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Exam #1: Case Management Study Guide Exam Questions and Answers, Exams of Nursing

Bryant and Stratton College-AlbanyNursing

This document includes a complete set of study guide questions and answers for Exam #1 in Case Management. It covers core topics such as care coordination, patient advocacy, discharge planning, interdisciplinary collaboration, and utilization review. Ideal for students or professionals preparing for certification or coursework in nursing case management.

Typology: Exams

2024/2025

Available from 05/20/2025

Nurseexcel
Nurseexcel 🇺🇸

832 documents

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Exam #1: Case Management Study Guide Exam Questions and Answers
1. Whateiseaecaseemanagereaccountableefor?:eTheecaseemanagereiseaccountableeforecollabora
tivelyefacilitatingetheeassessment,eplanning,eimplementationeandeevalu-
eationeofecareecoordinationeandecareetransitionseinetheeacuteecareesetting.
2. Whateareecaseemanagerseadvocatesefor?:eNurseecaseemanagerseserveeaseadvocatesef
oreoptionseandeservicesetoemeetetheepatienteandefamilyeneeds,ewhileepromotingequality,eco
steeffectiveeoutcomeseforetheeassignedecaseetypes.
3. Whatearee5ekeyefunctionseanderesponsibilitieseofeaecaseemanager?:e1.eCoor-
edinationeandefacilitationeofecare
2. Utilizationeanderesourceemanagement
3. Trackingeofeavoidableedelays
4. Transitionaleandedischargeeplanning
5. Qualityeandeprocesseimprovement
4. Aenurseecaseemanageremusteencompasseaeknowledgeeofetheehealthecareeenvironmen
tewitheregardsetoewhate4easpects?:e1.eClinical
2. Business/Financial
3. Managerial
4. Professionalism
5. Inetheeclinicalesetting,ewhatetypeeofeassessmentedoesetheecaseemanagereperform?:eP
atienteandefamilyeintervieweanderevieweofemedicalerecord
6. Whatetypeeofeplanningeiseperformedebyetheecaseemanagereineaeclinicalesetting?:eConsultew
ithetheephysician,ehealthecareeteameandepatient/familye-
edevelopeplaneofecareetoefacilitateeaetimelyedischargee/transitioneplan
7. Whatetypeeofeimplementationeiseperformedebyetheecaseemanagereinetheeclinicaleset
ting?:eImplementsetheeplaneofecareeineaetimelyemanneretoefacilitateeaccomplishmenteofeg
oalseandeinterventions.
8. Whatetypeeofeevaluationsedoecaseemanagerseperformeinetheeclinicalesetting?-
:eReassessmenteforeanyedeclineeinestatuseandeplanerevisions
9. Whatearee4eroleseofetheecaseemanagereinemanagingebusiness/financialecon-
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1 e/e 16

Exam #1: Case Management Study Guide Exam Questions and Answers

  1. Whateiseaecaseemanagereaccountableefor?:e Theecaseemanagereiseaccountableeforecollabora tivelyefacilitatingetheeassessment,eplanning,eimplementationeandeevalu- eationeofecareecoordinationeandecareetransitionseinetheeacuteecareesetting.
  2. Whateareecaseemanagerseadvocatesefor?:e Nurseecaseemanagerseserveeaseadvocatesef oreoptionseandeservicesetoemeetetheepatienteandefamilyeneeds,ewhileepromotingequality,eco steeffectiveeoutcomeseforetheeassignedecaseetypes.
  3. Whatearee 5 ekeyefunctionseanderesponsibilitieseofeaecaseemanager?:e 1.eCoor- edinationeandefacilitationeofecare
  4. Utilizationeanderesourceemanagement
  5. Trackingeofeavoidableedelays
  6. Transitionaleandedischargeeplanning
  7. Qualityeandeprocesseimprovement
  8. Aenurseecaseemanageremusteencompasseaeknowledgeeofetheehealthecareeenvironmen tewitheregardsetoewhate 4 easpects?:e 1.eClinical
  9. Business/Financial
  10. Managerial
  11. Professionalism
  12. Inetheeclinicalesetting,ewhatetypeeofeassessmentedoesetheecaseemanagereperform?:e P atienteandefamilyeintervieweanderevieweofemedicalerecord
  13. Whatetypeeofeplanningeiseperformedebyetheecaseemanagereineaeclinicalesetting?:e Consultew ithetheephysician,ehealthecareeteameandepatient/familye- edevelopeplaneofecareetoefacilitateeaetimelyedischargee/transitioneplan
  14. Whatetypeeofeimplementationeiseperformedebyetheecaseemanagereinetheeclinicaleset ting?:e Implementsetheeplaneofecareeineaetimelyemanneretoefacilitateeaccomplishmenteofeg oalseandeinterventions.
  15. Whatetypeeofeevaluationsedoecaseemanagerseperformeinetheeclinicalesetting?- :e Reassessmenteforeanyedeclineeinestatuseandeplanerevisions
  16. Whatearee 4 eroleseofetheecaseemanagereinemanagingebusiness/financialecon-

