Relias Case Management Assessment A | Complete Questions &
Answers (Solved) 100% Correct - 200 Questions
This exam assesses advanced understanding of the Case Management Process, including assessment, planning,
facilitation, coordination, monitoring, and evaluation within complex healthcare systems. Candidates must
demonstrate the ability to synthesize evidence-based guidelines, ethical principles, and regulatory standards to
optimize patient outcomes and resource utilization. It contains 200 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Case Management Process, Utilization Management, Care Coordination and Transition
Planning, Patient Advocacy and Ethics, Legal and Regulatory Compliance, Documentation and Communication,
Resource Management and Cost Containment, Quality Improvement and Outcomes Measurement,
Interdisciplinary Collaboration, Psychosocial and Cultural Considerations. Targeted learning outcomes include:
Apply the case management process to complex clinical scenarios; Analyze barriers to care coordination and
propose evidence-based solutions; Evaluate the effectiveness of case management interventions using outcome
metrics. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students can
study with confidence and self-correct as they work through the bank. Use it as a high-yield review immediately
before the exam, or as a structured practice tool during the unit - the rationales double as concise teaching notes.
The recommended writing time is 3 hours, with a passing score of 90%. Aligned with Accredited by the
Section 1: Case Management Process (Questions 1-20)
1 During the assessment phase of the case management process, a case manager
identifies that a patient with chronic obstructive pulmonary disease has a history
of multiple emergency department visits and hospital readmissions within the past
year. The patient reports inconsistent use of prescribed inhalers due to cost and
lack of understanding of the regimen. Which of the following actions should the
case manager prioritize first in the planning phase?
A) Arrange for a pulmonary rehabilitation program to improve exercise tolerance
and reduce exacerbations
B) Refer the patient to a financial counselor to explore medication assistance
programs and subsidy options
C) Develop an individualized education plan focusing on inhaler technique and
disease self-management
D) Coordinate a transitional care plan that includes a follow-up appointment with a
pulmonologist within one week
Answer: B
Rationale: The assessment reveals cost and knowledge as key barriers. Addressing
financial barriers first (option B) is critical because without affordable access to
medications, education and follow-up (options C and D) will be ineffective.
Pulmonary rehabilitation (option A) is beneficial but not the immediate priority
when medication adherence is compromised by cost.
,2 A case manager is evaluating the effectiveness of a care coordination intervention
for a population of patients with diabetes. Six months post-implementation, the
case manager reviews outcome data: HbA1c levels have decreased by an average
of 0.5%, but emergency department visits for hypoglycemia have increased by
15%. Which of the following conclusions is most appropriate?
A) The intervention is effective overall, as the primary outcome (HbA1c)
improved
B) The intervention may have unintended consequences, and a root cause analysis
is warranted
C) The increase in ED visits is unrelated to the intervention and should be ignored
D) The intervention should be discontinued immediately due to the increase in
adverse events
Answer: B
Rationale: Effective case management requires monitoring both intended and
unintended outcomes. The improvement in HbA1c suggests some benefit, but the
increase in hypoglycemic events (a serious adverse outcome) indicates a potential
flaw in the intervention, such as overly aggressive glycemic targets or inadequate
patient education. A root cause analysis (option B) is needed to understand the
relationship before modifying or discontinuing the intervention (option D). Option A
ignores the harm, and option C is dismissive.
3 In the context of case management, which of the following best describes the
concept of 'care transitions' as a distinct phase within the case management
process?
A) The transfer of a patient from one healthcare setting to another, requiring
coordination and communication to ensure continuity
B) The process of discharging a patient from the hospital to home with a follow-up
phone call within 48 hours
C) The period during which a patient moves from acute illness to recovery,
managed primarily by the primary care provider
D) The handoff of a patient from a case manager to a social worker for community
resource linkage
Answer: A
Rationale: Care transitions are a core component of the case management process,
specifically within the coordination and monitoring phases. They involve any
movement between settings (e.g., hospital to skilled nursing facility, hospital to
home) and require comprehensive planning, communication, and follow-up to
prevent adverse events. Option A captures this broad definition. Option B is too
,narrow (only discharge to home with a phone call). Option C is vague and not
specific to transitions. Option D describes a task handoff, not a care transition.
