CCM sample test

Question 1

1. A pediatric patient who is ventilator-dependent and has a gastrostomy button is scheduled to be discharged to home with visits from a home health nurse. Prior to discharge, the nursing case manager’s most critical action is to:

assess the patient’s long-term home care needs.
procure the required home medical equipment.
secure funding sources for home health care.
verify the safety of the patient’s home environment.

Answer 1

verify the safety of the patient’s home environment.

Question 2

Which type of authorization is generated when services are rendered?

Concurrent.
Prospective.
Retrospective.
Subauthorization.

Answer 2

Concurrent.

Question 3

3. Managing clinical outcomes, studying variance trends, and evaluating actions taken to correct deviations from critical pathways are components of:

performance improvement.
risk management.
the nursing process.
utilization review.

Answer 3

performance improvement

Question 4

4. Medication errors, orders for unnecessary tests, and omission of standard tests or procedures are classified as which type of variance?

Community.
Operational.
Patient.
Practitioner.

Answer 4

practitioner

Question 5

5. To avoid hospital readmission, a patient requires services at a specialty clinic. Because the services are not covered under the patient’s healthcare plan, the nursing case manager intercedes with the patient’s insurance company. In this situation, the nurse is acting in the role of:

broker.
consultant.
negotiator.
provider.

Answer 5

negotiator

Question 6

When using a utilization tool to perform a concurrent review, the nursing case manager recognizes that:

discharge is required whenever the tool so indicates.
exceptions exist because utilization tools reflect only average circumstances.
patients have the right to set length of stay without incurring nonreimbursable costs.
the use of utilization tools guarantees payment for services.

Answer 6

exceptions exist because utilization tools reflect only average circumstances.

Question 7

Ideally, nursing case management planning identifies goals that are:

anticipated, acceptable, and appropriate.
challenging and timely.
patient focused and cost effective.
realistic, measurable, and specific.

Answer 7

realistic, measurable, and specific.

Question 8

8. A patient who is experiencing homelessness has been admitted to the hospital with multiple health care issues. The nursing case manager, physician, social worker, and clinical dietitian work together to care for the patient. This interprofessional interaction is referred to as:

collaboration.
consultation.
continuity.
coordination.

Answer 8

collaboration.

Question 9

11. The nursing case manager receives a referral to provide case management services for an adolescent mother who was recently diagnosed with HIV. Which statement indicates that the patient understands her illness?

“I can never have sex again, so I guess I will always be a single parent.”
“I will wear gloves when I’m caring for my baby because I could infect my baby with AIDS.”
“My CD4 count is 200 and my T cells are less than 14%. I need to stay at these levels by eating and sleeping well and staying healthy.”
“My CD4 count is 800 and my T cells are greater than 14%. I need to stay at these levels by eating and sleeping well and staying healthy.”

Answer 9

“My CD4 count is 800 and my T cells are greater than 14%. I need to stay at these levels by eating and sleeping well and staying healthy.”

Question 10

9. Which healthcare provider at a rehabilitation facility addresses the cognitive, behavioral, and psychological problems that result following a patient’s traumatic brain injury?

Medical social worker.
Neuropsychiatrist.
Neurosurgeon.
Psychologist.

Answer 10

neuropsychiatrist

Question 11

10. Authoritative statements addressing the foundational knowledge and skills of the nursing case manager’s actions are:

codes of conduct.
codes of ethics.
standards of practice.
state licensures.

Answer 11

standards of practice

Question 12

12. To treat an infected foot, a patient with Medicare Part A is prescribed a two-week course of IV antibiotics, wound care, and physical therapy for mobility training. The nursing case manager recommends discharge to:

a skilled nursing facility.
an acute care hospital.
an acute rehabilitation facility.
home with home health services.

Answer 12

a skilled nursing facility

Question 13

13. The nursing case manager reviews information about the number of patients with asthma who have received care from a specialist, those who have not, and the number of emergency department (ED) visits and inpatient hospitalizations for both groups. When comparing the data to develop interventions, the nurse engages in:

aggregate data analysis.
benchmarking.
collaboration.
integrated data solutions.

