Ch 13: Case Management
5. Which of the following best explains why every client doesn't receive care from a case manager? A. Case management time is demanding; thus it is restricted to complex cases. B. Many health agencies do not employ case managers. C. Most clients would not benefit from case management. D. Most nurses do not know how to function as case managers.
ANS A Case management time is demanding; thus it is restricted to complex cases. Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses' caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet. DIF: Cognitive Level: Understand (Comprehension) REF: p. 235
18. Which of the following is the primary goal of case management? (Select all that apply.) A. To ensure that care coordination occurs across the continuum B. To emphasize evidence-based clinical decision making C. To manage resource use and control expenses D. To stress the advantages and benefits of community-based care
ANS A, B, C A. To ensure that care coordination occurs across the continuum B. To emphasize evidence-based clinical decision making C. To manage resource use and control expenses The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision making, guideline use, and disease-management programs; and control expenses by managing care processes and outcomes. DIF: Cognitive Level: Understand (Comprehension) REF: p. 233
19. A case manager is concerned about his exposure to possible lawsuits. Which of the following are appropriate actions to take to minimize this risk? (Select all that apply.) A. Assure clients they can appeal any decision. B. Carefully document client involvement and reasons for decisions. C. Share client information with the other involved providers and agencies. D. Confirm credentials and capabilities of providers or agencies to give care.
ANS A, B, D A. Assure clients they can appeal any decision. B. Carefully document client involvement and reasons for decisions. D. Confirm credentials and capabilities of providers or agencies to give care. Elements that reduce risk exposure include clear documentation of the extent of participation in decision making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources—which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with HIPAA, no nurse is allowed to share information with others without written consent of the client. DIF: Cognitive Level: Apply (Application) REF: p. 243
4. Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? A. A 24-year-old who has a master's degree in public health B. A 34-year-old who will be moving from a large city C. A 44-year-old who was born and raised in the community D. A 54-year-old who, until recently, was a member of the community's school board
ANS B A 34-year-old who will be moving from a large city Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict-resolution skills; critical-thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills. DIF: Cognitive Level: Apply (Application) REF: pp. 233-234
2. Which of the following best describes why planning care for an individual is so challenging in today's health care system? A. Because today's clients have high expectations of the health care system B. Because multiple providers, payers, and settings have to be coordinated C. Because of the new high technology constantly being created and used for client treatment D. Because so many different health care providers are in the acute care setting today
ANS B Because multiple providers, payers, and settings have to be coordinated Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client's continuum of care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 233
7. A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important consideration that should be made by the nurse? A. Case management plans should be used only by nurses to manage care. B. Case management plans should be individualized for each client. C. Case managements plans provide additional expense to the client and family. D. Case management plans focus on the natural progression of the disease.
ANS B Case management plans should be individualized for each client. Adaptation of the case management care plan to each client's characteristics is a crucial skill for standardizing the process and outcome of care. It links multiple provider interventions to client responses and offers reasonable predictions to clients about health outcomes. Institutions report that sharing case management plans with clients empowers the clients to assume responsibility for monitoring and adhering to the plan of care. DIF: Cognitive Level: Apply (Application) REF: p. 237
14. The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. Which of the following terms best describes this action? A. Assertiveness B. Collaboration C. Cooperation D. Compromising
ANS B Collaboration In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties. DIF: Cognitive Level: Apply (Application) REF: p. 242
12. A nurse reviews with the client what the client can expect during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, "You've got my care all mapped out." Which of the following tools is the nurse using to determine what will happen when? A. Care planning B. Critical pathway C. Demand management D. Use management
ANS B Critical pathway Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measureable outcomes. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. DIF: Cognitive Level: Apply (Application) REF: p. 233
15. A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing process does this correspond? A. Assessment phase B. Diagnosis phase C. Planning phase D. Implementation phase
ANS B Diagnosis phase The diagnosis phase of the nursing process is analogous to identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment. DIF: Cognitive Level: Apply (Application) REF: p. 235
8. A client spends a great deal of his time on the Internet or reading articles related to diabetes and its long-term effects. One day the client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse? A. "Life care plans are only for young persons who are newly diagnosed." B. "Life care plans are primarily used to determine long-term financial needs for legal reasons." C. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." D. "I was waiting for you to express interest in having a life care plan."
