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Origin: Chapter 12- Care Management, Case management, 1

1. The nurse discusses home care options with an 85-year-old client who recently fractured
her humerus in a fall in her house. She is recovering well now but says the experience
has made her see that it is time for her to change her living arrangements. The client can
still bathe herself and cook meals on occasion but says she would like to live where
nursing care is available onsite and where communal dining and recreation options are
offered. Which of the following living arrangements could the nurse recommend?
A) Assisted living facility
B) Independent living in a senior living facility
C) Nursing home
D) Apartment located near a hospital
Ans: A
Feedback:
Assisted living is a type of community-based care that combines quasi-independent
living with the availability of nursing care onsite and through home care visits. It is
generally a level of care for people who cannot live on their own, but are not yet ready
for a nursing home. This type of living arrangement is different from living
independently in one's own apartment, such as living in a senior living facility, in that
many activities are provided communally (e.g., eating, recreation) and there is an
organized effort to create a “caring community” where residents' needs are supervised
and met.

Origin: Chapter 12- Care Management, Case management, 2


2. A community care nurse at a healthcare agency assists in coordinating a plan for
providing health services in the most cost-effective way possible to a large number of
members living in the region. This work is known as:
A) Case management
B) Home healthcare
C) Interdisciplinary collaboration
D) Care management
Ans: D
Feedback:
Care management is the coordination of a plan or process to bring health services
together as a common whole in a cost-effective way. Case management is the
development and coordination of care for a selected client and family. Home healthcare
is a provision of healthcare that occurs in the setting clients consider their home.
Interdisciplinary collaboration is the sharing of evidenced-based practice and skills as an
integration strategy with clients and families in homes and other healthcare settings.

Origin: Chapter 12- Care Management, Case management, 3


3. The case manager works with a client who has type 2 diabetes and heart disease. In this
role, which actions should the nurse take in managing the client's diseases? (Select all
that apply.)
A) Provide weekly coaching sessions by telephone for blood glucose management.

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B) Supervise cardiac stress tests in the exercise room of the local hospital.
C) Administer emergency insulin when the client arrives at the hospital in a diabetic
coma.
D) Demonstrate use of a glucose meter to the client.
E) Review heart-healthy and diabetic-friendly food options with the client and his
family.
Ans: A, D, E
Feedback:
Disease management often focuses on chronic illness such as heart disease, heart failure,
diabetes, pulmonary disease, urinary incontinence, and asthma. In disease management
programs, in addition to medications, there is strong emphasis on the use of telephone
coaching, Internet resources, and intensive client and family teaching to advance self-
care and adherence to wellness care. Recently, to help clients and families manage their
health problems in an effective and efficient manner, there has been an effort to bundle
disease states together in light of many comorbidity patterns. Supervising a cardiac
stress test and administering emergency glucose are clinical interventions that go
beyond basic disease management.

Origin: Chapter 12- Care Management, Case management, 4


4. The case manager works with a 10-year-old girl who has asthma. Because the client's
family has trouble affording inhalers, the case manager researches client assistance
programs through which they could receive free medications. This aspect of case
management is known as:
A) Care management
B) Advocacy
C) Disease management
D) Interdisciplinary collaboration
Ans: B
Feedback:
Advocacy is always moving the needs of clients, families, and communities to a point of
awareness that will advance change and increase quality of a life and experience. Care
management is the coordination of a plan or process to bring health services together as
a common whole in a cost-effective way. Disease management is a system of
coordinated healthcare interventions and communications for groups of people with
conditions in which client self-care efforts are significant. Disease management
emphasizes prevention at the secondary and tertiary level using evidence-based practice
guidelines. Interdisciplinary collaboration is sharing of evidence-based practice and
skills by several disciplines as an integration strategy with clients and families in homes
and other healthcare settings.

