Deck 9: Case Management

Question 1

The case manager gave the client a list of eight possible sources for the equipment needed for care after discharge. Which of the following best describes why the nurse did not just tell the client the best source for the equipment?

A) The client has a right to select providers of needed resources.
B) The nurse did not know which source was the best resource.
C) The client must make a decision independently.
D) The nurse did not care which source is chosen.

Answer 1

The client has a right to select providers of needed resources.

Question 2

Which of the following best describes why health care institutions are unhappy beyond the fact that they are not receiving the previous high reimbursement for procedures from Medicaid or Medicare?

A) Because clients are well informed and know they do not really have to pay their hospital bills
B) Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs
C) Because it is harder to continue giving charity care when less reimbursement is received from the federal government
D) Because recent legislation has required that all reimbursement be based on quality performance measures

Answer 2

Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs

Question 3

Which of the following best describes the purpose of case management from the client's perspective?

A) To help clients navigate a complex, fragmented, confusing health care system to obtain appropriate care
B) To help clients recognize that health care resources are limited and must be used wisely
C) To help clients understand their varied health problems and the best approach to maintain their health
D) To help clients obtain whatever care they need or desire

Answer 3

To help clients navigate a complex, fragmented, confusing health care system to obtain appropriate care

Question 4

Which of the following elderly persons are often the targets of case management?

A) Those who are homebound and have multiple complex problems
B) Those who live alone without close relatives
C) Those who show clear evidence of mental and physical decline
D) Those with chronic long-term health problems needing pharmaceutical intervention

Question 5

A client has been referred to a case management program. Which of the following actions would the nurse most likely take first?

A) Admit the client for services.
B) Determine the appropriateness for inclusion in the program.
C) Contact the physician to determine if services are necessary.
D) Contact the most appropriate community agencies for additional assistance.

Question 6

Which of the following best describes the goals of nursing case management regardless of setting? (Select all that apply.)

A) Ensure that all clients have a case manager
B) Contain costs and control use of services
C) Decrease duplication and fragmentation
D) Enhance client's quality of life
E) Focus on avoiding hospitalization or institutionalization
F) Maintain routine communication channels

Question 7

Which of the following are considered core functions of a case manager? (Select all that apply.)

A) Assessment and diagnosis of client needs
B) Planning and facilitation of client care needs
C) Giving direct client care as needed
D) Advocating for the client
E) Obtaining needed resources and funding for the client
F) Submitting appropriate forms to involved agencies for the client

Question 8

Which of the following best describes why nurses are increasingly becoming case managers when social workers have historically been so successful in the role?

A) Because of the need for ongoing patient assessment.
B) Because of a shortage of licensed social workers.
C) Nurses seek such roles as being easier than direct clinical care.
D) Social workers expect higher salaries than nurses in the same role.

Question 9

Which of the following best describes when case management is implemented for hospitalized patients?

A) Immediately on admission
B) Immediately on discharge
C) When a nurse recognizes the need and makes the appropriate referral
D) When the patient is assigned a case manager

Question 10

A nurse has been working as a case manager for the past 6 months and would like to become certified. Which of the following organizations should the nurse pursue certification through?

A) Case Management Society of America (CMSA)
B) American Nurses Credentialing Center (ANCC)
C) American Nurses' Association (ANA)
D) Centers for Medicare and Medicaid (CMS)

Question 11

A nurse is explaining case management to a client. Which of the following statements would be the most appropriate for the nurse to make?

A) "We assess, plan, facilitate, and advocate to save money as much as possible."
B) "We coordinate your care so you obtain needed services without incurring undue costs."
C) "We seek the lowest cost provider to give you what care is necessary."
D) "We collaborate with you to coordinate your care for the best outcome."

Question 12

Which of the following best describes the aftermath of the deinstitutionalization of mentally ill patients into the community during the 1970s?

A) Community health centers were created and gave care to such clients.
B) Families were eager to accept their family members back home.
C) Many mentally ill clients without social skills ended up in nursing homes.
D) Without follow-up care, many clients were readmitted to care.

Question 13

Which of the following best describes how a case manager identifies people who would benefit from case management services? (Select all that apply.)

A) Evidence-based criteria
B) Families who express doubt that the patient is receiving adequate care
C) Patient having setbacks from treatment
D) Referrals from health care providers or agencies
E) Risk identification from data management
F) Use of health risk screening tools

Question 14

A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role. Which of the following will be most difficult for the nurse new to this role?

A) Having the ability to be a leader and work autonomously
B) Obtaining knowledge of community resources
C) Gaining knowledge of reimbursement structures and financial strategies
D) Getting practice at evaluating patient outcomes

Question 15

A health care provider has charged more than a managed care organization (MCO) typically pays for a procedure. Which of the following would most likely be the result?

A) Provider may be removed from the MCO's list of approved providers.
B) The MCO will re-examine the payment for that procedure.
C) Provider would get the typical payment instead of what was charged.
D) The MCO would be forced to increase its typical payment for that procedure.

Question 16

Which of the following clients may be eligible for hospital-based, disease-specific case management support? (Select all that apply.)

A) Those who have high-cost conditions
B) Those with physicians who request such intervention for their patients
C) Those who may be maintained in a stable condition in their home environment
D) Those who have access to private insurance plans
E) Those who have requested such services
F) Those whose hospital has a collaborative agreement with a home health nursing agency

Question 17

A hospital is going to start a care management program. Which of the following groups of clients would most likely be selected to first receive such services?

A) Clients who represent the most common diagnosis group to be admitted
B) Clients who request such services from their local hospital
C) Clients with chronic illnesses
D) Clients with the least education

Question 18

Which of the following has the largest influence on the case manager's role?

A) Criteria of the program for accepting clients
B) Location of the program
C) Population served by the program
D) The specific program that employs the case manager

Question 19

Who first created the idea of a continuum of care, which later evolved into the term "case management"?

A) Florence Nightingale, when she engaged in activities such as writing letters for the wounded.
B) Lillian Wald, who created health education programs for the whole community.
C) Social workers, who function as discharge planners, use the term.
D) Those who coordinated services for discharged psychiatric patients after World War II (WWII) used the term.

Question 20

Which of the following best describes why utilization review departments are becoming case management units?

A) Funding is available for case management responsibilities.
B) Monitoring service use alone does not improve patient outcomes.
C) It facilitates using nurse experts for case management.
D) It promotes the current trend of naming "utilization review" units "case management."