NEW YORK CASE MANAGEMENT NURSING PRACTICE EXAM | STUDY GUIDE |
TESTBANK | LATEST UPDATE 2026/2027 | ADVANCED QUESTIONS | 100%
CORRECT ANSWERS
Table of Contents:
• Comprehensive Case Management & Care Coordination — Questions 1–5
• Care Planning, Assessment & Transitions — Questions 6–10
• New York Medicaid, Health Homes & Regulatory Compliance — Questions 11–15
• Utilization Management, Quality & Resource Allocation — Questions 16–20
• Ethics, Advocacy, Documentation & Interprofessional Practice — Questions 21–25
• Complex Clinical Decision-Making & Population-Based Case Management —
Questions 26–30
INTRODUCTION
This advanced New York Case Management Nursing practice examination evaluates
the clinical judgment, care-coordination skills, regulatory knowledge, ethical
reasoning, and systems-level decision-making expected of experienced nurses
working in case management. Questions emphasize individualized care planning,
transitions of care, utilization management, interdisciplinary collaboration,
documentation, patient advocacy, health disparities, Medicaid Health Home
principles, and complex discharge planning. The examination reflects current New
York guidance and contemporary professional practice, including person-centered
planning, comprehensive assessment, care transitions, follow-up, and coordination
across medical, behavioral-health, and community services. Expect challenging
scenarios requiring prioritization, interpretation of policy requirements, risk analysis,
and selection of the safest and most appropriate professional action rather than
simple factual recall.
COMPREHENSIVE CASE MANAGEMENT & CARE COORDINATION
Question 1
A registered nurse case manager is coordinating care for a Medicaid member with
heart failure, diabetes, depression, recurrent emergency-department visits,
medication nonadherence, and unstable housing. During the initial comprehensive
assessment, the patient states that obtaining stable housing is the most important
,factor affecting the ability to follow the treatment plan. Which intervention best
reflects advanced person-centered case management?
A. Establish a medication-adherence goal first because medication management
has the greatest direct effect on mortality.
B. Develop an individualized plan that incorporates the patient's housing priority
while integrating medical, behavioral-health, and social-service interventions.
C. Refer the patient to a housing agency and defer development of the medical
plan until housing is secured.
D. Assign the patient to separate case managers for medical, behavioral-health, and
social-service needs.
Correct Answer: B
Explanation: Person-centered case management integrates medical, behavioral-
health, functional, and social needs while incorporating the individual's stated
goals and preferences into the care plan. New York Health Home standards
emphasize an individualized plan of care integrating these domains.
Question 2
A case manager discovers that a patient is simultaneously receiving Medicaid-
funded care-management services through two programs. Both programs have
independently developed plans of care, and the interventions are beginning to
conflict. What is the most appropriate case-management response?
A. Allow both programs to continue because additional case managers increase
service availability.
B. Ask the patient to select whichever program has the most convenient office
location.
C. Coordinate with the responsible programs and managed-care organization to
resolve duplication and establish clear responsibility for overall care coordination.
D. Close the newer case-management referral immediately without notifying the
patient or other providers.
Correct Answer: C
Explanation: New York Health Home standards emphasize one dedicated care
, manager with overall accountability and require clear lines of responsibility to
prevent duplication of services.
Question 3
A patient with chronic kidney disease, depression, and recurrent falls refuses a
recommended home-health referral. The patient demonstrates decision-making
capacity and clearly explains the reasons for refusal. Which action by the case
manager is most appropriate?
A. Override the refusal because the intervention is clinically beneficial.
B. Document the refusal and close the case because the patient is noncompliant.
C. Explore the patient's concerns, provide relevant education, assess alternatives,
respect the informed decision, and revise the plan accordingly.
D. Contact the patient's family and request that they persuade the patient to accept
the referral.
Correct Answer: C
Explanation: Respect for autonomy requires the nurse to support informed
decision-making rather than equate refusal with incapacity or noncompliance.
Effective case management identifies barriers and collaboratively modifies the
plan.
