CERTIFIED CASE MANAGER (CCM)
EXAMINATION Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A case manager is reviewing a patient’s discharge plan after an acute stroke.
Which is the PRIMARY goal of case management in this situation?
A. Increase hospital revenue
B. Ensure continuity of care across settings
C. Reduce physician workload
D. Limit patient follow-up visits
B. ENSURE CONTINUITY OF CARE ACROSS SETTINGS
Rationale: The primary role of case management is to coordinate care across the
healthcare continuum, ensuring safe transitions between acute care,
rehabilitation, and home or community services. This reduces fragmentation,
improves outcomes, and prevents readmissions. The other options may be
indirect effects but are not the core goal.
2. A case manager is developing a care plan for a diabetic patient with
frequent admissions. What is the FIRST step?
A. Implement insulin therapy changes
B. Identify patient needs and barriers
C. Schedule specialist referrals
D. Arrange home nursing services
,B. IDENTIFY PATIENT NEEDS AND BARRIERS
Rationale: Case management begins with comprehensive assessment.
Understanding barriers such as medication adherence, socioeconomic
challenges, and health literacy is essential before planning interventions.
Without assessment, interventions may be inappropriate or ineffective.
3. Which ethical principle requires the case manager to respect a competent
patient’s refusal of treatment?
A. Beneficence
B. Justice
C. Autonomy
D. Fidelity
C. AUTONOMY
Rationale: Autonomy ensures patients have the right to make informed
decisions about their care, including refusal of treatment. Beneficence focuses
on doing good, justice on fairness, and fidelity on loyalty to commitments.
4. A patient lacks insurance coverage for rehabilitation. What is the MOST
appropriate case manager action?
A. Discharge the patient early
B. Refer to community resources
C. Avoid rehabilitation referral
D. Request physician payment waiver
B. REFER TO COMMUNITY RESOURCES
Rationale: Case managers advocate for access to care by identifying alternative
funding sources, community programs, or charitable services. Denying care due
to insurance limitations is inappropriate.
, 5. Which tool is commonly used to evaluate patient functional status in case
management?
A. APGAR score
B. Karnofsky Performance Scale
C. Glasgow Coma Scale
D. Capillary refill test
B. KARNOFSKY PERFORMANCE SCALE
Rationale: The Karnofsky Scale assesses functional impairment and ability to
perform daily activities, widely used in case management for chronic and
terminal illness planning.
6. A case manager notices conflicting treatment plans between providers.
What should be done FIRST?
A. Ignore the conflict
B. Report to hospital administration
C. Facilitate interdisciplinary communication
D. Cancel one treatment plan
C. FACILITATE INTERDISCIPLINARY COMMUNICATION
Rationale: Case managers coordinate care teams and resolve conflicts through
communication and collaboration before escalation or cancellation of care
plans.
7. Utilization review primarily focuses on:
A. Patient satisfaction
B. Cost of medications only
C. Appropriateness and efficiency of care
D. Nursing staff performance
C. APPROPRIATENESS AND EFFICIENCY OF CARE
Rationale: Utilization review evaluates whether healthcare services are
necessary, appropriate, and cost-effective, ensuring optimal resource use.
, 8. Which level of prevention is case management MOST associated with?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Quaternary prevention
C. TERTIARY PREVENTION
Rationale: Case management primarily focuses on managing chronic illness,
preventing complications, and reducing disability—key aspects of tertiary
prevention.
9. A patient is noncompliant due to cultural beliefs. What should the case
manager do?
A. Discharge the patient
B. Educate without cultural consideration
C. Incorporate cultural beliefs into care plan
D. Report patient to physician only
C. INCORPORATE CULTURAL BELIEFS INTO CARE PLAN
Rationale: Culturally competent care improves adherence and outcomes. Case
managers must respect and integrate cultural values into planning.
10.Which document defines scope of services and responsibilities in case
management?
