Practice Test Q & A

Medicare B benefits include: A-hospitalization (acute care); B-skilled nursing facility care; C-clinical laboratory services; D-hospice care

C-clinical laboratory services

A flowchart format of health care decisions that target a specific health condition along with treatment processes, care sequences and usually including an expected medical course, is referred to as a: A-medical flowchart; B-diagnostic tree; C-clinical pathway; D-practice guideline

C-clinical pathway

Best practice profiling in health care can best be described as the: A-evaluation of various services within a single specialty to determine the most effective system of health care delivery; B-intensive evaluation of a health care service, foundation or organization for quality outcomes indicators; C-comparison of relevant benchmark data to determine services, process or functions that produce superior outcomes; D-identification of errors and obstacles that impede quality health care services, functions and programs.

C-comparison of relevant benchmark data to determine services, process or functions that produce superior outcomes

Which of Piaget's states of cognitive development is characterized by the ability to think logically, use abstraction and test hypotheses: A-sensorimotor; B-preoperational, preconceptual and intuitive; C-concrete operational; D-formal operational

C-concrete operational

For a client with a chronic mental health disorder, recovery means: A-absence of symptoms; B-discontinuation of mental health service; C-coping with symptoms and problems; D-independence in meeting individual needs

C-coping with symptoms and problems

With continuous quality improvement (CQI) model, the focus of improvement is on: A-processes; B-staff; C-administrative personnel; D-clients

A-processes

The purpose of stop loss insurance is to: A-protect the insurance company against excessive payments; B-defer medical expenses until a time when funds become available; C-replace a part of insurance coverage and may exclude certain treatments; D-limit the types of services covered

A-protect the insurance company against excessive payments

The medical-social model of case management focuses on: A-acute care patients; B-long term care patients; C-rehabilitation patients; D-trauma patients

B-long term care patients

All departments in a healthcare institution should strive toward: A-autonomy; B-a common vision of care; C-increased budget allocation; D-spirit of competition

B-a common vision of care

Home management activities a person performs on a regular basis such as meal preparatiomnand housework are: A-cognitive activities; B-activities of daily living (ADLs); C-instrumental activities of daily living (IADLs); D-executve functions

B-activities of daily living (ADLs)

The most cost effective solution for an elderly patient with mild to moderate Alzheimer's disease who can no longer stay along while her primary caregiver works part-time outside the home is: A-residential care facility; B-adult day care program; C-adult day healthcare; D-home health agency

B-adult day care program

Which of these statements is TRUE about advanced directives? A-the documents need not be legally executed; B-advance directives are used if the patient becomes incompetent; C-advance directives removed autonomy from the patient; D-advance directives can be drawn up by the next of kin if the patient is incompetent

B-advance directives are used if the patient becomes incompetent

Which of these is an eligibility criterion for the SCHIP program? A-patient over 65; B-low income; C-having supplemental insurance; D-outpatient coverage only

B-low income

Stress can motivate learning. The most rapid learning occurs at which of the following stress levels: A-low stress; B-low to moderate stress; C-moderate to high stress; D-high stress

B-low to moderate stress

Case management standards are set by the various disciplines involved (social workers and nurses) as well as by the Case Management Society of America. The standards are further supported by: A-application criteria; B-measurement guidelines; C-practice outlines; D-intervention definitions

B-measurement guidelines

Which of the following ins 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-medical decision making

When developing guidelines for evidence-based practice, the weakest justification for establishing a procedure is: A-evidence review; B-staff preference; C-policy considerations; D-expert judgement

B-staff preference

You are 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 of within 2 hours of admission; C-pulmonary consult and assess educational needs; D-administer anitpyretics and pain medications as needed

B-start IV antibiotics in the ER of within 2 hours of admission

Health care registries are defined as: A-systems used to admit patients to a health care facility; B-systems used to collect and follow patient information; C-case management billing programs; D-computer operated waiting lists

B-systems used to collect and follow patient information

An 80 year old patient is dying of cancer and has been in and out of consciousness. The family should be encouraged to: A-go home, as the patient does not know they are present; B-talk to the patient, as hearing is usually the last sense to fail; C-offer the patient frequent sips of water to avoid dehydration; D-raise the head of the patient's bed if respirations become rattling to help the patient clear secretions

B-talk to the patient, as hearing is usually the last sense to fail

Which of the following most closely characterized Selye's biological theory of stress and aging: A-the body is a machine that wears out over time; B-the body's response to stress is characterized by a generalized adaptation syndrome; C-all cells and organisms have a programmed life span; D-over time, mutations occur that interfere with body functioning and cause aging

B-the body's response to stress is characterized by a generalized adaptation syndrome

The acronyms DMAIC and DMADV refer to quality improvement sub-methodologies used within which of the following models: A-Shewhart cycle; B-continuous quality improvement; C-Six sigma model; D-Deming cycle

C-Six sigma model

All of the following are true about Care Maps EXCEPT: A-MAP timelines can be in hours, days, weeks or months; B-common diagnoses usually fall within a 24-hour time frame; C-a 24 week gestation infant in the neonatal intensive unit (NICU) usually falls into a 3-4 week timeline; D-variance time frames are also part of the MAP timeline

C-a 24 week gestation infant in the neonatal intensive unit (NICU) usually falls into a 3-4 week timeline

The protective strategy for insurance companies that involves limiting the maximum dollar benefits for a policy is: A-reinsurance; B-deferred liability; C-a cap; D-third party liability

C-a cap

The primary focus of a risk mitigation program is: A-to decrease adverse patient outcomes and reduce liability; B-to improve processes of care; C-to improve patient outcomes; D-to adhere to professional standards

A-to decrease adverse patient outcomes and reduce liability

Perceptions of health, illness, disease, healing and wellness are most influences by: A-family and religion; B-gender and income; C-culture and language; D-age and education

C-culture and language

According to the Standards of Practice for Case Managers, there are four key functions of a case manager. Which of the following in NOT one of the key functions? A-planner; B-assessor; C-litigator; D-advocate

C-litigator

The first step in developing a healthcare management program is to: A-identify resources; B-develop strategies; C-define the population; D-determine outcomes measurement

C-define the population

The CAGE assessment tool is used to assess: A-abuse of alcohol; B-gambling addiction; C-dementia; D-sex addction

C-dementia

Health screening tools are categorized in which of the following 3 ways: A-self administered, interview based and integrated; B-descriptive, quantitative and qualitative; C-descriptive, evaluative and predictive; D-scaled, aggregate and discrete

C-descriptive, evaluative and predictive

A prospective review: A-is performed while the patient is still in the facility; B-is performed after patient discharge from a facility; C-determines if admission to a facility is medically necessary; D-is a quality control measure

C-determines if admission to a facility is medically necessary

All of the following are true about disability insurance EXCEPT: A-disability insurance is most often limited to income replacement coverage; B-medical care 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 considered a medical plan

You have decided to become a case manager for a friend. Which of the following best describe this situation? A-unbiased relationship; B-favoritism; C-dual relationship; D-professional courtesy

C-dual relationship

The three broadest definitions of health care supplies and equipment are: A-ambulation aids, pill dispensers, and wound care products; B-personal care aids, dressings, and pharmaceuticals; C-durable medical equipment, disposables and pharmaceuticals; D-disposables, durable equipment and personal care products

C-durable medical equipment, disposables and pharmaceuticals

A legal document that specifically designates someone to make decision regarding medical and end of life care if a client is mentally incompetent is a: A-advance directive; B-do not resuscitate order; C-durable power of attorney; D-general power of attorney

C-durable power of attorney

A legal document that specifically designates someone to make decisions regarding medical and end of life care if a patient is mentally incompetent is a/an: A-advance directive; B-do not resuscitate order; C-durable power of attorney for health care; D-general power of attorney

C-durable power of attorney for health care

All of the following are components of a functional capacity evaluation EXCEPT: A-musculoskeletal screening; B-review of medical record; C-literacy screening; D-testing of physical ability

C-literacy screening

The term "subrogation" refers to: A-payment by a secondary insurer after primary insurance benefits have been exhausted; B-benefit negotiations between patients, physicians and insurers; C-medical expense reimbursement of an insurer or self-insured employer out of a third-party settlement; D-subcontracting medical care services to a third-party provider

C-medical expense reimbursement of an insurer or self-insured employer out of a third-party settlement

The Performance Oriented Mobility Assessment (POMA) primarily assesses: A-time needed to stand and walk a prescribed distance; B-gait speed; C-mobility, gait and balance under different conditions; D-balance

C-mobility, gait and balance under different conditions

Failing to provide reasonable care based upon appropriate standards and expertise is an example of: A-laziness; B-poor judgment; C-negligent conduct; D-inadequate supervision

C-negligent conduct

According to Tuckman's group developmental stages, the stage in which members express positive feelings toward each other is: A-forming; B-Storming; C-norming; D-performing

C-norming

Clients whose income is too low to afford health insurance but too high to quality for federally funded insurance belong to a/an: A-indigent group; B-network model; C-notch group; D-catastrophic case group

C-notch group

If the CCM observes an elderly patient in an assisted living facility is unkempt, dehydrated and fearful and has a number of unexplained bruises, the CCM's most appropriate response is to: A-notify the owner of the facility; B-reprimand the caregivers; C-notify appropriate state authorities, such as adult protective services; D-arrange for transfer to another facility

C-notify appropriate state authorities such as adult protective services

How do team members usually deal with issues of power? A-by observing the leader; B-by arguing; C-by following strict rules; D-by rotating leadership roles

A-by observing the leader

Factors that influence a case manager's approach to a case include all of the following EXCEPT: A-case management fees; B-community resources; C-payer systems; D-referral sources

A-case management fees

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-change agent illness; B-maladaptive situation; C-behavioral disorder; D-grievance

A-change agent illness

The most appropriate addition to an interdisciplinary care team (ICT) to assist in coordinating care for increasing numbers of pediatric clients would be: A-child life specialist; B-occupational therapist; C-dietician; D-play therapist

A-child life specialist

Outcome are derived from: A-client, nurse and system; B-client only; C-clients, physician and nurses; D-nurse ony

A-client, nurse and system

The correct temperature for steam sterilization is: A-270 F; B-250 F; C-370 F; D-350 F

A-270 F

According to the Consolidated Omnibus Budget Reconciliation Act (COBRA), the usual duration for which an ex-employee may have continued insurance coverage is: A-12 months; B-18 months; C-24 months; C-36 months

B-18 months

Case management preceptorship and mentoring differ in which of the following ways: B-1990; B-preceptors work with experienced staff while mentors work exclusively with those new to the field; C-preceptors are members of academia while mentors are actively working case managers; D-preceptors are working case managers while mentors are members of academia

B-1990

The Case Management Society of America was founded in: A-1985;n B-1990; C-1993; c-1995

B-1990

The average length of stay (LOS) in an acute hospital for a complete knee replacement is approximately: A-3 days; B-4 days; C-7 days; D-10 days.

B-4 days

After complicated labor and Caesarean, a woman must be covered for hospitalization by her insurance carrier for: A-24 hours; B-96 hours; C-48 hours; D-36 hours

B-96 hours

The Confusion Assessment Method is a tool that covers 9 factors related to mental status. This tool is used to assess for: A-delirium; B-Alzheimer's disease; C-substance abuse; D-brain injury

B-Alzheimer's disease

Which of the following in NOT a recommended vaccine for health care personnel: A-Hepatitis A; B-Hepatitis B; C-Hepatitis C; D-Influenza

B-Hepatitis B

An example of documentation that is currently on the Joint Commission's "Do Not Use" list is: A-5 mg; B-0.5 mg; C-15 U; D-@

C-15 U

If a client has only Medicare and no supplementary insurance and her physician accepts Medicare, the client's out of pocket cost for care will be: A-nothing; B-10%; C-20%; D-80%

C-20%

The correct elbow angle for an officer worker when sitting in a chair and using a computer keyboard is: A-45 degrees; B-60 degrees; C-90 degrees; D-120 degrees

C-90 degrees

The addiction self-help group that is intended for adults who grew up in a home with an alcoholic is: A-Al anon; B-Alateen; C-Adult Children of Alcoholics (ACOA); D-Children are People

C-Adult Children of Alcoholics (ACOA)

An alternative medical system that dates back 5,000 years and has been practiced primarily in India is known as: A-naturopathic medicine; B-homeopathic medicine; C-Ayurvedic medicine; D-bioenergy therapy

C-Ayurvedic medicine

The national organization that may provide the best information for the family of a young man who suffered a third concussion as a football injury is: A-American College of Sports Medicine; B-American Association of Physical Medicine and Rehabilitation; C-Brain Trauma Foundation; D-Orthopedic Research Society

C-Brain Trauma Foundation

Which is a contraindication for organ donation: A-age of 65 years; B-history of alcoholism; C-active pancreatic cancer; D-age of 2 years or less

C-active pancreatic cancer

For a person with a dual diagnosis, the initial treatment usually focuses on: A-detoxification; B-rehabilitation; C-mental health treatment; D-coping strategies

A-detoxification

Threatening to injure and withhold food and clothes from a person who is uncooperative is an example of: A-physical abuse; B-psychological abuse; C-neglect; D-financial abuse

B-psychological abuse

A histogram is a typ of: A-pie chart; B-scattergram; C-monogram; D-bar graph

C-bar graph

The first step in negotiation for a CCM should be: A-statement of problem; B-discussion; C-research; D-statement of financial limits

C-research

The Instrumental Activities of Daily Living (ADL) tool includes assessment of: A-bathing; B-toileting; C-ascending and descending stairs; D-financial responsibility

D-financial responsibility

All of the following are social service agencies that can assist case manager in obtaining community resources for the patients EXCEPT:A-Centers for Medicaid eligibility ; B-Centers for Independent Living; C-Department of Social Services; D-Agency on Aging

A-Centers for Medicaid eligibility

The Quality Improvement Organization Program is operated under the auspices of the: A-Centers for Medicare and Medicaid Services; B-Joint Commission; C-National Quality Forum; D-National Committee for Quality Assurance

A-Centers for Medicare and Medicaid Services

Which of these is true about pre-existing conditions: A-According to HIPAA, a medical insurance company is required to waive waiting periods for pre-existing conditions, provided there has been no change in coverage; B-a person diagnosed with asthma 20 years ago who has 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-exisiting condition; D-all of the above

A-According to HIPAA, a medical insurance company is required to waive waiting periods for pre-existing conditions, provided there has been no change in coverage

