NURS 640 Exam 1 Questions and Answers Already Passed Latest Update 2025-2026
Chronic care model - Answersfocuses on improving care for chronic diseases. 1. Delivery of
high quality care requires a range of strategies that must closely involve and engage the patient.
2. Team care is essential.
Transitional Care Model (TCM) - AnswersAPN provides comprehensive in hospital planning and
home follow up care coordination, including training and support for nurses by a
multidisciplinary HF team. Care plans developed by nurses in collaboration with pt physicians
that reflect pt and caregiver goals and evidence based guidelines; pt and caregiver education;
coordination of care across settings; and nurse delivered clinical services including medication
management.
Care Transitions Intervention (CTI) - AnswersA transition coach (RN or APN) provides tools and
teaches self-management and communication skills to pt and caregivers so they can
coordinate their care and follows up with home visit and telephone calls. CTI focuses on
medication self-management; pt assembled personal health recorded, primary care and
specialist follow up and teaching the pt how to recognize and follow up on ref flag symptoms.
Re-Engineered Discharge (project RED) - Answersnurse discharge advocate provides; pt
education, medication reconciliation and education; instruction about red flags; teach back
learning process; coordination of physician appointments and follow up testing; EBP written
discharge plan shared with pt and all providers. A clinical pharmacist follows up by telephone to
reinforce discharge plan, review medications and solve problems.
Enhanced Discharge Planning program (EDPP) - Answersmaster prepared workers with
experience in geriatric and community based practice provide a phone based intervention to
supplement the existing discharge process; pre discharge review of pt chart and consultation
with pt providers about potential barriers to successful transition; follow up phone call to
assess pt ability to adhere to discharge plan and to determine if medical and social services
specified in the discharge plan have been received; to identify medication problems and
adherence, ensure knowledge of red flags. The EDPP model emphasizes addressing
psychosocial and medical issues that emerge after discharge.
Medical decision making - Answersmaking is a process that you are continuously evaluating
and refining based on new data you obtain. To be particularly skilled in this, you must be
cognizant of the biases you may bring to your evaluation of the patient's case and the human
errors that can occur during the course of evaluation management. A good clinician looks at
both for their own errors and the errors of colleagues and make the necessary corrections to
avoid harm to the patient.
full compensated - AnswersIs pH normal? PaCO2 and HCO3 abnormal
uncompensated. - AnswerspH abnormal? PaCO2 or HCO3 abnormal
,Mild PAO2 - Answers60-79 mmHg
Moderate PaO2 - Answers40-59mmHg
Severe PaO2 - Answers< 40mmHg
Metabolic Acidosis - AnswersLactic acidosis, ketoacidosis (diabetic, alcoholic, starvation),
toxins (methanol, salicylates) renal failure (acute or chronic)
Respiratory alkalosis - Answers§ hypoxia (decreased inspired oxygen, high altitude, ventilation,
hypotension, severe anemia)
§ CNS-mediated disorders (hyperventilation, anxiety, neurologic disease, CVA, infection, trauma,
tumor, drugs, heat, hepatic failure)
§ Pulmonary disease (interstitial lung disease, pneumonia, PE, pulmonary edema)
§ Mechanical overventilation
Metabolic alkalosis - AnswersExcessive body bicarb content (renal alkalosis, Gastrointestinal
alkalosis)
Pulse oximetry - AnswersMeasures peripheral arterial oxygen saturation. AKA "the fifth vital
sign." In most patients peripheral oxygen saturation as measured by pulse oximetry (SpO2)
provides accurate information on tissue oxygenation, which allows the clinician to assess and
treat patients who are potentially hypoxemic. As a general principle, clinicians should pay
attention to trends on oxygenation and when treating patients with supplemental oxygen for
hypoxemia, clinicians should target levels that are desirable for the specific etiology, while
simultaneously avoiding oxygen toxicity. A target level of 88 to 92 percent may be sufficient in a
patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who is
chronically hypercapnic.
Arterial blood gas interpretation normal values - Answers●pH - 7.35 to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
Respiratory acidosis - Answersa disturbance in acid-base balance usually due to alveolar
hypoventilation that can be acute or chronic. It is characterized by an increased PaCO2 >45
mmHg (hypercapnia) and a reduction in pH (pH <7.35).
