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Which evaluation would you perform to determine if a client has the capability to return to work?
a. pain tolerance evaluation
b. functional capacity evaluation
c. disability evaluation
d. evaluation by client interview
B: The functional capacity exam is a process of assessing a person's physical andfunctional abilities to perform tasks. The patient's performance level should match thedemands of the occupation in question. The purpose of the exam is to determine if a patient
Risk management is a 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: There are six domains for case management practice. These include case managementconcepts, case management principles and practice strategies/practice, psychosocial andsuppqrt systems, healthcare management and delivery, healthcare reimbursement, andvocational concepts/strategies. Risk management is a subdomain of case managementprinciples and practice/strategies.
The case management process of documenting goals, objectives, and actions to meet a client's needs is called:
C: Planning is the process by which a case manager documents goals, objectives, andactions that will meet a client's needs. Assessment entails gathering data about a client'sspecial needs and situation prior to forming a case management plan. Coordination involvesorganization, modification, and documentation of resources necessary to achieve goals setforth in the plan, and monitoring involves securing information needed to gauge theeffectiveness of the plan.
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 is one of the major categories of knowledge necessary for acase manager, because there are many different reimbursement mechanisms availabledepending upon the patient's particular situation.
The primary role of the case manager is to act as a:
a. patient advocate
b. disease manager
c. utilization reviewer
d. care plan creator
A: Patient advocate is the best answer. Advocacy is essential to a case manager's dailypractice. A case manager acts on behalf of clients who may not be able to speak forthemselves or who are not knowledgeable about health care. Above all, the case managershould always have the client's best interest in mind.
Which model of healthcare decision making best demonstrates the principle of beneficence?
a. patient sovereignty
c. shared decision making
B: A relationship between healthcare practitioners and patients is paternalistic andbeneficent. This means that people trust the practitioner to do what is in the best medicalinterest of the patient. Paternalism is justified in that patients usually don't comprehendmedical concepts well enough to make the correct decision about their care. In the patientsovereignty model, the patient is "boss." In this case, one could argue that the patient knowsbetter than anyone else what is in his best interests. Shared decision making means thehealth care team and the patient work together.
According to the Standards of Practice for Case Managers, there are four key functions of a case manager. Which of the following is NOT one of the key functions?
C: The four key functions of a case manager are planner, assessor, facilitator, andadvocate. A case manager must assess a situation to identify problems that need casemanagement. The case manager must also plan long- and short-term goals in collaborationwith the client, the client's family, and with other healthcare professionals. Facilitationincludes coordinating and implementing the care plan, maintaining communication, andexpediting care. As an advocate, the case manager ensure that the client's needs areidentified and addressed.
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: The term "within the walls" (WTW) refers to activities within the acute hospital environment. This is distinct from "beyond the walls" (BTW), which refers to case management in outpatient and community settings.
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
C: This scenario describes the process known as a viatical settlement whereby a patient can obtain cash value from a life insurance policy prior to death. Answers A, B, and D are irrelevant to the situation.
A relationship whereby a case manager acts in a client's best interest based on trust is known as:
b. ex parte
d. due diligence
A: A case manager establishes a relationship with a client to advocate for his best interests. This makes the case manager a fiduciary. The term ex parte refers to a legal proceeding or a legal order. A tort, on the other hand, refers to a wrongful act performed willfully. When a person investigates a business or personal relationship prior to signing a contract, he is performing due diligence.
When a case manager refers a client to a specific provider, what type of relationshipexists between the case manager and the provider?
a. vicarious agency
c. ostensible agency
C: The relationship that exists between the case manager and a referral provider is an ostensible agency. If that provider were to perform negligent actions, the referring case manager may also become subject to litigation. A fiduciary is a relationship whereby the case manager acts in the client's best interests. The case manager is an advocate for the client, not the provider.
A case manager knowingly refers a patient to a provider who is unqualified to renderservices to the patient This is known as a:
a. temporary referral
b. dual relationship
c. referral by client consent
d. negligent referral
D: A case manager has to have knowledge of the referral provider's credentials and clinical experience. If a case manager sends a patient to an unqualified referral provider,this constitutes a negligent referral. It is important for the case manager to check in with patients afterward to assure that they had a positive experience with the provider. It is also the case manager's responsibility to report any misconduct on the part of that provider.
