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Case Management Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. Which of the following best describes case management? a. A tool... of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate ANS: C Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system. Managed care is a tool of health maintenance organizations. Care management is an enduring process in which a population manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or a group. 2. Which of the following best describes why planning care for an individual is so challenging in today’s health care system? a. Because today’s clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client treatment d. Because so many differenNt UheRaSlthIcNaGreTpBro.viCdeOrsMare in the acute care setting today ANS: B Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client’s continuum of care. The complexities of the system, not the high expectations of the population, new technology, or different providers, is why planning care is so challenging. Coordination of all of these aspects of care, not just one of them, is what makes planning so difficult. 3. Which of the following best describes the primary problem that can result from health care today being given by many different care providers? a. Clients are not sure which provider to see first. b. Health care providers have to make referrals to other providers. c. Clients sometimes are not sure who their primary provider is. d. Overuse, underuse, or gaps in care may result. ANS: D A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication. Clients who have a primary care provider typically know who that provider is and recognize that this is the provider that should be seen first. The referral system is not a primary problem with health care being given by various providers. It is the fragmentation of services that causes the problems within the system. 4. Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 24-year-old who has a master’s degree in public health b. A 34-year-old who will be moving from a large city c. A 44-year-old who was born and raised in the community d. A 54-year-old who, until recently, was a member of the community’s school board ANS: B Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict-resolution skills; critical-thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills. 5. Which of the following best explains why every client doesn’t receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers. ANS: A Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses’ caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet. Health agencies continue to employ more case managers as the cost spent foNr UthRe ScaIreNsGavTesBt.heCaOgMency money in the long-term. Because case management is labor intensive and costly, it is unrealistic for all clients to have a case manager although additional clients could benefit from case management. Nurses fulfill the roles of advocate, care coordinator, and referral agent which are necessary to function as case managers. 6. The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for continuing care to be implemented? a. A physician who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic ANS: C Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client’s health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phonebank location. Wireless prescriptions and plans of care are not necessary for a client who is receiving telehealth services. Home visits may not be necessary for a telehealth client. Through the use of telehealth, the need to visit clinics is decreased. 7. A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important consideration that should be made by the nurse? a. Case management plans should be used only by nurses to manage care. b. Case management plans should be individualized for each client. c. Case managements plans provide additional expense to the client and family. d. Case management plans focus on the natural progression of the disease. ANS: B Adaptation of the case management care plan to each client’s characteristics is a crucial skill for standardizing the process and outcome of care. It links multiple provider interventions to client responses and offers reasonable predictions to clients about health outcomes. Institutions report that sharing case management plans with clients empowers the clients to assume responsibility for monitoring and adhering to the plan of care. Case management plans should link the care that is provided together and involve multiple providers. Case management is part of the standard of care that is provided and does not provide an additional expense to the client, although it may cause an additional expense to the agency. Disease management, not case management, focuses on the natural progression of the disease. 8. A client spends a great deal of his time on the Internet or reading articles related to diabetes and its long-term effects. One day the client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse? a. “Life care plans are only for young persons who are newly diagnosed.” b. “Life care plans are primarily used to determine long-term financial needs for legal reasons.” c. “You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn’t really appropriate.” d. “I was waiting for you to express interest in having a life care plan.” ANS: C Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professNioUnaRl SmIalNprGacTtiBce.. COOthMers who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging. Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice, not young persons with a newly diagnosed illness. The life care plan is a customized, medically-based document that provides assessment of all present and future needs (i.e., medical, financial, psychological, vocational, spiritual, physical, and social), including services, equipment, supplies, and living arrangements for a client. These plans may be used by either a plaintiff or defense lawyer to analyze damages. They are also used to set financial rewards, which can be used to pay for care in the future and create a lifetime care plan. 9. Which of the following Medicaid clients would most likely receive case management? a. An elderly person b. A person receiving rehabilitation following an injury c. A person who has a high-cost chronic disease d. A person with acute illness ANS: C Some states, through their Medicaid programs, are developing disease-management programs for high-cost chronic diseases among their populations, such as asthma and diabetes. An elderly person is most likely receiving Medicare services, not Medicaid services. Additonally, there is not any information that states that the elderly person has a high-cost chronic disease. A person who is receiving rehabilitation following an injury or who has an acute illness does not have a diagnosis that warrants case management, as case management is reserved for those with high-cost chronic diseases. 10. Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client’s rights and self-determination ANS: D In today’s practice, the nurse advocate makes the client’s rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. Integrating evidence-based practice is part of the role of the nurse as a researcher. Gaining organizational and government support and improving community service needs identified by research are not roles of the nurse as an advocate. In the advocate role, the nurse promotes the self-determination of the group. 11. A case manager advocates for a client by helping an insurer understand the client’s needs and desires and by helping the client understand programs and benefits offered by the insurer. What role is the nurse? a. Arbitrator b. Systems allocator c. Mediator d. Negotiator ANS: D NURSINGTB.COM Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. As a systems allocator, the nurse distributes limited health care resources according to a plan or rationale. Mediating is the process of assisting parties to understand each other’s concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome. 12. A nurse reviews with the client what the client can expect during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, “You’ve got my care all mapped out.” Which of the following tools is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management ANS: B Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measureable outcomes. Care planning involves developing a plan of care for an individual. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. 13. A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client’s recovery is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client’s family considered most important ANS: C One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable. To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences. Changing the goal allows other possibilities, which may or may not include long-term care, to be considered. The client outcomes in different settings are not being addressed at this time. Examining the aspects that the family feels is most important can better be considered by bNroUaRdeSniIngNtGhTe gBo.alC. OM 14. The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. Which of the following terms best describes this action? a. Assertiveness b. Collaboration c. Cooperation d. Compromising ANS: B In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties. Assertiveness is the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. When compromising, an individual attempts to find a mutually acceptable solution that partially satisfies both parties. 15. A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing process does this correspond? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase ANS: B The diagnosis phase of the nursing process is analogous to the identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment. During the assessment phase, the nurse develops networks with the target population and disseminates written materials. In the planning phase, the nurse validates and prioritizes problems with all participants. When working through the implementation phase, the nurse contacts providers and negotiates contracts and services. 16. A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process. Which of the following activities would the nurse most likely use? a. Asking the client what is most important b. Seeking appropriate referrals for the client c. Assuring the client that his wishes will be supported d. Determining the order in which actions will occur ANS: C Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking the client what is most important is a way to illuminate values, which occurs in the assessment phase. Seeking appropriate referrals for the client occurs in the assessment phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase. 17. A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? a. Advocating for the client whose values conflict with those of the medical service provider b. Collaborating between nuNrsinRg aInd oGccuBpa.tiConaMl health personnel c. Educating a group regarding community services that are available if ever needed d. Resolving conflict between a primary-care clinic and a tertiary health care facility ANS: C Primary prevention involves the use of the information exchange process to increase the client’s understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed. MULTIPLE RESPONSE 1. Which of the following are the primary goals of case management? (Select all that apply.) a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care ANS: A, B, C The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision making, guideline use, and disease-management programs; and control expenses by managing care processes and outcomes. Case management involves more aspects of care than only care that occurs in the community. Thus, stressing the advantages and benefits of community-based care is not part of the primary goals of case management. 2. A case manager is concerned about his exposure to possible lawsuits. Which of the following are appropriate actions to take to minimize this risk? (Select all that apply.) a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Share client information with the other involved providers and agencies. d. Confirm credentials and capabilities of providers or agencies to give care. ANS: A, B, D Elements that reduce risk exposure include clear documentation of the extent of participation in decision making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources—which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), no nurse is allowed to share information with others without written consent of the client. NURSINGTB.COM [Show More]

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