CCM exam secrets practice test

An insurance company has purchased insurance to protect itself from a highly expensive case. This type of insurance is called.: A. Stop loss. B. Capitation. C. Deferred liability. D. Third-party liability.

49. Stop loss, also known as reinsurance, is insurance bought by an insurance company to protect itself from highly expensive cases. There are some diagnoses that are statistically proven to be extremely expensive, such as organ transplantation, and aids.

A legal document that specifies puma provider should call upon for consent of treatment decisions when a patient becomes mentally incompetent is a: A. Advanced directive. B. Healthcare proxy. C. Patient self-determination. D. Collaboration.

86. A healthcare proxy is a legal document specifying whom a provider should call upon for consent of treatment decisions when a patient becomes mentally incompetent. And advanced directive is a legal document executed while the patient is still competent. Patient self-determination refers to the process by which the patient makes treatment decisions, including drawing up, advanced directives, deciding to discontinue care, and electing, do not resuscitate status.

A prospective payment system (PPS): A. Is a Medicare payment based on a patient's diagnosis at the time of hospital admission B. Is the same as fee for service system C. Is part of Medicare supplemental insurance D. Is similar to Medicare, part D

A. A PPS is a Medicare payment based on a patient's diagnosis at the time of admission to the hospital.

A relationship, whereby a case manager act in a client best interest based on trust is known as: A. Fiduciary. B. Ex parte. C tort D. Due diligence.

A. A case manager establishes a relationship with a client to advocate for his best interest. This makes the case manager a fiduciary. The term ex parte refers to illegal, proceeding or a legal order. A tort, on the other hand, refers to a wrongful act performed will it fully. When a person investigates a business or personal relationship prior to signing a contract, he is performing due diligence.

The presence of one or more disorders in addition to a primary disease is called a/an: A. Comorbidity. B. Red flag. C. Pre-existing condition. D. Axis II disorder.

A. A co-morbidity is a disorder that occurs in addition to a primary disease. For example, diabetics often have comorbidities, such as heart disease, neuropathy, or retinopathy. The term axis two is a classification section in the DSM/IV/TR, psychiatric manual, and refers to personality disorders and mental disability. A pre-existing condition is a physical or mental illness or disability, that you have prior to enrolling in a health plan.

A physician performed a Tensilon test for myasthenia gravis on a hospitalized patient. The number 95858 was entered to bill for the procedure. This number is known as a.: A. CPT code B. ICD -10 code C. DRG code D. Medicare code.

A. A current procedural terminology (CPT) code is a numeric code that describes a diagnostic, medical, or surgical service. CPT codes describe uniform information about medical services and procedures for the benefit of physicians, coders, and payers, ICD 10 codes are alpha, numeric designations, that represent diseases or conditions.

If an attorney ask you to describe the patient's conditions as you observed it on a specific date or to describe any treatment you saw, what type of witness are you in this case? A. Fact, witness. B. Expert witness. C. Both A and B D. Witness on behalf of the patient.

A. A fact, witness supplies information about things seen or heard. You are an expert witness if you supply specialized information such as clarifying procedures, and processes. Expert witnesses should be impartial.

Which one of the following can function as a gatekeeper? A. Nurse. B. Medical assistant. C. Pharmacist. D. None of the above.

A. A gatekeeper is a professional and a manage care organization, who determines if a patient will, or will not be referred to a specialist. Physicians, nurses, and physician assistance can all function as gatekeepers.

A critical piece of equipment breaks down and prevents completion of a test on a client. What type of variance does this represent? A. Operational B. Patient. C. Healthcare, professional. D. Healthcare company.

A. A variance is anything that does not happen how and when it supposed to happen. If a piece of equipment breaks down before patient testing is complete, an operational variance has occurred. In the case of healthcare, professional variances, the provider causes a delay in attaining the expected outcome. Patient variances may cause delays due to unexpected changes in patient condition or due to refusal of a procedure.

A formal report of a work related injury, written by the employer is: A. First report of injury (FROI) B. Impairment rating. C. Functional capacity examination. D. Scheduled injury.

A. An FROI is written by the employer to report a work related injury to begin. The process of filing a Worker's Compensation claim employers are not trained to do functional capacity exams, or to provide an impairment rating. Impairment ratings are based on the findings of a physician.

An adult patient who sustained a spinal cord injury, has developed depression, anxiety, and feelings of anger. A case manager should recognize this catastrophic injury as a.: A. Change agent illness. B. Maladaptive situation. C. Behavioral disorder. D. Grievance.

A. Any illness or injury that changes a persons life is called a change, agent illness. It may affect a patient, socially, physically, or psychologically. Patients often feel a sense of fear, loss, independency. Anxiety and depression are common as well.

All of the following describe clinical pathways, except: A. Clinical practice guidelines. B. Multidisciplinary in nature. C. Proactive setting of plans for a specific diagnosis. D. A form of care coordination.

A. Clinical pathways help standardize care for a particular diagnosis. The pathways are multidisciplinary and nature and often significantly improve outcomes. Pathways include a timeline for providing interventions, whereas guidelines typically do not follow strict timelines.

Which of the following is a major component of essential knowledge for case manager? A. Healthcare reimbursement. B. Moral character. C. Independent practice principles. D. Statistical analysis.

A. Healthcare reimbursement is one of the major categories of knowledge necessary for a case manager, because there are many different reimbursement mechanisms available, depending upon the patients particular situation.

An adult patient becomes incompetent and has no surviving relatives, no close, friends, and no medical legal guardian. Which of the following should serve as surrogate to make medical decisions? A. Two physicians. B. The case manager. C. A social worker D. The medical ethics committee.

A. In cases, such as this one, where, no parents, spouse, sibling, significant other, or close friend is available to make decisions, two physicians can serve as surrogate.

Model said, deliver coordinated, comprehensive, and accessible health and manage care from a primary care. Staff are known as: A. Medical home models. B. Alternative care models. C. Palliative care models. D. Cost benefit models.

A. Medical home models encourage a proactive and plan approach to healthcare. The primary care physician is at the center of the model along with involvement of the non-physician staff.

Which of these is true about pre-existing conditions? A. According to HIPAA, a medical insurance company is required to wave waiting period for pre-existing conditions, provided there has been no lapse and coverage B. A person diagnosed with asthma 20 years ago, who is not needed any medical treatment for the past 12 years is not considered to have a pre-existing condition. C. Pregnancy is considered a pre-existing condition. D. All of the above.

A. Medical insurance companies are required to waive the waiting period if there is no laps and coverage. A pre-existing condition is any condition for which a patient has ever received treatment, regardless of how long it has been since the patient was last seen by a physician for the condition. According to HIPAA, pregnancy is no longer considered a pre-existing condition.

Consider an interdisciplinary clinical pathway for a patient who has just had total hip replacement surgery. Which of the following activities are appropriate for the assessment component of the pathway on postoperative day one? A. Neurovascular checks every four hours and Hemovac checks every eight hours. B. Regular diet. C. Up in the chair for 30 minutes daily. D. Antiembolic hose, patient every two hours, cough/deep breathe.

A. Neurovascular checks every four hours and Hemovac checks every eight hours are classified as assessments. On the other hand, "regular diet" comes under the category of fluids and nutrition. Up in a chair, anti-embolic, hose, and cough/deep breathing treatments.

Case management is sometimes called: A. A second generation primary nursing. B. Home healthcare, nursing C. The equivalent of a nurse practitioner. D. Nursing with an additional degree and social work.

A. Nursing case management is an offshoot of primary nursing. It all allows for care, focused on outcomes within a cost containment framework.

The ORYX initiative: A. Requires healthcare organizations to report performance data to joint commissions on accreditation of healthcare organizations (JCAHO) for accreditation. B. Does not pertain to case management, roles and responsibilities C. Was started by JCAHO in 2005. D. Not related to JCAHO.

A. ORYX (outcome research, yields excellence) requires hospitals to collect data and transmit them to the joint commission for a minimum of four core measure sets to evaluate the performance data for accreditation purposes. The initiative was started by the joint commission in 1997. Case managers who work in Jayco accredited organization should understand the importance of case manager roles and responsibilities because they are crucial to accreditation.

