Case Management Nurse Certification
Exam Final Questions and Answers
1.vProvider
2.vServices
3.vSettingv
4.vTime
5.vCostv-vCORRECTvANSWER-5vrightsvofvutilizationvreview
211v-vCORRECTvANSWER-
federallyvfundedvsupportvreferralvservicesvandvcrisisvmanagement.
25v-vCORRECTvANSWER-
thevdollarvamountvthevgiftsvarevlimitedvtovtovavoidvconflictvofvinterest
4vpartsvofvclinicalvpathwayv-vCORRECTvANSWER-1.vtimeline
2.vcategoriesvofvcare/activitiesvandvinterventions
3.vintermediatevandvlongvtermvoutcomevcriteria
4.vvariancevtracking
arev4vpartsvofvwhat?
55v-vCORRECTvANSWER-
Medicarevwillvbeginvcoveragevofvhomevoxygenvwithvanvarterialvbloodvgasvresultvatvorvabovev
avpartialvpressurevofv___mmvHgvwhilevatvrestvonvroomvair.
80%v-vCORRECTvANSWER-medicarevcoversvwhatvpercent?
80%v-vCORRECTvANSWER-MedicarevPartvBvonlyvcoversvwhatvpercent?
88v-vCORRECTvANSWER-
medicarevwillvcovervhomevoxygenvifvO2vsatvisvatvorvbelowv_____%vwhilevatvrestvonvroomvair,
vexercisingvonvroomvairvorvwhilevasleepvorvavgreatervthanvnormalvfallvinvoxygenvlevelvduringv
sleepv(avdecreasevinvarterialvPOv2vmorevthanv10vmmvHg,vorvdecreasevinvarterialvoxygenvsat
urationvmorevthanv5%)vassociatedvwithvsymptomsvorvsignsvreasonablyvattributablevtovhypo
xemiav(e.g.,vimpairmentvofvcognitivevprocessesvandvnocturnalvrestlessnessvorvinsomnia).
Av-vCORRECTvANSWER-WhatvpartvofvMedicarevcoversvskilledvnursingvfacility?
abandonmentv-vCORRECTvANSWER-
willfulvneglectvofvresponsibilityvofvanothervpersonvbyvavpersonvwhovisvassignedvtovcarevforvth
atvpatientvorvbyvavpersonvinvavcaregivingvposition.
,access,vinspect,vcopyv-vCORRECTvANSWER-
HIPAAvindividualvrightv#3visvthevindividual'svrightvtovtheirvhealthvinformationvtovdovwhat?
accountablevcarevorganizationsv-vCORRECTvANSWER-
groupsvofvdoctors,vhospitals,vandvothervhealthvcarevproviders,vwhovcomevtogethervvoluntari
lyvtovgivevcoordinatedvhighvqualityvcarevtovtheirvMedicarevpatients.Theyvdecreasevfragment
ationvandvimprovevcollaboration.vCreatedvfromvthevaffordablevcarevact.v"medicalvneighborh
ood"
Acutevcarev-vCORRECTvANSWER-
AvhospitalvthevlargestvHealthcarevsettingvinvthevUnitedvStates.vCasevmanagersvneedvtovens
urevtestsvarevdonevinvavtimelyvmeandervresultsvarevgivenvtovprovidervandvHealthcarevteamvd
eterminesvthevnextvstep.
advlitemv-vCORRECTvANSWER-
guardianshipvappointedvtovrepresentvavchildvwhenvthevparentsvconflictvorvinvsituationsvsuchv
asvabuse.
adultsv-vCORRECTvANSWER-
Thesevlearnersvarevautonomous,vgoalvandvrelevancyvoriented,vhavevexperience,vcarevabo
utvwhatvisvpracticalvandvneedvrespect.
advancedvdirectivev-vCORRECTvANSWER-
writtenvstatementvofvmedicalvwishesvinvthevfuturevinvtheveventvtheyvarevunablevtovmakevdeci
sionsvforvthemselves.vItvincludesvavlivingvwillvorvavdurablevpowervofvattorney.
affordablevcarevactv-vCORRECTvANSWER-
thisvlawvinv2010vcreatedvthevinnovationvcentervwithvinvthevcentervforvmedicarevandvmedicaid
vservicesvwhichvassistsvwithvresearchvregardingvquality.
