NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
Chronic care model - ANSWER---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.
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
,NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
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)
,NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
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
, NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
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).
Metabolic acidosis - ANSWER---diagnosed 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 - ANSWER---is 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 - ANSWER---o Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
Vocal fold dysfunction syndrome - ANSWER---paradoxical vocal fold
adduction, acute and chronic upper airway obstruction.
QUESTIONS AND SOLUTIONS GRADED A+
Chronic care model - ANSWER---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.
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
,NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
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)
,NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
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
, NURS 640 EXAM 1 EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS AND SOLUTIONS GRADED A+
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).
Metabolic acidosis - ANSWER---diagnosed 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 - ANSWER---is 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 - ANSWER---o Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
Vocal fold dysfunction syndrome - ANSWER---paradoxical vocal fold
adduction, acute and chronic upper airway obstruction.