The primary role of the case manager is to act as a: A. Patient advocate. B. Disease manager. C. Utilization reviewer D. Care plan creator

A. Patient advocate is the best answer. Advocacy is essential to a case managers daily practice. A case manager acts on behalf of clients who may not be able to speak for themselves or who are not knowledgeable about healthcare. Above all, the case manager should always have the clients best interest in mind.

A client who wants to receive Worker's Compensation privately discloses to you that he was injured when he fell off a bicycle rather than while it worked. Which of the following options is the best course of action? A. Report the information to the worker compensation carrier. B. Keep the information confidential. C. Withdrawal from the case. D. Tell the patient you'll decide what to do in the next couple of days.

A. Patients often disclosed "secrets" to case managers. You are obligated to report the truth. Advise a client that you were going to notify the Worker's Compensation carrier.

According to the CDC, which of the following is a reportable disease? A. Pertussis. B. Breast cancer. C. Asbestos. D. Cystic fibrosis.

A. Pertussis, more commonly, called whooping cough, is listed as a reportable disease by the centers for disease, control, (CDC).

The term polypharmacy ref: A. The use of multiple medications. B. The use of multiple pharmacies to fill prescriptions. C. Patients who are appropriately taking multiple medication's for a chronic illness. D. None of the above.

A. Polypharmacy refers to the use of multiple medication's, or the taking of more medication's at our medically indicated. It is a common phenomenon in the elderly.

Which of the following is not a prosthetic device? A. Wrist brace. B. Dentures. C. Artificial heart. D. Gastric band.

A. Prosthetic devices are artificial replacements for a part of the body that is missing due to birth, defect or injury. Prosthetic devices can also be placed inside the body, such as an artificial heart, dentures, artificial lungs, or a gastric band. A wrist brace is an orthotic device. Orthotics are applied externally to a part of the body to support, align, or improve movement.

Laws that prevent physicians from receiving "kickbacks" for referrals and consultations are: A. Stark laws. B. Security standards for health information. C. False claim laws. D. HIPAA laws

A. Stark laws, prevent physicians from receiving kickbacks for referrals and consultations.

Which of the following applies to TRICARE prime? A. It is an HMO option. B. It is a PPO option. C. It is a fee for service option. D. It covers all healthcare.

A. TRICARE prime is an HMO option. TRICARE is the PPO auction. TRICARE standard is the fee for service option. TRICARE prime does not cover all healthcare procedures. There are some items that require pre-authorization.

The regulatory agency that overseas Anne monitors all plans that provide care to Medicare and Medicaid beneficiaries is called: A. Healthcare financing administration (HCFA) B. National committee for quality assurance (CQA) C. JCAHO. D. National Association for healthcare quality (NAHQ)

A. The HCFA developed a way to measure improvement and quality in the Medicaid and Medicare population. It monitors all health plans providing care to Medicare/Medicaid beneficiaries. In CQA provides accreditation to manage care plans. NAHQ is an organization for healthcare quality management professionals. It promotes continuous quality improvement by providing educational opportunities for management level professionals within healthcare settings.

Payment based on a fixed daily dollar amount is known: A. Per diem reimbursement. B. Cost reimbursement. C. Capitation. D. Fee for service

A. The question defines a per diem reimbursement. A cost space reimbursement refers to actual cost of the patient care. In fee for service, the provider bills, the insurance company and the company pays for services. Citation is a fixed monthly payment paid to a provider in advance of services.

A scale used to classify a patient's functional impairment is: A. Karnofsky scale B. Glasgow scale. C. Pain scale. D. Body mass index.

A. The.Karnofsky scale, classifies a patient's functional impairment. It is useful to assess the prognosis of patients. The lower the score is, the worst the prognosis. The Glasgow scale, grades levels of coma.

A patient with terminal cancer needs expensive treatment, but is at the end of insurance coverage. The family has no financial resources. The case manager is now faced with a dilemma between the best interest of the patient and the best interest of the payer. This type of conflict is called.: A. Focus of advocacy. B. Conflict of duty. C. Supremacy values. D. Justice.

A. This scenario describes a common case. Management dilemma, called focus of advocacy. Supremacy of values refers to determining whether the values of the patient, family, case, manager, or ensure should take presidents. A conflict of duties exist when a case manager causes harm to others while carrying out a client wishes.

From the standpoint of documentation, the patient's discharge agent is the: A. Physician B. Case manager. C. Multidisciplinary team. D. Social worker.

A. When considering documentation, the physician is the agent of discharge. Documentation should never imply that the case manager discharge the patient.

A partnership of physicians, hospitals, and other providers that manage healthcare is a: A. Integrated delivery system. B. Exclusive provider organization C. Prefer preferred provider organization. D. Discounted fee for service plan.

A. an integrated delivery system consist of hospitals, physicians, and other providers to manage healthcare. It provides services along the continuum of care. EPO is a form of manage care that provides benefits only if care is given by providers in a specified network. PPO is a type of insurance that establishes contracts with healthcare providers. A discounted fee for service plan pays providers a previously agreed-upon discount for a specified service.

When a case manager works jointly with various medical health and social service providers, she is working in the role of: A. Collaborator. B. Coordinator. C. Leader. D. Quality manager.

A. case managers often collaborate with various other service providers about patient needs. A coordinator organizes complex services. And the role of leader, the case manager takes leadership responsibilities in areas, such as utilization review, gatekeeping, revenue management, and allocation of resources. Quality management involves improving patient safety and improving the quality of care.

Which of the following is the best definition of a case management dashboard? A. A management reporting system providing executive summary level reports of the program. B. A decision making tree that provides wise assessments and interventions. C. A set of tools and risk stratification of a population. D. Case management care plan

A. case managers often create dashboards to assist in meeting case management, goals, patient needs, and the needs of other case management clients. By using dashboard reports, one can determine whether or not a case management department is progressing. It is efforts to improve. It is similar to report card.

The process that protects the client and ensures that person hired to practice case management are providing quality services by reviewing their licensure, competencies, and history of malpractice is known as: A. Credentialing. B. Certification. C. Accreditation. D. Licensing.

A. credentialing protects the client by ensuring that individuals hired to practice case management are capable of providing quality service. It involves reviewing competencies, licensure, history of malpractice, and other parameters. Certification is a credential awarded by a certifying agency to a person who meets certification criteria bypassing an examination. Accreditation is granted by a nationally recognized agency to a healthcare organization that meets required sanders. licensure affirms that a person has the basic knowledge and skills to practice a profession.

Grids that outline the key event, expected to occur each day during a patient's hospitalization are: A. Critical pathways. B. Clinical guidelines. C. Case management grid. D. Multidisciplinary plans.

A. critical pathways are grids depicting. The key events expected to occur on each day of a patient's hospitalization. They are also known as critical paths.

A treatment plan that involves a patient spending at least four hours per day and a structured setting receiving psychoeducation and individual and group therapy is known as: A. Partial hospitalization. B. Ambulatory care. C. A community based setting. D. Inpatient hospitalization.

A. during a partial hospitalization, a patient spends at least four hours daily in a structured setting, receiving psychotherapy and milieu therapy. Ambulatory care is outpatient treatment for patients that do not need a structured setting.

Premiums, copayments, coinsurance, and deductibles are all considered to be: A. Cost sharing strategies for insurance companies. B. Protective strategies for insurance companies. C. Reimbursement strategies for the client. D. Coordination of benefits for the client.

A. most insurance companies use cost sharing strategies. The beneficiary is responsible for part of the cost by being responsible for deductibles, copayments, coinsurance, and premiums. On the other hand, and example of a protective strategy would be an insurance company "capping "coverage to a predetermined maximum.

Which of these is true about prescription assistance programs? A. Most people don't know about them. B. They are available to patients with Medicaid. C. They are available to non-US residence. D. Most people find them easy to apply for.

A. over 200 pharmaceutical companies have prescription assistant programs to help uninsured persons who are unable to afford their medication's. A few people know about these programs. Moreover, people who know about them find the application process, challenging and confusing. To be eligible, the patient cannot have Medicaid or health insurance.