aggregatevdatav-vCORRECTvANSWER-
datavthatvhasvavcommonvvariable.vAnvexamplevwouldvbevdiabetes.
allvpatientvrefinedvdiagnosisvrelatedvgroupsv(APDRG)v-vCORRECTvANSWER-
typevofvpaymentvwithv2vsubclassesvbasedvonv1.vseverityvofvillnessv(organvsystemvfailurevorvl
ossvofvfuntionvandv2.vriskvofvmortality
Americansvwithvdisabilitiesvactv-vCORRECTvANSWER-
thisvactvestablishedvinv1990vhasv5vtitles.v
companiesvcannotvdiscriminatevandvmustvmakevreasonablevaccommodationsvifvtheyvhavev
15vorvmorevemployees,vmustvhavevaccessvtovpublicvtransportation,vhavevaccessvtovteleco
mmunicationvdevices,vandvseekvrestitutionvforvdamagevcausedvbyvinaccessibilityvofvservice
s.
, Appealv-vCORRECTvANSWER-
Avformalvwayvofvlodgingvavdisagreementvwithvavclaimvpaymentvorvbenefitvdenial
arthritisvimpactvmeasurementvscalesv-vCORRECTvANSWER-
healthvriskvassessment:vDisease-specificvmeasurevofvphysical,vsocial,vandvemotionalvwell-
beingvdesignedvasvavmeasurevofvoutcomevinvarthritis.
-
scales:vmobility,vphysicalvactivityv(walking,vbending,vlifting),vdexterity,vhouseholdvactivityv(
managingvmoneyvandvmedications,vhousekeeping),vsocialvactivities,vactivitiesvofvdailyvlivin
g,vpain,vdepression,vandvanxiety.v
Scorevrange:vRangevisv0-10vforveachvsection.vTotalvhealthvscorev0-60.
-->vZerovrepresentsvgoodvhealthvstatus,v10vandv60vrepresentvpoorvhealthvstatus.
Assess,vplan,vimplement/intervention,vmonitor/evaluationv-vCORRECTvANSWER-
4vstagesvofvcasevmanagement
assultv-vCORRECTvANSWER-
anvintentionalvtort/actvofvthreateningvorvattemptingvtovtouchvwithoutvconsent.
autonomyv-vCORRECTvANSWER-
respectingvthevindividual'svrightvtovmakevtheirvownvdecisions
Autonomyvvs.vshamev-vCORRECTvANSWER-Ericksonv1v1/5-3
Bv-vCORRECTvANSWER-WhatvpartvofvMedicarevcoversvdurablevmedicalvequipment?
balancedvbudgetvactv-vCORRECTvANSWER-
actvthatvgivesvmedicarevandvmedicaidvservicesvauthorityvtovestablishvandvoverseevavprogra
mvthatvallowsvprivate,vnationalvaccreditedvorganizationsvtov"deem"vweathervorvnotvavmedica
revadvantagevorganizationvisvcompliantvwithvmedicarevrequirements.vexample:vJCAHOvan
dvNCQA
BalancedvBudgetvActv-vCORRECTvANSWER-
Lawvenactedvinv1977vthatvcreatedvthevmedicarevpartvCv+vchoicevprogram,valsovknowsvasvth
evmedicarevadvantagevplan,visvavmanagedvcarevoptionvthatvallowsvnewvtypesvofvhealthvplan
svundervprivatevcompaniesvtovcovervmedicarevbenefitsvatvavcapitatedv(pervenrollee)vamount
vtovincludevhospitalvandvmedical,vpartsvAvandvB.
BASIS-32v-vCORRECTvANSWER-healthvriskvassessment:v32-
itemvBehaviorvandvSymptomvIdentificationvScale.vbehavioralvhealthvassessmentvtool.
-vmeasuresvthevchangevinvself-
reportedvsymptomvandvproblemvdifficultyvovervthevcoursevofvtreatment.
-
vassesses:vRelationvtovSelfvandvOthers,vDepressionvandvAnxiety,vDailyvLivingvandvRolevFu
nctioning,vImpulsivevandvAddictivevBehavior,vPsychosis.
