NURS 640 EXAM 1 QUESTIONS AND
ANSWERS
Chronic=care=model=-=ans-
✔✔focuses=on=improving=care=for=chronic=diseases.=1.=Delivery=of=high=quality=care=r
equires=a=range=of=strategies=that=must=closely=involve=and=engage=the=patient.=2.=Te
am=care=is=essential.
Transitional=Care=Model=(TCM)=-=ans-
✔✔APN=provides=comprehensive=in=hospital=planning=and=home=follow=up=care=coord
ination,=including=training=and=support=for=nurses=by=a=multidisciplinary=HF=team.=Car
e=plans=developed=by=nurses=in=collaboration=with=pt=physicians=that=reflect=pt=and=ca
regiver=goals=and=evidence=based=guidelines;=pt=and=caregiver=education;=coordinatio
n=of=care=across=settings;=and=nurse=delivered=clinical=services=including=medication=
management.
Care=Transitions=Intervention=(CTI)=-=ans-
✔✔A=transition=coach=(RN=or=APN)=provides=tools=and=teaches=self-
management=and=communication=skills=to=pt=and=caregivers=so=they=can=coordinate=t
heir=care=and=follows=up=with=home=visit=and=telephone=calls.=CTI=focuses=on=medicat
ion=self-
management;=pt=assembled=personal=health=recorded,=primary=care=and=specialist=foll
ow=up=and=teaching=the=pt=how=to=recognize=and=follow=up=on=ref=flag=symptoms.
Re-Engineered=Discharge=(project=RED)=-=ans-
✔✔nurse=discharge=advocate=provides;=pt=education,=medication=reconciliation=and=e
ducation;=instruction=about=red=flags;=teach=back=learning=process;=coordination=of=ph
ysician=appointments=and=follow=up=testing;=EBP=written=discharge=plan=shared=with=p
t=and=all=providers.=A=clinical=pharmacist=follows=up=by=telephone=to=reinforce=dischar
ge=plan,=review=medications=and=solve=problems.
Enhanced=Discharge=Planning=program=(EDPP)=-=ans-
✔✔master=prepared=workers=with=experience=in=geriatric=and=community=based=practi
ce=provide=a=phone=based=intervention=to=supplement=the=existing=discharge=process;
=pre=discharge=review=of=pt=chart=and=consultation=with=pt=providers=about=potential=b
arriers=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=disch
arge=plan=have=been=received;=to=identify=medication=problems=and=adherence,=ensur
,e=knowledge=of=red=flags.=The=EDPP=model=emphasizes=addressing=psychosocial=an
d=medical=issues=that=emerge=after=discharge.
Medical=decision=making=-=ans-
✔✔making=is=a=process=that=you=are=continuously=evaluating=and=refining=based=on=n
ew=data=you=obtain.=To=be=particularly=skilled=in=this,=you=must=be=cognizant=of=the=bi
ases=you=may=bring=to=your=evaluation=of=the=patient's=case=and=the=human=errors=th
at=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=corre
ctions=to=avoid=harm=to=the=patient.
full=compensated=-=ans-✔✔Is=pH=normal?=PaCO2=and=HCO3=abnormal
uncompensated.=-=ans-✔✔pH=abnormal?=PaCO2=or=HCO3=abnormal
Mild=PAO2=-=ans-✔✔60-79=mmHg
Moderate=PaO2=-=ans-✔✔40-59mmHg
Severe=PaO2=-=ans-✔✔<=40mmHg
Metabolic=Acidosis=-=ans-
✔✔Lactic=acidosis,=ketoacidosis=(diabetic,=alcoholic,=starvation),=toxins=(methanol,=sali
cylates)=renal=failure=(acute=or=chronic)
Respiratory=alkalosis=-=ans-
✔✔§=hypoxia=(decreased=inspired=oxygen,=high=altitude,=ventilation,=hypotension,=sev
ere=anemia)
§=CNS-
mediated=disorders=(hyperventilation,=anxiety,=neurologic=disease,=CVA,=infection,=trau
ma,=tumor,=drugs,=heat,=hepatic=failure)
§=Pulmonary=disease=(interstitial=lung=disease,=pneumonia,=PE,=pulmonary=edema)
§=Mechanical=overventilation
Metabolic=alkalosis=-=ans-
✔✔Excessive=body=bicarb=content=(renal=alkalosis,=Gastrointestinal=alkalosis)
Pulse=oximetry=-=ans-
✔✔Measures=peripheral=arterial=oxygen=saturation.=AKA="the=fifth=vital=sign."=In=most=
patients=peripheral=oxygen=saturation=as=measured=by=pulse=oximetry=(SpO2)=provide
s=accurate=information=on=tissue=oxygenation,=which=allows=the=clinician=to=assess=an
d=treat=patients=who=are=potentially=hypoxemic.=As=a=general=principle,=clinicians=shou
ld=pay=attention=to=trends=on=oxygenation=and=when=treating=patients=with=supplement
al=oxygen=for=hypoxemia,=clinicians=should=target=levels=that=are=desirable=for=the=spe
cific=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=obstruct
ive=pulmonary=disease=(COPD)=who=is=chronically=hypercapnic.