System, in which all payers of healthcare (individuals, the government, and private insurer) pay the same rates for the same medical service is called: A. And all payer system. B. A federal payer system. C. Socialized medicine. D. An alternative delivery system

A. there is only one correct answer (a). And then all pair system, pairs of the healthcare bills, whether they are individuals, companies, or the government, pay the same rates for the same medical service. The rates are set by the government.

Transitions of care are best described as: A. Transfer of accurate, patient information across different settings. B. Care received by a patient overtime and over multiple providers/settings. C. A process of assessing a patient's needs after discharge to home or elsewhere. D. Assessment of a patient's capacity to manage his own care needs.

A. transitions of care involve transfer of accurate patient information across different settings. Transfer from a rehabilitation facility to a skilled nursing facility is an example of a care transfer. Having good transitional care plans in place minimizes the risk of adverse events during trans. Answer B describes continuity of care, answer, C refers to discharge, planning, and answer D defines functional status.

The process that occurs when a patient is not given needed test, services, and resources to diagnose and treat a medical condition is called: A. Under utilization. B. Subacute care. C. Palliative care. D. Variance.

A. under utilization refers to the process by which a patient is not provided necessary services or resources to properly diagnose and treat a medical condition. Subacute care generally refers to caregiving in a skilled nursing facility. Palliative care provides the best possible. Comfort measures for a patient with a chronic progressive or terminal illness. Variances deviate from expected care.

An agreement whereby Medicare pays an HMO, and monthly amount for each member enrolled is called: A. A Medicare risk contract. B. A Medigap plan. C., an indemnity plan D. A medical services organization.

A. when Medicare agrees to pay an HMO, a monthly amount for each member enrolled, this process is called a Medicare risk contract. There is risk for the HMO if services needed by the patient exceeded the fixed monthly payment. By the same token, the HMO benefits, if the member does not need services during the period.

Which of the following is true about a preferred provider organization (PPO)? A. A PPO is not an insurance model. B. PPO's offer a preferred panel of physicians. C. PPO use physicians gatekeepers. D. A PPO allows use of physicians and encourage a lower cost to the member.

B. A PPO is an insurance model that offers patient to preferred panel of physicians. A patient may choose to utilize an outside physician, but this would result in lower reimbursement and a greater cost to the patient member. HMO use physicians as gatekeepers.

Which of the following is true about a CareMap? A. It is another name for a clinical management guidelines. B. It is a combination of a critical pathway, and a nursing care plan. C. it does not include multidisciplinary action D. All of the above.

B. A care, multidisciplinary action plan (CareMap) combines nursing care plans with a critical pathway. A time should be recorded for each intervention. CareMaps expedite patient care by improving the outcome of the hospitalization.

An adult patient has been hospitalized for several weeks. The staff has met to discuss the severity of the patient's illness and level of medical stability. This type of review is called a.: A. Concurrent review. B. Continued stay review. C. EPSTD review D. Prospective review.

B. A continued stay review occurs at specific intervals during a hospital stay. Alternately, a concurrent review is performed to determine treatment necessity and appropriateness, while the patient is still in the hospital. Early periodic screening, diagnosis, and treatment (EPSDT) exams are for children. A prospective review is a pre-certification process that takes place before services are rendered to the patient.

Which of the following patients is a good candidate for a transport via stretcher van? A. A patient with cerebral palsy, who already has his own wheelchair. B. A debilitated patient who is unable to sit up C. A patient who requires cardiac monitoring. D. A quadriplegic with a running IV line that contains potassium

B. A debilitated patient who cannot sit for any length of time is a good candidate for stretcher van transport. Patients who require choir cardiac monitoring knee transport in a BLS or a LS ambulance, depending on the level of monitoring needed. Patients with a running IV line containing potassium. Need an ALS ambulance.

An individual wants to change jobs, but he is unable to do so, because he would lose valuable medical benefits. This situation is known as.: A. A pre-existing condition. B. Job lock. C. Job freeze. D. Both B and C

B. A patient faces a predicament when he wants to change jobs, but he faces losing crucial healthcare benefits if he does. This situation is known as job lock. The individual feels "locked in" to the job just to keep the same level of benefits.

Which model of healthcare decision-making best demonstrates the principle of beneficence? A. Patient sovereignty. B. Paternalism C. Shared decision-making. D. Maternalism

B. A relationship between healthcare practitioners and patients is paternalistic and beneficial. This means that people trust the practitioner to do what is in the best medical interest of the patient. Paternalism is justified in that patient usually don't comprehend medical concepts well enough to make the correct decision about their care. In the patient sovereignty model, the patient is open. "boss." In this case, one could argue that the patient knows better than anyone else what is in his best interest. Shared decision making means the healthcare team and the patient work together.

A patient's medical insurance plan includes a clause that allows the insurance plan to pay for initial treatment until payer responsibility is determined. This clause is called.: A. Coordination of benefits. B. Right of subrogation. C. And indemnity clause. D. A settlement.

B. A right of subrogation clause allows insurance plans to pay for initial treatment until payer. Responsibility is ascertain. Coordination of benefits let's payers decrease payments by the amount of coverage provided by another medical insurance policy. And indemnity is a form of commercial medical insurance, whereby the patient pays a deductible, and a percentage of cost.

Which of the following disqualifies a spouse from cobra benefits? A. A reduction in the employees work hours. B. Voluntary or involuntary employment term termination due to gross misconduct by the covered employee C. Legal, separation, or divorce of the covered employee. D. Death of the covered employee

B. A spouse of a covered employee is eligible for cobra benefits for the events described in answers a, C, and D. Termination of employment due to gross misconduct results in no benefits for the spouse.

A temporary partial disability is defined as: A. Impairment that renders a worker, unable to work in any capacity that carries the expectation of recovery and return to normal employment B. Impairment that prevents a worker from returning to his usual job, but still allow him to work in some capacity until the injury is healed. C. An impairment or injury that results in a decrease in a wage earning capacity. D. None of the above.

B. A temporary partial disability renders a worker, unable to perform his usual job temporarily. While waiting to regain full function, the worker can continue to work in some capacity. Answer a refers to temporary total disability; answer C refers to permanent, partial disability.

Which of the following is most characteristic of assertiveness in a case management situation? A. Assertiveness specifically direct you to do the most important task first. B. Assertiveness allows you to act instead of react in a particular situation. C. Assertiveness allows you to send messages using non-verbal cues, such as posture and facial expressions. D. Assertiveness allows you to act as a referee.

B. Assertiveness is an important part of communication, and is a desirable skill for a case manager, because of frequent encounters with tents situations. It simply gets the patience needs met. Answer a describes prioritization; answer, C describes, non-verbal communication; and, acting as a referee falls in the realm of conflict resolution.

Which of the following is not one of the stages of the case management process? A. Implementation of the case management plan. B. Medical decision-making. C. Follow up. D. Assessment.

B. Case managers do not make medical decisions. That is the domain of the physician. Stages of the case management process include implementation of the case management plan, follow up, assessment, problem, identification, coordination of the case, plan, and continuous monitoring and reevaluation.

All of the following are indicators of end-stage dementia, except: A. Inability to hold the head up. B. Ejection fraction of less than 20%. C. Difficulty swallowing. D. Limited speech (six or less).

B. Common indicators of end-stage dementia include the inability to walk, sit, or hold the head up; difficulty, swallowing; limited speech; and weight loss. An injection fraction of less than 20% is indicative of end-stage heart disease.

A manage care contract may have provisions that prohibit Doctors from discussing treatment choices with patients if the choices are not covered by their manage care plan. This provision is an example of: A. Confidentiality provision. B. Gag clause. C. Ethical dilemma. D. Clinical pathway.

B. In a managed healthcare plan, a gag clause prevents healthcare providers from discussing with the patient treatment options that are not covered by that particular manage care plan.

Which of these statements is true about advanced directives? A. The documents did not be the legally executed. B. Advanced directives are used if the patient becomes incompetent. C. Advanced directors remove autonomy from the patient. D. Advanced directives can be drawn up by the next of if patient is incompetent.

B. In advanced directive is legally executed. The document delineates the patient's health related decisions. The patient draws it up while he/she is still mentally competent.