Respiratory alkalosis - Answersusually due to alveolar hyperventilation which leads to a
decrease in PaCO2 (hypocapnia) and an increase in the pH. It can also be acute or chronic. In
acute respiratory alkalosis, the PaCO2 level is below the lower limit of normal (<35 mmHg or 4.7
kPa) and the serum pH is appropriately alkalemic (>7.45).
, Metabolic acidosis - Answersdiagnosed when the serum pH is reduced and the serum
bicarbonate concentration is abnormally low (often defined as <22 meq/L, but the threshold
may vary across clinical laboratories).
Metabolic alkalosis - Answersis usually accompanied by hypokalemia, is defined as a disorder
that causes elevations in the serum bicarbonate concentration and arterial pH. In a patient with
an uncomplicated (simple) metabolic alkalosis, both parameters are above normal. However,
this may not be present in patients with mixed acid-base disorders.
Venous blood sample - Answerso Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
Vocal fold dysfunction syndrome - Answersparadoxical vocal fold adduction, acute and chronic
upper airway obstruction.
Disorders of the upper airways - AnswersAcute obstruction include trauma to the larynx or
pharynx, foreign body aspiration, laryngospasm, laryngeal edema from thermal injury or
angioedema, infections (acute epiglottis, Ludwig angina, pharyngeal or retropharyngeal abscess)
and acute allergic laryngitis.
Chronic obstruction of the upper airway - Answerscarcinoma of the pharynx or larynx, laryngeal
or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold paralysis.
Characteristic findings= inspiratory stridor, intercostal retractions on inspiration, palpable
inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on auscultation.
response to bronchodilator therapy, normal spirometry immediately after an attack, -
AnswersDyspnea, wheezing that may be distinguished from asthma or exercise induced asthma
by the lack of
Disorders of the lower airways - AnswersTracheal obstruction= intrathoracic (below the
suprasternal notch) or extrathoracic.
Bronchial obstruction - Answerspulmonary secretions, aspiration, foreign bodies, bronchomalcia,
bronchogenic carcinoma, masses and tumors metastatic to the airways.
Intermittent or mild persistent asthma - Answerssymptoms are worse at night. Circadian
variations in bronchomotor tone and bronchial reactivity reach their nadir between 3am and
4am, increasing symptoms of bronchoconstriction
Chronic care model - Answersfocuses on improving care for chronic diseases. 1. Delivery of
high quality care requires a range of strategies that must closely involve and engage the patient.
2. Team care is essential.
Transitional Care Model (TCM) - AnswersAPN provides comprehensive in hospital planning and
home follow up care coordination, including training and support for nurses by a
multidisciplinary HF team. Care plans developed by nurses in collaboration with pt physicians
that reflect pt and caregiver goals and evidence based guidelines; pt and caregiver education;
coordination of care across settings; and nurse delivered clinical services including medication
management.
Care Transitions Intervention (CTI) - AnswersA transition coach (RN or APN) provides tools and
teaches self-management and communication skills to pt and caregivers so they can
coordinate their care and follows up with home visit and telephone calls. CTI focuses on
medication self-management; pt assembled personal health recorded, primary care and
specialist follow up and teaching the pt how to recognize and follow up on ref flag symptoms.
Re-Engineered Discharge (project RED) - Answersnurse discharge advocate provides; pt
education, medication reconciliation and education; instruction about red flags; teach back
learning process; coordination of physician appointments and follow up testing; EBP written
discharge plan shared with pt and all providers. A clinical pharmacist follows up by telephone to
reinforce discharge plan, review medications and solve problems.
Enhanced Discharge Planning program (EDPP) - Answersmaster prepared workers with
experience in geriatric and community based practice provide a phone based intervention to
supplement the existing discharge process; pre discharge review of pt chart and consultation
with pt providers about potential barriers to successful transition; follow up phone call to
assess pt ability to adhere to discharge plan and to determine if medical and social services
specified in the discharge plan have been received; to identify medication problems and
adherence, ensure knowledge of red flags. The EDPP model emphasizes addressing
psychosocial and medical issues that emerge after discharge.