An insurance plan that supplements services not covered by Medicare is known as: A-Medicaid; B-catastrophic coverage; C-Medigap; D-capitation

-Medigap

Milliman care guidelines and InterQual differ in purpose primarily in which of the following ways: A-Milliman addresses utilization review, while InterQual addresses quality control issues; B-Milliman addresses treatment guidelines while InterQual addresses the continuum of care; C-Milliman offers guidelines, while InterQual mandates care criteria; D-Millimqn is used by clinicians while InterQual is used by insurers

-Milliman addresses treatment guidelines while InterQual addresses the continuum of care

The terms licensure and certification are sometimes used interchangeably, but they actually differ in which of the following ways: A-licensure is evidence of merely attending a program of training, while certification refers to a process of examination and performance; B-certification is evidence of merely attending a program of training, while licensure refers to a process of examination and performance; C-licensure is a legal form of professional validation, while certification refers to competence in a specialized area of a profession; D-certification is a legal form of professional validation, while licensure refers to competence in a specialized area of a profession

-licensure is a legal form of professional validation, while certification refers to competence in a specialized area of a profession

Which of the following is considered an ancillary service? A-nursing care; B-physician care; C-occupational therapy; D-obstetric care

-occupational therapy

Case management is sometimes called: A-second generation primary nursing; B-home healthcare nursing; C-the equivalent of a nurse practitioner; D-nursing with an additional degree in social work

-second generation primary nursing

An air ambulance is reimbursed by Medicare if: A-the patient requests it; B-the patient's family requests it; C-the medical condition is life threatening and land ambulance travel would be too time consuming; D-all of the above

-the medical condition is life threatening and land ambulance travel would be too time consuming

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-CPT code; B-ICD-10 code; C-DRG code; D-Medicare code

A-CPT code

The Agency for Healthcare Research and Quality (AHRQ) quality indicators (QI) that measure the quality of care for disorders sensitive to outpatient care (with good care reducing the need for hospitalization are: A- Prevention QIs; B-Inpatient QWIs; C-Patient Safety indicatiors (PSIs); D-Pediatric QIs

A- Prevention QIs

With Medicare, the benefit period ends: A-60 days after discharge from inpatient facility; B-30 days after discharge from inpatient facility; C-at the time of discharge from an inpatient facility; D-150 days after discharge from impatient facility

A-60 days after discharge from impatient facility

Appeals for denial for urgent care must be decided by the insurance company within: A-72 hours; B-48 hours; C-24 hours; D-12 hours

A-72 hours

Three nationwide referral resources for senior services include which of the following A-Eldercare Locator, Snap for Seniors, and the 211 telephone information and referral; B-Just for Seniors, Senior Connections and Golden Lions; C-Grey Panthers, American Association for Retired Persons and Senior Living; D-Senior Connections, Retired Referrals and Elder Advantage

A-Eldercare Locator, Snap for Seniors, and the 211 telephone information and referral

The government agency that regulates protection of human subjects involved in research projects for experimental treatments is: A-FDA; B-OSHA; C-CMS; C-CDC

A-FDA

A tool that provides a client's self-assessment of functional health and quality of life issues is: A-Health Status Survey (SF-36); B-Patient Health Questionnaire (PHQ); C-Post Deployment Clinical Assessment Tool (PDCAT); D-Barthel Index

A-Health Status Survey (SF-36)

The regulatory agency that oversees and monitors all health plans that provide care to Medicare and Medicaid beneficiaries is called: A-Healthcare Financing Administration (HCFA); B-National Committee for Quality Assurance (NCQA); C-JCAHO; D-National Association for Healthcare Quality (NAHQ)

A-Healthcare Financing Administration (HCFA)

The patient statement that indicates readiness for information about his condition is: A-I don't understand what it means to be bipolar; B-no one in my family has ever had a mental disease; C-there's something wrong with me; D-just give me some pill and I'll be fine

A-I don't understand what it means to be bipolar

The fraternal or religious organization that provides grants for community health projects to combat HIV/AIDS is: A-Kiwanis; B-Knights of Columbus; C-Lions Club International; D-Rotary International

A-Kiwanis

The cultural belief that good health derives from a gift from God is common to: A-Middle Eastern Americans; B-African Americans; C-Japanese Americans; D-Chinese Americans

A-Middle Eastern Americans

When choosing a community vendor to supply Durable Medical Equipment (DME) to a client, the most important factor is A-reliability, B-Proximity, C-Quality, D-Cost

A-Reliability

Laws that prevent physicians from receiving "kickbacks" for referrals and consultations are: A-Stark laws; B-security standards for health information; C-false claims laws; D-HIPAA laws

A-Stark laws

An agreement whereby Medicare pays an HMO a 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-a Medicare risk contract

Palliative care can begin when: A-a client is diagnosed with a life-threatening illness; B-a client's life expectancy is less than 1 year; C-a client's life expectancy is six months or less; C-a client requests palliative care

A-a client is diagnosed with a life-threatening disease

The most important element when reintegrating a brain-injured patient back into the community after a stay in a rehabilitation center is: A-a comprehensive plan; B-patient compliance; C-family support; D-follow up

A-a comprehensive plan

Using the average cost of a problem and the cost of intervention to demonstrate saving is: A-cost benefit analysis; B-an efficacy study; C-a product evaluation; D-a cost effective analysis

A-a cost benefit analysis

When considering outcome measures; striving for patient satisfaction is: A-a long term outcome; B-a short term outcome; C-both a long term and short term outcome; D-a process

A-a long term outcome

Which of the following complies with the American Medical Association's guidelines for informed consent: A-a patient with meningioma is provided a list of treatment options, wait and observe, radiosurgery or craniotomy; B-a patient with possible breast cancer is told that her only option for diagnosis is a fine needle aspirations; C-a preoperative patient is advised that she has nothing to worry about because gall bladder surgery poses almost no risks; D-a patient with 4th stage pancreatic cancer is advised that he must have chemotherapy or he will die

A-a patient with meningioma is provided a list of treatment options, wait and observe, radiosurgery or craniotomy

A problem list focuses on: A-a prioritized list of patient problems based on assessment, history and interview; B-all identifies patient problems based on assessment, history and interview; C-the patient's self reported problems; D-a standardized list of problems related to a specific diagnosis

A-a prioritized list of patient problems based on assessment, history and interview;

Root cause analysis refers to: A-a search for causal factors producing a given outcome or result; B-a method of chi-square analysis to manipulate data; C-a computer subroutine or root program used to analyze data; D-the logistic regression of data against an identified data point

A-a search for causal factors producing a given outcome or result

Clinical decision trees are most frequently used when: A-a situation does not clearly present a best course or action; B-a clinician is relatively inexperienced; C-a specialist is not available in an urgent situation; D-numerous comorbidities are present

A-a situation does not clearly present a best course or action

The 1966 "Partnership for Health Act" defined health as: A-state of complete well being; B-an interdisciplinary enterprise; C-a case management outcome; D-the promotion of wellness

A-a state of complete well being

The five basic levels of care in the health care system include which of the following: A-acute, subacute, custodial, assisted living and outpatient; B-acute, subacute, custodial, home and outpatient; C-acute, subacute, custodial, private nursing and outpatient; D-acute, subacute, hospice, custodial, and outpatient

A-acute, subacute, custodial, assisted living and outpatient

A socioeconomic indicator that suggests a red flag for further screening for case management includes: A-admission from sheltered living facility; B-residence in low income urban area; C-divorced woman with adult children; D-inability to drive

A-admission from sheltered living facility

Which of the following theories is characterized by the contention that life is an unending process of changes and transitions: A-life course/life span; B-modernization; C-geo transcendence; D-exchanges

A-life course/life span

When healthcare providers disagree about the best plan of care, the first step in resolving this conflict is to: A-allow both individuals to present their side of the conflict without bias; B-encourage them to reach a compromise; C-tell they the are violating professional standards of conduct; D-make a decision about the matter

A-allow both individuals to present their side of the conflict without bias

For non-English speaking patients, a medical interpreter differs from a medical translator in which of the following ways: A-an interpreter works with spoken language and a translator deals with written language; B-a translator deals with spoken language and an interpreter deals with written language; C-medical interpreter addresses specific treatments and procedures and a medical translator deals with non-medical issues; D-a medical translator addresses specific treatments and procedures and a medical interpreter deals with non-medical issues

A-an interpreter works with spoken language and a translator deals with written language

The Indian Health Service (IHS) provides health services to members of: A-any federally recognized Indian tribes or Alaska natives; B-Federally recognized Indian tribes or Alaska natives residing in the state of the service center; C-specific federally recognized Indian tribes or Alaska natives; D-Federally recognized Indian tribes or Alaska natives residing in a specified regional area

A-any federally recognized Indian tribes or Alaska natives

A 24 year old hospice patient with terminal leukemia expresses his preference to avoid artificial hydration once he is no longer able to take fluids by mouth. The hospice nurse should explain: A-artificial hydration can be withheld in accordance with the patient's wishes; B-artificial hydration must be provided because it is unethical to deny a patient basic nutrition and hydration; C-dehydration typically contributes to increased respiratory secretions and vomiting during the dying process; D-without artificial hydration the patient will likely experience more pain during the dying process

A-artificial hydration can be withheld in accordance with the patient's wishes

URAC case management accreditation standards require healthcare organizations, such as managed care program, to establish processes to: A-assess, plan and implement case management interventions; B-evaluated outcomes of case management interventions; C-conduce peer reviews of case management interventions; D-cut costs of case management interventions

A-assess, plan and implement case management interventions

When dealing with the psychosocial aspects of chronic illness, the nurse case manager should do all of the following EXCEPT: A-assume the role of therapist for the client and family; B-listen and learn about the impact of the illness on the client and family; C-empower clients and families to develop coping strategies; D-provide referrals to support groups and social services

A-assume the role of therapist for the client and family

Healthy literacy primarily requires: A-basic reading, numerical and comprehension and communications skills; B-a thorough understanding of disease and appropriate treatments; C-an above-average intellectual capacity; D-motivation to learn about health

A-basic reading, numerical and comprehension and communications skills

All of the following describe clinical pathways EXCEPT: A-clinical practice guidelines; B-multidisciplinary in nature; C-proactive setting of plans for specific diagnosis; D-form of care coordination

A-clinical practice guidelines

Statements that are systematically developed to aid health providers and patients to determine appropriate health care options in defined clinical circumstances are known as: A-clinical practice guidelines; B-standards of practice; C-care delivery standards; D-care algorithms

A-clinical practice guidelines

The type of variance that occurs when durable medical equipment for home care is unavailable is: A-community variance; B-practitioner variance; C-institution/systems variance; D-client/family variance

A-community variance

The presence of one or more disorders in addition to a primary disease is called a/an: A-comorbidity; B-red flag; C-preexisting condition; D-Axis II disorder

A-comorbidity

An individual has Medicaid coverage, and the case manager is having difficulty finding a provider who is willing to provide needed health care for Medicaid-only payment rates. The case manager's best option is to: A-contact the local Medicaid field office for consultation; B-negotiate for the patient to pay additional out-of-pocket expenses; C-call the local physician's licensing board to complain; D-tell the patient to seek alternate insurance options

A-contact the local Medicaid field office for consultation

A 50 year old man dying from liver disease is Catholic and asks to take final communion even though it is 2 am. The nurse should: A-contact the patient's priest or a priest on call for the institution and ask him to come right away; B-tell the patient that no priest is available; C-ask the patient if he would be willing to see the Protestant chaplain who is on call; D-tell the patient the priest will be called at 7 am

A-contact the patient's priest or a priest on call for the institution and ask him to come right away

The primrary purpose of negotiation in CCM practice is to: A-control costs and provide medically necessary services; B-avoid conflict and promote cooperation; C-educate participants; D-represent the payor's interests

A-control costs and provide medically necessary services

Premiums, copayments, coinsurance and deductibles are all considered: 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-cost-sharing strategies for insurance companies

The method used to determine monetary savings resulting from planned interventions is: A-cost/benefit analysis; B-cost-effective analysis; C-efficacy study; D-cost/utility analysis

A-cost/benefit analysis

The process that protects the client and ensures that persons 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; C-licensing

A-credentialing

Grids that outline the key events expected to occur each day during a patient's hospitalization are: A-critical pathways; B-clinical guidelines; C-case management grids; D-multidisciplinary plans

A-critical pathways

The process of identifying key issues, understanding each party's perspective, considering possible solutions and outcomes, determining best options, agreeing on contingencies, and monitoring and evaluating outcomes is known as: A-critical thinking and problem solving; B-brainstorming and collaboration; C-program evaluation and implementation; D-goal setting and assessment

A-critical thinking and problem solving

The best definition for when a 'living will' becomes effective is when: A-decisional capacity is lost; B-a person is terminally ill or permanently unconscious; C-a physician feels that the document should be invoked; D-further treatment appears to be futile

A-decisional capacity is lost

Underutilization may result from: A-delays in performing necessary diagnostic procedures; B-client's insistence on expensive procedures; C-client's being in a teaching hospital; D-physician's concern about liability

A-delays in performing necessary diagnostic procedures

A 60 year old make is being treated for myocardial infarction. While he is progressing well physically, he becomes upset when asked to make independence decisions and he rings the call bell constantly asking for reassurance that he will get well. This psychological response to stress is an example of: A-dependence; B-passivity; C-depression; D-confusion

A-dependence

If a terminally ill 41 year old patient is concerned that designating a health care power of attorney (proxy) in an advance directive will result in loss of control over end of life decisions, the hospice nurse should explain that the: A-designated proxy will only dictate end of life decision making if the patient is unable to express his or her wishes; B-patient should only complete and advance directive once he or she is willing to relinquish control of decision making to the designated proxy; C-advance directive is more important with an elderly palliative care patient; D-patient should designate his or her primary physician as the health care power of attorney

A-designated proxy will only dictate end of life decision making if the patient is unable to express his or her wishes

A nurse documents a treatment on the wrong chart. Which is the correct action: A-drawing a line through the entry and writing "error"; B-leaving the initial entry but indicating below that it was documented on the wrong chart; C-whiting out the entry so it's not legible; C-recopying the entire page omitting the entry

A-drawing a line through the entry and writing "error"

The primary consideration in medication management for a patient with chronic kidney disease is: A-drug clearance; B-drug frequency; C-drug dosage; D-drug absorption