4 A case manager is developing a comprehensive care plan for a patient with
multiple chronic conditions, including heart failure, diabetes, and chronic kidney
disease. The patient is on multiple medications and has a history of nonadherence
due to complex dosing schedules. Which of the following strategies is most
aligned with the 'planning' phase of the case management process?
A) Prescribing a fixed-dose combination pill to simplify the medication regimen
B) Conducting a medication reconciliation and collaborating with the patient to
prioritize goals
C) Arranging for home health nursing to administer daily medications
D) Referring the patient to a pharmacist for a comprehensive medication review
Answer: B
Rationale: The planning phase involves collaborative goal setting and development
of a patient-centered plan. Option B (medication reconciliation and goal
prioritization with the patient) is a core planning activity that engages the patient and
addresses adherence barriers. Option A is a prescribing action outside the case
manager's scope unless they are a prescriber. Option C is an intervention that may be
implemented after planning. Option D is a referral, which is part of the
implementation phase, not the initial planning.
5 A case manager is monitoring a patient with a spinal cord injury who is
transitioning from inpatient rehabilitation to home. The case manager notes that
the patient's home environment lacks wheelchair accessibility, and the family
expresses concern about providing care. Which of the following actions should
the case manager take during the 'monitoring' phase?
A) Delay the discharge until home modifications are completed
B) Schedule a home visit to assess the environment and provide caregiver training
C) Refer the patient to a social worker to arrange for home modifications
D) Document the concerns and proceed with discharge as planned
Answer: B
Rationale: Monitoring involves ongoing assessment of the patient's progress and the
effectiveness of the care plan. Option B (home visit and caregiver training) allows
the case manager to directly observe barriers and intervene proactively, which is
consistent with monitoring. Option A is a planning/coordination action, not
monitoring. Option C is a referral, which may be appropriate but does not involve
the case manager's monitoring role. Option D ignores the identified risks.
, 6 In the case management process, which of the following is a primary purpose of
the 'evaluation' phase?
A) To determine the patient's eligibility for services and benefits
B) To assess the quality and outcomes of case management interventions against
established benchmarks
C) To identify the patient's strengths, needs, and preferences
D) To coordinate referrals and appointments with specialists
Answer: B
Rationale: The evaluation phase focuses on measuring the effectiveness, efficiency,
and quality of the case management process and interventions. Option B correctly
describes this purpose. Option A is part of assessment. Option C is assessment.
Option D is coordination/implementation.
7 A case manager is working with a patient who has a history of substance use
disorder and is currently enrolled in a methadone maintenance program. The
patient is also being treated for hepatitis C. The case manager discovers that the
patient has missed two consecutive methadone clinic appointments. Which of the
following is the most appropriate initial step in the case management process?
A) Discharge the patient from case management due to nonadherence
B) Contact the patient to explore barriers to attendance and re-engage in care
C) Notify the hepatitis C treatment team to discontinue antiviral therapy
D) Refer the patient to a higher level of substance use treatment
Answer: B
Rationale: The case management process emphasizes patient engagement and
addressing barriers. Missed appointments are a red flag, but the initial step is to
reach out to the patient (option B) to understand the reasons (e.g., transportation,
side effects, relapse) and collaboratively problem-solve. Option A is premature and
punitive. Option C is not indicated without assessing the situation. Option D may be
necessary but is not the first step.
8 During the 'facilitation' phase of case management, a case manager is coordinating
a multidisciplinary team meeting for a patient with complex needs. Which of the
following strategies best ensures effective collaboration and patient-centered care?
