PROPHECY RN CASE MANAGEMENT
PRACTICE EXAM 1 QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
1. A case manager is coordinating discharge for a patient who needs
home health care services. What is the first step?
A. Arrange transportation home
B. Notify the insurance company
C. Assess the patient’s home environment
D. Schedule the first follow-up visit
Rationale: Assessing the home environment ensures that the patient’s
needs can be safely met at home and identifies any barriers to care.
2. Which document is essential to obtain before releasing any patient
information to outside agencies?
, A. Insurance authorization
B. Physician order
C. Care plan summary
D. Signed patient consent
Rationale: HIPAA requires patient consent to release protected health
information.
3. The main goal of case management is to:
A. Reduce staff workload
B. Ensure all policies are followed
C. Provide cost-effective, quality care
D. Limit patient stays
Rationale: Case management focuses on coordinating services to deliver
quality care while managing resources effectively.
4. Which patient would benefit most from case management services?
A. Healthy postpartum mother
B. Adolescent with acute appendicitis
C. Elderly patient with multiple chronic conditions
D. Healthy surgical patient
Rationale: Patients with complex, ongoing needs benefit most from case
management.
, 5. When prioritizing caseloads, which patient should the case manager
see first?
A. Patient requesting early discharge
B. Patient with signs of abuse and no safe discharge plan
C. Patient needing routine follow-up
D. Patient awaiting rehab placement
Rationale: Safety is the priority; suspected abuse must be addressed
immediately.
6. What is a key responsibility of the RN case manager in the
interdisciplinary team?
A. Provide bedside care
B. Perform diagnostic testing
C. Coordinate and communicate care plans
D. Prescribe medications
Rationale: The RN case manager serves as the liaison between disciplines
and ensures the care plan is coordinated.
7. Which statement about utilization review is correct?
A. It is only done at discharge
B. It’s used to justify overutilization
, C. It delays care delivery
D. It evaluates the necessity of care services
Rationale: Utilization review ensures appropriate use of resources and
medical necessity.
8. A patient refuses home health services. The case manager should:
A. Discharge the patient immediately
B. Force the patient to accept services
C. Respect the patient’s decision and document
D. Notify local authorities
Rationale: Patients have the right to refuse care; this must be respected
and documented.
9. A new RN asks the case manager for the meaning of “continuum of
care.” The best response is:
A. Care stops when the patient is discharged
B. Care starts when patient enters hospital
C. Only inpatient care is included
D. Care is provided across all health settings
Rationale: Continuum of care means patients receive coordinated services
throughout various stages and settings.
PRACTICE EXAM 1 QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
1. A case manager is coordinating discharge for a patient who needs
home health care services. What is the first step?
A. Arrange transportation home
B. Notify the insurance company
C. Assess the patient’s home environment
D. Schedule the first follow-up visit
Rationale: Assessing the home environment ensures that the patient’s
needs can be safely met at home and identifies any barriers to care.
2. Which document is essential to obtain before releasing any patient
information to outside agencies?
, A. Insurance authorization
B. Physician order
C. Care plan summary
D. Signed patient consent
Rationale: HIPAA requires patient consent to release protected health
information.
3. The main goal of case management is to:
A. Reduce staff workload
B. Ensure all policies are followed
C. Provide cost-effective, quality care
D. Limit patient stays
Rationale: Case management focuses on coordinating services to deliver
quality care while managing resources effectively.
4. Which patient would benefit most from case management services?
A. Healthy postpartum mother
B. Adolescent with acute appendicitis
C. Elderly patient with multiple chronic conditions
D. Healthy surgical patient
Rationale: Patients with complex, ongoing needs benefit most from case
management.
, 5. When prioritizing caseloads, which patient should the case manager
see first?
A. Patient requesting early discharge
B. Patient with signs of abuse and no safe discharge plan
C. Patient needing routine follow-up
D. Patient awaiting rehab placement
Rationale: Safety is the priority; suspected abuse must be addressed
immediately.
6. What is a key responsibility of the RN case manager in the
interdisciplinary team?
A. Provide bedside care
B. Perform diagnostic testing
C. Coordinate and communicate care plans
D. Prescribe medications
Rationale: The RN case manager serves as the liaison between disciplines
and ensures the care plan is coordinated.
7. Which statement about utilization review is correct?
A. It is only done at discharge
B. It’s used to justify overutilization
, C. It delays care delivery
D. It evaluates the necessity of care services
Rationale: Utilization review ensures appropriate use of resources and
medical necessity.
8. A patient refuses home health services. The case manager should:
A. Discharge the patient immediately
B. Force the patient to accept services
C. Respect the patient’s decision and document
D. Notify local authorities
Rationale: Patients have the right to refuse care; this must be respected
and documented.
9. A new RN asks the case manager for the meaning of “continuum of
care.” The best response is:
A. Care stops when the patient is discharged
B. Care starts when patient enters hospital
C. Only inpatient care is included
D. Care is provided across all health settings
Rationale: Continuum of care means patients receive coordinated services
throughout various stages and settings.