A-drug clearance

Initial symptom management of shortness of breath in a palliative care client usually includes: A-elevating the head and using a fan aimed toward the person's face; B-corticosteroids; C-oxygen by nasal cannula; D-bronchodilators

A-elevating the head and using a fan aimed toward the person's face

A relationship whereby a case manager acts in a client's best interest base on trust is known as: A-fiduciary; B-ex parte; C-tort; D-due diligence

A-fiduciary

The best approach to solving a problems that involves 3 different departments in the hospital is: A-forming an interdisciplinary team that works together to find a solution; B-the administration resolves the problem independently; C-each department proposes a solution to administration; D-all three departmetns have a joint meeting to brainstorm possible solutions

A-forming an interdisciplinary team that works together to find a solution

The CCM in the admitting department services essentially as: A-gatekeeper; B-negotiator; C-communicator; D-supervisor

A-gatekeeper

The Milliman care guidelines that can be used for clients with very complex medical situations that to not easily fit into other guidelines are: A-general recovery guidelines; B-inpatient and surgical care guidelines; C-chronic care guidelines; D-ambulatory care guidelines

A-general recovery guidelines

When preparing written material for patients, what readability level would be appropriate for a homogenos adult patient group in an affluent area: A-grade 6 level; B-ugrade 9 level; C-grade 3 level; D-grade 12 level

A-grade 6 level

The best place for a 47 year old male with an IQ of 68 who cannot live along is probably: A-group home; B-skilled nursing facility; C-assisted living facility; D-mental health facility

A-group home

Which of the following is a major component of essential knowledge for a case manager? A-healthcare reimbursement; B-moral character; C-independent practice principles; D-statistical analysis

A-healthcare reimbursement

Health information and identified demographics of a single person are referred to as: A-individual data; B-personal data; C-singular data; D-prime data

A-individual data

Under the Medicare hospice benefit, respite care for relief of the patient's family caregiver refers to: A-inpatient hospice care for up to 5 consecutive days; B-home hospice care for up to 5 consecutive days; C-inpatient hospice care for up to 10 days; D-initiation of a do not resuscitate order

A-inpatient hospice care for up to 5 consecutive days

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 a fee-for-service system; C-is part of Medicare supplemental insurance; D-is similar to Medicare Part D

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

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 health care

A-it is an HMO option

One advantage of group instruction over one on one instruction is: A-it is more cost effective; B-it requires less planning; C-it allows more time for questions; D-it is more flexible

A-it is more cost effective

Kolb's mode of experiential learning is best described as: A-knowledge develops from experience interacting with cognition and perception; B-knowledge and experience are equally important; C-experience precedes knowledge in learning; D-learning cannot be acquired without experience and perception

A-knowledge develops from experience interacting with cognition and perception

For a client with peripheral arterial disease, an ankle-brachial index (ABI) score of 0.4 indicates: A-limb threatening condition with pain at rest; B-borderline perfusion; C-critical limb threatening condition; D-narrowing of one or more blood vessels

A-limb threatening condition with pain at rest

Which of the following is on of the 12 leading health indicators (determinants of health) outlined in Healthy People 2020: A-mental health; B-chronic disease; C-immunization; D-family support

A-mental health

Providing professional guidance and being someone to whom other staff can bring questions or concerns may be described as: A-mentoring; B-role modeling; C-supervising; D-coaching

A-mentoring

If a necessary medical treatment or service is denied to a patient, a case manager;s options include all of the following EXCEPT: A-misconstruing the client's financial status to meet benefit eligibility; B-requesting a benefit plan exception for circumstances of hardship; C-seeking community resources to provide coverage as needed; D-advocating for a longer stay to meet patient needs, pending the availability of other options

A-misconstruing the client's financial status to meet benefit eligibility

Which of these is true about prescription assistance programs: A-most people don't know about them; B-they are avialable to patients with Mediciad; C-they are available to non-U.S. residents; C-most people find them easy to apply for

A-most people don't know about them

Empathy with the patient, understand resistance, identifying patient readiness to change, and clear and honest communication are all safeguards to ensure ethical case manager behavior during the process of: A-negotiation; B-treatment; C-interviewing; D-motivating

A-negotiation

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 4 hours and hemovac checks every 8 hours; B-regular diet; C-up in the chair for 30 minutes daily; D-antiembolic hose, turn patient every 2 hours, cough/deep breathe

A-neurovascular checks every 4 hours and hemovac checks every 8 hours

The manner of making eye contact, the tone of voice, along with touch, gestures, and posture are examples of: A-non verbal communication; B-therapeutic communication; C-proxemics; D-non therapeutic communication

A-non verbal communication

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-operational

Client empowerment primarily requires: A-options, authority and action; B-time and effort; C-intellectual capacity; D-institutional support

A-options, authority and action

A person who is resistant to seeing a psychologist for severe emotional problems because of personal belief that prayer will heal may benefit most from: A-pastoral counseling; B-personal meditation; C-medications; D-spiritual instructions

A-pastoral counseling

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

Case management differs from managed care in that case management is primarily: A-people oriented; B-systems oriented; C-regulation oriented; D-nursing oriented

A-people oriented

Payment based on a fixed daily dollar amount is known as: A-per diem reimbursement; B-cost-based reimbursement; C-capitation; D-fee for service

A-per diem reimbursement

According to the CDC, which of the following is a reportable disease? A-pertussis; B-breast cancer; C-abestosis; D-cystic fibrosis

A-pertussis

From the standpoint of documentation, the patient's discharge agent is the: A-physician; B-case manager; C-multidisciplinary team; D-social worker

A-physician

Case management systems should be adapted to accommodate all of the following EXCEPT the: A-political or cultural view of the case manager; B-organizational setting in which the services are provided; C-socioeconomic needs of the population being served; D-developmental characteristics of the clients being served

A-political or cultural view of the case manager

A risk factor for malnutrition is: A-poverty; B-recent weight loss of 5 pounds; C-recent weight gain of 5 pounds; D-dentures

A-poverty

Quality data have all of the following characteristics EXCEPT they are: A-predictable; B-reliable; C-unbiased; D-valid

A-predictable

The case management model in which the CCM has a therapeutic relationship with the patient is: A-primary therapist model; B-generalist model; C-private case management model; D-interdisciplinary team model

A-primary therapist model

A CCM who is contracted by an individual or family to manage healthcare needs and services is a/an: A-private case manager; B-independent case manager; C-community-base case manager; D-internal case manager

A-private case manager

The acronyms HMO, PPO, and POS all refer to: A-private health insurance plans, B-methods of cost-benefit analysis; C-clinical quality outcome indicators; D-evidence-based medical measures

A-private health insurance plans

The main difference between 'quality management' and 'risk management' is: A-problem prevention vs problem analysis and liability control; B-clinical practice vs business management standards; C-practicum based vs policy based models of care; D-care provider vs administration oriented standards

A-problem prevention vs problem analysis and liability control

The coping mechanism that involves actively searching for a way to reduce stress and cope is: A-problem solving; B-avoidance; C-physical activity; D-spirituality

A-problem solving

The National Quality Forum (NQF) measures that determine if correct actions, such as cervical cancer screening, have been completed are: A-process measures; B-outcomes measures; C-patient experience measures; D-structural measures

A-process measures

Job accommodations for an office worker with fine moter impairment might include: A-providing speech recognition program for computer access; B-modifying workstation to increase accessibility; C-providing standing/lean stools; D-providing rolling safety ladders

A-providing speech recognition program for computer access

The American Geriatrics Society's Guideline for the Prevention of Falls in Older Persons recommends (among other things): A-remediation of visual deficits where possible (e.g., glasses); B-home health care aide; C-stretching exercises; D-dietary modifications

A-remediation of visual deficits where possible (e.g., glasses)

The ORYX initiative: A-requires healthcare organizations to report performance data to Joint Commission on Accreditation of Healthcare Organizations (JCAHCO) for accreditation; B-does not pertain to case management roles and responsibilities; C-was started by JCAHO in 2005; D-is not related JCAHO

A-requires healthcare organizations to report performance data to Joint Commission on Accreditation of Healthcare Organizations (JCAHCO) for accreditation

Criteria for Social Security Disability Insurance (SSDI) include a physical/mental disability as well as: A-restriction in employment ability; B-age greater than 65; C-limited income; D-expectation of permanent disability

A-restriction in employment ability

In an operating room, the restricted area usually includes the: A-scrub sinks; B-instrument processing area; C-patient reception area; D-clean storage supply area

A-scrub sinks

Malcolm Knowles theory of andragogy includes which of the following three key characteristics of the adult learner: A-self-direction, learning readiness and a problem centered orientation to learning; B-autonomy, self direction, and a life experience orientation to learning; C-practicality, goal orientation, and respect; D-life experience, practicality and self direction

A-self-direction, learning readiness and a problem centered orientation to learning;

A primary purpose of interdisciplinary teams is: A-sharing ideas and perspectives to solve problems; B-cost savings; C-improved patient satisfaction; D-time saving

A-sharing ideas and perspectives to solve problems

The 3 midnight rule for extended Medicare benefits applies to clients transferring to: A-skilled nursing facilities; B-home health agency services; C-long-term care facilities for rehabilitation; d-assisted living facilities

A-skilled nursing facilities

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

A-stop loss

A client being discharged from an acute hospital with an infusuion pump for multiple intravenose medications can be transferred to: A-sub-acute rehabilitation facilities; B-skilled nursing facility; C-sub-acute and skilled nursing facilities; D-intermediate care facility

A-sub-acute rehabilitation facilities

An affidavit of merit is usually filed to: A-support a lawsuit for malpractice; B-refute a lawsuit for malpractice; C-reward excellence in service; D-confer accreditations

A-support a lawsuit for malpractice

The difference between computer application program and system software is best described by which of the following statements? A-system software operates a computer's internal systems, while application programs provide the user with a directly applied service; B-system software provides the user with an applied service, while application programs operate the computer's internal systems; C-system software is provided to many computers through an organization's computer network, while application program operate on a single computer; D-system software operates on a single computer, while application program are provided to many computers through an organization's computer network

A-system software operates a computer's internal systems, while application programs provide the user with a directly applied service

When considering the use of an interpreter for a patient who does not speak English, which consideration is most important: A-the interpreter has training in medical vocabulary for both languages; B-the interpreter speaks both languages well; C-the interpreter knows the patient's history; D-the interpreter is available onsite

A-the interpreter has training in medical vocabulary for both languages

When a client's spouse asks for information about another client, the response that complies with the Health Insurance Portability and Accountability Act (HIPPA) is: A-the law doesn't allow me to give out any information about clients in order to protect their privacy and safety; B-His wife is in the lounge, you can go ask her; C-why are you asking; D-He has bipolar disease, like your husband.

A-the law doesn't allow me to give out any information about clients in order to protect their privacy and safety

If a client has insurance from a self-funded, employer sponsored health plan and questions of coverage arises, the CCM should contact: A-the plan's benefit manager; B-the employer; C-the client; D-the physician

A-the plan's benefit manager

The National Patient Safety Goals communication requirements related to telephone orders or reporting include: A-the receiver reading back the orders or report; B-the receiver repeating each part of an order or report as it's given; C-the individual giving orders or reports asks information is understood; D-the individual giving orders or reports repeats each item twice

A-the receiver reading back the orders or report

Under the CMS Inpatient Rehabilitation Facility Prospective Payment Systen (IRFPPS), an impairment group is grouped according to: A-the same impairment category; B-similar age, motor functioning and cognitive ability; C-the number of comorbidities; D-the type of cormobidity

A-the same impairment category

The Health Insurance Portability and Accountability Act (HIPPA) regulates: A-the transfer of patients from one facility to another; B-the rights of the individual related to privacy of health information; C-medical trials; D-workplace safety

A-the transfer of patients from one facility to another

The term polypharmacy refers to: A-the use of multiple medications; B-the use of multiple pharmacies to fill prescriptions; C-patients who are appropriately taking multiple medications for chronic illness; D-none of the above

A-the use of multiple medications

Transitions of care are best described as: A-transfer of accurate patient information across different settings; B-care received by a patient over time and over multiple providers/settings; D-assessment of a patient's capacity to manage his own care needs

A-transfer of accurate patient information across different settings

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(s) to make medical decisions? A-two physicians; B-the case manager; C-a social worker; D-the medical ethics committee

A-two physicians

The process that occurs when a patient is not given needed tests, services, and resources to diagnose and treat a medical condition is called: A-underutilization; B-subacute care; C-palliative care; D-variance

A-underutilization

Medical malpractice (i.e. failure to respond as a reasonable and prudent professional resulting in harm) and negligence (i.e., failing to act as any reasonable and prudent person in a given circumstance independent of any professional context, as the failure does not address training or special skills) are both examples of: A-unintentional torts; B-intentional negligence; C-unintentional misconduct; D-quasi-malpractice

A-unintentional torts

Which of the following is NOT a prosthetic device: A-wrist brace; B-dentures; C-artificial heart; C-gastric band

A-wrist brace

Models that deliver coordinated, comprehensive and accessible health and managed 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

Bloom's taxonomy outline behaviors necessary for learning. Which 3 kinds of learning does the theory describe: A-cognitive, affective and psychomotor; B-auditory, visual and kinesthetic; C-formal and informal; D-attitudes, subjective norms and behavioral intention

B-auditory, visual and kinesthetic

A patient with a hip and/or knee replacement qualifies for CMS admission to an inpatient rehabilitation facility if additional criteria are met, including: A- BMI >40; B- BMI >50; C-age >65; D-age >70

B-BMI > 50

Which of the following applies to CHAMPVA? A-It is valid for 3 of the 7 uniformed services; B-CHAMPVA is a part of the Tricare system; C-CHAMPVA coverage stops when the participants become eligible for Medicare; D-CHAMPVA covers veterans

B-CHAMPVA is a part of the Tricare system

Consumer Assessment of Healthcare Provider and Systems consumer satisfaction surveys are administered under the auspices of the: a-Joint Commission; B-Centers for Medicare and Medicaid Services; C-National Quality Forum; D-Agency for Health Care Research and Quality

B-Centers for Medicare and Medicaid Services

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-Folstein Mini-Mental State exam

The primary purpose of a health coach is to: A-prescribe treatment; B-guide clients to discuss concerns regarding recover; C-Counsel clients; D-ensure treatment compliance

