fowler’s

• Initiated oxygen therapy

• Educated mother and child on inhaler use and asthma triggers

Outcome:

• Patient stabilized within 30 minutes

• SpO₂ increased to 96%

• Breathing normalized, anxiety reduced

Asthma NCLEX Practice Questions

1. A patient with asthma is experiencing shortness of breath. What is the priority nursing action?
   A. Notify the physician
   B. Administer bronchodilator
   C. Place the patient in supine position
   D. Start IV fluids
   Correct Answer: B

2. Which of the following is a sign of an impending asthma attack?
   A. Bradycardia
   B. Decreased respiratory rate
   C. Use of accessory muscles
   D. Hyperpigmentation
   Correct Answer: C

3. A nurse is teaching a client with asthma about peak flow monitoring. When should the patient check their peak flow?
   A. At bedtime
   B. Before meals
   C. Every morning before taking medication
   D. Once a week
   Correct Answer: C

4. Which medication is most appropriate for acute asthma exacerbation?
   A. Salmeterol
   B. Montelukast
   C. Albuterol
   D. Fluticasone
   Correct Answer: C

5. Which dietary recommendation is most appropriate for a client with asthma?
   A. High-sodium diet
   B. Avoidance of sulfite-containing foods
   C. High-protein meals only
   D. Elimination of fluids
   Correct Answer: B

6. A client is using a metered-dose inhaler. Which step indicates a need for further teaching?
   A. Holding breath for 10 seconds
   B. Shaking the inhaler before use
   C. Inhaling before pressing the canister
   D. Waiting 1 minute between puffs
   Correct Answer: C

7. What is the purpose of corticosteroids in asthma management?
   A. Bronchodilation
   B. Anti-inflammatory effect
   C. Increase respiratory rate
   D. Promote sleep
   Correct Answer: B

8. Which environmental factor should the nurse advise the patient to avoid?
   A. Dry air
   B. Clean bedding
   C. Filtered air
   D. Steam inhalation
   Correct Answer: A

9. During an asthma attack, which sound is most likely to be heard?
   A. Stridor
   B. Crackles
   C. Wheezing
   D. Pleural rub
   Correct Answer: C

10. A nurse teaches a client with asthma about early signs of poor control. Which sign should the patient report immediately?
    A. Slight fatigue after exercise
    B. Coughing at night
    C. Nasal congestion
    D. Mild headache
    Correct Answer: B

Final Thoughts

Creating a comprehensive asthma care plan in nursing involves more than just medication administration. It requires critical thinking, patient education, and timely intervention to manage triggers, optimize respiratory function, and improve patient quality of life. By understanding asthma’s pathophysiology and applying appropriate nursing diagnoses and interventions, you’ll be better prepared for both NCLEX questions and clinical situations.