2 e/e 16 ecerns?:e 1.eEnsureethatetheeleveleofecareeiseappropriateeandeserviceseareemedicallyenecessary

  1. Proactivelyeidentifyedelayseinecare,edelayseinedischargeeanderiskeofereadmission
  2. Maintainecompetenceeofeutilizationereviewe(inpatientevs.eobservationestatus)
  3. Documenteavoidableedelays/days
  4. Whatearee 5 emanagerialedutieseofetheecaseemanager?:e 1.eAenurseecaseeman- eageremustedisplayeleadershipeskillseinedecisionemakingeandeproblemesolving
  5. MusteactivelyeparticipateeineInterdisciplinaryeTeameMeetingseandemaintaineopenecommuni cationewithephysicians
  6. Striveetoemakeeproductiveeuseeofetimeethroughetheesettingeofepriorities
  7. Fostereaneenvironmenteofeprofessionalism

4 e/e 16

  1. Faithebasedeprograms
  2. Independentecaseemanagementeconsultingefirms

5 e/e 16

  1. WhateisetheeANCCeNursingeCaseeManagementeboardecertificationeexami- enation?:e Aecompetencyebasedeexaminationethateprovideseaevalideandereliableeas- esessmenteofetheeentry- leveleclinicaleknowledgeeandeskillseoferegisteredenurseseine theenursingecaseemanagementespec ialtyeaftereinitialeRNelicensure.eOnceeyouecom- epleteeeligibilityerequirementsetoetakeetheecertificationeexaminationeandesuccessfullyepassethee exam,eyoueareeawardedetheecredential:eRegisteredeNurse-BoardeCertifiede(RN- BC).eThisecredentialeisevalidefore 5 eyears.eYouecanecontinueetoeuseethisecredentialebyemaintainingey ourelicenseetoepracticeeandemeetingetheerenewalerequirementseineplaceeatetheetimeeofeyourecerti ficationerenewal.
  2. Whateareetheeeligibilityecriteriaeforebecomingeaecaseemanager?e(4):e 1.eHoldeaecurrent,eac tiveeRNelicenseewithineaestateeoreterritoryeofetheeUnitedeStateseor theeprofessional,elegallyerecognizedeequivalenteineanotherecountry.eInternationaleApplicant s:eLearneabouteadditionalerequirementseforecandidateseoutsideetheeUS.
  3. Haveepracticedetheeequivalenteofe 2 eyearsefull-timeeaseaeregisteredenurse.
  4. Haveeaeminimumeofe2,000ehourseofeclinicalepracticeeinenursingecaseemanagementewithinethee laste 3 eyears.
  5. Haveecompletede 30 ehourseofecontinuingeeducationeinenursingecaseemanagementewithinethee laste 3 eyears.
  6. Whatedoesetransitionaleplanninge(dischargeeplanning)ehelpetoeensureeinehealthcare?:e T hiseprocesseensuresethatetheeinterdisciplinaryehealthcareeteamepro- evidesepatientsewitheappropriateeserviceseinetheemosteappropriateesettinge(leveleofecare)easedeli neatedeinetheestandardseandeguidelineseoferegulatoryeandeaccreditationeagenciese(federaleande private).
  7. Withouteongoingeassessmenteforetimelyetransferetoeaemoreeappropriateeleveleofecare,ewha tedoehospitalserisk?:e Theyeriskeeitherenoereimbursementeforeserviceserenderedeoredenialeofepay mentseforeall,eoreaeportioneof,etheseeservices.
  8. Whateisetransitionaleplanning?:e Aedynamiceinteractiveecollaborativeeandein- eterdisciplinaryeprocesseofeassessmenteandeevaluationeofetheehealthcareeneedseofepatientseand etheirefamilieseorecaregiverseduringeandeaftereaephase/episodeeofeillness.
  9. Whateiseaeprimaryereasoneforetransitionaleplanning?:e Planningeandebrokeringeofenecessarye