B-Guide clients to discuss concerns regarding recovery

The difference between a Medigap plan and Medicare Select is that: A-Medicare Select offers fewer plans; B-Medicare Select requires the use of specific providers; C-Medicare Select offers more flexibility in choosing providers; D-Mediare Select is usually more expensive

B-Medicare Select requires use of specific providers

The governmental agency responsible for blood-borne pathogens standards in medical institutions is: A-CDC; B-OSHA; C-EPA; D-FDA

B-OSHA

Which of the following is true about a preferred provider organization (PPO)? A-a PPO is not an insurance model; B-PPOs offer a preferred panel of physicians; C-PPOs use physicians as gate keepers; D-a PPO allows use of outside physicians and incurs a lower cost to the member

B-PPOs offer a preferred panel of physicians

The following act prevents transfer of a client from the ED until the client stabilizes: A-the Health Insurance Portability and Accountability Act (HIPPA); B-The Emergency Medical Treatment and Active Labor Act (EMTALA); C-American with Disabilities Act (ADA); D-Older Americans Act (OAA)

B-The Emergency Medical Treatment and Active Labor Act (EMTALA)

What type of precaution is appropriate under CDC isolation guidelines for a patient with tuberculosis: A-Tier I standard precautions; B-Tier II airborne precautions; C-Tier II droplet precautions; D-Tier II contact precautions

B-Tier II airborne precautions

A patient has been admitted to the hospital to rule our 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 exists; B-You may code symptoms, but not the suspected condition; you may skip coding until the test results are available; D-you may code the rule-out dx, but only for outpatients

B-You may code symptoms, but not the suspected condition

Working for the best interests of the patient despite conflicting personal values and assisting patients to have access to appropriate resources may be defined as: A-moral agency; B-advocacy; C-agency; C-collaboration

B-advocacy

Data analysis is defined as: A-mathematical calculations, using recognized algorithms and methods; B-an examination of data to derive useful information; C-the computerized manipulation of data in an organized fashion; D-the collection and aggregation of data into a database

B-an examination of data to derive useful information

Which of the following is most characteristic of assertiveness in a case management situation? a-assertiveness specifically directs 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 sent messages using nonverbal cues such as posture and facial expressions; D-assertiveness allows you to act as a referee

B-assertiveness allows you to act instead of react in a particular situation

The first step in crisis intervention is: A-devising a plan; B-assessing the problem and triggering event; C-teaching coping mechanisms; D-evaluating resources

B-assessing the problem and the triggering event

The 5 components of nursing care management framework identified by the American Nurses Credentialing Center are: A-planning, organizing, coordination, advocacy, and monitoring; B-assessment, planning, implementation, evaluation and interaction; C-communication, planning, facilitation, advocacy, and monitoring; D-evaluation, linking, coordination, advocacy and monitoring

B-assessment, planning, implementation, evaluation and interaction

For employment experience to be accepted for CM certification, the applicant must: A-perform at least 6 or 8 essential activities related to client contact; B- be licensed or certified to practice independently; C-practice management experience at last 25% of the tine; D-perform work in at least for of six core components of case managment

B-be licensed or certified to practice independently

The legal element of negligence that refers to a failure to carry out duties in accordance with accepted and usual standards of practice is: A-duty; B-breach; C-causation; D-harm

B-breach

When an insurance plan negotiates a specific fee for a procedure (including all charges) and pays one bill, this is referred to as: A-unbundling; B- bundling; C-fee for service; D-discounted fee for service

B-bundling

Appropriate methods of professional and interdisciplinary communication include all of the following EXCEPT: A-chart notes; B-cafeteria consults; C-telephone discussions; D-team meetings

B-cafeteria consults

When instituting a plan for risk management, the primary concern in the statement of purpose should be: A-reduction in financial risk; B-client safety; C-decreased liability; D-scope of program

B-client safety

Bloodshot eyes, sniffing repeatedly, altered sleeping habits, and marked weight loss are indications of: A-excessive smoking; B-cocaine abuse; C-alcoholism; D-marijuana abuse

B-cocaine abuse

A violation of professional boundaries on the part of the CCM is: A-accepting a box of chocolates to be shared by all unit staff from a client's daughter; B-confiding to the client the he, like the client, is getting divorced, so he understand's the client's stress; C-Assisting a client in placing a call to his landlord so the client can explain that he cannot pay his rent on time; D-noticing that a client is crying and placing his hand on the client's shoulder

B-confiding to the client the he, like the client, is getting divorced, so he understand's the client's stress

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 interests of the patient and the best interests of the payor. This type of conflict is called: A-focus of advocacy; B-conflict of duties; C-supremacy of values; D-justice

B-conflict of duties

Under the transtheoretical model of stages of change, the stage during which the person intend to change at some point and is aware of costs and benefits of change is: A-precontemplation; B-contemplation; C-preparation; D-action

B-contemplation

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-EPSDT review; D-prospective review

B-continued stay review

A specified dollar amount that a client must pay at the time of receiving healthcare services is A-premium; B-copayment; C-deductible; D-coinsurance

B-copayment

A cost saving study showed that a free medical clinic ordered 17 different types of dressing supplies because of varying staff preferences. Because of this large number, the clinic was not able to buy in sufficient bulk to receive a large quantity discount. The best solution to this problem is: A-continue to order the same types of supplies to keep the staff happy; B-create an ad hoc team to survey staff preferences and agree on a reduced number of dressing supplies; C-reduce number of dressing supplies ordered to administrative preference; D-complete a 6 month survey of the use of dressing supplies

B-create an ad hoc team to survey staff preferences and agree on a reduced number of dressing supplies

According to the American Nurses Associations position statement, a patient's request not to receive artificial hydration or nutrition in association with end of life care may be: A-inconsistent with the primary ethical and professional expectation of a palliative care nurse; B-decided on an individual case basis and may be consistent with appropriate end of life care; C-considered a form of active euthanasia; D-usually causes discomfort for the terminally ill patient

B-decided on an individual case basis and may be consistent with appropriate end of life care

A 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-defective testing

A patient who is post amputation of a lower limb and insists he needs no physical therapy or rehabilitation is probably experiencing? A-self confidence; B-denial; C-delusions; D-fear

B-denial

Older adults with chronic illnesses that result in pain and/or physical limitation should often be evaluated for: A-dementia; B-depression; C-drug abuse; D-alcoholism

B-depression

A financial evaluation is completed for all of the following EXCEPT to: A-identify available resources for health care and stability; B-determine the client's eligibility for case management services; C-ensure any requisite pre-approvals for proposed health care treatments and services; D-assist a client and family to apply for additional benefits that may be necessary for health care needs

B-determine the client's eligibility for case management services

When a patient has two or more health plans, the CCM should initially: A-determine which plan provide the best coverage; B-determine which plan provides primary and secondary (tertiary, etc) coverage; C-ask the patient to choose which plan to use; D-assume both plans will pay for coverage

B-determine which plan provides primary and secondary (tertiary, etc) coverage

The criteria for being "homebound" for eligibility for home health coverage under Medicare include: A-leaving home under emergency circumstances only; B-leaving home with assistance for medical treatment or short nonmedical purposes; C-use of assistive device; D-inability to drive

B-leaving home with assistance for medical treatment or short nonmedical purposes

A learner outcome for teaching diabetics about insulin reaction is: A-identify different types of insulin; B-list and describe the symptoms of insulin reaction; C-identify foods high in carbohydrates; D-explain the difference in Type 1 and Type 2 diabetes

B-list and describe the symptoms of insulin reaction

Disagreements between family members about the plan of care when a palliative care patient lacks the capacity to make treatment decisions should be managed by: A-pursing legal action to expedite designation of a single family member as medical decision maker; B-encouraging the family to consider and discuss what they believe the patient would choose if he or she were able to express his or her wishes; C-informing the family that palliative care planning is inappropriate unless the family can reach an agreement; D-encouraging each family member to consider what they would choose for themselves in similar circumstances

B-encouraging the family to consider and discuss what they believe the patient would choose if he or she were able to express his or her wishes

All of the following are characteristics of subacute care EXCEPT: A-a medically stable patient; B-exhaustive diagnostic work-ups; C-care performed in the home; D-a relatively constant treatment plan

B-exhaustive diagnostic work-ups

Denial or non-certification of services may result from: A-extended hospitalization because of postoperative myocardial infarction; B-extended hospitalization because PT is not available on weekends; C-change in policy after services rendered; D-client's death

B-extended hospitalization because PT is not available on weekends

A retrospective attempt to determine the cause of an event is: A-root cause analysis; B-external benchmarking; C-internal trending; D-tracer methodology

B-external benchmarking

A patient with liver disease and a history of depression commits suicide after repeatedly ringing the call bell and telling a nurse that he wanted to die. Which of the following is an act of negligent omission: A-giving the patient the wrong dosage of antidepressant; B-failing to notify the crisis management team or appropriate authorities of the patient's suicidal statements; C-documenting that the patient was attention seeking; C-moving the call bell out of the patient's reach

B-failing to notify the crisis management team or appropriate authorities of the patient's suicidal statements

A patient is facing an upcoming surgical procedure, but his coverage for the procedure is not clear. Week;s after filing a written request, the insurer has still not provided clarification. The procedure in now becoming unduly delayed. The best case management response would be to: A-writer further letters to various administrator at the company; B-file a grievance with the appropriate oversight agency; C-perform the procedure and request coverage later; D-advise the client to hire an attorney to press the matter

B-file a grievance with the appropriate oversight agency

Which evaluation would you perform to determine if a client hast he capability to return to work? A-pain tolerance evaluation; B-functional capacity evaluation; C-disability evaluation; D-evaluation by client interview

B-functional capacity evaluation

In a subacute facility, a stroke patient who requires 20 days of care and rehabilitation and/or nursing services four hours a day is categorized as: A-chronic subacute; B-general subacute; C-transitional subacute; C-long term transitional subacute

B-general subacute

TRICARE refers to a: A-cardiac catheterization procedure; B-government insurance plan; C-multilayer nursing care system; D-subacute care facility

B-government insurance plan

Transitions of care generally require: A-change in physician; B-handoff/handover; C-facility transfer; D-vehicle transportation

B-handoff/handover

Durable medical equipment (DME) classified as assistive devices include: A-electric beds; B-handrails; C-crutches; D-apnea/sleep monitores

B-handrails

A legal document that specifies whom a provider should call upon for consent of treatment decisions when a patient becomes mentally incompetent is a/an: A-advanced directive; B-healthcare proxy; C-patient self-determination; D-collaboration

B-healthcare proxy

A community resource that can provide nursing and personal care in the home is: A-public health department; B-home health agency; C-social services; D-senior citizens organzations

B-home health agency

Which of the following surgical complications is unlikely to be related to improper positioning: A-joint dislocation; B-hypoglycemia; C-peripheral nerve damage; D-hypoventilation

B-hypoglycemia

A terminally ill patient is showing decreased awareness of his surroundings, decreased oral intake of solids or liquids, and in no longer able to get out of bed. The most likely explanation for this constellation of findings is: A-loss of hope; B-impending death; C-depression; D-unrinary retention

B-impending death

Under the chronic care model, the primary purpose of utilizing community resource is to: A-identify client needs; B-improve client's self management skills; C-reduce the need for rehospitalization; D-reduce costs

B-improve client's self management skills

The level of care that provides people with moderate assistance in activities of daily living and periodic supervision for some activities is: A-custodial care; B-intermediate care; C-skilled nursing; D-acute care

B-intermediate care

Which of the following is true about a Care Map? A-it is another name for clinical management guideline; B-it is a combination of a critical pathway and a nursing care plan; C-it does not usually include multidisciplinary action; D-all of the above

B-it is a combination of a critical pathway and a nursing care plan;

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 new setting is providing; C-it occurs when the wrong does of a medication is given to a patient; C-it occurs when the wrong medication is given to a patient

B-it is a process of comparing medications the patient is taking at the time of admission with what the hospital or new setting is providing

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 National Patient Safety Goals set into action by JCAHO; C-hospital admission is the only logical time to perform medication reconciliation; D-medication reconciliation consists solely of listing all of a patient's current medications

B-it is one of the National Patient Safety Goals set into action by JCAHO

The client centered model of care in which a primary care physician manages, facilitates and coordinates all levels of care, including care provided by specialists is: A-Chronic care model; B-Medical home model; C-Planned care model; D-expanded care model

B-medical home model

Intensive case management for assertive community treatment is focused on providing care for: A-brain injuries; B-mental health issues; C-spinal cord injuries; D-Alheimer's disease

B-mental health issues

Which assessment tool for dementia involves remembering and repeating the names of 3 common objects and the face of a clock with all 12 numbers and hands indicating the time specified by the examiner: A-Mini mental status exam; B-mini cog; C-digit repetition test; confusion assessment method

B-mini cog

The initial enrollment period for Medicare Part D for a 45 year old disable patient who is newly eligible for Medicare is: A-three months prior to Medicare eligibility and four months after; B-months 21 through 27 after receiving Social Security or Railroad Retirement Board (RRB) benefits; C-April 1 to June 30; D-three months prior to Medicare eligibility and seven months after

B-months 21 through 27 after receiving Social Security or Railroad Retirement Board (RRB) benefits

If the CCM at a hospital determines that a client does not need a discharge plan for transition of care, but the physician orders one, the hospital; A-can choose to omit the discharge plan; B-must develop the plan; C-may develop a simplified discharge plan; D-may subsitute with general information materials

B-must develop the plan

After a high risk blood borne pathogen exposure, a health care worker decides to take post exposure prophylaxis (PEP) with a 3 drug HIV retroviral program. How long should the employee take the PEP according to the latest CDC guidelines: A-one week; B-one month; C-6 months; D-one year

B-one month

With mandatory beneficiary ownership of capped rental durable medical equipment (DME) once ownership has based to the beneficiary, Medicare will pay for: A-routine service & maintenance; B-only repairs necessary to make DME serviceable; C-all routine service & repairs; D-no service or repairs.