A) Inviting only the physicians and nurses to the meeting to streamline
decision-making
B) Sending a summary of the meeting to the patient after decisions have been
made
Answers (Solved) 100% Correct - 200 Questions
This exam assesses advanced understanding of the Case Management Process, including assessment, planning,
facilitation, coordination, monitoring, and evaluation within complex healthcare systems. Candidates must
demonstrate the ability to synthesize evidence-based guidelines, ethical principles, and regulatory standards to
optimize patient outcomes and resource utilization. It contains 200 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Case Management Process, Utilization Management, Care Coordination and Transition
Planning, Patient Advocacy and Ethics, Legal and Regulatory Compliance, Documentation and Communication,
Resource Management and Cost Containment, Quality Improvement and Outcomes Measurement,
Interdisciplinary Collaboration, Psychosocial and Cultural Considerations. Targeted learning outcomes include:
Apply the case management process to complex clinical scenarios; Analyze barriers to care coordination and
propose evidence-based solutions; Evaluate the effectiveness of case management interventions using outcome
metrics. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students can
study with confidence and self-correct as they work through the bank. Use it as a high-yield review immediately
before the exam, or as a structured practice tool during the unit - the rationales double as concise teaching notes.
The recommended writing time is 3 hours, with a passing score of 90%. Aligned with Accredited by the
Section 1: Case Management Process (Questions 1-20)
1 During the assessment phase of the case management process, a case manager
identifies that a patient with chronic obstructive pulmonary disease has a history
of multiple emergency department visits and hospital readmissions within the past
year. The patient reports inconsistent use of prescribed inhalers due to cost and
lack of understanding of the regimen. Which of the following actions should the
case manager prioritize first in the planning phase?
A) Arrange for a pulmonary rehabilitation program to improve exercise tolerance
and reduce exacerbations
B) Refer the patient to a financial counselor to explore medication assistance
programs and subsidy options
C) Develop an individualized education plan focusing on inhaler technique and
disease self-management
D) Coordinate a transitional care plan that includes a follow-up appointment with a
pulmonologist within one week
Answer: B
Rationale: The assessment reveals cost and knowledge as key barriers. Addressing
financial barriers first (option B) is critical because without affordable access to
medications, education and follow-up (options C and D) will be ineffective.
Pulmonary rehabilitation (option A) is beneficial but not the immediate priority
when medication adherence is compromised by cost.
,2 A case manager is evaluating the effectiveness of a care coordination intervention
for a population of patients with diabetes. Six months post-implementation, the
case manager reviews outcome data: HbA1c levels have decreased by an average
of 0.5%, but emergency department visits for hypoglycemia have increased by
15%. Which of the following conclusions is most appropriate?
A) The intervention is effective overall, as the primary outcome (HbA1c)
improved
B) The intervention may have unintended consequences, and a root cause analysis
is warranted
C) The increase in ED visits is unrelated to the intervention and should be ignored
D) The intervention should be discontinued immediately due to the increase in
adverse events
Answer: B
Rationale: Effective case management requires monitoring both intended and
unintended outcomes. The improvement in HbA1c suggests some benefit, but the
increase in hypoglycemic events (a serious adverse outcome) indicates a potential
flaw in the intervention, such as overly aggressive glycemic targets or inadequate
patient education. A root cause analysis (option B) is needed to understand the
relationship before modifying or discontinuing the intervention (option D). Option A
ignores the harm, and option C is dismissive.
3 In the context of case management, which of the following best describes the
concept of 'care transitions' as a distinct phase within the case management
process?
A) The transfer of a patient from one healthcare setting to another, requiring
coordination and communication to ensure continuity
B) The process of discharging a patient from the hospital to home with a follow-up
phone call within 48 hours
C) The period during which a patient moves from acute illness to recovery,
managed primarily by the primary care provider
D) The handoff of a patient from a case manager to a social worker for community
resource linkage
Answer: A
Rationale: Care transitions are a core component of the case management process,
specifically within the coordination and monitoring phases. They involve any
movement between settings (e.g., hospital to skilled nursing facility, hospital to
home) and require comprehensive planning, communication, and follow-up to
prevent adverse events. Option A captures this broad definition. Option B is too
,narrow (only discharge to home with a phone call). Option C is vague and not
specific to transitions. Option D describes a task handoff, not a care transition.