Medicare part D A. Covers hospital/hospitalization expenses. B. Provides a prescription drug benefit. C. is synonymous with Medicare advantage D. Covers physician services, diagnostic test, medical equipment, and ancillary services.

B. Medicare part D provides prescription drug benefits. Medicare part a covers hospital expenses. Medicare part B covers services listed in D Medicare advantage is another name for Medicare part C.

Which of the following best describes the process of medical reconciliation? A. It is a program that regularly assesses, medical and nursing performance to ensure quality of care. B. It is a process of comparing medications The patient is taking at the time of admission with what the hospital or a new setting is providing. C. It occurs when the wrong dose of a medication given to a patient. D. It occurs when the wrong medication is given to a patient.

B. Medication reconciliation is done to prevent errors or accidental omissions of medication. A reconciliation is performed by comparing medication's. The patient is taking at the time of hospital admission with what the patient will be taking in the hospital. Answer a describes, quality assurance, and answers C and D both describe a medication error.

All of the following are characteristics of subacute care: A. A medically stable patient. B. Exhaustive diagnostic work ups C. Care performed in the home. D. A relatively constant treatment plan.

B. Patient under subacute care don't need diagnostic work ups. Subacute care includes all levels of care not requiring acute hospitalization. The patients are medically stable and have a constant treatment plan.

The process of stratifying a population based based on its risk for certain outcomes, Izz is called: A. Outcomes management. B. Predictive modeling. C. Population Management D. Discharge planning.

B. Patients are risk stratified to determine needs for intervention before an adverse event occurs. It is a form of proactively avoiding increases in medical cost.

Which of the following is true about treatment protocols? A. Protocols are more specific than algorithms. B. Protocols address specific treatments for a given clinical problem. C. Protocols do not allow provider, flexibility, and treatment options. D. Protocols only assessments rather than therapeutic interventions.

B. Protocols address, specific treatments for given clinical problem and allow providers some flexibility and selecting treatment options. Protocols are less specific than algorithms.

All of the following our guidelines for use of patient restraints, except: A. The use of the least restraining measure possible to accomplish the desired effect B. The use of restraints for patient safety, and staff convenience. C. Careful documentation of reasons for restraints. D. Check on the patient at least every 30 minutes.

B. Restraint should never be used for staff convenience. In addition, all reasons and incidents that precipitated restraint should be well documented. Frequent patient checks should also be done.

A patient has been admitted to the hospital to rule out a suspected condition. Which of the following is true about billing codes for this patient? A. You may code for the suspected condition, as if it actually exist. B. You may code symptoms, but not the suspected condition. C. You may skip coding until test results are available. D. You may code the rule out diagnosis, but only for outpatient.

B. Rule out or suspected diagnosis cannot be coded as if suspected condition exist. This applies to both inpatient and outpatient. Under these conditions, you should code symptoms until a definitive diagnosis is made.

You are the case manager for a client with a chronic illness. The healthcare team strongly recommends treatment, but the patient and family oppose it. Which is the most appropriate step to take next? A. Arrange for a second opinion. B. Carefully review options with the patient to ensure complete understanding. C. Immediately consult the hospital ethics committee. D. Transfer the patient's care to another hospital.

B. Sometime patients oppose treatment due to in adequate understanding of clinical information and treatment options. Before proceeding with other actions, the case manager should ensure that the patient has a complete understanding. Discussions and decisions are carefully documented in the chart.

A case manager performs, a psychological health assessment on a geriatric patient. The following categories are assessed: orientation to time, and place, recall, attention, and calculation, language, registration, and level of consciousness. This assessment is known as the: A. Functional ability assessment. B. Folstein mini mental state exam. C. Comprehensive geriatric assessment. D. YESAVAGE geriatric scale

B. The Folstein, mini mental state exam assesses various categories, including orientation to time and place, recall, language, registration, and others. Functional ability assessment evaluates the capacity to perform activities of daily living. A comprehensive geriatric exam is performed by a group of multidisciplinary geriatric experts, and evaluates all aspects of health and functioning. The Yesavage scale evaluates a geriatric patient for depression.

Which statement is true about medication reconciliation? A. It has not proven to be effective at reducing adverse drug events. B. It is one of the patient safety goals set into action by JCAHO. C. Hospital admission is the only logical time to perform medication reconciliation. D. Medication reconciliation consist of listing all of patient's current medications.

B. The JCAHO implemented 14 national patient safety goals in 2006, one of which is medication reconciliation. It was designed to reduce adverse drug events. Reconciliation is important not only at the time of hospital admission, but also during any transition with the hospital, home, or any other facility.

Which evaluation would you perform to determine if a client has the capability to return to work? A. Pain tolerance evaluation. B. Functional capacity evaluation. C. Disability evaluation. D. Evaluation by client interview.

B. The functional capacity exam is a process of assessing a persons, physical and functional abilities to perform task. The patients performance level should match the demands of the occupation and question. The purpose of the exam is to determine if a patient is ready to go back to work after an injury.

Which one of the following is true about the Americans with disabilities act (ADA)? A. An individual need only submit evidence of impairment and diagnosis. B. The goal of the ADA is to offer maximum chances for societal integration to individuals and both the private public sectors. C. All impairments are protected under the ADA. D. The disability and question is an impairment that minimally limits activity.

B. The goals of the ADA include full participation, equal opportunity, independent, living, and economic self-sufficiency. Individuals must submit to a case by case assessment, in order to prove that their impairment is covered under ADA. Proof of all medical diagnosis is no longer sufficient.

You were reviewing a clinical pathway for a patient hospitalized with pneumonia. Which of the following are key outcome goals for day one? A. Check oxygen saturation, and baseline mental status. B. Start IV antibiotics in the ER or within two hours of admission. C. Pulmonary consult and assess educational needs. D. Administer antibiotics and pain medication as needed.

B. The only goal oriented activity out of the answer choices is "B," to start IV antibiotics within two hours of admission is not already started in the ED. Checking, oxygen saturation and baseline. Mental status are assessment. Obtaining a pulmonary consult and determining educational needs are under the category of consult and multidisciplinary act education. Administration of antipyretics and pain. Medications are therapy.

Which of these is an eligibility criterion for the SCHIP program? A. Patient over age 65. B. Low income. C. Having supplemental insurance. D. Outpatient coverage only.

B. The state children's health insurance program (SCHIP) is an insurance program for children. To be eligible for SCHIP, federal guidelines must be met. The child's family must be of low income status, not qualified for Medicaid, and not have any medical insurance.CHIP does cover inpatient services in addition to outpatient services.

Which of the following is not one of the main components of clinical pathways? A. Identified categories of care. B. Recommendations for best practices. C. A timeline. D. Long-term outcome criteria.

B. There are four main components of clinical pathways identified categories of care, a timeline, outcome, criteria, and allowance for variances.

Which of the following is true about transportation reimbursement? A. Insurance companies usually reimburse for transport to the patient's home. B. Medicare has strict guidelines for reimbursement for transportation. C. Medicare covers transportation to an ambulatory day surgery center. D. Medicare will not cover air ambulance transport.

B. medicare reimbursement for transportation cost is strict. Coverage for a ground ambulance depends on the patient destination and whether the ambulance, it's equipment, and personnel meet Medicare requirements. Air ambulances may be reimbursed for life-threatening conditions or if a land ambulance is not available. Insurance companies do not reimburse for transportation to the patient's home.

Which of the following is true about depression among the elderly? A. It is usually overt treated. B., heart attack, and stroke or risk factors C. Clinical tools to detect elder depression are not available. D. Geriatric depression is not widespread at this time.

B. risk factors for elder depression, include family, history, chronic disease, alcohol, abuse, heart, attack, or stroke, and anxiety disorders. Depression is usually under treated in the elderly because it may be difficult to recognize. Geriatric depression is widespread, especially in hospitals and nursing homes. Clinical tools do exist to help detect depression in the elderly.

A depressed patient begins giving away valued possessions, drawing up a wheel, and making funeral arrangements. This behavior demonstrates.: A. Suicidal ideation. B. Suicidal intent. C. A suicidal plan. D. Suicidal gestures.