ANS C "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice. Others who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging. DIF: Cognitive Level: Apply (Application) REF: pp. 237-238
9. Which of the following Medicaid clients would most likely receive case management? A. An elderly person B. A person receiving rehabilitation following an injury C. A person who has a high-cost chronic disease D. A person with acute illness
ANS C A person who has a high-cost chronic disease Some states, through their Medicaid programs, are developing disease management programs for high-cost chronic diseases among their populations, such as asthma and diabetes. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 237-238
16. A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process. Which of the following activities would the nurse most likely use? A. Asking the client what is most important B. Seeking appropriate referrals for the client C. Assuring the client that his wishes will be supported D. Determining the order in which actions will occur
ANS C Assuring the client that his wishes will be supported Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking the client what is most important is a way to illuminate values, which occurs in the assessment phase. Seeking appropriate referrals for the client occurs in the assessment phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase. DIF: Cognitive Level: Apply (Application) REF: p. 235
17. A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? A. Advocating for the client whose values conflict with those of the medical service provider B. Collaborating between nursing and occupational health personnel C. Educating a group regarding community services that are available if ever needed D. Resolving conflict between a primary care clinic and a tertiary health care facility
ANS C Educating a group regarding community services that are available if ever needed Primary prevention involves the use of the information exchange process to increase the client's understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed. DIF: Cognitive Level: Apply (Application) REF: p. 241
1. Which of the following best describes case management? A. A tool of health maintenance organizations B. Targeted toward a specific segment of the population C. Implemented with individual clients D. Used to monitor the health status, resources, and outcomes for an aggregate
ANS C Implemented with individual clients Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system. DIF: Cognitive Level: Remember (Knowledge) REF: p. 233
6. The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for continuing care to be implemented? A. A physician who is willing to use wireless prescriptions and plans of care B. Family permission for the nurse to make home visits C. Long-distance telephone service or a computer with Internet access D. Willingness of the caregiver to drive the client to the nearest clinic
ANS C Long-distance telephone service or a computer with Internet access Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client's health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phone bank location. DIF: Cognitive Level: Apply (Application) REF: p. 235
13. A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client's convalescence is beneficial and safe? A. To consider all possible consequences of long-term care placement B. To encourage the group to review the client outcomes in the different settings C. To expand the goal so that different solutions can be generated and considered D. To help the group focus on the critical aspects the client's family considered most important
ANS C To expand the goal so that different solutions can be generated and considered One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable. To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences. DIF: Cognitive Level: Apply (Application) REF: p. 241
11. A case manager advocates for a client by helping an insurer understand the client's needs and desires and by helping the client understand programs and benefits offered by the insurer. What role is the nurse? A. Arbitrator B. Counselor C. Mediator D. Negotiator
ANS D Negotiator Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. Mediating is the process of assisting parties to understand each other's concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome. DIF: Cognitive Level: Apply (Application) REF: pp. 236, 242
3. Which of the following best describes the primary problem that can result from health care today being given by many different care providers? A. Clients are not sure which provider to see first. B. Health care providers have to make referrals to other providers. C. Clients sometimes are not sure who their primary provider is. D. Overuse, underuse, or gaps in care may result.
ANS D Overuse, underuse, or gaps in care may result. A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 233-234
10. Which of the following best describes the goal or priority of the nurse advocate? A. To gain organizational and governmental support for the promotion of nursing objectives B. To improve community service needs identified by research findings C. To integrate evidence-based practice guidelines in the provision of community nursing service D. To promote the client's rights and self-determination
ANS D To promote the client's rights and self-determination In today's practice, the nurse advocate makes the client's rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. DIF: Cognitive Level: Understand (Comprehension) REF: p. 239