B-only repairs necessary to make DME serviceable

Before making a telephone call to a client to review his status, the CCM should: A-prepare a script; B-outline the objectives of the call; C-send a mail notification; D-notify the physician

B-outline the objectives of the call

Which right is included in the Patient's Bill of Rights: A-affordable healthcare; B-pain control; C-right to sue; D-access to latest medical technology

B-pain control

Which model of healthcare decision making best demonstrates the principle of beneficence? A-patient sovereignty; B-paternalism; C-shared decision making; D-maternalism

B-paternalism

The extent to which patient behavior follows the recommendations of a health care provider is referred to as: A-care plan concurrence; B-patient adherence; C-treatment synergy; D-protocol attention

B-patient adherence

Criteria for coerced treatment include: A-staff is fearful of the patient; B-patient is dangerous to self or others; C-patient is cognizant but refuses medications; D-patient refuses to participate in group therapy

B-patient is dangerous to self or others

Researchers have categorized which of the following three general information learning styles: A-auditory, visual and kinesthetic; B-perceptual modality, information processing and personality patterns; C-direct, ancillary and incidental and multimodal based; D-integrative, associated and preceptive

B-perceptual modality, information processing and personality patterns

If all shelters are full and an indigent uninsured client with planned discharge in three days is placed on a waiting list for a preferred shelter, then the CCMs next action should be to: A-call daily to determine where the client is on the list; B-place the client on a second waiting list; C-plan transfer to a skilled nursing facility under shelter placement is possible; D-refer the problem to social services

B-place client on a second waiting list

As related to continuous quality improvement, the acronym PDSA stands for: A-prepare, direct, summarize and anticipate; B-plan, do, study, act; C-postulate, disseminate, schedule and articulate; D-propose, discuss, situate and align

B-plan, do, study, act

One of the most common causes of the person to person spread of infection in hospitals is: A-crowded conditions; B-poor hand washing technique; C-inadequate housekeeping; D-antibiotic resistance

B-poor hand washing technique

Aside from the issue of insurance portability, the primary purpose of the Health Insurance Portability and Accountability Act of 1996 was to: A-ensure peer review of health care practices; B-protect private health information; C-address health care billing practices; D-set standards for quality review.

B-protect private health information

A young female teenager describes a brutal assault and rape to the nurse on duty. Which of the following actions should the nurse take first: A-check with the case manager on duty about possible police intervention; B-provide an environment of concern and emotional stabilization; C-clean the patient's wounds with normal saline and gauze; D-recommend a good attorney to the patient

B-provide an environment of concern and emotional stabilization

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 tests, medical equipment and ancillary expenses

B-provides a prescription drug benefit

The best initial method of ensuring correct medication dosage for a home client who wants to remain independent but sometimes forgets to taker her morning medications or takes a double dose is: A-hiring an aide to come in daily and give medications; B-providing an electronic alarmed medication delivery device; C-placing the client in an assisted living facility; D-arranging for someone to telephone daily

B-providing an electronic alarmed medication delivery device;

If you are named in a lawsuit, one of the first things you should do is: 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-obtain the record and review it carefully

Free or low cost vaccinations, health screenings, health education classes, tracking and reporting communicable diseases and collection of local health statistic for prevention and regulatory programs are all functions typically carried out by: A-acute care hospitals; B-public health services; C-urgent care clinics; D-health insurers

B-public health services

Which of the following professional communication skills are used to facilitate communication with intra-and inter-disciplinary teams: A-interpreting the statements of others to facilitation the flow of ideas; B-reacting and responding to facts rather than feelings; C-providing advice when it appears needed; C-asking questions to challenge other people's ideas

B-reacting and responding to facts rather than feelings

If a 24 year old Asian client states a treatment preference but plans to leave the decision to her family members, the CCM should: A-try to convince the client to assert herself; B-recognize that cultural values regarding individualism vary, and respect the client's right to be guided by family; C-tell the family that the client should be the one to make the decision; D-ask the ethics committee to intervene

B-recognize that cultural values regarding individualism vary, and respect the client's right to be guided by family

All of the following are examples of nonmedical levels of care EXCEPT: A-identified categories of care; B-recommendations for best practices; C-a timeline; D-long-term outcome criteria

B-recommendations for best practices

The primary purpose of pharmacy benefit management is to: A-increase use of generic drugs; B-reduce cost of drugs; C-promote drug safety; D-provide a drug formulary for clients

B-reduce the costs of drugs

A home health nurse visits an older adult and observes that the patient has little food in the house. The patient states he has run out of money and cannot buy groceries, but he does not want his family and friends to know. Which nurse response is appropriate: A-going to the store and buying a small bag of groceries for the patient; B-referring the patient to the appropriate social service agencies; C-calling the patient's daughter anyway and telling her that the patient needs assistance; D-asking the next door neighbor who has expressed a willingness to help to provide meals.

B-referring the patient to the appropriate social service agencies

The primary focus of Worker's Compensation is to: A-prevent economic hardship; B-return people to work; C-contain costs; D-promote worker's safety

B-return people to work

A patient's medical insurance plan includes a clause that allows the insurance plan to pay for initial treatment until payor responsibility is determined. This clause is called: A-coordination of benefits; B-right of subrogation; C-an indemnity clause; D-a settlement

B-right of subrogation

The 5 Rights of delegation include: A-right time, right place, right person, right direction, right evaluation; B-right person, right place, right time, right assignment; right supervision; C-right task, right time, right circumstance; right place, right supervision; D-right task, right circumstance, right person, right direction, right supervision

B-right person, right place, right time, right assignment; right supervision

A surgical patient develops a wound infection and informs the nurse that she plans to sue the hospital. Which department would handle this issue: A-the adminstration; B-risk management; C-human resources; D-infection control

B-risk management

A set of expected behaviors and consequences related to a CCMs place in particular social structure, such as an acute hospital is: A-process; B-role; C-activity; D-function

B-role

If all clients develop urinary infections with urinary catheters are evaluated per urine culture and sensitivities for microbial resistance, but only those clients with clinically evident infections are included, this is an example of: A-information bias; B-selection bias; C-compliance bias; D-admission bias

B-selection bias

Under the 60 percent rule, the condition that require additional clinical criteria to qualify for CMS payment for stay in an inpatient rehabilitation facility (IRF) is: A-stroke; B-amputation; C-brain injury; D-severe osteoarthritis

B-severe osteroarthritis

In the field of quality improvement, the term, 'core measures' refers to: A-National Qualify Forum standards for quality contol in health care; B-specific Centers for Medicare and Medicaid Services require quality control measures; C-Joint Commission criteria for quality improvement; D-health provider selected quality improvement measures

B-specific Centers for Medicare and Medicaid Services require quality control measures

When conflicts arise over coverage for treatment, the CCM's primary responsibility is to: A-the payor; B-the client; C-the utilization review committee; D-the care provider

B-the client

A client's or parent's refusal of care may be overridden if: A-the physician orders the care provided despite client objections; B-the client is mentally incompetent; C-the patient is elderly; D-the client is a minor child

B-the client is mentally incompetent

Data mining refers to: A-that data collection derived from underground geological projects; B-the process of drawing relevant data from a larger data set; C-the entering of specific data into a specific computer database; D-data analysis that uses a hidden or background computer program.

B-the process of drawing relevant data from a larger data set

All of the following are guidelines for the use of patient restraints EXCEPT: A-the use of the least restrictive 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-a check on the patient at least every 30 minutes

B-the use of restraints for patient safety and staff convenience

Jung's theory about the development of the personality over the lifespan is referred to as: A-hierarchy of needs; B-theory of individualism; C-age stratification; D-life course

B-theory of individuation

When a case manager refers a client to a specific provider, what type of relationship exists between the case manager and provider? A-vicarious agency; B-advocate; C-ostensible agency; D-favoritism

C-ostensible agency

SAL of 10-6 is a measure of sterility assurance and means which of the following: A-there is equal to one chance in a million that a viable microorganism remains on an instrument following sterilization; B-there is equal to or less than once chance in a million that a viable microorganism remains on an instrument following sterilization; C-there is less than once chance in a million that a viable microorganism remains on an instrument following sterilization; D- none of the above are true

B-there is equal to or less than once chance in a million that a viable microorganism remains on an instrument following sterilization

For quality/performance improvement, the best tool to determine methods to streamline processes is: A-root cause analysis; B-tracer methodology; C-family survey; D-staff survey

B-tracer methodology

In Kurt Lewin's change theory, the first stage, motivation to change, is also referred to as: A-freezing; B-unfreezing; C-unfrozen; D-refreezing

B-unfreezing

Which of the following disqualifies a spouse from COBRA benefits: A-reduction in the employee's work hours; B-voluntary or involuntary employment termination due to gross misconduct by the covered employee; C-legal separation or divorce of the covered employee; D-death of covered employee

B-voluntary or involuntary employment termination due to gross misconduct by the covered employee

The best question to elicit information about a patient's pain is: A-are you having pain; B-will you describe your pain for me; C-what kind of pain are you having; C-what is your pain on a scale from 1 to 10

B-will you describe your pain for me

When conducting a survey or program evaluation, the easiest way to quantify are A-Descriptive informational questions, B-yes-no questions; C-Multiple choice questions, D-Rating scale

B-yes no questions

Discovering, responding and incorporating the values of clients and families in the health care experience refers to: A-sociodemographic tolerance; B-cultural competence; C-individuality integration; D-psychosocial acknowledgment

C-pathophysiology components of a disease

An employer allows an eligible employee, spouse and their dependents to maintain health insurance coverage when an employee resigns from employment. This is known as: A-HIPPA; B-managed care; C-COBRA; D-PPO

C-COBRA

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 stopped when a patient is DNR; C-DNR orders should be reviewed periodically and revised if needed; D-staff can withhold food and water from a DNR patient

C-DNR orders should be reviewed periodically and revised if needed

A pediatric theorist who focused on the social environment is: A-B.F. Skinner; B-Alfred Adler; C-Erik Erickson; D-Jean Piaget

C-Erik Erikson

The theory that states that a change is one family member's behavior will effect others in the family is: A-Health Belief Model (Rosenstock); B-Theory of Planned Behavior (Ajzen); C-Family Systems Theory (Bowen); D-Theory of Reasonee Action (Fishbein & Ajzen)

C-Family Systems Theory (Bowen)

The best response to a patient who insists that healthcare providers are lying about her need to transfer from acute care to a skilled nursing facility is: A-the staff would never lie to a patient; B-the doctor ordered your transfer, so you can't stay here; C-I'll try to answer all of your questions and explain your need for a transfer; D-I agree with you, but Medicare won't pay for your stay here.

C-I'll try to answer all of your questions and explain your need for a transfer

Bower and Falk (1996) defined effective resource management as: A-doling out material goods assessed as essential for client health and well-being; B-coordinating the delivery of targeted goods and services identified by medical providers as necessary for client recovery from illness or injury; C-Identifying, confirming, coordinating and negotiating resources to meet client needs; D-Determining the most efficient and cost-effective method of service and resource delivery to meet a client's health and recovery needs

C-Identifying, confirming, coordinating and negotiating resources to meet client needs

When evaluating outcomes data for evidence based practice, the type of data that includes measures of mortality, longevity and cost-effectiveness is: A-clinical; B-psychosocial; C-integrative; D-physiological

C-Integrative

The health education "Stages of Change Model" developed by; A-Diniz, Schmidt and Stothers; B-Malcolm Knowles; C-James Prochaska; D-Hildegarde Peplau

C-James Prochaska

Using a 4 point Likert scale to assess clients with low self-care, a client with severe risk of failing to adhere to medical regiments/treatments is classified as: A-Level 1; B-Level 2; C-Level 3; D-Level 4

C-Level 3

The psychological theory that characterized a hierarchy of needs culminating in self actualization was developed by: A-Jung; B-Havighurst; C-Maslow; D-Freud

C-Maslow

All of the following are true about Medicare Select EXCEPT: A-Medicare Select is a Medicare supplemental insurance product; B-Medicare Select policies are managed care policies; C-Medicare Select plans are higher in 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 are higher in cost than traditional Medigap plans

All of the pathogenic organisms listed below are commonly associated with surgical site infections EXCEPT: A-S. aureus; B-Enterococcus spp; C-S. pneumoniae; D-S epidermidis

C-S. penumoniae

A case mix group, as defined by the Health Insurance Perspective Payment System (HIPPS) is: A-a classification system based on utilization of resources; B-a data set containing elements to review for a comprehensive assessment of client function: C-a classification system based on clinical characteristics of clients; D-a data set used by home health agencies to measure outcomes and risk factors

C-a classification system based on clinical characteristics of clients

An "ombudsman" is best described as: A-an accreditation analyst who evaluates health care organizations, programs and policies; B-an independent official who arbitrates health care disputes and levies sanctions and fines where required; C-a neutral source of assistance to address the health care services concerns of local citizens; D- and insurance investigator who resolves health care coverage and benefit issues

C-a neutral source of assistance to address the health care services concerns of local citizens

The Pareto Principle as related to nursing case management indicates that: A-resource allocation must be multidisciplinary to be cost effective; B-a systematic and dynamically adaptable framework is required; C-about 80% of all health resources are used by 20% of the population; D-no professional discipline owns the practice of case managment

C-about 80% of all health resources are used by 20% of the population

The palliative care advance practice nurse should be proficient in all of the following EXCEPT: A-providing consultation to other medical professionals in complicated palliative care cases; B-providing direct education to patients and caregivers; C-administering medication with the primary purpose of hastening death; D-maintaining knowledge of current evidence based evaluation and treatments in palliative care

C-administering medication with the primary purpose of hastening death

Health information and demographics gathered by repeated measurements or by combining a collection of individual data are referred to as: A-population data; N-cumulative data; C-aggregate data; D-collective data

C-aggregate data

The process that occurs when a person elects to stay in her hone 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-aging in place

Which nurses should be covered by malpractice insurance: A-advance practice nurses only; B-nurse practitioners only; C-all licensed nursing personnel; D-all unlicensed nursing assistants

C-all licensed nursing personnel

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 resolutions; C-allowing the physician to do all the patient education; D-improving patient compliance by education

C-allowing the physician to do all the patient education

The best definition of benchmarking is the: A-calibration of medical machinery to ensure accurate and consistent performance; B-comparison of products, services and practices among different providers or leaders in a given specialty; C-analysis of data to produce a baseline performance index for purposes of outcome comparisons; D-compilation of recent performance data into standardized format for later analysis

C-analysis of data to produce a baseline performance index for purposes of outcome comparisons

A Hispanic patient is admitted to a hospital unit where a nurse is to obtain the patient's admission history, but the patient speaks very little English. What should te nurse do? A-as the patient's 12 year old son, who is fluent in English to interpret; B-use sign language and pictures to supplement questions; C-arrange for an interpreter; D-ask the patient's wife, who speaks fair English, to answer the questions for the patient

