NURS 640 ACTUAL EXAM PAPER 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◉ Transitional Care Model (TCM). Answer: 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). Answer: 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). Answer: 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.
◉ Enhanced Discharge Planning program (EDPP). Answer: 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.
◉ Medical decision making. Answer: 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. Answer: Is pH normal? PaCO2 and HCO3
abnormal
◉ uncompensated.. Answer: pH abnormal? PaCO2 or HCO3 abnormal
,◉ Mild PAO2. Answer: 60-79 mmHg
◉ Moderate PaO2. Answer: 40-59mmHg
◉ Severe PaO2. Answer: < 40mmHg
◉ Metabolic Acidosis. Answer: Lactic acidosis, ketoacidosis (diabetic,
alcoholic, starvation), toxins (methanol, salicylates) renal failure (acute
or chronic)
◉ Respiratory alkalosis. Answer: § 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. Answer: Excessive body bicarb content (renal
alkalosis, Gastrointestinal alkalosis)
◉ Pulse oximetry. Answer: 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. Answer: ●pH - 7.35
to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
◉ Respiratory acidosis. Answer: 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).
◉ Respiratory alkalosis. Answer: usually 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).
QUESTIONS WITH SOLUTIONS GRADED A+
◉ Transitional Care Model (TCM). Answer: 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). Answer: 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). Answer: 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.
◉ Enhanced Discharge Planning program (EDPP). Answer: 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.
◉ Medical decision making. Answer: 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. Answer: Is pH normal? PaCO2 and HCO3
abnormal
◉ uncompensated.. Answer: pH abnormal? PaCO2 or HCO3 abnormal
,◉ Mild PAO2. Answer: 60-79 mmHg
◉ Moderate PaO2. Answer: 40-59mmHg
◉ Severe PaO2. Answer: < 40mmHg
◉ Metabolic Acidosis. Answer: Lactic acidosis, ketoacidosis (diabetic,
alcoholic, starvation), toxins (methanol, salicylates) renal failure (acute
or chronic)
◉ Respiratory alkalosis. Answer: § 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. Answer: Excessive body bicarb content (renal
alkalosis, Gastrointestinal alkalosis)
◉ Pulse oximetry. Answer: 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. Answer: ●pH - 7.35
to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
◉ Respiratory acidosis. Answer: 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).
◉ Respiratory alkalosis. Answer: usually 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).