Exam Final Questions and Answers
1.vProvider
2.vServices
3.vSettingv
4.vTime
5.vCostv-vCORRECTvANSWER-5vrightsvofvutilizationvreview
211v-vCORRECTvANSWER-
federallyvfundedvsupportvreferralvservicesvandvcrisisvmanagement.
25v-vCORRECTvANSWER-
thevdollarvamountvthevgiftsvarevlimitedvtovtovavoidvconflictvofvinterest
4vpartsvofvclinicalvpathwayv-vCORRECTvANSWER-1.vtimeline
2.vcategoriesvofvcare/activitiesvandvinterventions
3.vintermediatevandvlongvtermvoutcomevcriteria
4.vvariancevtracking
arev4vpartsvofvwhat?
55v-vCORRECTvANSWER-
Medicarevwillvbeginvcoveragevofvhomevoxygenvwithvanvarterialvbloodvgasvresultvatvorvabovev
avpartialvpressurevofv___mmvHgvwhilevatvrestvonvroomvair.
80%v-vCORRECTvANSWER-medicarevcoversvwhatvpercent?
80%v-vCORRECTvANSWER-MedicarevPartvBvonlyvcoversvwhatvpercent?
88v-vCORRECTvANSWER-
medicarevwillvcovervhomevoxygenvifvO2vsatvisvatvorvbelowv_____%vwhilevatvrestvonvroomvair,
vexercisingvonvroomvairvorvwhilevasleepvorvavgreatervthanvnormalvfallvinvoxygenvlevelvduringv
sleepv(avdecreasevinvarterialvPOv2vmorevthanv10vmmvHg,vorvdecreasevinvarterialvoxygenvsat
urationvmorevthanv5%)vassociatedvwithvsymptomsvorvsignsvreasonablyvattributablevtovhypo
xemiav(e.g.,vimpairmentvofvcognitivevprocessesvandvnocturnalvrestlessnessvorvinsomnia).
Av-vCORRECTvANSWER-WhatvpartvofvMedicarevcoversvskilledvnursingvfacility?
abandonmentv-vCORRECTvANSWER-
willfulvneglectvofvresponsibilityvofvanothervpersonvbyvavpersonvwhovisvassignedvtovcarevforvth
atvpatientvorvbyvavpersonvinvavcaregivingvposition.
,access,vinspect,vcopyv-vCORRECTvANSWER-
HIPAAvindividualvrightv#3visvthevindividual'svrightvtovtheirvhealthvinformationvtovdovwhat?
accountablevcarevorganizationsv-vCORRECTvANSWER-
groupsvofvdoctors,vhospitals,vandvothervhealthvcarevproviders,vwhovcomevtogethervvoluntari
lyvtovgivevcoordinatedvhighvqualityvcarevtovtheirvMedicarevpatients.Theyvdecreasevfragment
ationvandvimprovevcollaboration.vCreatedvfromvthevaffordablevcarevact.v"medicalvneighborh
ood"
Acutevcarev-vCORRECTvANSWER-
AvhospitalvthevlargestvHealthcarevsettingvinvthevUnitedvStates.vCasevmanagersvneedvtovens
urevtestsvarevdonevinvavtimelyvmeandervresultsvarevgivenvtovprovidervandvHealthcarevteamvd
eterminesvthevnextvstep.
advlitemv-vCORRECTvANSWER-
guardianshipvappointedvtovrepresentvavchildvwhenvthevparentsvconflictvorvinvsituationsvsuchv
asvabuse.
adultsv-vCORRECTvANSWER-
Thesevlearnersvarevautonomous,vgoalvandvrelevancyvoriented,vhavevexperience,vcarevabo
utvwhatvisvpracticalvandvneedvrespect.
advancedvdirectivev-vCORRECTvANSWER-
writtenvstatementvofvmedicalvwishesvinvthevfuturevinvtheveventvtheyvarevunablevtovmakevdeci
sionsvforvthemselves.vItvincludesvavlivingvwillvorvavdurablevpowervofvattorney.
affordablevcarevactv-vCORRECTvANSWER-
thisvlawvinv2010vcreatedvthevinnovationvcentervwithvinvthevcentervforvmedicarevandvmedicaid
vservicesvwhichvassistsvwithvresearchvregardingvquality.
