# Situation: The public health nurse at a Barangay Health Station (BHS) follows up adults with asthma, chronic obstructive pulmonary disease (COPD), and hypertension who are listed in the barangay registry for noncommunicable diseases (NCDs). A 34-year-old man with asthma has a personal best peak expiratory flow (PEF) of 450 L/min. Today, with a cough and mild wheeze, his PEF is 355 L/min. According to his written asthma action plan, which zone is he in and what should he do? Round off to the nearest whole percent.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627117  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse at a Barangay Health Station (BHS) follows up adults with asthma, chronic obstructive pulmonary disease (COPD), and hypertension who are listed in the barangay registry for noncommunicable diseases (NCDs).

A 34-year-old man with asthma has a personal best peak expiratory flow (PEF) of 450 L/min. Today, with a cough and mild wheeze, his PEF is 355 L/min. According to his written asthma action plan, which zone is he in and what should he do? Round off to the nearest whole percent.

## 보기

1. Green zone: continue the usual daily treatment
2. Red zone: use the reliever and seek emergency care
3. Yellow zone: stop the controller until the cough clears
4. Yellow zone: use the reliever and contact the provider **✔ 정답**

**정답: 4**

## 해설

His PEF is 355 ÷ 450 × 100 = 78.9%, or 79% of his personal best. The green zone starts at 80% (360 L/min), so he is just inside the yellow zone (50 to 79%): he uses his reliever, follows his action plan, and contacts his provider. The red zone, below 50%, calls for the reliever and emergency care.

## 심화 해설

Calculating the percentage of personal best
A written asthma action plan divides peak expiratory flow (PEF) readings into zones based on the client's personal best. This man's personal best is 450 L/min and today's reading is 355 L/min. His percentage is 355 ÷ 450 × 100 = 78.9%, which rounds to 79%. The green zone starts at 80% of personal best, which for him is 360 L/min. At 79%, he is just inside the yellow zone (50 to 79%). In the yellow zone, he uses his reliever, follows the steps in his action plan, and contacts his provider.

What each zone means
The green zone (80% or more) means good control: he continues his usual daily treatment. The yellow zone (50 to 79%) means asthma is worsening: he takes his reliever, usually inhaled salbutamol (albuterol), keeps taking his controller, follows the plan's specific instructions, and contacts his health provider. The red zone (below 50%, which for him is below 225 L/min) is a medical alert: he uses his reliever and seeks emergency care immediately. His cough and mild wheeze match the yellow-zone picture of early worsening.

| Zone | Percent of personal best | PEF for this client | Action |
| --- | --- | --- | --- |
| Green | 80% or more | 360 L/min or more | Continue usual treatment |
| Yellow | 50% to 79% | 225 to 359 L/min | Reliever, follow plan, contact provider |
| Red | Below 50% | Below 225 L/min | Reliever and emergency care |

Why the other answers are wrong
Green zone is tempting because 355 is close to 360, but the cut-off is fixed, and 79% is below 80%. Red zone overstates the problem; he is far above 50%. The option that places him correctly in the yellow zone but tells him to stop his controller is the most dangerous: the controller, usually an inhaled corticosteroid, treats the airway inflammation that drives the worsening, and it must never be stopped during an exacerbation. Watch out! An option can name the right zone and still be wrong because of the action attached to it; check both halves.

Teaching points for the nurse
Clients should know their personal best and the PEF numbers that mark each zone, written on the plan. The nurse reviews inhaler technique, reminds him to keep taking his controller daily even when he feels well, and explains when to move to the red-zone actions, such as a PEF below 225 L/min, breathlessness at rest, or difficulty speaking. Recording PEF readings in a diary helps the provider judge control at follow-up visits at the Barangay Health Station.

## 임상 시나리오

Asthma Action Plan ZonesUsing percent of personal best
Percent of personal best: 355 ÷ 450 × 100 = 78.9%, rounded to 79%. The green zone begins at 80% (360 L/min).

Yellow zone (50 to 79%): use the reliever, continue the controller, follow the plan, and contact the provider.

Red zone (below 50%, under 225 L/min for him): use the reliever and seek emergency care at once.

CautionNever stop the controller during worsening asthma, even in the yellow zone.

## 핵심 개념

- **Peak expiratory flow** — The fastest rate of air a person can blow out after a full breath, used to monitor asthma control.
- **Personal best** — The highest PEF a person achieves when asthma is well controlled, used to set action plan zones.
- **Asthma action plan** — A written plan telling a person with asthma what to do in green, yellow, and red zones.
- **Controller medicine** — A daily asthma medicine, usually an inhaled corticosteroid, that reduces airway inflammation.

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