C-arrange for an interpreter

Assessment of a palliative care patient's spiritual or religious beliefs should encompass which of the following: A-screening for spiritual beliefs that may conflict with the palliative care nurse's religious practices; B-encouraging the patient to join a religious community if they do not already belong to one; C-asking about spiritual customs or rituals around the illness and death that are meaningful to the patient; D-assessing spiritual or religious beliefs only if the patient volunteers information about religion and spirituality

C-asking about spiritual customs or rituals around the illness and death that are meaningful to the patient

When preparing material to teach a 28 year old auto mechanic about wound care; the first thing the nurse should do is: A-prepare an audiotape; B-prepare visual material, such as pictures and diagram;s C-assess a patient's learning style; D-prepare manipulatives, assuming a male mechanic will be a kinesthetic learner

C-assess a patient's learning style

Core measures for Centers for Medicare and Medicaid (CMS) include measures related to: A-cancer; B-brain injuries; C-asthma care for children; D- Alzheimer's disease

C-asthma care for children

A team leader makes decisions independently and strictly enforces all rules. This type of leadership is: A-bureaucratic; B-laissez faire; C-autocratic; D-democratic

C-autocratic

Which of the following biological theories of aging contend that cell mutations and failure of the immune system lead to disease: A-free radical; B-programmed/cellular; C-autoimmunity; C-homeostatic

C-autoimmune

The appropriate form of transportation for a psychiatric patient transferring from an acute care hospital to a psychiatric care facility is: A-private automobile; -wheelchair van; C-basic life support ambulance; D-advanced life support ambulance

C-basic life support ambulance

You are a specialist in maternal-infant case management. The labor and delivery nurse has told a pregnant woman in preterm labor that she is going to received betamethasone. Howe would you explain it to this patient? A-Betamethosone is a drug given to treat preeclampsia; B-betamethasone is routine giving to stop contractions in order to avoid preterm delivery; C-betamethasone is a steroid given to pregnant women to help fetal lung development in care of preterm birth; D-betamethasone strengthens contractions

C-betamethasone is a steroid given to pregnant women to help fetal lung development in care of preterm birth

The healthcare insurance reimbursement system that involves an advanced fixed monthly payment to a provider is: A-per-diem reimbursement; B-fee for service; C-pay for performance; D-capitation

C-capitation

Which of the following emphasized achievement of outcomes in defined time frames with limited resources: A-variance analysis; B-social work; C-case management; D-risk management

C-case management

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 least cost intensive patients

C-case management is a highly individualized process

During assessment and problem identification for a client with multiple physicians, if inconsistencies in medical data are found, the CCM should first: A-consult with the client; B-accept the latest information as most accurate; C-consult with the source of inconsistent data; D-ask for a medical review of client care.

C-consult with the source of inconsistent data

In cost analysis, conformance costs are: A-costs related to errors, failures or defects, including duplications of service and malpractice; B-all costs (processes, services, equipment, time, material, staff) necessary to provide products or processes without error; C-costs related to preventing errors such as monitoring and evaluation; D-costs that are shared, such as infrastructure costs

C-costs related to preventing errors such as monitoring and evaluation

Vocational services are primarily intended to assist individuals who have sustained catastrophic illness or injury with: A-socialization skills to develop interpersonal relationships; B-in-home activities of daily living for personal independence C-employment that accommodates physical and mental challenges; D-the achievement of self-actualized goals and aspirations

C-employment that accommodates physical and mental challenges

The type of assessment that evaluates hazards in the home, such as loose carpets, rotting food, or piles of paper on the floor, is: A-physical assessment; B-functional assessment; C-environmental assessment; D-psychosocial assessment

C-environmental assessmeny

A managed care contract may have provisions that prohibit doctors from discussing treatment choices if the choices are not covered by their managed care plans. This provision is an example of a/an: A-confidentiality provision; B-gag clause; C-ethical dilemma; D-clinical pathway

C-ethical dilemma

Clinical pathways should be based on: A-a survey of current practices in the area; B-committed recommendations; C-evidence based research; D-staff preferences

C-evidence based research

Which of the following is a human barrier encountered in the implementation of the case management model? A-limited budgets; B-systems constraints; C-fear of technology; D-unrealistic administrative expectations

C-fear of technology

An alert elderly home care patient who complains that items have been disappearing from her home is most likely a victim of: A-elder abuse; B-psychological abuse; C-financial abuse; D-physical abuse

C-financial abuse

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

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

C-full disclosure

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 at a garage sale; B-purchase a new car seat out of your own pocket for the patient; C-have advanced knowledge of community centers or facilities that provide car seats, and ensure the seat is available for the infant's use upon discharge; D-let the infant ride in the mother's arms as long as she goes directly home

C-have advanced knowledge of community centers or facilities that provide car seats, and ensure the seat is available for the infant's use upon discharge

The fundamental starting point for a case manager and patient is: A-an understanding of the patient's disease or injury; B-an appreciation of the patient's sociocultural situation; C-holistic understanding of the patient in all life dimensions; D-diagnostic clarity and a medically effective care plan

C-holistic understanding of the patient in all life dimensions

The Older Americans Act provides: A-hospital services; B-pharmacy assistance; C-home and community services; D-financial assistance to older adults

C-home and community services

The best intervention for a 68 year old man with COPD who lives alone and manages his won care been eating only candy and snack foods is: A-nutritional counseling; B-admission to assisted living facility; C-home delivery meals (Meals on Wheels); D-referral to occupational therapist

C-home delivery meals (Meals on Wheels)

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 as a: A-skilled nursing facility; B-entrepreneurial setting; C-hospital team; D-hospice setting

C-hospital team

Under the CMS Quality Framework for Home & Community Based Services, participant safeguards include: A-licensure and certification of staff; B-right to make decisions; C-incident reporting; D-surveys of outcomes

C-incident reporting

The type of healthcare insurance that pays in the form of predetermined payments for loss or damages rather than for healthcare services is: A-liability insurance; B-no fault auto insurance; C-indemnity insurance; D-accident and health insurance

C-indemnity insurance

The type of insurance plan that offers the most flexibility is the: A-health maintenance organization; B-managed indemnity plans; C-indemnity plans; D-point-of service plans

C-indemnity plans

Medical assault (e.g. the threat or attempt to render medical care over a patient's objections), medical battery (e.g. physical contact of a person without consent) and false imprisonment (e.g. inappropriate use of restraints) are all best defined as: A-civil infractions of the law; B-criminal conduct; C-intentional torts; C-penal code violations

C-intentional torts

A client is medically stable but needs intermittent nursing intervention to maintain stability. The patient also needs intermittent subcutaneous injections; routine nonsterile suctioning and a stable respiratory therapy plan. What level of care is the patient receiving? A-assisted living; B-custodial care; C-intermediate care; D-skilled nursing

C-intermediate care

If 2 clients need a hospital bed, but only one is available, the decision regarding which client to transfer should be based on the ethical principle of: A-non-malficence; B-beneficence; C-justice; D-autonomy

C-justice

The nurse is teaching a 45 year old woman with a colostomy to perform a colostomy irrigation. The nurse has prepared written directions and a video, but the patient ignores them. Instead, the patient picks up the equipment and looks at each part, trying to figure it out. The patient's learning style is probably: A-auditory; B-visual; C-kinesthetic; D-mixed

C-kinesthetic

Common forms of statistical analyses include all of the following EXCEPT: A-hypothesis testing; B-correlation and regression analysis; C-kurtosis modeling; D-confidence interval calculation

C-kurtosis modeling

According to behavioral theory, anxiety is: A-caused by interpersonal problems; B-inherited; C-learned from experience; D-caused by chemical imbalance

C-learned by experience

Disease management programs primarily focus on the: A-insurance costs of a particular disease; B-research on a particular disease; C-pathophysiology components of a disease; D-funding options for a particular disease

C-pathophysiology components of a disease

Three essential tools for employee/contractee evaluation are: A-mentor, preceptor and supervisor/contractor discussions; B-agency satisfaction surveys, informal discussions and staff meetings; C-performance appraisals, peer review and self-evaluation; D-colleague consults, in service meetings, and continuing educations

C-performance appraisals, peer review and self-evaluation

The case management process of documenting goals, objectives, and actions to meet a client's needs is called: A-assessment; B-coordination; C-planning; D-monitoring

C-planning

The Disaster Preparedness Committee is responsible for: A-instituting infection control procedures; B-establishing guidelines for the use of patient restraints; C-posting exit routes from each area of the hospital; D-ensuring compliance with air ventilation guidelines

C-posting exit routes form each area of the hospital

According to principles of adult learning, adult learners tend to be: A-unmotivated; B-lacking in self direction; C-practical and goal oriented; D-insecure

C-practical and goal oriented

Three kinds of utilization review include: A-clerical, clinical and research review; B-coverage, cost and quality review; C-preauthorization, concurrent and retrospective; D-resource, utilization and quality-control based review

C-preauthorization, concurrent and retrospective

The primary goal of rehabilitation for a patient who has suffered a spinal cord injury is to: A-promote independence; B-promote psychological well being; C-prevent complications; D-educated regarding rights of the disabled

C-prevent complications

Risk management is as subdomain of which one of the following core case management domains? A-psychosocial aspects; B-healthcare management and delivery; C-principles of practice; D-Case management concepts

C-principles of practice

The primary criterion for referal to a hospice program is: A-severe intractable pain; B-life-threatening disease; C-probability that death will occur within 6 months; D-DNR order

C-probability that death will occur within six months

The responsibility for a licensed or certified professional to remain current in knowledge, skills and other professional competencies rests primarily on the: A-employer, as a matter of accreditation; B-licensing/credentialing body that endorsed the individual; C-professional who holds a license, certification or credential; D-state oversight board that ensures consumer protection

C-professional who holds a license, certification or credential

A patient with mild paresis of one arm is going to need an assistive device to aid with walking. Which of the following is the most appropriate type of cane for this patient: A-C cane; B-functional grip cane; C-quad cane; D-hemi-walker

C-quad cane

The process by which you would screen the patient's medical record to determine if the patient received appropriate standards of care is known as: A-an incident report; B-risk management; C-quality review; D-utilization review

C-quality review

When a client is receiving occupational therapy in the home, documentation must include: A-costs; B-client preference; C-realistic and measurable goals; D-indirect supervision of unlicensed staff.

C-realistic and measurable goals

Criteria for Medicare coverage of home oxygen for a client receiving oxygen at 5L/minute includes drawing arterial blood gases with client: A-receiving oxygen at 5L/minute; B-receiving oxygen at <3L/minute; C-receiving oxygen at 4L/minutes; D-breathing room air

C-receiving oxygen at 4L/minute

Under InterQual's ISD criteria of severity of illness (SI) reflecting the need for acute hospitalization, onset of symptoms within one week is categorized as: A-acute/sudden onset; B-recently or newly discovered; C-recent onset; D-newly discovered.

C-recent onset

A necessary component of informed consent prior to a procedure is: A-names of assisting staff members; B-beginning and ending times; C-risks and benefits of procedure; D-facility statistics regarding procedure

C-risks and benefits or procedure

Legal accountability for a surgical count is a primary responsibility for the: A-surgeon; B-perioperative nurse; C-scrub person; D-entire surgical team

C-scrub person

Aside from the issue of insurance portability, the primary purpose of the Health Insurance Accountability Act of 1996 was to: A-ensure peer review of health care practices; C-self-determination; C-address health care billing practices; D-set standards for quality review

C-self-determination

The difference between confidentiality and privacy is best described as: A-information protection vs personal revelation; B-personal seclusion vs controlled information release; C-legal access vs limited exposure; C-self-determination

C-self-determination

The ethical principal of autonomy is best defined as: A-readiness for change; B-do no harm; C-self-determination; D-individual responsibility

C-self-determination

A 76 year old female with lung cancer was placed in hospice care by her physician 6 months earlier (two 90 day periods), but she is still alive. Her family asks the nurse if the patient will be removed from hospice care. The best response is: A-She will be removed from hospice care until her condition worsens because she had exceeded the 6 month period; B-she has exhausted all of her hospice benefits and will be removed from hospice care; C-she can continue with hospice care as long as the physician continues to authorize care every 60 days; D-she can continue with hospice care as long as the physician continues to authorize care every 90 days;

C-she can continue with hospice care as long as the physician continues to authorize care every 60 days;

To facilitate the continuum of care after a client is discharged from an acute hospital, the most important relationship for a CCM to develop is with: A-physician's staff; B-HMO clinicians; C-skilled nursing facilities and home health agencies; D-acute hospital administrators

C-skilled nursing facilities and home health agencies

A 32 year old single mother of a 4 year old child is being discharged after a hysterectomy for cervical cancer. She states she is very depressed because she has lost her job, cannot feed her family, and will soon be homeless. Which referral is most appropriate: A-food bank; B-homeless shelter; C-social worker; D-mental health clinic

C-social worker

The model for health maintenance organizations in which the HMO hires physicians to work in clinic-type settings is: A-group model; B-network model; C-staff model; D-direct contact model

C-staff model

When a facility is converting to the interoperable electronic healthcare delivery system the most important aspect to consider is: A-equipment choice; B-time needed for conversion; C-staff training; D-staff preference

C-staff training

The corner stone of infection control in surgery is: A-the skill of the attending physician; B-the expertise of the operating room nurses; C-sterilization and disinfection; D-the integrity of the patient's skin

C-sterilization and disinfection

The most common surgical site of infection is: A-deep incision infection; B-organ infection; C-superficial incision infection; D-fascia infection

C-superficial incision infections

Which scale is used to assess and predict the risk of a patient developing pressure sores based upon sensory perception, moisture, activity, mobility, nutrition pattern and friction and sheer: A-Norton scale; B-Pressure Ulcer Scale for Healing (PUSH); C-The Braden scale; D-Diabetic Foot Ulcer Scale (DFS)

C-the Braden scale

A 67 year old terminally ill person wishes to receive comfort care measures in his home. The patient's physician recommends placement in a hospice facility so that Medicare will cover the cost of hospice care. Which of the following statements most accurately describes the Medicare hospice benefit: A-the Medicare hospice benefit applies to patients who have a life expectancy of 12 months or less; B-the Medicare hospice benefit does not cover the cost of medications used to treat symptoms of terminal illness; C-the Medicare hospice benefit covers the cost of hospice benefits in multiple setting, including the patient's home; D-servicies provided under the Medicare hospice benefit vary from state to state

C-the Medicare hospice benefit covers the cost of hospice benefits in multiple setting, including the patient's home