B. suicidal intent is demonstrated by giving away possessions or by performing other life, closing actions. A person with suicidal ideation has thoughts about killing himself. A person with a suicidal plan has contemplated ways he could kill himself. A suicidal gesture is an attempt to call self injury without actually intending to commit suicide.

Under Medicare, part, B, all of the following are considered "suppliers "except: A. Ambulance services. B. Healthcare practitioners. C. Prosthetists D. Independent laboratories.

B. suppliers are providers, parentheses other than practitioners) of healthcare services that are allowed to bill under Medicare part B. These include ambulance services, independent, laboratories, prosthetists, orthotists , and durable medical equipment providers.

A fish physician ordered a lab test for a patient. The lab machine malfunctioned, and only produced partial results. Medicare was billed for the full test. This type of fraud is called: A. Reflex testing B. Defective testing C. Test fraud. D. Double billing.

B. this is a form of fraud, known as defective testing. If equipment fails during testing, yielding, partial, or no results, you cannot bill as if the test was completed in full. Double billing refers to charging more than once for the same service. Reflex testing occurs whenever results of a test fall within a given range, and a secondary test is done based on the initial results. For instance, if a TSH level is abnormal, a reflex test would include a full thyroid profile. It is fraudulent to run a reflex test and bill for it if it was not ordered by the physician.

The percentage of all medication errors in the hospital that can be attributed to lack of medication. Reconciliation is closest to.: A. 20% B. 38% C. 50% D. 60%

C. 50% of medication errors and hospitals can be attributed to lack of proper medication reconciliation.

Well, you are making a home visit to a patient, she asked you to change her surgical dressing on her abdomen. Which of the following is the best thing to do? A. Tell her you'll return later to do it after your shift is over. B. Gladly change the dressing because you have the training to do it anyway. C. Contact her home care nurse, or physician D. Reprimanded family members for not changing the dressing.

C. A case managers job is to coordinate medical treatment rather than to perform clinical hands on task. The best answer is to contact her home care nurse, or physician. Avoid the temptation to do the task yourself even if you have had past relevant training.

All of the following or components a functional capacity evaluation, except: A. Musculoskeletal screening. B. Review of the medical record. C. Literacy screening. D. Testing a physical ability.

C. A functional capacity evaluation includes grading, strength, activities, position, tolerance, activities, and mobile activities. It also includes a review of the medical record and evaluation of the muscular skeletal system. Literacy screening is not a component of the functional capacity evaluation.

A woman and her newborn infant are ready for discharge from the hospital. The mother does not have a car seat for the baby. What is the most appropriate solution to this problem? A. Give her a used car seat. You found it a garage sale. B. Purchased a new car seat out of your own pocket for the patient. C. Had advanced knowledge of community, sitters or facilities that provide car seats, and ensure the seat is available for the infants use upon discharge. D. Let the infant ride in the mothers arms as long as she goes directly home.

C. A good case manager will have a car seat available in anticipation of discharge and would have ascertained in advance if the parents had a car seat. You should never use a used car seat because you cannot be sure of its condition and safety. And infant should never ride in the mothers arms, because of the high risk of serious injury, or death in case of a collision.

A prospective review A. Is performed while the patient is still in the facility. B. Is performed after patient discharged from a facility. C. Determines if admission to a facility is medically necessary. D. Is quality control measure

C. A prospective review is also known as pre-certification. It occurs before services are delivered. The purpose is to determine if admission to a facility is medically necessary. On the other hand, a review done after discharge is a retrospective review. Retrospective reviews are useful evaluation tools for quality control. A concurrent review occurs while the patient is still in the facility.

An infant is born at home. The mother and baby present to the hospital two hours after birth and are admitted. According to the newborns and mothers, health protection act (NMHPA, parent, the length of the hospital stay is determined by starting at.: A. The physician initially sees the mother. B. The time of birth of the infant. C. The time of admission. D. The patient room is ready for occupancy.

C. According to the NMHPA, the length of hospital stay is determined by starting at the time of admission if delivery occurs outside the hospital. If delivery occurs in the hospital, it begins at the time of delivery. In the case of multiple birth, it begins at the time the last infant is born.

Which of the following is considered an ancillary service? A. Nursing care. B. Physician care. C. Occupational therapy. D. Obstetric care.

C. Ancillary services are those services needed by a patient in addition to nursing and medicine. These include things such as physical therapy, occupational therapy, nutrition, radiology, and laboratory services.

The judicious use of best practices in a clinical practice based on evidence from systematic research findings is called: A. A performance indicator. B. A quality improvement project. C. Evidence based healthcare. D. A clinical guideline.

C. And evidence based healthcare practice, uses current best practices from evidence obtained by systematic research findings.

An alternative medical system that dates back 5000 years and has been practiced for primarily in India is known as: A. Naturopathic medicine. B. Homeopathic medicine. C. Ayurvedic medicine D. Bio energy therapy.

C. Ayurvedic medicine Izz has Indian roots and dates back 5000 years. It employees diet and herbal remedies and uses body, mind, and spirit and disease, treatment and prevention homeopathic medicine employees remedies that stimulate the bodies innate healing processes. Pathic medicine, uses only natural substances, and natural means to treat illnesses.

The amount a beneficiary has to pay a provider for services covered by Medicare is called: A. Fee for service. B. Bundle payment. C. Beneficiary liability D. Bonus payment.

C. Beneficiary liability is an amount. The beneficiary is responsible for paying to a provider for Medicare covered services. It could be in the form of a copayment, deductible, or balance billing.

Complementary and alternative medicine (CAM) is best to find as: A. An evidence based medical practice. B. A healthcare practice that integrates unconventional protocols with conventional medicine. C. A form of therapeutic intervention not based on conventional western treatment method. D. The same thing as allopathic medicine.

C. CAM healthcare methods are not based on. Conventional allopathic protocols. Answer a describes conventional medicine; B describes integrative medicine allopathic medicine is another name for conventional western medicine.

Which of the following is true? A. The terms case management and managed care are equivalent. B. Case management is a uniform process for all patients. C. Case management is a highly individualized process. D. Case management aims to identify the lease cost intensive patient.

C. Case management is a highly individualized process, because no two patients are exactly alike in their needs. Contrary to what answer, choice, D states, case management aims to identify the most cost intensive patient.

Using aromatherapy along with pain medication to help decrease a patient's pain after a procedure is a form: A. Alternative medicine. B. Conventional medicine. C. Complementary medicine. D. Quackery.

C. Complementary medicine is used to in conjunction with conventional medicine. alternatively, alternate medicine is used instead of conventional medicine. Conventional medicine is evidence based.

All of the following are true about disability insurance, except: A. Disability insurance is most often limited to income replacement coverage. B. Medicare is occasionally included in coverage. C. Disability insurance is considered a medical plan. D. Disability insurance only covers illness or injury not covered by Worker's Compensation.

C. Disability insurance is not considered a medical plan. The rest of the answer choices are correct.

An air ambulance is reimbursed by Medicare if: A. The patient requested. B. The patient's family requested it C. The medical condition is life-threatening, and land. Ambulance travel would be too time-consuming. D. All of the above.

C. Medicare reimburses an air, ambulance transport if the patient has a life-threatening condition that requires immediate medical attention and travel by land ambulance would be too time-consuming.

All of the following are true about Medicare select: A. Medicare select is a Medicare supplemental health insurance product. B. Medicare select policies are managed care plans. C. Medicare select plans are hiring cost than traditional Medigap plans D. With Medicare select, a patient is required to use specific hospitals, clinics, and sometimes even specific physicians.

C. Medicare select plans have lower premiums than Medigap policies because of their requirements to use specific facilities, and, sometimes, specific physicians. All of the other statements are true.

An insurance plan that supplement services is not covered by Medicare is known as: A. Medicaid. B. Catastrophic coverage. C. Medigap. D. CAPITATION.

C. Medigap plans are insurance plans at supplement services, not covered by Medicare. On the other hand, Medicaid is federally funded insurance for the poor. Capitation is the periodic fee paid to a healthcare practice by each member enrolled in a health plan.

A patient who needs help regaining independence and performing baseline activities of daily living should receive which of the following? A. Physical therapy. B. Psychotherapy. C. Occupational therapy. D. Aromatherapy.

