Question 1

The population nurse case manager is preparing a case management plan for a client. What should the nurse remember about this type of plan when creating it for the client?

Accepted Answer

4. A case management plan is a series of expected outcomes of care and related activities that address the contribution of each discipline involved in the care of a particular patient or population. Effective case management plans are interdisciplinary and flexible and address clients' needs in a comprehensive fashion. The plans are not generic, static, or time-limited.

Question 2

The population health nurse case manager is determining a client's need for case management. Which indicators should the nurse identify as being social? (Select all that apply.)

Accepted Answer

2. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.
3. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.
4. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.
5. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.

Question 3

A client being case managed has become unstable. What should the nurse case manager do?

Accepted Answer

3. Care of unstable clients should not be delegated to unlicensed assistive personnel or automatically referred but should be retained by the case manager or other qualified personnel. After assessment the client might be referred to the primary care provider.

Question 4

The population nurse is reviewing goals with a newly hired case manager. Which goal should the nurse identify as being system-centered?

Accepted Answer

1. A system-centered goal for case management is reducing the duplication and fragmentation of services. Better coordination of care, access to affordable services, and ability to function independently are client-centered goals or benefits of case management.

Question 5

The nurse is managing the care of a client with end-stage renal failure, anemia, and chronic pain from osteoarthritis. Within the case management system, which tier should be used to guide this client's care?

Accepted Answer

3. A tiered case management system comprised of three levels. The first level is designed to provide self-care support for the bulk of the population needing services. The second level of case management involves high-risk disease management and might be appropriate for brittle diabetics or women with high-risk pregnancies who require more intense services and more frequent monitoring. The third level addresses care of clients with complex needs who require a broad array of services such as the client with renal failure, anemia, and chronic pain from osteoarthritis. There is no fourth tier in the tiered case management system.

Question 6

The local health department has been criticized for not providing effective communicable disease control programs. What ethical problem should the population health nurse identify that the health department is committing?

Accepted Answer

1. Negligence is the failure to act in a situation as a reasonably prudent nurse would if faced with the same situation. Failure of a local health department to provide effective communicable disease control programs could be considered an example of negligence at the population level. Breach of contract occurs when a managed care organization drops a client from the plan without adequate justification or when the system fails to pay for care that should be covered by the plan. Abandonment occurs when the case manager terminates services to a client with continuing needs without notifying the client or arranging for services from another provider. Variances are deviations from the typical path, which is not the best description of this situation.

Question 7

The population health nurse case manager is assisting a client identify the closest facility to have a required diagnostic test completed. Which principle of case management is the nurse performing with the client?

Accepted Answer

3. Assisting a client to identify the closest facility to have a required diagnostic test is an example of navigating the health care system. Assisting the client is not an example of client advocacy, client safety, or linking with community resources.

Question 8

A client who has asthma is being assisted by the case manager to achieve control of the disease. Which type of care is the case manager providing to the client?

Accepted Answer

2. Disease management is the process of intensively managing a particular disease across different care settings. Case management is assisting the same client to meet a wide variety of health and social needs. Multidisciplinary care is a team of health care professionals with a designated coordinator. Although the disease management plan might include assessment of risk factors that trigger asthma attacks, this is only one aspect of control of the disease.

Question 9

The population health nurse is reviewing the goals for managing the care of a client. Which goal should the nurse identify as being client-centered?

Accepted Answer

2. Improved quality of life is a client-centered goal or benefit of case management. Cost containment and cost-efficiency, decreased paperwork, and financial viability are system-centered goals or benefits of case management.

Question 10

The diabetes nurse education is telephoning clients to assess current Hgb A1c rates and the results of their last ophthalmologic examinations. Which case management model is the nurse using to provide care?

Accepted Answer

4. Disease-specific case management is often provided by a nurse with expertise in a particular area who provides both direct care related to management of the disease as well as education, advice, and referral for other needed services. In a linked model, the case manager makes referrals for services to independent services and networks. In intensive case management models, the majority of services needed by clients are offered by a single organization, often the organization that provides the case management services. Supportive case management addresses immediate discrete service needs and involves short-term service provision.

Question 11

The population health nurse case manager addresses the client's holistic needs when managing the care of the client. What actions should the nurse expect to perform when adhering to this case management principle? (Select all that apply.)

Accepted Answer

1. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.
2. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.
3. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.
4. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.

Question 12

The case manager arranges for the transfer of the client's records from the primary care provider to the home health agency. In which role is the case manager functioning?

Accepted Answer

3. The coordinator of care arranges seamless care across systems and agencies to meet client needs. An example of the coordinator of care's role function is arranging for transfer of client records from the primary care provider to the home health agency. The consultant provides assistance to clients and other health care professionals regarding client needs and available services. The clinical expert is knowledgeable regarding clinical conditions and best, evidence-based practice. The change agent promotes change in client behaviors and/or health care delivery systems.

Question 13

The nurse is making a referral for the client. What should be the nurse's first consideration for this referral?

Accepted Answer

4. The first consideration in making a referral is the acceptability of the referral to the client. The second consideration is the client's eligibility for the service provided. The presence of situational constraints or factors in the client's situation that would prevent him or her from following through with the referral is the third consideration. The cost of the service is not a consideration when making referrals.

Question 14

The nurse is deciding tasks to delegate to other caregivers. What should the nurse use to help making these delegation decisions?

Accepted Answer

3. The nurse manager is guided by the following decisions when making delegation decisions: stability of the client, competence of the person to whom the task is being delegated, level of decision making and problem solving required, ability of the client for self-care, and the predictability of the outcome of the task. Age, education, and ability for self-care will not help the manager make delegation decisions.

Question 15

The population health nurse is evaluating outcomes for a group of clients based upon the best possible achievable outcome. Which action is the nurse completing?

Accepted Answer

4. A benchmark is a standard of performance against which the performance of a given system can be judged. Clinical benchmarking reflects the best outcome actually achieved for a group of clients or a diagnosis, as well the best possible achievable outcome. Assessment involves identification of the need for case management services. Screening involves risk identification. Delegation involves transferring authority to a competent individual.

Quiz 12: Case Management