Nursing Case Management: A Focus at the Bedside

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions. Remember, there's only one answer to each question.

1.	Case management is a new model for the delivery of patient care.

a) True.
b) False.

2.	The evolvement of case management can be credited to the:

a) Industrial age.
b) Atomic age.
c) Socioeconomic age.
d) Revolutionary age.

3.	The coordination of public services for immigrants and the poor was set up to:

a) Provide a bonafied immunization program.
b) Avoid duplication of health and social services.
c) Decrease the use of hospitals for routine medical care.
d) Be a federal regulatory agency.

4.	The community service focus centered on:

a) Providing comprehensive health care for everyone.
b) Developing nurse-run support groups.
c) Obtaining necessary funding.
d) Educating individuals and families on self-care.

5.	In the early 1900s, the United States Public health Service designed an early case management system with the initial purpose of assisting the community in dealing with immunization and sanitation problems.

a) True.
b) False.

6.	In the mid 1930s, what act made funds available that provided for taking care of individual client health needs?

a) Community Welfare Act.
b) Health Care Reform Act.
c) Social Security Act.
d) Veteran’s Administration Act.

7.	A major impact on the refinement of case management was the Civil Rights Movement.

a) True.
b) False.

8.	The term “case management” first emerged in social welfare literature and practice in the early:

a) 1980s.
b) 1970s.
c) 1960s.
d) 1920s.

9.	Diagnosis-Related Groups (DRGs) were set up to pay for care based on services rendered.

a) True.
b) False.

10.	In the mid 1980s, nursing case management in the form of ________ emerged for dealing with restraints imposed by DRGs and third party payer resource conservation requirements.

a) Discharge planning and utilization review.
b) Nursing care plans and utilization review.
c) Discharge planning and quality assurance.
d) Quality assurance and nursing care plans.

11.	Managed care is a new concept.

a) True.
b) False.

12.	Who can be considered the original founder of HMOs?

a) Henry Kaiser.
b) Michael Shadid.
c) Donald Ross.
d) Clifford Loos.

13.	DRGs were designed as a method to encourage hospitals to regulate the use of resources and health care delivery archetypes.

a) True.
b) False.

14.	In the mid 1980s, as health care costs began to spiral upward, the initial focus of the insurance industry was on control of:

a) The number of physician office visits allowed.
b) The amount of outpatient diagnostic tests ordered.
c) Both outpatient and inpatient health care service utilization.
d) Utilization of inpatient health care services.

15.	The method of payment by which a third party payer covering a group of patients pays health care service providers a set amount of money each month for each of the patients within a specific health care plan subscriber group is called:

a) Capitation.
b) HMO coverage.
c) Fee-for-service.
d) Equal reimbursement.

16.	The focus of health care has switched from treatment of the disease state to wellness.

a) True.
b) False.

17.	Health care institutions generate more revenue by increasing their charges.

a) True.
b) False.

18.	The cost for new technology is paid for by:

a) Incorporating it into the health care bill.
b) Planning for it within the budget allowed by third party payers.
c) Holding fund raising events.
d) a & c.

19.	Lengths of stay along with patient acuities are becoming dramatically increased.

a) True.
b) False.

20.	With the changing health care delivery system of the present and the future, duplication and fragmentation of health care services must be eliminated altogether.

a) True.
b) False.

21.	The viability of health care institutions relies heavily on the procurement of:

a) Federal funding.
b) Medicare payments.
c) Managed care contracts.
d) State funding.

22.	Health care administrators have to find innovative ways to provide high quality health care with finite resources in a limited reimbursement climate.

a) True.
b) False.

23.	The goal of third party payer managed care is to:

a) Take the risk for providing the patient’s health care.
b) Deliver the maximum level of patient care at a rock-bottom price.
c) Have an outlined delivery system of health care providers.
d) None of the above.

24.	In an HMO, a primary care physician is frequently charged with authorizing any specialty services provided to a subscriber.

a) True.
b) False.

25.	The five HMO models are:

a) Group, Network, Individual, IPA, and Mixed.
b) Group, MPA, Network, Staff, and Mixed.
c) Group, Network, IPA, Mixed, and Case Managed.
d) Group, Network, Staff, IPA, and Mixed.

26.	Individual Practice Associations (IPAs) always reimburse for health care services performed by non-member providers.

a) True.
b) False.

27.	Physicians and health care facilities enter Preferred Provider Organization (PPO) health care contracts in the hopes of receiving:

a) A higher capitation rate.
b) An increased number of patients.
c) Full fee-for-service reimbursement.
d) Additional PPO contracts.

