2/6/26, 2:38 PM NURS 640 Exam 1
NURS 640 Exam 1 EXAM SCRIPT 2026
COMPREHENSIVE QUESTIONS AND SOLUTIONS
GRADED A+
Chronic care model
focuses 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.
Enhanced Discharge Planning program (EDPP)
master 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.
/ 1/56
,2/6/26, 2:38 PM NURS 640 Exam 1
Transitional Care Model (TCM)
APN 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)
A 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)
nurse 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.
/ 2/56
,2/6/26, 2:38 PM NURS 640 Exam 1
Medical decision making
making 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
Is pH normal? PaCO2 and HCO3 abnormal
Respiratory alkalosis
§ 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
Excessive body bicarb content (renal alkalosis, Gastrointestinal alkalosis)
/ 3/56
, 2/6/26, 2:38 PM NURS 640 Exam 1
Pulse oximetry
Measures 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
● pH - 7.35 to 7.45
● PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
● HCO3 - 21 to 27 mEq/L
Respiratory acidosis
a 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).
/ 4/56
NURS 640 Exam 1 EXAM SCRIPT 2026
COMPREHENSIVE QUESTIONS AND SOLUTIONS
GRADED A+
Chronic care model
focuses 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.
Enhanced Discharge Planning program (EDPP)
master 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.
/ 1/56
,2/6/26, 2:38 PM NURS 640 Exam 1
Transitional Care Model (TCM)
APN 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)
A 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)
nurse 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.
/ 2/56
,2/6/26, 2:38 PM NURS 640 Exam 1
Medical decision making
making 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
Is pH normal? PaCO2 and HCO3 abnormal
Respiratory alkalosis
§ 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
Excessive body bicarb content (renal alkalosis, Gastrointestinal alkalosis)
/ 3/56
, 2/6/26, 2:38 PM NURS 640 Exam 1
Pulse oximetry
Measures 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
● pH - 7.35 to 7.45
● PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
● HCO3 - 21 to 27 mEq/L
Respiratory acidosis
a 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).
/ 4/56