Origin: Chapter 12- Care Management, Case management, 5


5. The case manager for a 12-year-old boy who is obese and prediabetic. To help the client
develop a diet that will promote weight loss and control of his glucose level, the case
manager decides to consult with a dietician, who provides several current journal

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articles that present findings on various diets. This aspect of case management is known
as:
A) Care management
B) Advocacy
C) Disease management
D) Interdisciplinary collaboration
Ans: D
Feedback:
Interdisciplinary collaboration is sharing of evidence-based practice and skills by
several disciplines as an integration strategy with clients and families in homes and
other healthcare settings. Advocacy is always moving the needs of clients, families, and
communities to a point of awareness that will advance change and increase quality of a
life and experience. Care management is the coordination of a plan or process to bring
health services together as a common whole in a cost-effective way. Disease
management is a system of coordinated healthcare interventions and communications
for groups of people with conditions in which client self-care efforts are significant.
Disease management emphasizes prevention at the secondary and tertiary level using
evidence-based practice guidelines.

Origin: Chapter 12- Care Management, Case management, 6


6. A student is considering becoming a home health nurse. In researching this type of
nursing, the student finds that several key factors have played a part in the development
of home healthcare as it is today? These include: (Select all that apply.)
A) Increase in the number of hospitals nationwide
B) Reduction in the incidence of chronic diseases
C) Development of health insurance
D) Rising costs in healthcare
E) Increase in medical and nursing specialization
Ans: C, D, E
Feedback:
The development of health insurance, rising costs in healthcare in general, and medical
and nursing specialization all have played a part in the development of home healthcare
as it is today. Hospitals have not increased in number nationwide in recent years and the
incidence of chronic diseases has increased, not decreased.

Origin: Chapter 12- Care Management, Case management, 7


7. The nurse has recently been appointed to a community-based advisory board of an
agency that is interested in providing fiscally sound, high-quality care for clients they
decide will be their service population. Any profit margin that is acquired is reinvested
in the operations of the home healthcare service. Which type of agency is this?
A) Private/voluntary
B) Hospital based
C) Proprietary
D) Official

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Ans: A
Feedback:
Voluntary agencies are generally established as not-for-profit entities, although they
operate with the same fiscal objectives as “for-profit agencies.” A hospital-based agency
is a home health agency that is not freestanding in the community but is one of many
specialty services offered at a hospital setting. A proprietary agency is a home health
agency that is motivated by a for-profit philosophy. Official agencies are supported by
public monies that often come from taxes. The public monies can come from local,
state, or federal governments.

Origin: Chapter 12- Care Management, Case management, 8


8. The nurse recently took a position in a national chain of home healthcare agencies
directed at caring for clients who are on home hemodialysis. The services provided are
often paid for privately by families, and any profit margin is used to benefit the owner of
the agency. Which type of agency is this?
A) Private/voluntary
B) Hospital based
C) Proprietary
D) Official
Ans: C
Feedback:
A proprietary agency is a private agency that plans to and wants to make a profit. It can
be part of a local, national, or international chain of home healthcare agencies directed
toward any group of clients with particular healthcare problems or challenges. A
voluntary agency is generally established as a not-for-profit entity, although it operates
with the same fiscal objectives as “for-profit agencies.” A hospital-based agency is a
home health agency that is not freestanding in the community but is one of many
specialty services offered at a hospital setting. Official agencies are supported by public
monies that often come from taxes. The public monies can come from local, state, or
federal governments.

Origin: Chapter 12- Care Management, Case management, 9


9. Which type of agency can be either profit or nonprofit?
A) Private/voluntary
B) Hospital based
C) Proprietary
D) Official
Ans: B
Feedback:
A hospital-based agency is a home health agency that is not freestanding in the
community but is one of many specialty services offered at a hospital setting. It can be
for profit or nonprofit depending on the philosophy of the hospital. Voluntary agencies
are generally established as not-for-profit entities, although they operate with the same
fiscal objectives as “for-profit agencies.” A proprietary agency is a home health agency

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that is motivated by a for-profit philosophy. Official agencies are supported by public
monies that often come from taxes. The public monies can come from local, state, or
federal governments.