28.	Point of Service (POS) plans are plans that use financial incentives to encourage subscribers to receive health care from contracted physicians.

a) True.
b) False.

29.	One of the premises of unit-based managed care is that it approaches patient care:

a) Individually.
b) Philosophically.
c) Physiologically.
d) Holistically.

30.	In unit-based managed care, critical pathways are used to guide patient care.

a) True.
b) False.

31.	Utilization management is a unit-based program that appraises quality of delivered health care services based upon the goals set by the nursing care plan.

a) True.
b) False.

32.	Utilization management concepts were introduced because of the need to manage:

a) High-cost inpatient admissions and expensive health care procedures.
b) How soon patients are to be discharged from the hospital based on DRGs.
c) Patient transfers to the appropriate level of care.
d) Both b & c.

33.	Severity of illness (SI) refers to:

a) How ill the patient actually is.
b) The symptoms and abnormal clinical findings manifested by the patient.
c) The type and frequency of medical treatment that can be expected to be rendered to a hospitalized patient with a particular diagnosis.
d) Both a & c.

34.	The three components to the utilization review process are:

a) The prospective or admission review, the past stay review, and the concurrent or continued stay review.
b) The retrospective review, the pre-procedure review, and the prospective or admission review.
c) The prospective or admission review, the concurrent or continued stay review, and the retrospective review.
d) None of the above.

35.	Which of the following questions is the BEST one to ask when doing a concurrent or continued stay review?

a) “Why is the patient in the hospital, and what medical treatments is (s)he receiving that can only be delivered in an acute care setting?”
b) “What patient care goals still need to be met?”
c) “When was the patient admitted to the hospital, and what is the expected date of the patient’s discharge?”
d) “Is this admission related to any residual problems from past admissions?”

36.	Case management in one form or another can be found across all health care disciplines.

a) True.
b) False.

37.	Another term for case management is:

a) Care planning.
b) Care coordination.
c) Care direction.
d) None of the above.

38.	Case management organizes patients by:

a) Acuities.
b) Room numbers.
c) Specific case types.
d) Individual symptoms.

39.	Case management is coordinated by appointed patient case managers who possess advanced skills in:

a) Planning, coordinating, and evaluating patient care.
b) Planning, implementing, and evaluating patient care.
c) Planning, coordinating, and implementing patient care.
d) None of the above.

40.	How many fundamental steps are there to the process of planning and establishing health care goals?

a) 6
b) 3
c) 4
d) 5

41.	For case management to be successful, the patient needs to be fully involved in the care.

a) True.
b) False.

42.	The distinct difference between case management and bedside case management is that with bedside case management:

a) Primary care nursing is the focus.
b) The charge nurse on each patient care unit acts as the case manager.
c) The case manager is the nurse at the bedside participating in direct patient care.
d) Both a & b.

43.	The nursing process has fostered in the nurse a problem-solver approach to patient care that makes the transition into case management a fairly difficult one.

a) True.
b) False.

44.	In bedside case management, the nurse case manager is held accountable for only the clinical outcomes associated with patient care.

a) True.
b) False.

45.	In bedside case management, the nurse case manager coordinates all aspects of patient care utilizing some form of:

a) Nursing care plan.
b) The medical model.
c) Case management plan.
d) Both a & b.

46.	In bedside case management, the nurse case manager works jointly with physicians, other health care disciplines and third party payers to render cost-effective, quality patient care in what form of group practice?

a) Customary.
b) Non-hierarchical.
c) Standard.
d) Hierarchical.

47.	What among group members is imperative for the successful delivery of quality patient care through a bedside case management model?

a) Role sharing.
b) Communication.
c) Time management.
d) Mutual respect.

48.	One of the roles of the nurse case manager in a bedside case management approach to patient care is that of:

a) Advocate.
b) Counselor.
c) Referee.
d) None of the above.

49.	Within the shared group practice framework, bedside case management involves what type of approach to cost-effective, outcome oriented, quality patient care?

a) A primary nursing care approach.
b) A physician-run approach.
c) A patient care team approach.
d) Both b & c.

50.	To judiciously delegate patient care tasks, the nurse case manager supervising a team must be aware of the competency of each team member providing care to the assigned group of patients.

a) True.
b) False.

51.	To facilitate cost-effective, quality care within a bedside case management approach to patient care, which of the following is it important to include in the change of shift report?

a) The patient’s actual day of stay number and the authorized length of stay.
b) Any continued normal laboratory values.
c) A brief overview of the patient’s financial resources.
d) All normal physical assessment parameters.