You have decided to become a case manager for a friend. Which of the following bestdescribes this situation?
a. unbiased relationship
c. dual relationship
d. professional courtesy
C: This type of relationship is a dual relationship, because you are both friend and case manager. This often leads to a conflict of interest Having a friendship with the client outside of the clinical arena introduces biases that interfere with your performance as a professional.
A managed care contract may have provisions that prohibit doctors from discussingtreatment choices with patients if the choices are not covered by their managed care plan.This provision is an example of a( an):
a. confidentiality provision
b. gag clause
c. ethical dilemma
d. clinical pathway
B: In a managed healthcare plan, a gag clause prevents healthcare providers from discussing with the patient treatment options that are not covered by that particular managed care plan.
Which of these statements is TRUE about advance directives?
a. The documents need not be legally executed
b. Advance directives are used if the patient becomes incompetent
c. Advance directives remove autonomy from the patient
d. Advance directives can be drawn up by the next of kin if patient is incompetent
B: An advance directive is legally executed. The document delineates the patient's healthcare-related decisions. The patient draws it up while he/she is still mentally competent.
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: Medical power of attorney is a document allowing a person to appoint someone else to make medical care decisions in the event that he/she can't communicate. Living wills,medical power of attorney, and durable power of attorney are all types of advance directives.
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 a chronic illness
d. none of the above
A: Polypharmacy refers to the use of multiple medicines or the taking of more medications than are medically indicated. It is a common phenomenon in the elderly.
A 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. hospitalist team
d. hospice setting
C: Physicians who care for hospitalized patients are known as hospitalists. This eliminates the burden on the PCP so that he or she can focus on office practice. There isoften at least one case manager on a hospitalist team. Entrepreneurial case managers run their own case management businesses. Hospice case managers coordinate care of dying patients and their families. A skilled nursing facility is for patients who can no longer perform self-care.
You are the case manager for a client with a chronic illness. The healthcare teamstrongly recommends treatment, but the patient and family oppose it Which is the most appropriate step to take next?
a. Arrange for a second opinion
b. Carefully review options with the patient to ensure complete understanding
c. Immediately consult the hospital ethics committee
d. Transfer the patient's care to another hospital
B: Sometimes patients oppose treatment due to inadequate understanding of clinical information and treatment options. Before proceeding with other actions, the case manager should ensure that the patient has a complete understanding. Discussions and decisions are carefully documented in the chart.
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: In cases such as this one where no parent, spouse, sibling, significant other, or close friend is available to make decisions, two physicians can serve as surrogates.
Which of the following is an exception to written consent to 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: With anonymous testing, oral consent is acceptable. Other exceptions include emergency situations when a diagnosis is needed and the patient is unable to sign, to determine the cause of death, and for research purposes in which the patient remains anonymous.
2. The process by which you would screen the patient's medical record to determine if thepatient received appropriate standards of care is known as:
a. an incident report
b. risk management
c. quality review
d. utilization review
C: A quality review helps determine if a patient received recognized standards of care.An incident report is a tool used to document adverse or unusual occurrences. Risk management identifies, evaluates, and corrects risks that may lead to injury to patients,staff, or visitors. During utilization review, medical services are evaluated for necessity and appropriateness.
23. 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: Patient under subacute care don't need diagnostic work-ups. Subacute care includes all levels of care not requiring acute hospitalization. The patients are medically stable and have a constant treatment plan.
A client is medically stable but needs intermittent nursing intervention to maintain stability. The patient also needs intermittent subcutaneous injections, routine non-sterile suctioning, and a stable respiratory therapy plan. What level of care is this patient receiving?
a. assisted living
b. custodial care
c. intermediate care
d. skilled nursing
C: The scenario describes intermediate care. Under assisted living or custodial care, the client is stable, takes a consistent regimen of oral medications, and does not need suctioning. Skilled nursing is for complex, but generally stable, patients who may need central line care, IV push medications, variable adjustments in dosages of medicines, and assessment of laboratory values.
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 gatekeepers
d. A PPO allows use of outside physicians and incurs a lower cost to the member
B: A PPO is an insurance model that offers patients a preferred panel of physicians. A patient may choose to utilize an "outside" physician, but this would result in lower reimbursement and a greater cost to the patient member. HMOs use physicians as gatekeepers.