Question 4
A case manager notices that a patient repeatedly misses specialty appointments.
Investigation reveals that appointments are scheduled during the patient's work
hours and that transportation is unreliable. Which intervention demonstrates the
highest level of case-management reasoning?
A. Document repeated nonadherence and notify the primary provider.
B. Reschedule appointments at times compatible with the patient's circumstances
and coordinate transportation while addressing additional barriers.
C. Require the patient to sign a compliance agreement before further referrals are
made.
D. Recommend emergency-department evaluation whenever symptoms interfere
with appointment attendance.
, Correct Answer: B
Explanation: Advanced case management distinguishes behavioral nonadherence
from modifiable system and social barriers. Transportation, scheduling, and access
barriers should be addressed through coordinated interventions.
Question 5
An interdisciplinary team disagrees about the care plan for a medically complex
patient. The specialist recommends an aggressive treatment strategy, while the
primary-care provider believes the patient's functional status makes the plan
unrealistic. What should the nurse case manager do first?
A. Select the treatment plan recommended by the specialist.
B. Ask the hospital administrator to determine which provider has authority.
C. Facilitate structured communication among the providers and incorporate the
patient's goals, preferences, risks, and functional status into the decision.
D. Delay all services until the providers reach agreement independently.
Correct Answer: C
Explanation: Case managers coordinate rather than independently prescribe
treatment. When care plans conflict, structured interdisciplinary communication
and patient-centered decision-making are essential. New York standards
specifically recognize the need for defined processes when conflicting treatment is
provided.
CARE PLANNING, ASSESSMENT & TRANSITIONS
Question 6
A patient is being discharged after hospitalization for acute decompensated heart
failure. The patient has limited health literacy, lives alone, and has previously been
readmitted because medications were misunderstood. Which discharge-planning
intervention should the nurse prioritize?
A. Provide the patient with the standard written discharge packet.
B. Arrange a follow-up appointment but leave medication education to the
outpatient pharmacist.
C. Use teach-back to verify understanding, reconcile medications, confirm follow-
TESTBANK | LATEST UPDATE 2026/2027 | ADVANCED QUESTIONS | 100%
CORRECT ANSWERS
Table of Contents:
• Comprehensive Case Management & Care Coordination — Questions 1–5
• Care Planning, Assessment & Transitions — Questions 6–10
• New York Medicaid, Health Homes & Regulatory Compliance — Questions 11–15
• Utilization Management, Quality & Resource Allocation — Questions 16–20
• Ethics, Advocacy, Documentation & Interprofessional Practice — Questions 21–25
• Complex Clinical Decision-Making & Population-Based Case Management —
Questions 26–30
INTRODUCTION
This advanced New York Case Management Nursing practice examination evaluates
the clinical judgment, care-coordination skills, regulatory knowledge, ethical
reasoning, and systems-level decision-making expected of experienced nurses
working in case management. Questions emphasize individualized care planning,
transitions of care, utilization management, interdisciplinary collaboration,
documentation, patient advocacy, health disparities, Medicaid Health Home
principles, and complex discharge planning. The examination reflects current New
York guidance and contemporary professional practice, including person-centered
planning, comprehensive assessment, care transitions, follow-up, and coordination
across medical, behavioral-health, and community services. Expect challenging
scenarios requiring prioritization, interpretation of policy requirements, risk analysis,
and selection of the safest and most appropriate professional action rather than
simple factual recall.
COMPREHENSIVE CASE MANAGEMENT & CARE COORDINATION
Question 1
A registered nurse case manager is coordinating care for a Medicaid member with
heart failure, diabetes, depression, recurrent emergency-department visits,
medication nonadherence, and unstable housing. During the initial comprehensive
assessment, the patient states that obtaining stable housing is the most important
,factor affecting the ability to follow the treatment plan. Which intervention best
reflects advanced person-centered case management?
A. Establish a medication-adherence goal first because medication management
has the greatest direct effect on mortality.