7 e/e 16 overuseeofehealthcareeresources,elackeofecoordinationeandecommunication,eandepooreoutcomesef orepatients

  1. Whateareepreacuteeservices?:e Servicesethateareeofferedetoepreventeillnesseoredeterioratio n/changeseinetheepatient'sehealtheconditionethatemayerequireeacuteecareeorehospitalization
  2. Whateareesomeeexampleseofepreacuteeservices?e(6):e 1.eHealtheRiskeAssess- emente(echolesteroleandebloodepressure/hypertensionescreenings,emammography,eprostatees creening,eriskeassessmentequestionnairesefocusingeonedegreeeofehealthyelifestyle)
  3. Patienteandefamilyeeducationematerialseforewellness
  4. Healthepromotioneandeillnesseprevention
  5. Healtheadviceelines
  6. Triageeservices
  7. Counseling
  8. Whateareesomeesettingseforepreacuteeservices?e(4):e 1.eManagedeCareeOrga-enizations
  9. Ambulatory/clinics
  10. Physicianeofficeseoregroupepractices
  11. Community-basedehealthecenters
  12. Whateareeacuteeservices?:e Thoseethateareeprovidededuringeaneacuteeepisodeeofeillnesseandei neaehospitalesetting.
  13. Whateareesomeeexampleseofeacuteeservices?:e 1.eEmergencyeandetraumaecare 2.eProceduresesucheaseaecoronaryearteryebypassegraft
  14. Whateareesettingseforeacuteeservices?e(5):e 1.eHospitals
  15. Acuteerehabilitationefacilities
  16. Postanesthesiaeunits
  17. ICU's
  18. ED's
  19. Whateareepost- acuteeservices?:e Servicesethateareeprovidedeforepatientseaftereaneacuteeepisodeeofecare,ewhether eineaefacilityesettingeoreatehome
  20. Whyeareecaseemanagersesoeimperativeeineperiodseofetransition?:e Theyeareeoftenetheelinke thateprovideseconsistencyeforeourepatients
  21. Whatetypeseofecomponentsemustebeeincludedeforeaneinfrastructureetoeexistethatekeepset

8 e/e 16 heepatient- centeredecareeaepriorityeoverecareeproviderseorecareesettings?e(9):e 1.eIntegratedemedicalerec ords

  1. IntegratedeITesolutions
  2. Telehealtheservices
  3. Preventativeecare
  4. Chronicediseaseemanagement

10 e/e 16

  1. Confirmationeofeandefinalepreparationeforetheepatient'sedischargeeoretransition
  2. Dischargeeoretransitioneofetheepatientetoeanothereleveleofecareeoretoehome
  3. Follow-upecommunicationewithepatientepost-discharge
  4. Whoemustebeeincludedeinetheetransitionaleplanningeprocess?:e Bothetheesendereofeth eepatienteasewelleasetheereceivereofetheepatient
  5. WhateisetheeTransitionseofeCareeModelseCareeTransitionseInterventione(CTI)?:e Aefour- weekeprogramedesignedetoefosterepatienteengagementeandepromoteesafeetransitionsefromethee hospitaleofeskilledenursingefacilityetoehome