A. Treatment protocol
B. Job description
C. Care pathway
D. Clinical guideline
EXAMINATION Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A case manager is reviewing a patient’s discharge plan after an acute stroke.
Which is the PRIMARY goal of case management in this situation?
A. Increase hospital revenue
B. Ensure continuity of care across settings
C. Reduce physician workload
D. Limit patient follow-up visits
B. ENSURE CONTINUITY OF CARE ACROSS SETTINGS
Rationale: The primary role of case management is to coordinate care across the
healthcare continuum, ensuring safe transitions between acute care,
rehabilitation, and home or community services. This reduces fragmentation,
improves outcomes, and prevents readmissions. The other options may be
indirect effects but are not the core goal.
2. A case manager is developing a care plan for a diabetic patient with
frequent admissions. What is the FIRST step?
A. Implement insulin therapy changes
B. Identify patient needs and barriers
C. Schedule specialist referrals
D. Arrange home nursing services
,B. IDENTIFY PATIENT NEEDS AND BARRIERS
Rationale: Case management begins with comprehensive assessment.
Understanding barriers such as medication adherence, socioeconomic
challenges, and health literacy is essential before planning interventions.
Without assessment, interventions may be inappropriate or ineffective.
3. Which ethical principle requires the case manager to respect a competent
patient’s refusal of treatment?
A. Beneficence
B. Justice
C. Autonomy
D. Fidelity
C. AUTONOMY
Rationale: Autonomy ensures patients have the right to make informed
decisions about their care, including refusal of treatment. Beneficence focuses
on doing good, justice on fairness, and fidelity on loyalty to commitments.
4. A patient lacks insurance coverage for rehabilitation. What is the MOST
appropriate case manager action?
A. Discharge the patient early
B. Refer to community resources
C. Avoid rehabilitation referral
D. Request physician payment waiver
B. REFER TO COMMUNITY RESOURCES
Rationale: Case managers advocate for access to care by identifying alternative
funding sources, community programs, or charitable services. Denying care due
to insurance limitations is inappropriate.
, 5. Which tool is commonly used to evaluate patient functional status in case
management?
A. APGAR score
B. Karnofsky Performance Scale
C. Glasgow Coma Scale
D. Capillary refill test
B. KARNOFSKY PERFORMANCE SCALE
Rationale: The Karnofsky Scale assesses functional impairment and ability to
perform daily activities, widely used in case management for chronic and
terminal illness planning.
6. A case manager notices conflicting treatment plans between providers.
What should be done FIRST?
A. Ignore the conflict
B. Report to hospital administration
C. Facilitate interdisciplinary communication
D. Cancel one treatment plan
C. FACILITATE INTERDISCIPLINARY COMMUNICATION
Rationale: Case managers coordinate care teams and resolve conflicts through
communication and collaboration before escalation or cancellation of care
plans.
7. Utilization review primarily focuses on:
A. Patient satisfaction
B. Cost of medications only
C. Appropriateness and efficiency of care
D. Nursing staff performance
C. APPROPRIATENESS AND EFFICIENCY OF CARE
Rationale: Utilization review evaluates whether healthcare services are
necessary, appropriate, and cost-effective, ensuring optimal resource use.
, 8. Which level of prevention is case management MOST associated with?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Quaternary prevention
C. TERTIARY PREVENTION
Rationale: Case management primarily focuses on managing chronic illness,
preventing complications, and reducing disability—key aspects of tertiary
prevention.
9. A patient is noncompliant due to cultural beliefs. What should the case
manager do?
A. Discharge the patient
B. Educate without cultural consideration
C. Incorporate cultural beliefs into care plan
D. Report patient to physician only
C. INCORPORATE CULTURAL BELIEFS INTO CARE PLAN
Rationale: Culturally competent care improves adherence and outcomes. Case
managers must respect and integrate cultural values into planning.
10.Which document defines scope of services and responsibilities in case
management?
A. Treatment protocol
B. Job description
C. Care pathway
D. Clinical guideline