52.	Intra-shift report provides time for all patient care team members to participate in:

a) Quality improvement activities and budget planning.
b) Quality improvement activities and discharge planning.
c) Discharge planning and self-scheduling.
d) Discharge planning and staffing for the next shift.

53.	Which of the following ensure that every patient comes with a set of basic care instructions that structure the patient care team’s approach to procedure performance according to facility policy?

a) Case management plans.
b) Patient care plans.
c) Patient care protocols.
d) Both a & b.

54.	Bedside case management discourages cooperation between the hospital-based patient care disciplines and the community health care agencies facilitating continued care for the patient.

a) True.
b) False.

55.	Bedside case management combines what used to be several different plans of care into one multidisciplinary case management plan that contains mutually agreed upon patient care goals.

a) True.
b) False.

56.	Bedside case management encourages uniform treatment, increases fragmentation of health care services, and decreases health care service delays.

a) True.
b) False.

57.	Bedside case management facilitates the timely movement of the patient through the system by increasing the frequency and amount of:

a) Patient re-admissions.
b) Patient care documentation.
c) Patient care procedures.
d) Patient education.

58.	Which of the following instills patient satisfaction and a sense of ownership with regard to the case management plan?

a) Encouraging the patient’s participation in care.
b) Developing an improved patient education program.
c) Heightening the patient’s financial awareness.
d) Coordinating patient care from one level to the next.

59.	Bedside case management allows the nurse case manager to experience empowerment and a sense of self-actualization.

a) True.
b) False.

60.	Bedside case management decreases the skills of the patient care team members.

a) True.
b) False.

61.	Bedside case management elicits physician satisfaction by:

a) Decreasing the demanded time needed for problem solving.
b) Increasing patient satisfaction with regard to quality care.
c) Permitting more productivity time.
d) All of the above.

62.	The focus of practice for the bedside case manager is:

a) The hospital’s cost containment mandates.
b) The patient care team members.
c) The patient and the patient’s support person(s).
d) The physician’s orders.

63.	Qualifications the bedside case manager must inherently possess in order to orchestrate quality patient care that meets managed care dictates and requirements includes:

a) The ability to make definitive decisions and take responsibility for those decisions.
b) Experience writing policies and procedures.
c) At least a baccalaureate degree in nursing with a master’s degree in nursing preferred.
d) All of the above.

64.	Clinical responsibilities of the bedside case manager include all of the following except:

a) Coordination.
b) Evaluation.
c) Consultation.
d) Assessment.

65.	The bedside case manager acts as a patient advocate to:

a) Establish a working discharge plan.
b) Ensure the patient’s present and long-term health care needs are met.
c) Coordinate the efforts of the health care team.
d) Assure the appropriate physician orders are written.

66.	Financial responsibilities of the bedside case manager include all of the following except:

a) Developing and monitoring the annual financial goals for selected patient populations based on DRG group diagnoses.
b) Negotiating with third part payers for health care services needed by the patient.
c) Demonstrating direct accountability for the costs incurred by the delivery of patient care.
d) Arranging for new contracts with managed care companies.

67.	Most of the learning needs of the new bedside case manager will revolve around:

a) Management and financial responsibilities.
b) Clinical and management responsibilities.
c) Management and advocacy responsibilities.
d) Financial and clinical responsibilities.

68.	The use of critical pathways was developed originally in:

a) 1982
b) 1980
c) 1989
d) 1987

69.	The overall goals of a critical pathway include:

a) Coordinating care.
b) Decreasing variations in practice.
c) Improving clinical outcomes.
d) Managing length of stay.

70.	The clinical pictures of patients for whom critical pathways are developed fall into all of the following categories except:

a) High risk.
b) High cost.
c) High acuity.
d) High volume.

71.	Variables that must be considered when developing a critical pathway include:

a) The integration and streamlining of multidisciplinary documentation.
b) Joint Commission on Accreditation of Healthcare (JCAHO) regulation changes.
c) New patient care mandates set forth by the institution.
d) The authorized length of stay reimbursed by third party payers.

72.	All of the following are categories that the processes and interventions of a critical pathway can be grouped under except:

a) Discharge planning.
b) Teaching.
c) Treatments.
d) Transfer information.

73.	The use of critical pathways standardizes patient care and ensures consistency of the health care team’s patient care practices.

a) True.
b) False.