C. Occupational therapist, employee, motor, sensory, cognitive exercises, and various tasks to help improve a patient's performance of activities of daily living. A physical therapist helps patients with mobility and motor skills.

All of the following are key, success factors for disease management, except: A. Understanding the natural course of the disease. B. Aiming for prevention and resolution. C. Allowing the physician to all the patient education D. Improving patient compliance by education.

C. Peace, success factors for disease management include having knowledge of the course of the disease, focusing on patients who are likely to benefit from intervention, aiming for prevention and resolution, and providing continuity across various healthcare settings, and establishing data management systems.

The case manager is part of a team of physicians, who assume care for the PCP when patients are admitted to the hospital. This is known: A. Skilled nursing facility. B. Entrepreneurial setting. C. Hospitalist team. D. Hospice setting.

C. Physicians who care for hospitalized patients are known as hospitalist. This eliminates the burden on the PCP so that he or she can focus on office practice. There is often at least one case manager on a hospitalist team. Entrepreneurial case managers run their own case management businesses. Hospice case managers, coordinate care of dying patients and their families.a skilled nursing facility is for patients who can no longer perform self-care.

The case management process of documenting goals, objectives, and actions to meet a clients needs is: A. Assessment B. Coordination. C. Planning. D. Monitoring.

C. Planning is the process by which case manager, documents, goals, objectives, and actions that will meet a clients needs. Assessment entails gathering data about a client special needs and situation prior to forming a case management plan. Coordination involves organization, modification, and documentation of resources necessary to achieve goals. Set forth in the plan, and monitoring involves securing information needed to gauge the effectiveness of the plan.

The process by which you would screen the patient's medical record to determine if the patient received appropriate standards of care is known: A. An incident report. B. Risk management. C. Quality review. D. Utilization review.

C. Quality review helps determine if a patient received recognized standards of care. An incident report is a tool used to document adverse or unusual occurrences. Wrist management identifies, evaluates, incorrect, is risk that may lead to injury to patients, staff, or visitors. During utilization review, medical services are evaluated for necessity and appropriateness.

The case closure domain of case management focuses: A. Obtaining client consent for services. B. Utilization review. C. Notification of termination of services to all stakeholders. D. Evaluating the ability of a caregiver to perform necessary services.

C. The case closure domain focuses on ending the case manager, client relationship, and on notification of service termination to stakeholders. Answer a refers to the case finding an intake domain, while answer B refers to the utilization management, domain, and answer D refers to the psychosocial domain.

Which of the following applies to CHAMPVA? A. It is valid for three of the seven uniform services. B. CHAMPVA, is part of the TRICARE system. C. CHAMPVA covered when the participants become eligible for Medicare. D. CHAMPVA covers veterans.

C. The civilian health and medical programs of veteran affairs (CHAMPVA) is a law, allowing medical benefits, to survivors and dependence of veterans who are permanently and completely disabled with a service related condition. It is valid for all seven uniform services. CHAMPVA is not part of the TRICARE program. CHAMPVA coverage stops when a participant Becomes eligible for Medicare.

An employer allows an eligible employee, spouse, and their dependence to maintain health insurance coverage when the employer resigns from employment. This is known as.: A. HIPAA. B. Managed care. C. Cobra D. PPO.

C. The consolidated omnibus budget reconciliation act (cobra) of 1986 requires that employers allow eligible employees, their spouses, and dependence to maintain health insurance after the employee resigns from employment.

According to the standards of practice for case managers, there are four key functions of a case manager. Which of the following is not one of the key functions? A. Planner B. Assessor. See. Litigator. D. Advocate.

C. The four key functions of the case manager are planner, assessor, facilitator, and advocate. A case manager must assess a situation to identify problems that need case management. The case manager must also planned long and short term goals, and collaboration with the client, the clients family, and with other healthcare professionals. Facilitation includes coordinating and implementing the care plan, maintaining communication, and expediting care. As an advocate, the case manager, ensure that the clients needs are identified and addressed.

You are a specialist and maternal infant case management. The labor and delivery nurse has told a pregnant woman and preterm labor that she is going to receive betamethasone. How would you explain this to the patient? A. Betamethasone is a drug given to treat preeclampsia. B. Betamethasone is routinely given to stop contractions in order to avoid preterm delivery. C. Betamethasone is a steroid given to pregnant women to help fetal lung development in case of preterm birth. D. Betamethasone strengthens contractions.

C. The only correct answer is C. Betamethasone is a steroid given to pregnant women to facilitate fetal lung development when pre-term birth is anticipated.

A patient has received a complete description of a medical treatment regimen, including risk, hazards, complications, and prognosis. What is this type of explanatory procedure called? A. DSM-IV - TR guidelines B. Risk management. C. Full disclosure. D. Varicarious liability.

C. The process of giving a patient a complete description of medical treatment is called full disclosure. And vicarious liability, a person can be held liable for harm done to another person. Risk management, assesses, identifies, and controls risk that originate from operational factors. DSM-IV-TR guidelines are the diagnosis and management guidelines for psychiatric disorders.

A patient with mild paresis of one arm is going to need an assistive device to aid with walking. Which of the following is most appropriate type of cane for this patient? A. C cane B. Functional grip cane C. Quad cane D. Hemi-Walker

C. The quad cane would be most appropriate for this patient. It has a rectangular base with four support that contact the walking surface. These are more appropriate for patients who need more balance assistance, such as those with mild paresis of an arm, or a mild hemi paresis. The simplest cane is the C cane, a straight cane with a curved handle for those who need slight assistance. A functional grip cane has a straight rather than curved handle and allows for an improved grip and more support than see canes. Hemi walkers, have a much larger base than a quad cane, and provide more support for patients with more severe hemiplegia.

Which of the following emphasizes achievement of outcomes in defined time frames with limited resources? A. Variance analysis. B. Social work. C. Case management. D. Risk management.

C. The question itself provides a good definition of case management, the achievement of desired outcomes within a defined timeframe while limiting resources as much as possible.

When a case manager refers a client to a specific provider, what type of relationship exist between the case manager, and the provider? A. Vicarious agency. B. Advocate. C. Ostensible agency. D. Favoritism.

C. The relationship that exists between the case manager, and a referral provider is an ostensible agency. If that provider works to perform negligent actions. The referring case manager may also become subject to litigation. A fiduciary is a relationship, whereby the case manager act in the clients best interest. The case manager is an advocate for the client, not the provider.

A client is medically stable, but needs intermittent. Nursing intervention to maintain stability. The patient also needs intermittent, subacute injections, routine, non-sterile, suctioning, and a stable respiratory therapy plan. What level of care is this patient receiving? A. Assisted-living B. Custodial care. C. Intermediate care. D. Skilled nursing.

C. The scenario describes intermediate care. Under assisted-living or custodial care, the client is stable, takes a consistent regimen of oral medication's, and does not need suctioning. Skilled nursing is for complex, but state generally stable, patients who may need central line care, IV push medication, variable, adjustments, and dosages of medicines, and assessment of laboratory values.

The case management domain that focuses on workplace issues, disability, and job modification is called: A. Case finding an intake. B. Outcomes evaluation, and case closure. C. Vocational concepts and strategies. D. Psychosocial and economic issues.

C. The vocational concepts and strategies domain is a case management domain concentration on disability issues, identifying accessibility barriers in the clients home, determining the need for rehabilitative services, and arranging vocational services.

Risk management is a sub domain of which of the following court case management domains? A. Psychosocial aspects. Be. Healthcare management, and delivery. C. Principles of practice. D. Case management concepts.

C. There are six domains for case management practice. These include case management concepts, case management principles, and practice strategy/practice, psychosocial and support systems, health management, and delivery, healthcare, reimbursement, and vocational concepts/strategies. Risk management is a sub domain of case management principles, and practice/strategies.

A terminally ill. Client is exhausting, all financial resources to pay medical cost. The case manager has suggested obtaining cash value on his life insurance policy prior to death. This process is known as a: a. Nontraditional policy. B. Supplementary policy C. Viatical settlement. D. Gatekeeping.