Answer 13

aggregate data analysis

Question 14

14. The nursing case manager meets with a 15-year-old patient with type 1 diabetes, who has a recent A1C of 8%. The patient reports smoking two to three cigarettes per day, denies using alcohol, and states, “I hate having diabetes; I just want to be like my friends.” Which referral will benefit this patient’s immediate needs?

A smoking cessation group for adolescents.
A support group for adolescents with diabetes.
An education session about insulin, aimed at adolescents.
Family counseling.

Answer 14

A support group for adolescents with diabetes

Question 15

15. Which ethical principle is grounded in truth?

Autonomy.
Beneficence.
Fairness.
Veracity.

Answer 15

veracity

Question 16

16. To cover the cost of durable medical equipment, a patient who is enrolled in Medicare is required to:

appeal for coverage.
request coverage.
seek supplemental insurance.
share in the cost.

Answer 16

share in the cost

Question 17

17. When developing a program for patients who are newly diagnosed with diabetes, the nursing case manager demonstrates an understanding of learning styles by:

administering a pre- and post-test assessment.
allowing attendees time to voice their opinions.
providing a snack with a low glycemic index.
utilizing a variety of educational materials.

Answer 17

utilizing a variety of educational materials.

Question 18

Which primary resource guides the nursing case manager’s practice?

American Case Management Association’s Member Code of Conduct.
Case Management Society of America’s Standards of Practice for Case Management.
American Nurses Association’s Nursing: Scope and Standards of Practice.
American Nurses Association’s Nursing’s Social Policy Statement: The Essence of the Profession

Answer 18

Case Management Society of America’s Standards of Practice for Case Management.

Question 19

The nursing case manager, who refers a 67-year-old patient to a skilled nursing facility for rehabilitative care, knows that it will be billed under which component of Medicare?

Medicare Part A.
Medicare Part B.
Medicare Part D.
Medigap.

Answer 19

Medicare part A

Question 20

Which right is a provision in the American Hospital Association’s Patients’ Bill of Rights?

Competent patients must be informed about advance directives and be able to accept or refuse treatment.
Patients must have access to an interpreter or translation services to effectively communicate concerns and discuss the treatment plan, provide consent, and receive discharge information.
Patients must receive a timely response following a request of care and appropriate, professional care as ordered by a physician.
Patients must receive any necessary examination and treatment during any emergency or when female patients are in labor, dependent on their ability to pay.

Answer 20

Patients must have access to an interpreter or translation services to effectively communicate concerns and discuss the treatment plan, provide consent, and receive discharge information.

Question 21

A doctor wants to order a brand-name fibromyalgia medication that is not covered by a patient’s insurance provider. As the patient has failed multiple agents prior to this prescription, the nursing case manager:

advises the doctor that the medication is not covered and suggests revisiting some medications that were ordered before.
directs the patient to the website of the drug company’s patient assistance program for alternative medications.
negotiates the self-pay cost for the brand name medication with the pharmacy.
submits the request for prior authorization to the insurance company with accompanying medical justification.

Answer 21

submits the request for prior authorization to the insurance company with accompanying medical justification.

Question 22

A patient with hypertension resides in a homeless shelter 30 minutes from the patient’s primary clinic. The patient’s physician recommends checking their blood pressure three times per week to determine efficacy of the patient’s antihypertensive medications. The nursing case manager:

contacts a clinic more accessible to the patient for followup.
has the patient purchase a blood pressure machine to self-monitor.
informs the patient that they have to provide their own transportation.
instructs the patient to use a blood pressure machine at a local store.

Answer 22

contacts a clinic more accessible to the patient for follow up

Question 23

The nursing case manager is concerned about the increase in the number of falls requiring hospitalization among older adults in the community. In order to identify those patients at greater risk for readmission, the nurse:

administers the Short Form 36 Health Survey at a community health fair.
interviews individual patients with their families present.
requires in-home evaluations by physical and occupational therapists.
reviews the patients’ daily nutrition diaries and medication lists.

Answer 23

administers the Short Form 36 Health Survey at a community health fair.

Question 24

In synthesizing data for a disease management program, the nursing case manager uses which source of data triangulation to validate a conclusion?

Cost, containment, and length of stay.
Method, cause, and reaction.
Reason, rationale, and resolution.
Time, space, and person.