Origin: Chapter 12- Care Management, Case management, 10


10. The nurse takes care of a dependent family member whose husband is in the military.
Which government funding is most likely going to be used for home healthcare services
for this client?
A) Medicare
B) Medicaid
C) TRICARE
D) Veterans Administration
Ans: C
Feedback:
Government funding for home healthcare includes Medicare (federal), Medicaid (state),
TRICARE (federal funds for military personnel and their dependents), and the Veterans
Administration (federal funds for those who are currently serving or have served in the
armed services of the United States).

Origin: Chapter 12- Care Management, Case management, 11


11. Who primarily regulates the provisions of home healthcare? (Select all that apply.)
A) Insurance companies
B) Local government
C) State government
D) Federal government
Ans: C, D
Feedback:
Home healthcare is regulated by the state and federal government. Insurance companies
generally align themselves with the regulations stipulated by these governments.

Origin: Chapter 12- Care Management, Case management, 12


12. Which criteria must an individual meet to receive Medicare for home health services?
(Select all that apply.)
A) Home bound
B) Specific plan of care
C) Skilled healthcare needs
D) Intermittent care needs
E) Continuous 24-hour necessity for care
Ans: A, B, C, D
Feedback:
Medicare has the following criteria for eligibility: (1) home bound, (2) a plan of care,
(3) skilled needs, (4) intermittent care needs, and (5) necessity.

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Origin: Chapter 12- Care Management, Case management, 13
13. The nurse provides care covered by Medicare for a client over 2 hours during the day, 3
days during the week, for 60 days. Which type of care is the nurse providing?
A) Interdisciplinary
B) Skilled
C) Intermittent
D) Part-time
Ans: C
Feedback:
Intermittent care refers to a situation in which skilled care is usually provided over
several hours during the day, several days during the week, for a specified time period.
Interdisciplinary care is that provided by several disciplines as an integration strategy
with clients and families in homes and other healthcare settings. Skilled care involves
the professional abilities of a registered nurse or her/his supervised designee. Necessity
means that the service given by a home care agency is reasonable based on the status of
the client.

Origin: Chapter 12- Care Management, Case management, 14


14. The client wants to know how long Medicare will pay for skilled needs. How long can
the nurse continue to provide this care before she must seek a renewal if skilled needs
continue to exist?
A) 30 days
B) 45 days
C) 60 days
D) 90 days
Ans: C
Feedback:
Medicare requires the specified time period to be 60 days with appropriate renewals if
skilled needs continue to exist.

Origin: Chapter 12- Care Management, Case management, 15


15. The nurse reviews the official document called the Scope and Standards of Home Health
Nursing Practice. Using knowledge about the document providing guidelines for nurses
involved in home healthcare practice, which are included in the standards of care?
(Select all that apply.)
A) Assessment by collecting data about home care clients
B) Implementation of nurse-centered actions in collaboration with physicians
C) Diagnosis through the analysis of data
D) Outcome identification that helps identify nurse-sensitive measures
E) Planning nurse-sensitive interventions directed at the identified outcomes
Ans: A, C, D, E
Feedback:
The standards of care include the following key elements of the nursing process: (1)

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assessment by collecting data about home care clients; (2) diagnosis through the
analysis of these data; (3) outcome identification that helps home care nurses identify
nurse-sensitive measures; (4) planning in the form of nurse-sensitive interventions
directed at the identified outcomes; and (5) implementation of nurse-centered actions in
collaboration with clients and families, not with physicians.