C. This scenario describes the process known as viatical settlement, whereby a patient can obtain a cash value from a life insurance policy prior to death. Answers a, B, and D are irrelevant to the situation.

You have decided to become a case manager for a friend. Which of the following best describes the situation? A. Unbiased relationship. B. Favoritism. C. Dual relationship. D. Professional courtesy

C. This type of relationship is a dual relationship, because you are both friend and case manager. This often leads to a conflict of interest. Having a friendship with a client outside of the clinical arena, introduces biases that interfere with your performance as a professional.

Clients whose income is too low to afford health insurance, but too high to qualify for federally funded insurance belong to a: A. Indigent group. B. Network model. C. Notch group. D. Catastrophic case group.

C. Those whose income is too low to buy health insurance, but too high to qualify for a federally funded plan, belong to a notch group. Neither of the other answers is correct. Catastrophic cases are medical claims of high dollar amounts. And network model is a type of health plan that contracts with numerous groups of physicians.

A member of an office medical staff has documented a billing code for a more severe condition than the one documented in the patient's chart. This coding action is called.: A. A medical necessity. B. Downcoding. C. Upcoding D. CPT coding.

C. When a billing code makes a patient seem more severely ill than he really is, upcoding has occurred. Up coding is sometimes done intentionally to increase reimbursement, but it can also be done accidentally by an inexperienced coder. Consistently upcoming constitutes fraud.

Which of the following is true about viatical settlement? A. They are classified as an insurance product. B. They are a type of death benefit. C. They involve sale of a life insurance policy to a third-party before death occurs. D. When the policy is sold, it is not necessary for beneficiaries to sign a release to waive rights to the policy.

C. With viatical settlements, a third-party purchases, the policy (or a portion of it) at an amount that is less than the death benefit. The third-party then collects the death benefit after the seller dies. Viatical settlements are not an insurance product. They are also known as living benefits because the seller uses the funds to improve his quality of life prior to dying of a terminal illness. Beneficiaries must sign a waiver to give up rights to the policy.

Home management activities, a person performs on a regular basis, such as meal preparation and housework: A. Cognitive activities. B. Activities of daily living (ADL's) C. Instrumental activities of daily living (IADLs) D. Executive functions.

C. activities of home management that a person performs on a regular basis, such as housework and meal preparation or instrumental activities of daily living. Activities of daily living activities that are a part of normal daily, living, such as eating, bathing, and toileting. Cognitive activity stimulate brain function. On the other hand, executive functions are cognitive abilities that allow a person to prioritize and plan.

Which of the following is true about? "do not resuscitate" (DNR) orders? A. A patient cannot request a DNR order on himself. B. All therapeutic interventions are when a patient is DNR. C. DNR order should be reviewed periodically revised if needed. D. Staff withhold food and water from a DNR patient.

C. adults can request DNR orders on themselves if they are mentally competent. Under DNR status, only resuscitative actions are withheld. All other therapeutic interventions continue, such as drawing blood, suctioning, and giving blood transfusions. DNR orders should be periodically reviewed and revise as needed.

If you are named in a lawsuit, one of the first things you should do: A. Keep quiet and don't ask questions. B. Talk about the case with coworkers. C. Obtain the record and review it carefully. D. Talk about the case with the opposing attorney if asked

C. always obtain the record and review it. You should not talk about the case with coworkers, or the opposing attorney. Talk with your attorney or risk manager. If you have questions about the process, ask. If asked to provide a deposition, be honest and don't volunteer information. Answer"yes or no" questions with only a "yes" or "no" answer.

Uncoordinated care that is given through multiple providers and organizations is called: A. Patient centered care. B. Chronic care model C. Fragmented care. D. Transitions of care.

C. fragmented care occurs when uncoordinated care is given via multiple clinicians and organizations. It is a widely recognized problem. Efforts are now focusing on improving communication among healthcare providers and situations such as when a patient is discharged from the hospital. Patient centered care involves treating patients as partners and healthcare, using them to take responsibility for their health, and involving them in planning. Chronic care models are models for assessment and treatment of chronically ill patients.

A patient remains in the hospital for two additional days because of an inappropriate delay in discharge. These days are called: A. Incidents B. Acute days. C. Lag days. D. Length of stay.

C. lag days are inappropriate acute in patient days that occur when a patient should have been discharged sooner than she actually was. Insurance companies consider these days, not acute and a form of overutilization. The company may deny payment for the portion of the hospitalization deemed inappropriate. A good case manager can help avoid the occurrence of lag days.

Which of the following is a human barrier encountered in the implementation of the case management model? A. Limited budget. B. Systems constraints. C. Fear of technology. D. Unrealistic administrative expectations.

C. of the four answer choices, the only one that is "human" is fear of technology. Fear of data, keeping, and technology could be real to a health, professional, inexperience with data collection, computers, or evaluation of care. Answers a, B, and D are institutional barriers.

All of the following are true about caremaps except: A. MAP timelines can be an hours, days, weeks, or months. B. Common diagnosis usually fall within a 24 hour timeframe. C. A 24 week gestation infant in the neonatal intensive care unit (NICU) usually Falls into a 3 to 4 week timeline D. variance time frames are also part of the MAP timeline

C. timelines for multidisciplinary action plans very depending on the patient's clinical needs. It could be hours, days, weeks, or months. A Caremaps for a 24 week gestation infant could be several months. Variance time frames must also be determined, including determining how much leeway should be allowed for achieving the expected outcomes.

The process that occurs when a person elects to stay in her home, and to remain as independent as possible even though she is undergoing mental or physical decline is called: A. A continuing care retirement community. B. Assisted-living. C. Aging in place. D. Respite care.

C. when a person chooses to stay in her own living environment, despite physical and or mental decline, she has chosen to age in place. In assisted-living, assistance is given with activities of daily living. Continuing care retirement community is an expensive housing community that provides different levels of care from independent living to full-time nursing care.

Which of these statements is true about hospice care? A. Hospice care is solely for patients with terminal malignancies B. Hospice is for patient to have six or fewer months to live. C. In hospice, all further medical treatment has been stopped, including palliation. D. Hospice care is for any terminal condition.

D. Answers a and B are common misconceptions. Hospice is for patients with any terminal condition. Answer be is incorrect because it is difficult to know exactly how much longer a terminal patient will live. Even in the face of discontinuing, aggressive therapy, patients in hospice care should receive palliative care to maximize comfort.

Which of the following is true about case management (CM) in a school setting? A. CM deals mostly with crisis management B. CM responds to problems rather than addressing prevention. C. Capital CM is a random collection of interventions. D. Capital CM involves meeting with patients and families on a regular basis to prevent problems.

D. Case management in the school as a long-term relationship with a child and his family, usually lasting throughout the academic year. It includes comprehensive involvement and coordination of services to meet a child's healthcare needs. It is far more than crisis and problem management. Interventions are organized and not random. The goal of case management in schools is to decrease fragmented care, and to improve the quality of life for children with chronic illnesses.

Which of these is not covered according to the balanced budget act of 1997? A. Annual prostate cancer screening for patients over age 50. B. Bone density test for patients at risk for osteoporosis. C. Diabetes education D. One pneumo vaccine yearly.

D. Choices a, B, and C are procedures all covered according to the balance budget act of 1997. Pneumovax is covered, but only once in a lifetime, not every year.

Which of the following terms describes the capacity to feel and react to customs or traditions of a specific group of people? A. Patient centered care. B. Compassion. C. Empathy. D. Cultural sensitivity.

D. Cultural sensitivity is the capacity to feel, respect, and react to customs and traditions of a unique group of people. The terms, patient centered care, compassion, and empathy are all important. Answer D is the most specific, and therefore the best answer.

All of the following are examples of community resources, except: A. The American Cancer Society. B. Church groups. C. Easter Seals. D. Managed care organization.

D. Examples of community resources include the American Cancer Society, Easter seals, march of dimes, lions, club, and others. Church groups and civic groups are also community resources. They all serve as good patient support systems.

Which of the following is true about reporting elder abuse? A. The person reporting the abuse can be sued for slander. B. Reporting abuse is optional. C. Neglect is not considered a form of abuse. D. Exploitation of property is a form of abuse.