Medical decision making - Answersmaking is a process that you are continuously evaluating
and refining based on new data you obtain. To be particularly skilled in this, you must be
cognizant of the biases you may bring to your evaluation of the patient's case and the human
errors that can occur during the course of evaluation management. A good clinician looks at
both for their own errors and the errors of colleagues and make the necessary corrections to
avoid harm to the patient.
full compensated - AnswersIs pH normal? PaCO2 and HCO3 abnormal
uncompensated. - AnswerspH abnormal? PaCO2 or HCO3 abnormal
,Mild PAO2 - Answers60-79 mmHg
Moderate PaO2 - Answers40-59mmHg
Severe PaO2 - Answers< 40mmHg
Metabolic Acidosis - AnswersLactic acidosis, ketoacidosis (diabetic, alcoholic, starvation),
toxins (methanol, salicylates) renal failure (acute or chronic)
Respiratory alkalosis - Answers§ hypoxia (decreased inspired oxygen, high altitude, ventilation,
hypotension, severe anemia)
§ CNS-mediated disorders (hyperventilation, anxiety, neurologic disease, CVA, infection, trauma,
tumor, drugs, heat, hepatic failure)
§ Pulmonary disease (interstitial lung disease, pneumonia, PE, pulmonary edema)
§ Mechanical overventilation
Metabolic alkalosis - AnswersExcessive body bicarb content (renal alkalosis, Gastrointestinal
alkalosis)
Pulse oximetry - AnswersMeasures peripheral arterial oxygen saturation. AKA "the fifth vital
sign." In most patients peripheral oxygen saturation as measured by pulse oximetry (SpO2)
provides accurate information on tissue oxygenation, which allows the clinician to assess and
treat patients who are potentially hypoxemic. As a general principle, clinicians should pay
attention to trends on oxygenation and when treating patients with supplemental oxygen for
hypoxemia, clinicians should target levels that are desirable for the specific etiology, while
simultaneously avoiding oxygen toxicity. A target level of 88 to 92 percent may be sufficient in a
patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who is
chronically hypercapnic.
Arterial blood gas interpretation normal values - Answers●pH - 7.35 to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
Respiratory acidosis - Answersa disturbance in acid-base balance usually due to alveolar
hypoventilation that can be acute or chronic. It is characterized by an increased PaCO2 >45
mmHg (hypercapnia) and a reduction in pH (pH <7.35).
Respiratory alkalosis - Answersusually due to alveolar hyperventilation which leads to a
decrease in PaCO2 (hypocapnia) and an increase in the pH. It can also be acute or chronic. In
acute respiratory alkalosis, the PaCO2 level is below the lower limit of normal (<35 mmHg or 4.7
kPa) and the serum pH is appropriately alkalemic (>7.45).
, Metabolic acidosis - Answersdiagnosed when the serum pH is reduced and the serum
bicarbonate concentration is abnormally low (often defined as <22 meq/L, but the threshold
may vary across clinical laboratories).
Metabolic alkalosis - Answersis usually accompanied by hypokalemia, is defined as a disorder
that causes elevations in the serum bicarbonate concentration and arterial pH. In a patient with
an uncomplicated (simple) metabolic alkalosis, both parameters are above normal. However,
this may not be present in patients with mixed acid-base disorders.
Venous blood sample - Answerso Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
Vocal fold dysfunction syndrome - Answersparadoxical vocal fold adduction, acute and chronic
upper airway obstruction.
Disorders of the upper airways - AnswersAcute obstruction include trauma to the larynx or
pharynx, foreign body aspiration, laryngospasm, laryngeal edema from thermal injury or
angioedema, infections (acute epiglottis, Ludwig angina, pharyngeal or retropharyngeal abscess)
and acute allergic laryngitis.
Chronic obstruction of the upper airway - Answerscarcinoma of the pharynx or larynx, laryngeal
or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold paralysis.
Characteristic findings= inspiratory stridor, intercostal retractions on inspiration, palpable
inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on auscultation.
response to bronchodilator therapy, normal spirometry immediately after an attack, -
AnswersDyspnea, wheezing that may be distinguished from asthma or exercise induced asthma
by the lack of
Disorders of the lower airways - AnswersTracheal obstruction= intrathoracic (below the
suprasternal notch) or extrathoracic.
Bronchial obstruction - Answerspulmonary secretions, aspiration, foreign bodies, bronchomalcia,
bronchogenic carcinoma, masses and tumors metastatic to the airways.
Intermittent or mild persistent asthma - Answerssymptoms are worse at night. Circadian
variations in bronchomotor tone and bronchial reactivity reach their nadir between 3am and
4am, increasing symptoms of bronchoconstriction