Arterial=blood=gas=interpretation=normal=values=-=ans-✔✔●pH=-=7.35=to=7.45
●PaCO2=-=35=to=45=mmHg=(4.7=to=6=kPa)
●HCO3=-=21=to=27=mEq/L
Respiratory=acidosis=-=ans-✔✔a=disturbance=in=acid-
base=balance=usually=due=to=alveolar=hypoventilation=that=can=be=acute=or=chronic.=It=i
s=characterized=by=an=increased=PaCO2=>45=mmHg=(hypercapnia)=and=a=reduction=in
=pH=(pH=<7.35).
Respiratory=alkalosis=-=ans-
✔✔usually=due=to=alveolar=hyperventilation=which=leads=to=a=decrease=in=PaCO2=(hyp
ocapnia)=and=an=increase=in=the=pH.=It=can=also=be=acute=or=chronic.=In=acute=respirat
ory=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=-=ans-
✔✔diagnosed=when=the=serum=pH=is=reduced=and=the=serum=bicarbonate=concentrati
on=is=abnormally=low=(often=defined=as=<22=meq/
L,=but=the=threshold=may=vary=across=clinical=laboratories).
Metabolic=alkalosis=-=ans-
✔✔is=usually=accompanied=by=hypokalemia,=is=defined=as=a=disorder=that=causes=ele
vations=in=the=serum=bicarbonate=concentration=and=arterial=pH.=In=a=patient=with=an=u
ncomplicated=(simple)=metabolic=alkalosis,=both=parameters=are=above=normal.=Howev
er,=this=may=not=be=present=in=patients=with=mixed=acid-base=disorders.
Venous=blood=sample=-=ans-✔✔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=-=ans-
✔✔paradoxical=vocal=fold=adduction,=acute=and=chronic=upper=airway=obstruction.
Disorders=of=the=upper=airways=-=ans-
✔✔Acute=obstruction=include=trauma=to=the=larynx=or=pharynx,=foreign=body=aspiration
,=laryngospasm,=laryngeal=edema=from=thermal=injury=or=angioedema,=infections=(acut
e=epiglottis,=Ludwig=angina,=pharyngeal=or=retropharyngeal=abscess)=and=acute=allergi
c=laryngitis.
ANSWERS
Chronic=care=model=-=ans-
✔✔focuses=on=improving=care=for=chronic=diseases.=1.=Delivery=of=high=quality=care=r
equires=a=range=of=strategies=that=must=closely=involve=and=engage=the=patient.=2.=Te
am=care=is=essential.
Transitional=Care=Model=(TCM)=-=ans-
✔✔APN=provides=comprehensive=in=hospital=planning=and=home=follow=up=care=coord
ination,=including=training=and=support=for=nurses=by=a=multidisciplinary=HF=team.=Car
e=plans=developed=by=nurses=in=collaboration=with=pt=physicians=that=reflect=pt=and=ca
regiver=goals=and=evidence=based=guidelines;=pt=and=caregiver=education;=coordinatio
n=of=care=across=settings;=and=nurse=delivered=clinical=services=including=medication=
management.
Care=Transitions=Intervention=(CTI)=-=ans-
✔✔A=transition=coach=(RN=or=APN)=provides=tools=and=teaches=self-
management=and=communication=skills=to=pt=and=caregivers=so=they=can=coordinate=t
heir=care=and=follows=up=with=home=visit=and=telephone=calls.=CTI=focuses=on=medicat
ion=self-
management;=pt=assembled=personal=health=recorded,=primary=care=and=specialist=foll
ow=up=and=teaching=the=pt=how=to=recognize=and=follow=up=on=ref=flag=symptoms.
Re-Engineered=Discharge=(project=RED)=-=ans-
✔✔nurse=discharge=advocate=provides;=pt=education,=medication=reconciliation=and=e
ducation;=instruction=about=red=flags;=teach=back=learning=process;=coordination=of=ph
ysician=appointments=and=follow=up=testing;=EBP=written=discharge=plan=shared=with=p
t=and=all=providers.=A=clinical=pharmacist=follows=up=by=telephone=to=reinforce=dischar
ge=plan,=review=medications=and=solve=problems.
Enhanced=Discharge=Planning=program=(EDPP)=-=ans-
✔✔master=prepared=workers=with=experience=in=geriatric=and=community=based=practi
ce=provide=a=phone=based=intervention=to=supplement=the=existing=discharge=process;
=pre=discharge=review=of=pt=chart=and=consultation=with=pt=providers=about=potential=b
arriers=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=disch
arge=plan=have=been=received;=to=identify=medication=problems=and=adherence,=ensur
,e=knowledge=of=red=flags.=The=EDPP=model=emphasizes=addressing=psychosocial=an
d=medical=issues=that=emerge=after=discharge.