aggregatevdatav-vCORRECTvANSWER-
datavthatvhasvavcommonvvariable.vAnvexamplevwouldvbevdiabetes.
allvpatientvrefinedvdiagnosisvrelatedvgroupsv(APDRG)v-vCORRECTvANSWER-
typevofvpaymentvwithv2vsubclassesvbasedvonv1.vseverityvofvillnessv(organvsystemvfailurevorvl
ossvofvfuntionvandv2.vriskvofvmortality
Americansvwithvdisabilitiesvactv-vCORRECTvANSWER-
thisvactvestablishedvinv1990vhasv5vtitles.v
companiesvcannotvdiscriminatevandvmustvmakevreasonablevaccommodationsvifvtheyvhavev
15vorvmorevemployees,vmustvhavevaccessvtovpublicvtransportation,vhavevaccessvtovteleco
mmunicationvdevices,vandvseekvrestitutionvforvdamagevcausedvbyvinaccessibilityvofvservice
s.
, Appealv-vCORRECTvANSWER-
Avformalvwayvofvlodgingvavdisagreementvwithvavclaimvpaymentvorvbenefitvdenial
arthritisvimpactvmeasurementvscalesv-vCORRECTvANSWER-
healthvriskvassessment:vDisease-specificvmeasurevofvphysical,vsocial,vandvemotionalvwell-
beingvdesignedvasvavmeasurevofvoutcomevinvarthritis.
-
scales:vmobility,vphysicalvactivityv(walking,vbending,vlifting),vdexterity,vhouseholdvactivityv(
managingvmoneyvandvmedications,vhousekeeping),vsocialvactivities,vactivitiesvofvdailyvlivin
g,vpain,vdepression,vandvanxiety.v
Scorevrange:vRangevisv0-10vforveachvsection.vTotalvhealthvscorev0-60.
-->vZerovrepresentsvgoodvhealthvstatus,v10vandv60vrepresentvpoorvhealthvstatus.
Assess,vplan,vimplement/intervention,vmonitor/evaluationv-vCORRECTvANSWER-
4vstagesvofvcasevmanagement
assultv-vCORRECTvANSWER-
anvintentionalvtort/actvofvthreateningvorvattemptingvtovtouchvwithoutvconsent.
autonomyv-vCORRECTvANSWER-
respectingvthevindividual'svrightvtovmakevtheirvownvdecisions
Autonomyvvs.vshamev-vCORRECTvANSWER-Ericksonv1v1/5-3
Bv-vCORRECTvANSWER-WhatvpartvofvMedicarevcoversvdurablevmedicalvequipment?
balancedvbudgetvactv-vCORRECTvANSWER-
actvthatvgivesvmedicarevandvmedicaidvservicesvauthorityvtovestablishvandvoverseevavprogra
mvthatvallowsvprivate,vnationalvaccreditedvorganizationsvtov"deem"vweathervorvnotvavmedica
revadvantagevorganizationvisvcompliantvwithvmedicarevrequirements.vexample:vJCAHOvan
dvNCQA
BalancedvBudgetvActv-vCORRECTvANSWER-
Lawvenactedvinv1977vthatvcreatedvthevmedicarevpartvCv+vchoicevprogram,valsovknowsvasvth
evmedicarevadvantagevplan,visvavmanagedvcarevoptionvthatvallowsvnewvtypesvofvhealthvplan
svundervprivatevcompaniesvtovcovervmedicarevbenefitsvatvavcapitatedv(pervenrollee)vamount
vtovincludevhospitalvandvmedical,vpartsvAvandvB.
BASIS-32v-vCORRECTvANSWER-healthvriskvassessment:v32-
itemvBehaviorvandvSymptomvIdentificationvScale.vbehavioralvhealthvassessmentvtool.
-vmeasuresvthevchangevinvself-
reportedvsymptomvandvproblemvdifficultyvovervthevcoursevofvtreatment.
-
vassesses:vRelationvtovSelfvandvOthers,vDepressionvandvAnxiety,vDailyvLivingvandvRolevFu
nctioning,vImpulsivevandvAddictivevBehavior,vPsychosis.