D. Exploitation of property refers to an illegal use of a vernal vulnerable adults resources for personal profit. This is a form of elder abuse that has several forms such as abuse of joint accounts and forgery. As long as a person reports abuse, in good faith, he is protected from slander or liable claims. Reporting of abuse as mandatory.

The term "handoff "refers to: A. Transferring care of a patient from one care setting to another. B. Transferring care from one provider to another. C. Transferring a patient from one level of care to another. D. All of the above.

D. Handoffs involve three types of transfers from one provider to another, one setting to another, and from one level of care to another.

Which of the following is an example of hard savings? A. Avoidance of ED visits. B. Avoidance of medical complications. C. Avoidance of potential hospital reignition D. Changed to a lower level of care.

D. Hard savings are avoided cost that can be measured. Changing a patient to a lower level of care saves money in immeasurable amounts. Soft savings cannot be tangibly measured, such as those and items and answers a, B, and C.

A patient's routine, dialysis test, drugs, and supplies are paid by Medicare as a bundle of services. This type of payment is known as.: A. A discounted service. B. Bundling of services. C. A form of fraud. D. A composite rate.

D. In the case of this, patient, the bundle of services needed for dialysis, such as medication's, test, and supplies, is paid by Medicare. This is known as a composite rate.

The "usability "of information systems refers to their: A. Easiness. B. Low error rate. C. Intuitive navigation. D. All of the above.

D. Information systems should be user-friendly, and should not have a steep learning curve. It must allow the user to complete task quickly and with a low air rate.

According to Lewins, change theory, the "moving stage" occurs when: A. The need for change is recognized. B. The process for creating awareness for for change is started. C. A change becomes permanent. D. The need for change is accepted and implemented.

D. Lewins change theory is commonly used in nursing. There are three stages, unfreezing, moving, and refreezing. During the unfreezing stage, the need for change is recognized. During moving, the need for change is accepted and implemented. Refreezing, occurs when a change becomes permanent.

Which of the following is not an advanced directive? A. living will B. Medical power of attorney. C. Durable power of attorney. D. Last will and testament

D. Medical power of attorney is a document, allowing a person to appoint someone else to make medical care decisions in the event that he/she can't communicate. Living wills, medical, power of attorney, and durable power of attorney are all types of advanced directives.

A client entry into a case management program is determined by: A. Interview B. Networking systems. C. Referral. D. All of the above.

D. One of the components of case management is client, identification and outreach. Clients who need case management services must be identified. Entry into a case management program involves an interview process, a referral, or networking systems. A case manager may also promote eligibility for certain individuals.

A form of deep tissue massage intended to stretch facia to release adhesions and relieve muscle and joint restrictions is known as: A.Reiki B. Reflexology. C. Upledgers approach. D. Rolfing

D. Rolfing stretches fascia to release, adhesions and relieve muscle and joint restriction. It is usually given over a period of 10 sessions. Reflexology involves massaging points on the feet and hands to stimulate glands and body organs. Reiki is a technique of the laying on of hands to improve the flow of "Lifeforce energy" to bring about healing. Ledgers approach is a form of cranial sacral therapy that relieves restrictions in the meningeal fascia.

Which of the following is a Social Security program that provides supplemental income to eligible beneficiaries? A. AFDC. B. SCHIP. C. Medicare. D. SSI.

D. SSI is part of the Social Security program. It's benefits are available to low income people of any age age who are disabled. AFDC (A to families with dependent children) is a government program that assist. Low income families. SCHIP openstate children health insurance program) assistance to low income families who do not qualify for Medicaid.

A case manager knowingly refers a patient to a provider who is unqualified to render services to the patient. This is known as: A. Temporary referral B. Dual relationship. C. Referral by client consent. D. Negligent referral

D. The case manager has to have knowledge of the referral providers, credentials, and clinical experience. If a case manager sends a patient to an unqualified referral provider, this constitutes a negligent referral. It is important for the case managers to check in with patients afterward, to assure that they had a positive experience with the provider. It is also the case managers responsibility to report any misconduct on the part of that provider.

Nursing case management that is "within the walls" refers to which setting? A. Outpatient setting. B. Community clinic setting. See. Health maintenance organization (HMO). D. Acute hospital setting

D. The term "within the walls" (WTW) refers to activities within the acute hospital environment. This is distinct from "beyond the walls" (BTW), which refers to case management in outpatient and community settings.

The medical term for difficulty swallowing: A. APHAKIA B. Dysphasia. C. Akathisia D. Dysphagia

D. The term for difficulty and swallowing is dysphagia. Dysphasia, on the other head, refers to an absence of language function. Aphakia Is an ophthalmologic term, referring to the absence of the ocular lens. Lastly, akathisia is an abnormal level of agitation or restlessness.

All of the following required informed consent, except: A. an invasive treatment or procedure B. Treatments that carry potentially dangerous side effects C. A procedure that may result in serious complications. D. An emergency situation, in which lack of action would be a greater risk than the treatment itself.

D. This answer is an example of implied consent. In this case, the lack of an emergency action carries greater risk to the patient than the necessary procedure would.

When a patient chooses to make treatment decisions by drawing up, advanced directives, or appointing a healthcare proxy, and choosing not to be resuscitated, he is exercising the principle of: A. Palliative care. B. Hospice determination C. Developing an illness trajectory. D. Patient self determination.

D. This is an example of patient self-determination. In this process, the patient makes treatment decisions, such as establishing, advanced directives, appointing, a healthcare proxy, determining whether to withdraw nutrition, or electing not to be resuscitated.

Which of the following is an example to written consent to HIV testing? A. Having had pretest counseling. B. Have given oral consent. C. When the patient refuses written consent. D. When anonymous testing is requested.

D. With anonymous testing, oral consent is acceptable. Other exceptions include emergency situations when a diagnosis is needed, and the patient is unable to sign, to determine the cause of death, and for research purposes in which the patient remains anonymous.

Which of the following is/are a health literacy assessment tool? A. REALM. B. REALM.-SF C. MART. D. All of the above.

D. all of the answers given our health literacy assessment tools. Rapid estimate of adult literacy and medicine (REALM) is a word recognition test that consist of 22 common medical words. The patient is asked to pronounce as many words as possible out loud. That are ELM/SF is the short form of the same exam. MART (medical terminology, achievement, reading, test) places several medical words in small print on a simulated prescription bottle. The patient is then asked to read the label.

Under which of the following conditions can a case manager refuse to see a patient? A. If there is a conflict of interest in working with that patient. B. If providing services to that patient places and personal danger. C. A case manager cannot refuse to see a patient. D. A and B

D. if there is a possibility, conflict of interest in working with a patient, report it to your supervisor, so that another case manager can take the assignment. You should never place yourself in personal danger in order to provide services. Again, report dangerous conditions to your supervisor.

All of the following are examples of non-medical levels of care, except: A. Residential care facilities. B. Adult daycare C. Greenhouses. D. Skilled nursing facilities.

D. residential care facilities (also called assisted-living facilities) are similar to apartment buildings with private suites. Some of the characteristics include wheelchair, accessibility, higher toilets, and communications devices. Adult daycare, offers care outside the home as a temporary alternative for caregivers. Greenhouses are group homes, focusing on quality of life. skilled nursing facilities provide medical care.

In relation to case management, the profit or loss that results from a hospitals investment in case management is known as: A. Length of stay. B. Resource management outcome. C. Measurable outcomes. D. Return on investment.

D. return on investment (ROI) is the profit or loss that results from a hospitals investment in case management. To calculate ROI, compare cost of case management resources versus the benefit it produces by using the formula (benefit minus cost)/cost time 100 equals percent ROI.

An intense, work related program designed to restore, neuromuscular functions is called: A. Work hardening B. Work modification. C. Work rehabilitation. D. Work conditioning

D. work conditioning programs, restore, physical capacity, and endurance to enable a patient to return to work. The program is intensive and goal oriented and works to restore muscle performance and endurance. Work hardening uses simulated work activities to restore, physical and vocational functions. Work modification changes the work environment to accommodate the persons limitations. Work rehabilitation is a program of physical conditioning, exercise and conjunction with simulated job activities.