From a case management perspective, the difference between gross saving and net savings with reference to a service plan is: A-any savings realized; B-the sum of all potential charges less realized charges; C-the inclusion of case management fees; D-the difference between costs and benefits

C-the inclusion of case management fees

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 Mother's Health Protection Act (NMHPA) the length of the hospital stay is determined starting at: A-the time of the physician initially sees the mother; B-the time of birth of the infant; C-the time of admission; D-the time the patient's room is ready for occupancy

C-the time of admission

Which of the following is most likely to lead to medical errors: A-hand block printing of all orders; B-the use of bar coding and scanners; C-the use of medical abbreviations; D-computer generated orders

C-the use of medical abbreviations

Medical abandonment is best defined as: A-failure to render necessary medical treatment due to deliberate neglect; B-an unintentional oversight of requisite care from which harm resulted; C-the willful failure to be responsible for a person for whom has a care giving duty; D-the unavoidable and unintentional absence of a caregiver resulting in harm

C-the willful failure to be responsible for a person for whom has a care giving duty;

Which of the following is true about viatical settlements: 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 part 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-they involve sale of a life insurance policy to a third part before death occurs

The Tuberculosis Medicaid Program is intended for: A-only TB patients who qualify for regular Medicaid; B-All TB patients; C-uninsured or underinsured citizens or legal residents with TB; D-uninsured or underinsured citizens and legal or illegal residents with TB

C-uninsured or underinsured citizens or legal residents with TB

A psychosocial evaluation is indicated for a client with: A-chronic heart disease; B-homelessness; C-unintentional overdose; D-limited financial resources

C-unintentional overdose

A member of an office medical staff has documented a billing code for a ore sever condition than the one documented in the patient's chart. This coding action is called: A-a medial necesssity; B-downcoding; C-upcoding; C-CPT coding

C-upcoding

Reinforcement is the process of encouraging correct behavior and discouraging incorrect behavior. When using reinforcement, an educator should: A-emphasize positive reinforcement strategies; B-focus on extinguishing negative behaviors; C-use both positive and negative reinforcement strategies; D-avoid any emphasis on either positive or negative behaviors

C-use both positive and negative reinforcement strategies;

The most significant difference between utilization review and utilization management is: A-utilization review is conducted solely to determine insurance contract compliance, while utilization management is conducted for purposes of cost containment; B-utilization review is carried out by clinicians for quality control, while utilization management is carried out by facility administrators; C-utilization review is retrospective, while utilization management is oriented toward the present and future; D-utilization review is a clerical task, while utilization management is an administrative task

C-utilization review is retrospective, while utilization management is oriented toward the present and future

A terminally ill client is exhausting all financial resources to pay medical costs. 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-viatical settlement

Identifying the need for environmental modifications in a client's home is a role of the CCM under the domain of: A-Outcomes evaluation/case closure; B-utilization management; C-vocation concepts & strategies; D-clinical care management

C-vocation concepts & strategies

The case management domain that focuses on workplace issues, disability, and job modification is called: A-case finding and intake; B-outcomes evaluation and case closure; C-vocational concepts and strategies; D-psychosocial and economic issues

C-vocational concepts and strategies

If a client has outpatient surgery in the morning and stays overnight for extended observation, the client become inpatient: A-At midnight; B-after 8 hours; C-when the physician order inpatient services; D-after 24 hours.

C-when the physician orders inpatient services

The tendency of health care professionals to work in "silos: means: A-having a multidisciplinary perspective and appreciation; B-referring clients to other providers as needed; C-working independently and without collaboration; D-accepting and receiving consultation as needed

C-working independently and without collaboration

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- All of the above

A wealthy patient who has been on the unit for two weeks gives a nurse an expensive watch out of gratitude. What is the nurse's best response: A-you don't need to pay for nursing care; B-thank you so much, I will treasure this; C-this is much too expensive for me to accept; D- I'm sorry. This is so kind of you, but nurses are not allowed to accept gifts from patients.

D- I'm sorry. This is so kind of you, but nurses are not allowed to accept gifts from patients.

The most likely cause for variance in a clinical pathway (i.e. deviation from an expected patter on a clinical pathway is: A-patient noncompliance; B-practitioner variation; C-health care system deviation; D- all of the above

D- all of the above

The best response to a dying Hmong patient states that a shaman is coming to heal her is: A-"That is not realistic in your condition." B-"If you believe, then a cure is possible." C-"You will need your doctor's permission.; D-"What can I do to help?"

D-"What can I do to help?"

For a patient recovering from a brain injury, the Glasgow coma score that indicates potential for rehabilitation is: A-2; B-5; C-8; C-8; D-10

D-10

During case selection, the client that is most likely to need and benefit from case management services is: A-12 year old child having tonsillectomy; B-67 year old man having a transurethral resection of the prostate (TURP); C-47 year old Type 2 diabetic with severe insulin reaction after a bout of food poisoning with vomiting and diarrhea; D-72 year old woman with postoperative wound infection after hip replacement.

D-72 year old woman with postoperative wound infection after hip replacement.

The theorist who first identified a hierarchy of needs, including (1) physiological needs; (2) safety; (3) love and belonging; (4) self-esteem; (5) self-actualization, by which to achieve satisfaction and fulfillment was: A-Carl Jung; B-Erik Erickson; C-Jean Piaget; D-Abraham Maslow

D-Abraham Maslow

The theorist who first identified the hierarchy of needs including phsyiolological needs, safety needs, love and belonging, self esteem and self actualization by which to achieve satisfaction and fulfillment was: A-Carl Jung; B-Erik Erickson; C-Jean Piaget; D-Abraham Maslow

D-Abrahm Maslow

Which of the following provides research and funding for the development of evidence based practice guidelines: A-Occupational Health and Safety Association (OSHA); B-Food and Drug Administration (FDA); C-Health Insurance Portability and Accountability Act (HIPPA); D-Agency for Healthcare Research and Quality (AHRQ)

D-Agency for Healthcare Research and Quality (AHRQ)

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 above

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

D-CM involves meeting with patients and their families on a regular basis to prevent problems

The model for managed care that provides services at discounted rates to those enrolled is: A-Health Maintenance Organization (HMO); B-Point of Service Plan (POS); C-Preferred Provider Organization (PPO); D-Exclusive Provider Organization (EPO)

D-Exclusive Provider Organization (EPO)

Under the Affordable Care Act, an Accountable Care Organization (ACO0 is part of: A-mandated service delivery system; B-private insurance incentive; C-Medicaid; D-Medicare Shared Savings Program (MSSP)

D-Medicare Shared Savings Program (MSSP)

The healthcare accreditation agency that assists purchasers of health plan and consumers to evaluate performance of the health plan is: A-Centers for Medicare & Medicaid (CMS); B-TJC-formerly the Joint Commission; C-URAC; D-National Committee for Quality Assurance

D-National Committee for Quality Assurance

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

A client with both Tricare and Medicare may avoid hospitalization in a Veterans' Affairs facility because: A-Tricare and Medicare combines reimburse for only 80% of the costs; B-The VA can bill neither Tricare or Medicare; C-the VA cannot bill Tricare; D-the VA cannot bill Medicare

D-The VA cannot bill Medicare

According to InterQual ISD discharge reviews, the appropriate discharge documentation of a client admitted with a WBC of 15,000 and temperature of 39.8C is: A-client stable; B-infection cleared; C-clients lab finding and temperature are within normal limits; D-WBC 7,000 and temperature 37 C

D-WBC 7,000 and temperature 37 C

Measuring the effectiveness of an intervention rather than the monetary savings is: A-cost benefit analysis; B-an efficacy study; C-a product evaluation; D-a cost effective analysis

D-a cost effective analysis

The best determinant of the effectiveness of patient education is: A-patient's satisfaction; B-a patient's ability to demonstrate a behavior; C-a patient's ability to explain a procedure and demonstrate understanding; D- a patient's behavior modification and compliance rates

D-a patient's behavior modification and compliance rates

Nursing case management that is "within the walls" refers to which setting? A-outpatient setting; B-community clinic setting; C-health maintenance organization (HMO); D-acute hospital setting

D-acute hospital setting

A young adult in the emergency department for attempted suicide with three previous attempts should be: A-referred to outpatient mental health services; B-treated and discharged to family; C-asked to sign a no suicide contract before discharge; D-admitted to the hospital

D-admitted to the hospital

A client's entry into a case management program is determined by: A-interview; B-networking systems; C-referral; D-all of the above

D-all of the above

Critical components of universal precaution practice standards of the Occupational Safety and Health Administration (OSHA) include which of the following: A-use of person protective barriers; B-proper hand washing; C-precautions handling sharps; D-all of the above

D-all of the above

Medical practice standards and care algorithms are often referred to as: A-clinical practice guidelines; B-best practices or clinical protocols; C-care pathways or care maps; D-all of the above

D-all of the above

Which members of the healthcare institution are responsible for identifying performance improvement projects: A-administrative staff; B-nursing team leaders; C-physicians; D-all staff

D-all staff

If a biological indicator shows positive growth, which of the following steps is necessary: A-the sterilizer should be taken out of service; B-any items process in the load should be recalled; C-the BI should be reported to the supervisor; D- all of the above are trueq

D-all the above are true

In educational experiences, information retention is most directly affected by the: A-degree to which the information presented is entertaining; B-simplicity and clarity of the language used in the presentation; C-level to which the information presented is personally relevant; D-amount of practice incorporated into the learning experience

D-amount of practice incorporated into the learning experience

All of the following require 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 great risk than the treatment itself

D-an emergency situation in which lack of action would be great risk than the treatment itself

After being admitted to a long term care facility, a 70 year old patient with Medicare can enroll in Medicare Part D: A-up to 2 months after moving out of facility; B-any during during the stay only; C-up to 1 month before moving into the facility and up to 2 months after moving out; D-any time during the stay and up to 2 months after moving out of facility

D-any time during the stay and up to 2 months after moving out of facility

Continuous quality improvement (CQI) requires all of the following to achieve a stated goal or aim EXCEPT: A-a fully defined goal and enough tine to achieve it; B-a CQI "champion" or leader to mobilize others; C-goo working relationship and "buy in" from team members and administration; D-approve of the goal from accreditation or credentialing programs

D-approve of the goal from accreditation or credentialing programs

The American Nurses Association has identified all but one of the following as the Six Standards of Practice: A-interview, identify, plan, intervene, monitor and evaluate; B-listen, diagnose, treat, evaluate, report and revise; C-examine, consult, diagnose, plan, implement and evaluate; D-assess, diagnose, identify outcomes, plan, implement, evaluate

D-assess, diagnose, identify outcomes, plan, implement, evaluate

Upon discharge from an acute hospital, the most appropriate placement for a client who has slight demential and requires a simple daily dry dressing change but is medically stable and ambulates independently with a cane is: A-subacute/rehabilitation facility; B-skilled nursing facility; C-intermediate care facility; D-assisted living/custodial care facility

D-assisted living/custodial care facility

Which therapy involves the use of monitoring devices to allow people to control their own physiological responses: A-imagery; B-acupuncture; C-meditation; D-biofeedback

D-biofeedback

Eligibility criteria for Supplemental Security Income (SSI) for those with low income and few resources include: A-deafness; B-age 55 or older; C-chronic pain; D- blindness

D-blindness

A female patient scheduled for a surgical procedure is a Jehovah's Witness. What aspect of future care could be affected by the patient's religious practices: A-diet; B-covering of body with a burka; C-organ donation; D-blood transfusion

D-blood transfusion

During an interview with a patient, what type of patient response provides the most useful information about the patient: A-verbal responses; B-non verbal responses; C-silence; C- both verbal and non verbals responses

D-both verbal and non verbal responses

The InterQual utilization management tool, which is used to determine if interventions are appropriate and properly sequenced, is considered to be: A-a retrospective monitoring tool; B-clinical evidence summaries; C-level of care criteria tools; D-care planning criteria tools

D-care planning criteria tools

Which of the following is an example of hard savings: A-avoidance of ED visits;n B-avoidance of medical complications; C-avoidance of potential hospital readmission; D-change to a lower level of care

D-change to a lower level of care

An example of hard savings that can result from case management: A-avoiding hospital readmission; B-avoiding home health care; C-preventing medical errors; D-changing length of stay

D-changing length of stay

The greatest portion of health care costs and resources is directed to: A-perinatal and pediatric care issues; B-geriatric care issues; C-traumatic accidents and injuries; D-chronic disease in all age-groups

D-chronic disease in all age groups

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

The most important factor in determining beliefs about health is: A-race; B-age; C-gender; D-culture

D-culture

Implementation of a care plan involves all of the following EXCEPT: A-goal setting; B-negotiation; C-contracting; D-delegation

D-delegation

A Medicare client who was hospitalized for a brain injury may be eligible for home health care to provide: A-nursing care 24 hours a day; B-home delivered meals; C-personal care (bathing, dressing) alone; D-occupational therapy

D-occupational therapy

The Health Insurance Portability and Accountability Act of 1996 grants individuals the right to all of the following EXCEPT: A-copies of health records and notice about how health information will be used and shared; B-corrections added to the health information and reports about why health information was shared in certain situations; C-the option to give or refuse permission for information sharing, such as for marketing or certain other purposes; D-deletion or removal of negative personal health information from a treating provider's records

D-deletion or removal of negative personal health information from a treating provider's records

The Mini-Cog test to assess for dementia includes: A-counting backward from 100 by 7s; B-copying a picture of interlocking shapes; C-following simple 3 part directions; D-drawing the face of a clock with the hands indicating a specific time

D-drawing the face of a clock with the hands indicating a specific time

Medication reconciliation should be completed: A-prior to admission; B-during admission assessment; C-on discharge; D-during all phases of care

D-during all phases of care

The medical term for difficulty swallowing is: A-aphakia; B-dysphasia; C-akathesia; D-dysphagia

D-dysphagia

In order to enroll in a Medicare supplemental health insurance plan (Medigap), the primary requirement is: A-enrollment in Medicare Part A; B-enrollment in Medicare Part B; C-enrollment in Medicare Parts A, B & D; D-enrollment in Medicare Parts A & B

D-enrollment in Medicare Parts A & B

The first step in doing a cultural assessment is: A-explain the purpose of a cultural assessment; B-ask permission to do a cultural assessment; C-take thorough notes during communication; D-establish trust

D-establish trust

Which of the following is true about reporting elder abuse? A-the person reporting 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 is a form of abuse

