Chapter 22: Case Management

MULTIPLE CHOICE

1. An enduring process in which a manager establishes systems and monitors the health status, resources, and
outcomes for a targeted aggregate of the population is called:
a. Case management
b. Care management
c. Advocacy
d. Continuity of care
ANS: B
Care management is an enduring process in which a manager establishes systems and monitors the health status,
resources, and outcomes for a targeted aggregate of the population.

DIF: COG: Remembering REF: 485 OBJ: 1

2. When would a nurse use a critical path?

a. When implementing the five “rights” of case management
b. When demonstrating competencies required for practicing case management
c. When attempting to achieve a measurable outcome for a specific client
d. When effectively managing conflict resolution
ANS: C
A critical path is a case management tool used to achieve a measurable outcome for a specific client case.

DIF: COG: Applying REF: 489 OBJ: 1

3. A patient with a long history of asthma with many hospital admissions is referred to a case manager to assist in
the management of her disease. Disease management targets:
a. Chronic and costly disease conditions that require long-term care interventions
b. Patients who cannot handle their disease
c. Those who seek to control use by providing clients with correct information
d. Patients who will need an advanced practice nurse instead of physician for monitoring
ANS: A
Disease management activities target chronic and costly disease conditions that require long-term care
interventions. The other answers are false and/or describe other types of management.

DIF: COG: Applying REF: 485 OBJ: 1

4. Which type of management would be most appropriate for a nurse to use when helping clients improve their
health status?
a. Utilization management
b. Case management
c. Disease management
d. Demand management
ANS: D
Demand management seeks to control use by providing clients with correct information and education strategies to
make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make
fewer demands on the health care system.

DIF: COG: Analyzing REF: 485 OBJ: 1

5. Why must a nurse who is using population management be able to work with integrated care delivery systems?
a. Management has shifted from inpatient care to primary care providers as points of entry.
b. Emphasis is on episodic illness care for individuals rather than on population management.
c. Care management services and programs do not provide access and accountability, as provided by case
management services.
d. Assessment of the needs of the population is no longer necessary.
ANS: A
Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The
other statements are false.

DIF: COG: Analyzing REF: 484 OBJ: 1

6. Which activity would a nurse engage in when using population management?

a. Census taking to determine the total number of people in the population
b. Assessing the needs of the client population through compilation of health histories
c. Providing case management services for every citizen in the community
d. Selecting programs for wellness that are repeated annually
ANS: B
Population management involves assessing the needs of the client population through health histories, claims, use-
of-service patterns, and risk factors.

DIF: COG: Analyzing REF: 484 OBJ: 1

7. What are the five “rights” of case management?

a. Care, time, provider, setting, price
b. Patient, medication, route, time, documentation
c. Place, setting, patient, plan, outcomes
d. Disease process, time, place, beneficence, advocate
ANS: A
Care, time, provider, setting, and price are used to judge the effectiveness of case management.

DIF: COG: Understanding REF: 489 OBJ: 2

8. Which model addresses the structure and processes of using the population-based tools of disease management
and critical pathways to offer care for client populations?
a. Client-focused
b. System-focused
c. Social service
d. Long-term care
ANS: B
The system-focused model addresses the structure and processes of using the population-based tools of disease
management and critical pathways to offer care for client populations.

DIF: COG: Understanding REF: 494 OBJ: 2

9. Which are examples of knowledge domains used in case management?

a. Legal issues, malpractice recognition, and community involvement
b. Teaching, counseling, and education skills
c. Advocacy, political campaigning and legislative change
d. Grant application, bargaining contracts, and securing funding
ANS: B
Teaching, counseling, and education skills are an important part of case management in addition to program
evaluation and research.

DIF: COG: Understanding REF: 491 OBJ: 2

10. Which case management activity would most likely be implemented by a bachelor’s prepared nurse rather than
an advanced practice nurse (APN)?
a. Working with community aggregates
b. Working with systems of disease
c. Working with individuals
d. Working with outcomes management processes
ANS: C
Working with community aggregates, systems of disease, and outcomes management processes are implemented
by an APN.

