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A set of exam questions and verified answers related to case management assessment. It covers a wide range of topics in the field of case management, including patient care, care planning, insurance and billing, patient education, and regulatory compliance. The questions and answers provide insights into the knowledge and skills required for effective case management, such as identifying patient needs, coordinating care, navigating healthcare systems, and ensuring patient safety and satisfaction. The document could be useful for students or professionals seeking to enhance their understanding of case management principles and best practices.
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Your patient recieved a cancer diagnosis. You find them crying on their bed. They state they just got divorced and do not have family in town. What would be your PRIORITY action? - CORRECT ANSWERS Comfort your patient, listen to their concerns, and inform them of referrals to inpatient psychosocial services and an oncology nurse navigator. In your psychosocial aassessment you suspect the parent of you 6-year-old patient to be committing Munchhausen by Proxy Syndrome. What PRIORITY actions would you take to protect your patient? - CORRECT ANSWERS Immediately alert you patient's care team, report you suspicions to Child protective services, document you findings inthe patient's chart, and get psychiatry consult STAT to appropriately speparate the parent from the child or have the parent monitored in the room by a sitter You see a family friend on your case management case load. You know you can not care for this person as it would be a conflict of interest. If you were to quickly review their medical chart what legal act would you be violating? - CORRECT ANSWERS HIPPA Your patient is school-aged and has special needs. Their family is very concerned their child will be bullied because of these speical needs. What communication and planning tool would you recommend for the family with members of the school prior to start of school? - CORRECT ANSWERS ARD Your patient with a pre-existing condition purchased an individual healthcare plan online directly from the insurance payer. They did not purchase it on the Healthcare Market Exchange that is covered under the Affordable Care Act. They are upset that their plan does not cover pre-existing conditions for 6 months. What would be your response? - CORRECT ANSWERS The insurance plan you acquired directly from the insurance payer operates outside the Healthcare Market Exchange covered under the Affordable Care Act. As a result, it might have different terms and conditions, including waiting periods for pre-existing conditions. What are the three key domains of a functional status assessment? - CORRECT ANSWERS ADLs, IADLs, Mobility (fall)
You are using aggregated diagnosis groups (ADGs) to classify your patient's care. In which ADG would you classify your patient's infection? - CORRECT ANSWERS Disease etiology Your patient is stable and needs continuous infusion therapy. You are completing the care transition portion of the plan of care and discharge plan. What would be the MOST appropriate care delivery plan for the patient? - CORRECT ANSWERS Ensure a PICC or port access is placed in the hospital. Then give the patient the name of an ambulatory infusion siteof care for their infusions. What law was enacted to protect rights to access to their information and encourage patients to create an advance directive for medical care wishes? - CORRECT ANSWERS HIPAA You are implementing a care plan for your patient with schizophrenia. What PRIORITY diagnoses would you consider them to be at high risk? - CORRECT ANSWERS multiple diagnoses (depression, mania) and violent/unstable behavior A patient is admitted for inpatient sevices who has Medicare. Medicare Part A pays at 100% of the inpatient stay minus the patient's Part A deductible (if they have not met the deductible previously) for how many days? - CORRECT ANSWERS Day 1- 60 What Social Determinate of Health (SDOH) factor does the 2023 HEDIS measures have an updated focus on the patient outcomes? - CORRECT ANSWERS health equity Your patient struggles with polysubstance use of alcohol and narcotics. Their family is strugging to support the patient and how to best care for them once out of the hospital. What community support program? - CORRECT ANSWERS Al Anon Your patient has an alcohol use disorder. They state that they are considering entering an Alcoholics Anonymous program sometime soon but are unsure. What
Your patient with end-stage liver cancer has elected for care transition to hospice. As you are education the family they say, " I am so happy their chem can continue in hospice and have the options of being cured. "What would be your BEST response to educate the family member about the reality of the patient's hospice service? - CORRECT ANSWERS I appreciate you would like the opportunity for a cure. However, I want to make sure you understand they are entering hospice care which will provide measures for their comfort until they pass Your patient is admitted for a 24-hour observation. What are the 3 conditions (acuities) Medicare pays for the inpatient observation without further utilization review? - CORRECT ANSWERS chest pain, asthma, heart failure What is the FIRST step you need to submit when seeking approval for services of procedures for a patient? - CORRECT ANSWERS prior authorization A patient is admitted with a diagnosis of a pulmonary embolism. you see interqual criteria to implement the meidcal necessity an acuity level of the admission plan for the patient. Upon revisting the patient you notice unilateral eye drooping an dslurred speech. You immediately call for a stroke alert. What would be your BEST next step regarding you current plan of care assessment? - CORRECT ANSWERS Decreasing the acuity of the Plan of Care (POC), decreasing the length of stay, care transition, and discharge planning might not be appropriate because the patient's condition has potentially deteriorated and requires further assessment and intervention. You are educating your patient with heart failure about taking spironolactone (Aldactone). How would you BEST educate your patient on how spironolactone works and its relationship to potassium? - CORRECT ANSWERS Spironolactone is a potassium-sparing diuretic used to prevent hyperkalemia (high potassium levels) and to manage conditions like heart failure. This medication helps your body remove excess sodium and water while retaining potassium You would use predictive modeling tools to do what in your care plan assessment? - CORRECT ANSWERS to identify a patient acuity level