4 A case manager is developing a comprehensive care plan for a patient with
multiple chronic conditions, including heart failure, diabetes, and chronic kidney
disease. The patient is on multiple medications and has a history of nonadherence
due to complex dosing schedules. Which of the following strategies is most
aligned with the 'planning' phase of the case management process?
A) Prescribing a fixed-dose combination pill to simplify the medication regimen
B) Conducting a medication reconciliation and collaborating with the patient to
prioritize goals
C) Arranging for home health nursing to administer daily medications
D) Referring the patient to a pharmacist for a comprehensive medication review
Answer: B
Rationale: The planning phase involves collaborative goal setting and development
of a patient-centered plan. Option B (medication reconciliation and goal
prioritization with the patient) is a core planning activity that engages the patient and
addresses adherence barriers. Option A is a prescribing action outside the case
manager's scope unless they are a prescriber. Option C is an intervention that may be
implemented after planning. Option D is a referral, which is part of the
implementation phase, not the initial planning.
5 A case manager is monitoring a patient with a spinal cord injury who is
transitioning from inpatient rehabilitation to home. The case manager notes that
the patient's home environment lacks wheelchair accessibility, and the family
expresses concern about providing care. Which of the following actions should
the case manager take during the 'monitoring' phase?
A) Delay the discharge until home modifications are completed
B) Schedule a home visit to assess the environment and provide caregiver training
C) Refer the patient to a social worker to arrange for home modifications
D) Document the concerns and proceed with discharge as planned
Answer: B
Rationale: Monitoring involves ongoing assessment of the patient's progress and the
effectiveness of the care plan. Option B (home visit and caregiver training) allows
the case manager to directly observe barriers and intervene proactively, which is
consistent with monitoring. Option A is a planning/coordination action, not
monitoring. Option C is a referral, which may be appropriate but does not involve
the case manager's monitoring role. Option D ignores the identified risks.
, 6 In the case management process, which of the following is a primary purpose of
the 'evaluation' phase?
A) To determine the patient's eligibility for services and benefits
B) To assess the quality and outcomes of case management interventions against
established benchmarks
C) To identify the patient's strengths, needs, and preferences
D) To coordinate referrals and appointments with specialists
Answer: B
Rationale: The evaluation phase focuses on measuring the effectiveness, efficiency,
and quality of the case management process and interventions. Option B correctly
describes this purpose. Option A is part of assessment. Option C is assessment.
Option D is coordination/implementation.
7 A case manager is working with a patient who has a history of substance use
disorder and is currently enrolled in a methadone maintenance program. The
patient is also being treated for hepatitis C. The case manager discovers that the
patient has missed two consecutive methadone clinic appointments. Which of the
following is the most appropriate initial step in the case management process?
A) Discharge the patient from case management due to nonadherence
B) Contact the patient to explore barriers to attendance and re-engage in care
C) Notify the hepatitis C treatment team to discontinue antiviral therapy
D) Refer the patient to a higher level of substance use treatment
Answer: B
Rationale: The case management process emphasizes patient engagement and
addressing barriers. Missed appointments are a red flag, but the initial step is to
reach out to the patient (option B) to understand the reasons (e.g., transportation,
side effects, relapse) and collaboratively problem-solve. Option A is premature and
punitive. Option C is not indicated without assessing the situation. Option D may be
necessary but is not the first step.
8 During the 'facilitation' phase of case management, a case manager is coordinating
a multidisciplinary team meeting for a patient with complex needs. Which of the
following strategies best ensures effective collaboration and patient-centered care?
A) Inviting only the physicians and nurses to the meeting to streamline
decision-making
B) Sending a summary of the meeting to the patient after decisions have been
made