Medical=decision=making=-=ans-
✔✔making=is=a=process=that=you=are=continuously=evaluating=and=refining=based=on=n
ew=data=you=obtain.=To=be=particularly=skilled=in=this,=you=must=be=cognizant=of=the=bi
ases=you=may=bring=to=your=evaluation=of=the=patient's=case=and=the=human=errors=th
at=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=corre
ctions=to=avoid=harm=to=the=patient.
full=compensated=-=ans-✔✔Is=pH=normal?=PaCO2=and=HCO3=abnormal
uncompensated.=-=ans-✔✔pH=abnormal?=PaCO2=or=HCO3=abnormal
Mild=PAO2=-=ans-✔✔60-79=mmHg
Moderate=PaO2=-=ans-✔✔40-59mmHg
Severe=PaO2=-=ans-✔✔<=40mmHg
Metabolic=Acidosis=-=ans-
✔✔Lactic=acidosis,=ketoacidosis=(diabetic,=alcoholic,=starvation),=toxins=(methanol,=sali
cylates)=renal=failure=(acute=or=chronic)
Respiratory=alkalosis=-=ans-
✔✔§=hypoxia=(decreased=inspired=oxygen,=high=altitude,=ventilation,=hypotension,=sev
ere=anemia)
§=CNS-
mediated=disorders=(hyperventilation,=anxiety,=neurologic=disease,=CVA,=infection,=trau
ma,=tumor,=drugs,=heat,=hepatic=failure)
§=Pulmonary=disease=(interstitial=lung=disease,=pneumonia,=PE,=pulmonary=edema)
§=Mechanical=overventilation
Metabolic=alkalosis=-=ans-
✔✔Excessive=body=bicarb=content=(renal=alkalosis,=Gastrointestinal=alkalosis)
Pulse=oximetry=-=ans-
✔✔Measures=peripheral=arterial=oxygen=saturation.=AKA="the=fifth=vital=sign."=In=most=
patients=peripheral=oxygen=saturation=as=measured=by=pulse=oximetry=(SpO2)=provide
s=accurate=information=on=tissue=oxygenation,=which=allows=the=clinician=to=assess=an
d=treat=patients=who=are=potentially=hypoxemic.=As=a=general=principle,=clinicians=shou
ld=pay=attention=to=trends=on=oxygenation=and=when=treating=patients=with=supplement
al=oxygen=for=hypoxemia,=clinicians=should=target=levels=that=are=desirable=for=the=spe
cific=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=obstruct
ive=pulmonary=disease=(COPD)=who=is=chronically=hypercapnic.
Arterial=blood=gas=interpretation=normal=values=-=ans-✔✔●pH=-=7.35=to=7.45
●PaCO2=-=35=to=45=mmHg=(4.7=to=6=kPa)
●HCO3=-=21=to=27=mEq/L
Respiratory=acidosis=-=ans-✔✔a=disturbance=in=acid-
base=balance=usually=due=to=alveolar=hypoventilation=that=can=be=acute=or=chronic.=It=i
s=characterized=by=an=increased=PaCO2=>45=mmHg=(hypercapnia)=and=a=reduction=in
=pH=(pH=<7.35).
Respiratory=alkalosis=-=ans-
✔✔usually=due=to=alveolar=hyperventilation=which=leads=to=a=decrease=in=PaCO2=(hyp
ocapnia)=and=an=increase=in=the=pH.=It=can=also=be=acute=or=chronic.=In=acute=respirat
ory=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=-=ans-
✔✔diagnosed=when=the=serum=pH=is=reduced=and=the=serum=bicarbonate=concentrati
on=is=abnormally=low=(often=defined=as=<22=meq/
L,=but=the=threshold=may=vary=across=clinical=laboratories).
Metabolic=alkalosis=-=ans-
✔✔is=usually=accompanied=by=hypokalemia,=is=defined=as=a=disorder=that=causes=ele
vations=in=the=serum=bicarbonate=concentration=and=arterial=pH.=In=a=patient=with=an=u
ncomplicated=(simple)=metabolic=alkalosis,=both=parameters=are=above=normal.=Howev
er,=this=may=not=be=present=in=patients=with=mixed=acid-base=disorders.
Venous=blood=sample=-=ans-✔✔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=-=ans-
✔✔paradoxical=vocal=fold=adduction,=acute=and=chronic=upper=airway=obstruction.
Disorders=of=the=upper=airways=-=ans-
✔✔Acute=obstruction=include=trauma=to=the=larynx=or=pharynx,=foreign=body=aspiration
,=laryngospasm,=laryngeal=edema=from=thermal=injury=or=angioedema,=infections=(acut
e=epiglottis,=Ludwig=angina,=pharyngeal=or=retropharyngeal=abscess)=and=acute=allergi
c=laryngitis.