DIF: COG: Applying REF: 485 OBJ: 2

11. The case manager who uses effective collaboration and team strategies to make arrangements for services is
performing the role of:
a. Broker
b. Negotiator
c. Liaison
d. Facilitator
ANS: B
The case manager who uses effective collaboration and team strategies to make arrangements for services is
performing the role of negotiator.

DIF: COG: Applying REF: 490 OBJ: 2

12. When working with a client, when would it be most appropriate for a nurse to use life care planning?
a. When organizing a timeline of life events
b. When documenting client information and requests
c. When assessing present and future client needs
d. When estimating future costs for medical care
ANS: C
Life care planning is a customized, medically-based document that provides assessment of present and future
needs.

DIF: COG: Applying REF: 493 OBJ: 2

13. When case managers provide a formal communication link among all parties concerning the plan of care
management, they are assuming the role of:
a. Facilitator
b. Liaison
c. Coordinator
d. Negotiator
ANS: B
The case manager provides a formal communication link among all parties concerning the plan of care management
is performing the role of liaison.

DIF: COG: Applying REF: 490 OBJ: 2

14. Which nursing intervention does the case manager implement when fulfilling the role of coordinator?
a. Providing information to all parties about the situations affecting the client
b. Educating the client and providers in order to make informed decisions
c. Supporting all parties to work toward mutual goals
d. Arranging, regulating, and balancing needed health services for the client
ANS: D
The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the
client. Providing information to all parties about the client’s situation is the role of the monitor/reporter. Educating the
client and provider in order to make informed decisions is the role of educator, and supporting all parties to work
toward mutual goals is the role of facilitator.

DIF: COG: Applying REF: 490 OBJ: 2

15. Which are examples of case-managed conditions?

a. Bankruptcy, financial distress, depression
b. Flu, colds, frequent headaches
c. Malaria, bird flu, Dengue fever
d. AIDS, spinal cord injury, ventilator dependency
ANS: D
Case-managed conditions include many chronic conditions.

DIF: COG: Applying REF: 494 OBJ: 2

16. The public health nurse working with the chronically ill and families with young children needing age-specific
health maintenance is using which model of case management?
a. Client-focused
b. System-focused
c. Social service
d. Long-term care
ANS: A
The concern in client-focused models is with the relationship between case manager and client to support continuity
of care and to access providers of care.

DIF: COG: Applying REF: 494 OBJ: 2

17. In case management, the process of performing interdisciplinary, family, and client conferences would occur
during which phase of the nursing process?
a. Assessment
b. Diagnosis
c. Planning/outcome
d. Implementation
ANS: B
Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis
phase include holding conferences, determining conclusions on the basis of assessment, and using
interprofessional teams.

DIF: COG: Analyzing REF: 489 OBJ: 3

18. When the case manager contacts providers and negotiates services and price, which phase of the nursing
process is used?
a. Assessment
b. Diagnosis
c. Planning/outcome
d. Implementation
ANS: D
The implementation phase of the nursing process occurs when a case manager advocates for clients’ interests and
arranges for the delivery of service.

DIF: COG: Analyzing REF: 489 OBJ: 3

19. A case manager supports a client’s decision to return home after having a total hip replacement rather than go
to a skilled nursing facility. Which phase of the nursing process is being used?
a. Assessment
b. Planning/outcome
c. Implementation
d. Evaluation
ANS: C
The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and
supports the client’s decisions.

DIF: COG: Analyzing REF: 497 OBJ: 3

20. The process of moving conflicting parties toward an outcome is called:
a. Negotiation
b. Conflict management
c. Problem-purpose expansion method
d. Brainstorming
ANS: A
The process of moving conflicting parties toward an outcome is called negotiation.

DIF: COG: Remembering REF: 499 OBJ: 4

21. The first stage of collaboration is:

a. Trust building
b. Consensus
c. Collegiality
d. Awareness
ANS: D
Awareness is when one makes a conscious entry into a group process.