What condition does CMS require additional criteria for payment when compared to the Medicare inpatient reahabilitation facility (IRF) 60 percent rule? - CORRECT ANSWERS stroke You need to standardize a care plan to optimize efficiencey. What would you Implement? - CORRECT ANSWERS clinical measures Your patient is asking a lot of personal question that make you feel unabomfortable and cross professional boundaries. The patient states. I have a friend who would be perfect for you. Let me set you up to meet them. What would be your BEST response? - CORRECT ANSWERS What is the OVERALL goal of case management services for CMRNs? - CORRECT ANSWERS To meet patient needs through assessment, coordination, planning, resources, and evaluation of the plan of care A patient with a history of HIV is admitted with an infection and you are monitoring their febrile status. What symptoms would trigger a sepsis alert? - CORRECT ANSWERS Hypotension, tachycardia, dyspnea, and altered mental state You are completing the quality outcomes evaluation of the care plan for a patient. Under which section of the patient's health risk assessment would you include the patient's age and address? - CORRECT ANSWERS Demographics Your patient is a 3-year-old child. You notice they are extremely pale and lethargic. Labs show your patient is severely anemic. You are performing your psychosocial evaluation of this child. What information would you inquire about from the parents regarding their child? - CORRECT ANSWERS Child's medical history, diet, and overall care structure Standards of care and scopes of practice for the CMRN role include domain knowledge and steps and processes. What is one of the MOST important critical thinking scopes and knowledge areas? - CORRECT ANSWERS Continued knowledge of changes to healthcare practice and policies
would you create for the BEST outcomes? - CORRECT ANSWERS Patient- centered care In what way does motivational interviewing elicit behavior change from a patient? - CORRECT ANSWERS It encourages patients to explore and resolve any concerns and ambivalence in a positive engaging manner. You are submitting a quarterly report demonstrating costs and savings regarding case management activities. What is the name of this report? - CORRECT ANSWERS Cost-benefits report A patient has a NEW complaint of pain. Which statement is BEST for eliciting an initial assessment screening? - CORRECT ANSWERS Can you describe your pain to me and when it started? Your patient is having surgery. The pre-op nurse forgot to have your patient sign an informed consent about the surgery. Your patient just received a light-sedative IV medication but is highly coherent. Their spouse is with them and is their legal medical proxy. How would you handle this situation? - CORRECT ANSWERS Although your patient is highly coherent they have been medicated and may not be cognitively sound to sign the informed consent. Have the spouse sign the informed consent as the legal medical proxy. Your patient identifies as transgender. The patient's family is with them. You notice some familial conflict about your patient's gender identity. How would you support your patient in this situation? - CORRECT ANSWERS Ask your patient if they want to speak with you privately about some of their concerns and that you could politely ask the family to leave the room for a short time. Your patient states they are overwhelmed by all the information about their disease and care plan. As a result it is difficult for them to adequately express their thoughts. What type of barrier to communication is your patient experiencing? - CORRECT ANSWERS Psychological noise (?)
You encounter a patient with their spouse in their hospital room. They are overwhelmed by the recent diagnosis and subsequent care transitions needed upon discharge. What would be your BEST education practice to assure that both the patient and their spouse understand and are comfortable with the inpatient care plan and discharge plan? - CORRECT ANSWERS Teach-back method You have an older patient every time her care giver comes to visit you knows the patients bottle signs increase in a pair of that very nervous. They always quickly cover them selves in their bed, my name, and asked not to be left alone with the caregiver, what type of piece would you most likely suspect? - CORRECT ANSWERS concerns about potential elder abuse or mistreatment You are preparing a patient for discharge. They have COPD and require continuous supplemental oxygen upon discharge. The patient is resisting the oxygen at home. What would be your IMMEDIATE intervention? - CORRECT ANSWERS Inquire with open-ended questions as to why the patient is uncomfortable with oxygen at home. Further inquire if it is resistance or lack of education of their disease process. Re-assess their discharge planning. A patient with a history of HIV is admitted with an infection and you are monitoring their febrile status. What symptoms would trigger a sepsis alert? - CORRECT ANSWERS Hypotension, tachycardia, dyspnea, and altered mental state Your patient has autism. They are at risk of elopement from their hospital room to outside of the hospital. What precaution would you implement as part of their psychosocial assessment? - CORRECT ANSWERS Your are communicationg with your patient's hospitalist. How would you provide information regarding you patient's risk for an infection due to their current symptoms and recent labs? - CORRECT ANSWERS