Answer 24

time, space and person

Question 25

. A patient, covered by Medicare with limited financial means, was discharged from the hospital following total knee replacement surgery and will require six weeks of IV antibiotic therapy. The patient wants to go home. During the assessment, the nursing case manager discovers the patient lives alone, has no support at home, and lacks the dexterity to perform the infusion. What is the nurse's next step? Collaborate with the insurance company to extend the patient's hospital stay. Explain the barriers to going home and discuss other options with the patient. Make a home-infusion referral to fulfill the patient's request. Order self-administered occupational therapy dexterity training.

Answer 25

Explain the barriers to going home and discuss other options with the patient.

Question 26

The most common expectation of insurers is that an observation hospital stay will not exceed: 6hrs 12 hrs 24 hrs 48 hrs

Answer 26

24 hours

Question 27

The case mgmt plan includes all the following components except: Clients barriers/needs Case mgmt interventions to address clients needs Outcomes Goals

Answer 27

Outcomes are achieved as a result of implementing the case mgmt plan.

Question 28

Which are false about ho care infusion services? In most cases, home infusion services can be safely administered Home care patients must be stable to receive infusion services at home It is always more cost effective to deliver infusion services at home vs a clinic or Md office There does not always have to have a primary caregiver available

Answer 28

It is always more cost effective to deliver infusion services at home vs a clinic or Md office

Question 29

The 5 tasks of the case manager in the chronic care model include which of the following Assessment, planning and care coordination Assessment, interventions, and f/u Assessment, planning and f/u Assessment, follow up and care coordination

Answer 29

Assessment, f/u and care coordination

Question 30

The American association of managed care nurses (AAMCN) lists the components of managed care nursing as the clinical process, case management process, the utilization review process and which of the following? Physician review process Retrospective review process Disease management process Appeal process

Answer 30

Disease management process (Also quality management and demand management processes is in their standards)

Question 31

The type of insurance plan that offers the most flexibility is the: A) Point-of -Service Plan (POS) B) Health Maintenance Organization (HMO) C) Preferred Provider Organization (PPO) D) Indemnity Plan

Answer 31

Indemnity plan

Question 32

Which of the following is a system of healthcare delivery whose goal is to maintain quality, cost- efficient, and effective healthcare. A) Managed Care B) Preferred Provider Organization (PPO) C) Health Maintenance Organization (HMO) D) Utilization Review

Answer 32

Managed care

Question 33

The case manager is working with a client in a weight loss program. The client makes the statement, " I have thrown out all of the unhealthy food in the house. I also started collecting healthy recipes and am ready to start my new way of eating on Monday." The case manager knows the client is in which stage of change? A) Pre-Contemplation B) Action C) Preparation D) Contemplation

Answer 33

Preparation

Question 34

Eligibility criteria for Social Security Disability Insurance (SSDI) include the inability to work based on a physical/ mental disability as well as A) age 62 or older. B) age 65 or older. C) having a work history and accumulation enough work credits. • D) meeting income guidelines.

Answer 34

having a work history and accumulation enough work credits -Earned benefit! -Physical/medical impairment and cannot work and no be able to adjust to other work because of condition -disability expected to last for at least 1 year or to result in death

Question 35

Workers' compensation pays for all of the following except: A) Benefits to survivors of workers who die of work- related causes B) Rehabilitation and training for workers who are unable to return to pre-injury careers C) Medical care for work-related injuries D) Legal fees

Answer 35

Legal fees Workman’s comp: -pmt for medical tx and expenses -pmt time off work for recovery -pmt for any perm impairment -voc rehab if worker can’t return to pre injury career -payment of benefits in event of death. Dependents get burial expenses and lump sum pmt in most states

Question 36

The percentage of billed charges that the member of a health plan pays for covered services is the: A) deductible B) coinsurance C) copayment D) fee for service

Answer 36

Co insurance: a fixed percentage

Question 37

Higher-order norms or fundamental assumptions that are consistent with a society's moral principles and constitute higher standards of moral behavior are: societal mores. codes of conduct. ethical principles. cultural values.