11 e/e 16

  1. WhateiseaneadvantageeofetheeTransitionseofeCareeModelseCareeTransitionseInterventione (CTI)?:e Decreaseserehospitalizations
  2. WhateareetheefourepillarseforesafeetransitionseinetheeCTIemodel?:e 1.eMedicationeself- management
  3. Maintenanceeofeaepersonalehealtherecord
  4. Primaryecareeproviderefollow-up
  5. Alertnessetoeredeflagse(e.g.emanagementeofesymptomseoresituationseofeconcern)
  6. WhateiseuniqueetoetheeCTIemodeleofetransitioneplanning?:e Aetransitionecoacheiseusedeforeth eepatient,ethatefocuseseonetheepatient'seself- identifiedegoalseandehelpsetheepatientedevelopecomfortewitheself- careemanagementeandeengagementeinetakingecareeofehiseorehereownehealth.
  7. InetheeCTIemodeleofetransitioneplanning,edoesetheecoacheassumeehomeecareeofecaseeman agementeresponsibilites?:e No,etheecoacheinitiatesecontactewhileetheepatienteiseinetheehospital,e obtainsepatienteconsentetoeparticipate,eandecompleteseaehomeevisite 72 ehoursepost- discharge.eTheyethenecompleteethreeephoneecallseafteretheehomeevisitethatefocuseonefollow- upecareewithetheeprimaryecareeprovider,emedications,eandeotheresupporteservices.
  8. WhateisetheeTransitionaleCareeModele(TCM)?:e Iteinvolveseae 1 - 3 emontheperiodeofeinterventionsetoepreventerehospitalizations.
  9. WhateisetheefocuseofetheeTransitionaleCareeModele(TCM)?e(9):e Focuseseonehigh- riskeoldereadultsewithespecificeriskefactorseincludingecognitiveeimpairment,eandeanyeofetheefollo wing:
  10. 80 eyearseoreolder
  11. Functionaledeficits
  12. Activeepsychiatricecondition
  13. Foureoremoreecomorbidities
  14. Sixeoremoreeprescribedemedications
  15. Twoeoremoreehospitalizationseinetheepastesixemonths
  16. Inadequateesocialesupportesystem
  17. Poorehealtheliteracy
  18. Pooreadherenceetoemedicaleregimen
  19. WhateiseuniqueeaboutetheeTCMetransitionaleplanningemodel?:e EmploysetheeroleeofeaneAd

13 e/e 16 firstevisitetoetheireprimaryecareeproviderepost- discharge,eandecommunicatesewithetheePCPetoeensureethateimportanteinformationehasebeeneexc hanged.eTheyealsoeassistetheepatienteineidentifyingeearlyesignseandesymptomseofeworseningecon dition.

  1. WhatedoesetheeTCMerelyeonetoefunction?:e Patienteengagement,egoal- setting,eandecommunicationewithepatient,efamily,eandememberseofehealthcareeteam.
  2. WhateisetheefocuseofetheeBettereOutcomeseforeOldereAdultsethrougheSafeeTransitionse( BOOST)?:e Focuseseonehospitaledischargeeprocesseandecommunica- etionewithepatientseandereceivingeproviders
  3. WhateisetheeadvantageeofetheeBOOSTemodeleofetransitionaleplanning?:e En- ehancesequalityeofetransitionseandeoffersetoolseforetheestandardizationeofetransitionalecare
  4. Whateareethee 8 eP'seforeriskeassessmenteinetheeBOOSTemodel?:e 1.ePolyphar-emacy
  5. Psychologicalecomorbidities
  6. Principalediagnosiseofecancer,estroke,ediabetes,eCOPD,eoreheartefailure
  7. Physicalefunctionelimitations
  8. Poorehealtheliteracy
  9. Pooresocialesupportesystem
  10. Priorehospitalizationeinethee 6 emothsebeforeeindexeperiod
  11. Palliativeecareeneeds
  12. WhatedoesetheeBOOSTemodeleinvolve?:e 1.eDischargeeplanning
  13. Medicationereconciliation
  14. PatienteandeFamilyeCommunication
  15. Dischargeeinstructions
  16. Communicationewithepatient'sePCPebeforeedischarge
  17. WhatedoesetheeBOOSTemodelealsoefacilitateeforetheepatient?:e Schedulingeofetheepatient'se follow-upecareeappointmenteandeincludesepost-dischargeetelephoneecalletoepatient
  18. InetheeBOOSTemodel,ewhatemethodeiseusedeinepatienteeducationeandedis- echargeeinstructions?:e Usesetheeteach-backemethod
  19. WhateisetheepurposeeofetheeProjecteREDe(Re- EngineeredeDischarge)memodeleofetransitionaleplanning?:e Improvesehospitaledischargeeproc ess,epromotesepatientesafety,ereducesehospitalizations,eandeenhancesepatient'seexperienceewi

14 e/e 16 thecare

  1. Whateareethee 11 einterventionseofetheeProjecteREDemodeleofetransitionaleplanning?:e 1.eLanguageeassistance
  2. SchedulingeAppointmentseforefollow-upecareeandetesting
  3. Follow-upeonependingetest-resultsepost-discharge
  4. Organizationeofepost-dischargeeserviceseandeequipment

16 e/e 16 seareeneededeatespecificetimes

  1. Whateareetheecaseetypesethateareeusuallyeselectedeforeacuteecareeclinicalepathways?:e Thoseethateareehighevolumeeorehigheriskeandepredictable,esucheaseMIeandesurgicaleprocedurese (e.g.eendoscopy,echolecystectomy,ecataractesurgery)