DIF: COG: Understanding REF: 501 OBJ: 4

22. Mutual benefit with limited loss for everyone is a goal of:
a. Negotiating
b. Assertiveness
c. Conflict management
d. Cooperation
ANS: C
Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed
toward learning all parties needs and desires, detecting their areas of agreement and disagreement, determining
their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal.

DIF: COG: Understanding REF: 499 OBJ: 4

23. The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of
breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, “Tell me more about
how you will work full time and breastfeed.” Asking this question is an example of which aspect of the advocacy
process?
a. Verification
b. Clarification
c. Amplification
d. Affirmation
ANS: B
Clarification is a process in which the nurse and client strive to understand meanings in a common way.

DIF: COG: Applying REF: 496 OBJ: 4

24. Upholding a client’s right to make a choice and to act on the choice involves:
a. Affirming
b. Supporting
c. Informing
d. Decision making
ANS: B
Supporters approve and support clients’ actions.

DIF: COG: Applying REF: 497 OBJ: 4

25. An individual who pursues neither his or her concerns nor another’s concerns is using which conflict
management behavior?
a. Accommodating
b. Collaborating
c. Avoiding
d. Compromising
ANS: C
The individual would be “avoiding.”

DIF: COG: Applying REF: 500 OBJ: 4

26. The nurse is involved in a conflict resolution situation with the parents of a 2-year-old boy. The parents are
deciding if “spanking” the child is a disciplinary method that they will employ. The mother says, “I do not believe in
spanking. I see it as abusive and demeaning.” The mother’s statement is an example of:
a. Cooperation
b. Assertiveness
c. Bargaining
d. Collaboration
ANS: B
The mother’s statement is an example of assertiveness, the ability to present one’s own needs.

DIF: COG: Applying REF: 499 OBJ: 4

27. Which principle of justice is influenced when excessive attention to cost containment impairs the nurse’s duty to
provide measures to improve health?
a. Autonomy
b. Beneficence
c. Confidentiality
d. Justice
ANS: B
Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to
provide measures to improve health or relieve suffering.

DIF: COG: Applying REF: 502 OBJ: 5

28. Which ethical principle is influenced when care in a managed system is provided by less-experienced providers?
a. Autonomy
b. Beneficence
c. Confidentiality
d. Justice
ANS: D
Justice calls for equal distribution of health care with reasonable quality.

DIF: COG: Applying REF: 502 OBJ: 5

29. A case manager submits documentation that a nursing visit was completed at a client’s home, but it was never
performed. According to the general areas of legal risk, how would this action best be categorized?
a. Liability for managing care
b. Fraud/abuse
c. Negligent referral
d. Confidentiality/security
ANS: B
Fraud/abuse occurs when false statements of claims are made and filed.

DIF: COG: Applying REF: 501-502 OBJ: 5

MULTIPLE RESPONSE

1. What knowledge and skills are required in order to become a competent case manager? Select all that apply.
a. Knowledge of community resources and financing mechanisms
b. Written and oral communication skills
c. Proficient negotiation and conflict-resolving practices
d. Application of evidence-based practices and outcomes measurements
ANS: A, B, C, D
The knowledge and skills required to achieve competency include knowledge of community resources and financing
mechanisms, written and oral communication and documentation, proficient negotiating and conflict-resolving
practices, and the ability to apply evidence-based practices and outcomes measures.

DIF: COG: Understanding REF: 487 OBJ: 2

2. What action should a nurse take in order to reduce the risk of liability? Select all that apply.
a. Provide accurate documentation of client visits.
b. Inform clients of their rights of appeal.
c. Refer clients to the providers of their choice.
d. Utilize care planning whenever possible.
ANS: A, B
To reduce risk exposure, it is important to provide clear documentation of client encounters and inform clients of
their rights of appeal. Client choice is important when choosing a provider; however, the nurse is responsible for
using reasonable care when selecting referral choices for a client. Although care planning may be helpful for
establishing a plan with the client, it is not necessary in reducing the risk of liability.

DIF: COG: Analyzing REF: 502 OBJ: 5