Answer 37

Ethical principles

Question 38

The State Children's Health Insurance Program (SCHIP) provides health insurance coverage for uninsured and underinsured children who: • require additional health insurance coverage to Medicaid. have household income above the Medicaid qualifyin income. • require additional health insurance coverage to private insurance. have household income below the Medicaid qualifying income.

Answer 38

"The best and correct answer is "have household income above the Medicaid qualifying income”

Question 39

A healthcare cost trend factor that can be most directly impacted by case managers is: case mix index. • cost-shifting. contract changes. intensity of service.

Answer 39

"The best and correct answer is "intensity of service."

Question 40

• MENO comment The client understands that the health coach functions as a(n) ally. teacher. medical authority. resource specialist.

Answer 40

Ally

Question 41

A key component of the Chronic Care Model is strict adherence to prescribed medication management. focus on care for exacerbations or complications. use of multiple specialty providers. planned, regular interactions with caregivers.

Answer 41

The best and correct answer is "planned, regular interactions with caregivers."

Question 42

In motivational interviewing theory, an individual in the contemplation stage of change • acknowledges there is a problem. develops and implements a plan of change. stops using drugs and alcohol. becomes overwhelmed by the thought of making a change.

Answer 42

The best and correct answer is "acknowledges there is a problem

Question 43

Chape MCUd According to the Center for Medicare and Medicaid Services (CMS), hospitals are required to provide a list at discharge of post-discharge providers for patients to choose a: hospice provider. home health agency. parish nursing provider. primary care physician.

Answer 43

The best and correct answer is "home health agency."

Question 44

Insert Table Chart Text Shape Media Comment Share It is easier for a case manager to obtain the cooperation of other disciplines if the key player is a physician. a non-threatening relationship has been developed. the case manager develops the plan first. an established team exists prior to case management.

Answer 44

The best and correct answer is "a non-threatening relationship has been developed."

Question 45

Snape Media Comment Which of the following describes the role of hospital risk management departments? To identify employees that should be terminated To rate clients based on their risk potential To evaluate risks to prevent future loss To use anecdotal reports to analyze events

Answer 45

The best and correct answer is "To evaluate risks to prevent future loss"

Question 46

Which of the following is used in most predictive modeling tools to identify the severity levels of a population? • Lab values. • Paid medical claims. • Health risk assessment results. • Practice management.

Answer 46

• The best and correct answer is "Paid medical claims."

Question 47

In a workers compensation case, a field-based case manager intervention may be required if the treating physician o prescribes short-term physical therapy. labels the period of disability as indefinite. • orders short-term chiropractic care. reports that the injured worker can return to his or he job.

Answer 47

The best and correct answer is "labels the period of disability as indefinite."

Question 48

The main purpose of client involvement in developing a rehabilitation plan is to meet regulatory requirements. organize the delivery of services and control costs. improve precision in achievement of goals. set long-term goals.

Answer 48

The best and correct answer is "improve precision in achievement of goals."

Question 49

Which of the following is a term used to describe a learned, progressive process or coping mechanism as a result of reacting to the behavior of a substance abuser? Co-dependency. Repression. Dysfunction. Denial.

Answer 49

Codependency

Question 50

According to the Rehabilitation Act of 1973, tasks that must be performed on the job, even if the method differs between employees with and without disabilities, are called physical job demands. essential job functions. reasonable accommodations. worker traits.

Answer 50

Essential job functions

Question 51

Two essential components of a risk management program are a, application of techniques and controls B. fall prevention and fall, preparedness C. loss control, and loss prevention D, risk identification and compliance

Answer 51

Loss control and loss prevention

Question 52

Higher-order norms or fundamental assumptions that are consistent with society’s moral principles and constitute higher standards of moral behavior are a. Societal mores B. Codes of conduct. C. Ethical principles D. Cultural values.

Answer 52

Ethical principles

Question 53

Historically, senior programs in the US have not served older people well due to a. lack of care coordination B. Lack of community resources C. Cost of nursing home care. D. Lack of family support.

Answer 53

Lack of care coordination

Question 54

A client’s husband was recently hospitalized for cirrhosis of the liver and has accepted diagnosis of alcoholism. What is the most appropriate support group to refer her to a. NA. B. A. A. C. Al-Anon D. OA.

Answer 54

Al anon