The Instrumental Activities of Daily Living (IADL) tool includes assessment of: A-bathing; B-toileting; C-ascending or descending stairs; D-financial responsibility

D-financial responsibility

Which of these statements is true about hospice care? A-hospice care is solely for patients with terminal malignancies; B-hospice is for patients who have six or fewer months to live; C-in hospice, all further medical treatment has stopped, including palliation; D-hospice care is for any terminal illness

D-hospice care is for any terminal illness

The primary purpose of the Caseload Matrix is caseload calculations to A-Differentiate activities and interventions; B-measure specific outcomes; C-determine accuracy of caseload calculations; D-identify variables in various settings affecting caseloads

D-identify variables in various settings affecting caseloads

A requirement for participation in a pharmacy assistance program usually includes: A-prescription insurance coverage or Medicare D; B-generic prescriptions only; C-U.S. residency; D-income of less than 200% of Federal poverty level

D-income of less than 200% of Federal poverty level

Guidelines for eligibility and reimbursement in Medicaid programs are established by: A- SSA; B-individual counties; C-state consortia; D-individual states

D-individual states

In Erikson's psychosocial model of development, which state is typical of those entering young adulthood: A-identify vs role confusion; B-initiative vs. guilt; C-ego integrity vs despair; D-intimacy vs isolation

D-intimacy vs isolation

Which of the following is NOT an advance directive: A-living will; B-medical power of attorney; C-durable power of attorney; D-last will and testament

D-last will and testament

Common barriers to providing optimal palliative care to patients living in poverty include all of the following EXCEPT: A-fragile or non existent housing; B-less stable support systems; C-undependable transportation to medical visits; D-less effective coping skills

D-less effective coping skills

The capacity to understand and use health care information is most strongly influenced by: A- Gender; B-marital status; C-ethinicity; D-literacy

D-literacy

A 66 year old male on Medicare is being discharged home. He has an open, draining abdominal wound that he is unable to care for independently because of poor vision. His 14 year old grandson lives with him. The best solution is: A-transferring the patient to an extended care facility; B-keeping the patient in the hospital until the wound has healed; C-teaching the man's 14 year old grandson to provide wound care; D-making a referral to a home health agency to provide in home care.

D-making a referral to a home health agency to provide in home care

The level of independence or care in the hone for an adult female indicated by a discharge Functional Independence Measure (FIM) score is 63, with scores in all areas ranging from 3 to 4 is: A-complete independence in care; B-modified independence, including use of assistive devices and activity modification; C-supervision only (standby without physically assisting; D-minimal to moderate contract assistance (physically assisting)

D-minimal to moderate contract assistance (physically assisting)

The process of establishing goals, continuously gathering provider information, measuring progress and modifying interventions is needed is called: A-evaluation; B-outcomes measurement; C-clinical assessment; D-monitoring

D-monitoring

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-negligent referral

Spore on the patient's skin and on instruments are most apt to be destroyed by: A-The Bowie-Dick test; -disinfectant; C-ethylene oxide; D-none of the above

D-none of the above

Pain Assessment in Advanced Demential (PAINAD) utilizes: A-a face scale with pictures of smiling or crying faces; B-a 0 to 10 severity scale (0 no pain and 10 the worst); C-monitoring of blood pressure changes; D-observations of non-verbal behavior

D-observations of non verbal behavior

Which of these is NOT covered according to the Balanced Budge Act of 1997? A-annual prostate cancer screening for patients over 50; B-bone density tests for patients at risk for osteoporosis; C-diabetes education; D-one Pneumovax vaccine yearly

D-one Pneumovax vaccine yearly

When a patient chooses to make treatment decisions by drawing up advance 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-patient self-determination

Spend down is the process by which: A-insurance companies pay benefits; B-insurance companies contract with stop loss plans; C-people utilize funds in a health savings account; D-people spend down assets on medical bills to qualify for Medicaid

D-people spend down assets on medical bills to qualify for Medicaid

A managed care provider has denied payment for a specific procedure. An appeal may then subsequently be submitted, providing additional documentation. Denial of services is always provided by a: A-nurse; B-clerk; C-business manager; D-physician

D-physician

A Medicare Advantaged Plan (MAP) is/an: A-supplemental (Medigap) insurance plan; B-a form of Medicaid for Medicare recipients; C-optional plan administered by Medicare; D-plan approved by Medicare but administered by private insurance companies

D-plan approved by Medicare but administered by private insurance companies

If a client in an acute hospital has comorbidities of prostate cancer, Type I diabetes, hypertension and pneumonia, the priority treatment is: A-prostate cancer; B-Type 1 diabetes; C-hypertension; D-pneumonia

D-pneumonia

Viatical settlements primarily benefit: A-beneficiaries; B-healthcare providers; C-insurance companies; D-policy holders

D-policy holders

The Prospective Pay System bases medical services reimbursement on: A-the client's ability to pay for services rendered; B-usual and customary fees as billed by other practitioners; C-average fees as billed in a given geographical area; D-predetermined rates for diagnostic-related groups

D-predetermined rates for diagnostic-related groups

Failure mode and effects analysis (FEMA) is done: A-retrospectively; B-upon utilization of a new process; C-during the trail of a new process; D-prior to utilization of a new process

D-prior to utilization of a new process

The 1975 federal education for All Handicapped Children Act requires all of the following EXCEPT: A-free public education with equal opportunity for handicapped children; B-the development of proper evaluation and classification procedures; C-individualized education program based on evaluation; D-private in-hone education based on disability severity

D-private in-hone education based on disability severity

Underutilization management services, the review that determines whether hospitalization is justified is: A-telephonic review; B-retrospective review; C-concurrent review; D-prospective review

D-prospective review

The purpose of the National Quality Forum is to: A-ensure that health care facilities remain clean; B-set standards for business tax compliance; C-monitor infection control policies; D-provide standardized health care quality measures

D-provide standardized health care quality measures

Under a healthcare management program for diabetics, a targeted approach to reducing complications includes: A-providing posters in physicians' offices; B-providing television commercials; C-participating in a community health fair; D-providing nutritional counseling

D-providing nutritional counseling

Medical invasion of privacy (e.g. taking digital images of a patient without consent, breaking confidentiality) and defamation of character (e.g. verbally delivered false or malicious statements that injure a person's reputation, such as prejorative statements about a patient in an elevator; falsehood or malicious and damaging communications in writing, print, signs or pictures, such as prejorative chart notes, that damage a persons reputation) are both examples of: A-statutory violations; B-criminal conduct; C-civil code infractions; D-quasi-intentional torts

D-quasi-intentional torts

If a child has been hospitalized 3 times in 12 months with acute asthma because of noncompliance with the treatment regimen, the best initial action of the CCM is: A-make referral to child protective services (CPS); B-reprimand the parents; C-suggest a change in treatment regimen; D-question the reasons for noncompliance

D-question the reasons for noncompliance

An important purpose of a critical pathway is to: A-allow flexibility; B-focus on one discipline; C-establish accountability; D-reduce/prevent variations in care

D-reduce/prevent variations in care

The most appropriate rehabilitation placement for a 72 year old woman who lives alone and had a hip replacement 5 days earlier is: A-rehabilitation in an acute hospital; B-rehabilitation in the provider's office; C-rehabilitation in her home; D-rehabilitation in a skilled nursing/rehabilitation facility

D-rehabilitation in a skilled nursing/rehabilitation facility

In relation to case management, the profit or loss that results from a hospital;s 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

Which of the following is no considered one of the five rights of medication administration: A-client; B-drug; C-dose; D-routine

D-routine

The most commons screening tool in managed care and among health care providers is the: A-functional living index; B-mini mental status examination; C-Hopkins symptom checklist 25; D-short form 36 health survey

D-short form 36 health survey

When an organization offers training, in-services, orientation to new law and other opportunities for employees or contract providers to obtain new skills and knowledge, it is formally referred to as: A-continuing education; B-credentialing; C-tuition reimbursement; D-staff development

D-staff development

For a trauma patient who will need long-term care and has no coverage and no financial resources beyond Social Security Income, the acute care CCM should explore: A-charity organizatations; B-extended acute care; C-home health agency care; D-state long-term care programs

D-state long-term care programs

The type of group therapy that aims to help members who share a common problem learn to cope is; A-education group; B-self-help group; C-psychotherapy group; D-support group

D-support group

An example of unskilled care is: A-administering sliding scale insulin; B-instructing a client on a low sodium diet; C-instructions in the use of assistive devices; D-taking and reporting routine vital signs,

D-taking and reporting routine vital signs

A prevention strategy that encourages physicians, nurses and other healthcare providers to discuss smoking cessation with all adolescents is an example of: A-secondary prevention; B-universal primary prevention; C-indicated primary prevention; D-targeted primary prevention

D-targeted primary preventon

The most significant challenge to community based CCMs is: A-The acutely ill; B-pediatric clients; C-mothers and infants; D-the chronically ill

D-the chronically ill

A 23 year old Hmong male has acute appendicitis but refuses to sign the consent form until his grandfather arrives. The probable reason is: A-the patient has no insurance; B-the patient lives with his grandfather and is dependent upon him for support; C-the patient is afraid to have surgery without family present; D-the grandfather is the eldest make in the family and makes the decisions for the family

D-the grandfather is the eldest make in the family and makes the decisions for the family

According to Lewin's change theory, the "moving stage occurs when: A-the need for change is recognized; B: The process for creating awareness for change is started; C-a change becomes permanent; D-the need for change is accepted and implemented

D-the need for change is accepted and implemented

The nurse's scope of practice is defined by: A-Medicare; B-The American Nurses Association; C-The Health Insurance Portability and Accountability Act; D-the state Nurse Practice Act

D-the state Nurse Practice Act

Bereavement is: A-a normal response to loss; B-the public expression of grief; C-change of mood and feeling of sadness; D-the time period of mourning

D-the time period of mourning

Algorithms and protocols are similar and dissimilar in which of the following ways: A-algorithms are applied in treatment situations, but protocols are applied in care coordination decisions; B-they are both treatment oriented, but protocols are supported by scientific data; C-there is no difference between algorithms; D-they both use stepwise sequencing, but algorithms are supported by research-based data

D-they both use stepwise sequencing, but algorithms are supported by research-based data

The term, "least restrictive setting" refers to: A-the voluntary nature of patient-provider health care delivery; B-a 'start low and go slow' approach; C-protocols regarding the use of patient physical restraints; D-treatment in settings that promote maximal patient autonomy

D-treatment in settings that promote maximal patient autonomy

An example of a situational crisis is: A-moving away from home; B-graduating from high school; C-going to college; D-unplanned/unwanted pregnancy

D-unplanned/unwanted pregnancy

A CCM is in the emergency department (ED) must consider national indicators for ED crowding such as: A-need for follow up appointments; B-acute hospitalization; C-diversions; D-unsafe discharges

D-unsafe discharges

Under the Case Management Society of America (CMSA)Standards of Practice, the standard of facilitation, coordination, and collaboration can be demonstrated by: A-documentation of termination of care; B-documentation of ongoing efforts at collaboration with the client; C-use of screening for high-risk individuals; D-use of mediation/negotiation

D-use of mediation/negotiation

Polypharmacy is best defined as: A-having medications dispensed from more than one pharmaceutical source; B-the pharmaceutical compounding of medicinal blends to provide individually tailored medications and dosages; C-using a team of pharmacists when addressing patient medication issues; D-using multiple medications in a single patient

D-using multiple medications in a single patientAppro

The five fundamental steps of an evidence-based practice include all of the following EXCEPT: A-evaluating and then applying the evidence located; B-problem identification and literature/rescource review; C-re-examination of the outcomes and revising as needed; D-varying the techniques used for optimum results

D-varying the techniques used for optimum results

An Alzheimer patient walked away from the hospital and was found hiding in the parking lot. The most appropriate nursing diagnosis to account for his behavior is: A-acute confusion; B-risk prone health behavior; C-impaired memory;n D- wandering

D-wandering

When ordering durable medical equipment, case managers should also ensure all of the following EXCEPT that the: A-equipment arrives in working order; B-patient and caregiver know how to use it properly; C-training for safety and maintenance is completed; D-warranties and manufacturers' date is included

D-warranties and manufacturers' date is included

Which of the following is an exception to written consent for HIV testing? A-having had pretest counseling; B-having given oral consent; C-when the patient refuses written consent; D-when anonymous testing is requested

D-when anonymous testing is requested

The most critical skill for a CCM collaborating in an interdisciplinary team is; A-patience; B-assertiveness; C-empathy with others; D-willingness to compromise

D-willingness to compromise

Which is the most critical skill for a nurse collaborating in an interdisciplinary team: A-patience; B-assertiveness; C-empathy with others; D-willingness to compromise

D-willingness to compromise

Using real tasks or simulated work-related tasks and progressive exercises to strengthen and condition a person to return to work is an example of: A-job coaching; B-work adjustment; C-transitional employment; D-work hardening

D-work hardening

A patient with end stage bone cancer has elected hospice and palliative care. The patient is experiencing severe bone pain from a tumor, and the physician orders radiotherapy to reduce the tumor's size and to reduce pain. Is this treatment acceptable under hospice care criteria? A-No, the patient has elected to forego curative treatment, so Medicare will not pay for the radiotherapy; B-No the patient needs to be removed from hospice care first; C-Yes, the hospice recommends only palliative care but curative treatment is acceptable; D-yes, if the purpose of the treatment is to relieve pain, it is essentially palliative

D-yes, if the purpose of the treatment is to relieve pain, it is essentially palliative

When determining burden of proof for acts of negligence, risk management would classify willfully providing inadequate care while disregarding the safety and security of another as: A-negligent conduct; B-gross negligence; C-contributory negligence; D-comparative negligence

N-gross negigence

The best time to initiate conflict resolution is: A-when those in conflict have had time to resolve their differences; B-when conflict first emerges; B-when conflict interferes with function; D-when those involved ask for conflict resolution

N-when conflict first emerges

If an adult patient is concerned about the emotional effect of his terminal illness on his 7 year old child, the hospice nurse should explain that: A-a 7 year old child is not old enough to understand serious illness and death; B-changing family routines will help the child to come to terms with the illness; C-there are age appropriate ways to assist a child through the grieving process; D-it is helpful to let the child overhear other family members talking about the death of the parent rather than having a direct converstation

there are age appropriate ways to assist a child through the grieving process