Origin: Chapter 12- Care Management, Case management, 16


16. What services is telehealth used to deliver? (Select all that apply.)
A) Chronic care and specialty consultations
B) Home telenursing
C) Electronic referrals to specialists in expert health facilities
D) Transmission of healthcare information to people in the same geographical area
Ans: B, C
Feedback:
Telehealth is a form of electronic communication used to deliver (1) acute (not chronic)
care and specialty consultations, (2) home telenursing, and (3) electronic referrals to
specialists in expert health facilities. According to Thede, it involves “using electronic
communications for transmitting healthcare information such as health promotion,
disease prevention, professional or lay education, diagnosis, or actual treatment to
people located at a different geographical area.”

Origin: Chapter 12- Care Management, Case management, 17


17. Using knowledge of the parish or faith community nurse, which interventions are likely
to perform on the basis of the key roles of this type of nurse? (Select all that apply.)
A) Teaching a class to faith community members on managing high blood pressure
B) Providing counsel on preventing upper respiratory illness to member
C) Referring a faith community member to a nutritionist for dietary counsel
D) Assisting an obstetrician in the birth of a faith community member's child
E) Administering vaccinations at a local health clinic
Ans: A, B, C
Feedback:
The seminal work of Westberg identified seven key roles of the parish or faith
community nurse: (1) health educator, (2) personal health counselor, (3) referral agent,
(4) coordinator of volunteers, (5) developer of supportive groups, (6) integrator of faith
and health, and (7) health advocate. A faith community nurse would not likely assist an
obstetrician with a birth or administer vaccinations at a local health clinic.

Origin: Chapter 12- Care Management, Case management, 18


18. The home care agency has just received a client referral from a physician and assigned
the case. Within how many hours from receiving the referral should the nurse plan to
make the initial visit to this client, on the basis of typical agency policy?
A) 12 hours
B) 24 hours

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C) 36 hours
D) 48 hours
Ans: B
Feedback:
Generally, home care agencies make sure that an initial visit is made within 24 hours
after receiving a referral.

Origin: Chapter 12- Care Management, Case management, 19


19. The community health nurse can receive a referral to a home health agency at any time.
Which phases are included in a home visit? (Select all that apply.)
A) Plan personal safety of visit
B) Initiating a visit
C) Preparation
D) Actual visit
E) Termination of the visit
Ans: B, C, D, E
Feedback:
There are five phases to a home visit: (1) initiating the visit, (2) preparation, (3) the
actual visit, (4) termination of the visit, and (5) postvisit planning.

Origin: Chapter 12- Care Management, Case management, 20


20. The home health nurse has to ensure that a safety plan is in place to address falls. Using
knowledge that 55% of fall-related injuries occur with falls inside the home, a total of
more than 60% of these falls occur in which two rooms?
A) Living room and hallway
B) Kitchen and bathroom
C) Hallway and bedroom
D) Living room and bedroom
Ans: D
Feedback:
The most common rooms where people fall include the living room (31%), bedroom
(30%), kitchen (19%), bathroom (13%), and hallway (10%).

Origin: Chapter 12- Care Management, Case management, 21


21. The nurse works with 68-year-old client who is having great difficulty managing his
blood glucose level. The nurse finds that the client is not following the diet that he had
agreed to follow and is eating portions that are far too large. He apologizes and explains
that he is grieving the loss of his wife, who died 2 weeks ago. The nurse shares
condolences with him on his loss and explain that it is perfectly understandable to have
trouble following a new diet while grieving. In this scenario, the nurse is using which
principal approach in motivational interviewing?
A) Expressing empathy
B) Supporting self-efficacy

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C) Rolling with resistance
D) Finding a discrepancy
Ans: A
Feedback:
Empathy is an approach to clients that involves trying to see clients' lives through their
own lens and trying to think about their experiences as they would think about them.
Self-efficacy is the belief on the part of the client that change is possible. In
motivational interviewing, the home care nurse does not fight client resistance but “rolls
with it.” Home care nurses also work to develop opportunities for clients to discover
discrepancies between their current behavior and what they want to accomplish through
changed behaviors.

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