74.	The critical pathway the bedside case manager chooses for the patient needs to be addressed with the patient’s physician within how many hours of the patient’s admission?

a) 36
b) 12
c) 24
d) 48

75.	Critical pathways allow for the use of subjective data versus individual judgements for goal evaluation.

a) True.
b) False.

76.	Protocols are a researched set of specific patient care instructions developed by the institution that contain:

a) Patient care outcome criteria.
b) Directions regarding the preparation needed prior to completing a particular patient care task.
c) Patient teaching information.
d) Methods for resolving variances from the critical pathway.

77.	Variances show which of the following events that can influence patient outcomes?

a) System events.
b) Patient events.
c) Care provider events.
d) All of the above.

78.	Bedside case management takes the focus of quality improvement from individual departments and centralizes it as an overall evaluation process that examines every aspect of patient care.

a) True.
b) False.

79.	Bedside case management provides for and promotes patient care systems which cross departmental lines.

a) True.
b) False.

80.	Bedside case management, like continuous quality improvement (CQI), has been developed to improve the quality of patient care and the delivery of health care services by all of the following ways except:

a) Focusing on operational improvement.
b) Having a patient-centered approach to care.
c) Decreasing costs of providing health care services.
d) Instituting a collaborative effort among the various health care disciplines.

81.	Bedside case management is similar to continuous quality improvement (CQI) in which of the following ways?

a) Performs statistical analysis of data regarding the process.
b) Identifies root causes of problems.
c) Identifies practice standards for meeting patient outcomes.
d) Selects a solution.

82.	Patient care standard outcome indicators can be defined as:

a) Important timing-related outcomes that indicate patient progression along the critical pathway.
b) Health care discipline specific actions that must transpire to guarantee the patient’s progression along the critical pathway.
c) Any positive or negative occurrences which modify the expected patient outcomes of the critical pathway.
d) None of the above.

83.	Bedside case management is instituted in acute care facilities for which of the following reasons?

a) Increase physician and staff education.
b) Improve continuity and quality of patient care.
c) Promote a collaborative practice approach to patient care.
d) All of the above.

84.	The first step in the planning process before bedside case management can actually be instituted is assessing the costs for the care provided to high volume, high cost, high resource usage diagnosis related groups.

a) True.
b) False.

85.	The overall goal of the bedside case management institution task force is to:

a) Solicit the support of hospital administration.
b) Examine what it would take to establish a bedside case management patient care delivery model within the hospital.
c) Gain the endorsement of all of the hospital’s department managers.
d) Develop recommendations for employing or appointing an individual to direct the bedside case management program.

86.	Ways to encourage physician participation in the institution of a bedside case management model of patient care delivery include:

a) Getting hospital administration involved in interfacing with the physicians.
b) Placing information folders in strategic places so physicians can review them.
c) Sponsoring a luncheon for the physicians with the guest speaker being a physician familiar with bedside case management.
d) All of the above.

87.	Responsibilities that the bedside case manager will be held accountable for may include all of the following except:

a) Monitoring patient progress along the critical pathway.
b) Taking appropriate actions to rectify any variance.
c) Asking the physician which critical pathway is appropriate for the patient.
d) Making needed referrals and following up to make sure appropriate consultations have been made.

88.	Before instituting a bedside case management patient care delivery model, it is necessary to conduct an assessment of the nursing staff’s clinical competence with regard to managing patient care.

a) True.
b) False.

89.	The nurses who take on the bedside case manager role will need to know how to:

a) Work with third party payers.
b) Handle diagnosis related groups.
c) Conduct concurrent chart reviews.
d) All of the above.

90.	The process for evaluating bedside case management must be developed during what phase of the institution process?

a) Implementation phase.
b) Planning phase.
c) Evaluation phase.
d) Assessment phase.

91.	Because of what it already does and as it continues to grow and fully develop, nursing case management will have the ability to promote the connection between health care institutions and larger health care delivery systems.

a) True.
b) False.

92.	It is predicted, that in the twenty-first century, case management practice will be molded primarily by the needs and demands of:

a) The health care provider.
b) Third party payers.
c) The health care consumer.
d) Governmental health care agencies.

93.	As the population in the United States grows older, it will become necessary for case management programs to focus services solely within the walls of the hospital.

a) True.
b) False.

94.	Two relatively new case management programs that nurses will probably become even more involved with as the programs continue to evolve are:

a) Disease state management and contract management.
b) Demand management and symptom management.
c) Disease state management and demand management.
d) Contract management and symptom management.