NURS 640 EXAM 1 EXAM SCRIPT 2026
COMPREHENSIVE QUESTIONS AND
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
COMPREHENSIVE QUESTIONS AND
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