B. Develop an individualized plan that incorporates the patient's housing priority
while integrating medical, behavioral-health, and social-service interventions.
C. Refer the patient to a housing agency and defer development of the medical
plan until housing is secured.
D. Assign the patient to separate case managers for medical, behavioral-health, and
social-service needs.
Correct Answer: B
Explanation: Person-centered case management integrates medical, behavioral-
health, functional, and social needs while incorporating the individual's stated
goals and preferences into the care plan. New York Health Home standards
emphasize an individualized plan of care integrating these domains.
Question 2
A case manager discovers that a patient is simultaneously receiving Medicaid-
funded care-management services through two programs. Both programs have
independently developed plans of care, and the interventions are beginning to
conflict. What is the most appropriate case-management response?
A. Allow both programs to continue because additional case managers increase
service availability.
B. Ask the patient to select whichever program has the most convenient office
location.
C. Coordinate with the responsible programs and managed-care organization to
resolve duplication and establish clear responsibility for overall care coordination.
D. Close the newer case-management referral immediately without notifying the
patient or other providers.
Correct Answer: C
Explanation: New York Health Home standards emphasize one dedicated care
, manager with overall accountability and require clear lines of responsibility to
prevent duplication of services.
Question 3
A patient with chronic kidney disease, depression, and recurrent falls refuses a
recommended home-health referral. The patient demonstrates decision-making
capacity and clearly explains the reasons for refusal. Which action by the case
manager is most appropriate?
A. Override the refusal because the intervention is clinically beneficial.
B. Document the refusal and close the case because the patient is noncompliant.
C. Explore the patient's concerns, provide relevant education, assess alternatives,
respect the informed decision, and revise the plan accordingly.
D. Contact the patient's family and request that they persuade the patient to accept
the referral.
Correct Answer: C
Explanation: Respect for autonomy requires the nurse to support informed
decision-making rather than equate refusal with incapacity or noncompliance.
Effective case management identifies barriers and collaboratively modifies the
plan.
Question 4
A case manager notices that a patient repeatedly misses specialty appointments.
Investigation reveals that appointments are scheduled during the patient's work
hours and that transportation is unreliable. Which intervention demonstrates the
highest level of case-management reasoning?
A. Document repeated nonadherence and notify the primary provider.
B. Reschedule appointments at times compatible with the patient's circumstances
and coordinate transportation while addressing additional barriers.
C. Require the patient to sign a compliance agreement before further referrals are
made.
D. Recommend emergency-department evaluation whenever symptoms interfere
with appointment attendance.
, Correct Answer: B
Explanation: Advanced case management distinguishes behavioral nonadherence
from modifiable system and social barriers. Transportation, scheduling, and access
barriers should be addressed through coordinated interventions.
Question 5
An interdisciplinary team disagrees about the care plan for a medically complex
patient. The specialist recommends an aggressive treatment strategy, while the
primary-care provider believes the patient's functional status makes the plan
unrealistic. What should the nurse case manager do first?
A. Select the treatment plan recommended by the specialist.
B. Ask the hospital administrator to determine which provider has authority.
C. Facilitate structured communication among the providers and incorporate the
patient's goals, preferences, risks, and functional status into the decision.
D. Delay all services until the providers reach agreement independently.
Correct Answer: C
Explanation: Case managers coordinate rather than independently prescribe
treatment. When care plans conflict, structured interdisciplinary communication
and patient-centered decision-making are essential. New York standards
specifically recognize the need for defined processes when conflicting treatment is
provided.
CARE PLANNING, ASSESSMENT & TRANSITIONS
Question 6
A patient is being discharged after hospitalization for acute decompensated heart
failure. The patient has limited health literacy, lives alone, and has previously been
readmitted because medications were misunderstood. Which discharge-planning
intervention should the nurse prioritize?
A. Provide the patient with the standard written discharge packet.
B. Arrange a follow-up appointment but leave medication education to the
outpatient pharmacist.
C. Use teach-back to verify understanding, reconcile medications, confirm follow-
