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Exam (elaborations)

Case Management Nurse Certification Exam Final Questions and Answers

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Case Management Nurse Certification Exam Final Questions and Answers 1.v Provider 2.v Services 3.v Settingv 4.v Time 5.v Costv-v CORRECTv ANSWER-5v rightsv ofv utilizationv review 211v-v CORRECTv ANSWER federallyv fundedv supportv refe...

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Document information

  • October 14, 2024
  • 22
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

  • case management nurse certification exam final qu
  • 5v rightsv ofv utilizationv review

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  • Case Management Nurse Certification
  • Case Management Nurse Certification

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Case Management Nurse Certification
Exam Final Questions and Answers

1.vProvider
2.vServices
3.vSettingv
4.vTime
5.vCostv-vCORRECTvANSWER-5vrightsvofvutilizationvreview

211v-vCORRECTvANSWER-
federallyvfundedvsupportvreferralvservicesvandvcrisisvmanagement.

25v-vCORRECTvANSWER-
thevdollarvamountvthevgiftsvarevlimitedvtovtovavoidvconflictvofvinterest

4vpartsvofvclinicalvpathwayv-vCORRECTvANSWER-1.vtimeline
2.vcategoriesvofvcare/activitiesvandvinterventions
3.vintermediatevandvlongvtermvoutcomevcriteria
4.vvariancevtracking
arev4vpartsvofvwhat?

55v-vCORRECTvANSWER-
Medicarevwillvbeginvcoveragevofvhomevoxygenvwithvanvarterialvbloodvgasvresultvatvorvabovev
avpartialvpressurevofv___mmvHgvwhilevatvrestvonvroomvair.

80%v-vCORRECTvANSWER-medicarevcoversvwhatvpercent?

80%v-vCORRECTvANSWER-MedicarevPartvBvonlyvcoversvwhatvpercent?

88v-vCORRECTvANSWER-
medicarevwillvcovervhomevoxygenvifvO2vsatvisvatvorvbelowv_____%vwhilevatvrestvonvroomvair,
vexercisingvonvroomvairvorvwhilevasleepvorvavgreatervthanvnormalvfallvinvoxygenvlevelvduringv

sleepv(avdecreasevinvarterialvPOv2vmorevthanv10vmmvHg,vorvdecreasevinvarterialvoxygenvsat
urationvmorevthanv5%)vassociatedvwithvsymptomsvorvsignsvreasonablyvattributablevtovhypo
xemiav(e.g.,vimpairmentvofvcognitivevprocessesvandvnocturnalvrestlessnessvorvinsomnia).

Av-vCORRECTvANSWER-WhatvpartvofvMedicarevcoversvskilledvnursingvfacility?

abandonmentv-vCORRECTvANSWER-
willfulvneglectvofvresponsibilityvofvanothervpersonvbyvavpersonvwhovisvassignedvtovcarevforvth
atvpatientvorvbyvavpersonvinvavcaregivingvposition.

,access,vinspect,vcopyv-vCORRECTvANSWER-
HIPAAvindividualvrightv#3visvthevindividual'svrightvtovtheirvhealthvinformationvtovdovwhat?

accountablevcarevorganizationsv-vCORRECTvANSWER-
groupsvofvdoctors,vhospitals,vandvothervhealthvcarevproviders,vwhovcomevtogethervvoluntari
lyvtovgivevcoordinatedvhighvqualityvcarevtovtheirvMedicarevpatients.Theyvdecreasevfragment
ationvandvimprovevcollaboration.vCreatedvfromvthevaffordablevcarevact.v"medicalvneighborh
ood"

Acutevcarev-vCORRECTvANSWER-
AvhospitalvthevlargestvHealthcarevsettingvinvthevUnitedvStates.vCasevmanagersvneedvtovens
urevtestsvarevdonevinvavtimelyvmeandervresultsvarevgivenvtovprovidervandvHealthcarevteamvd
eterminesvthevnextvstep.

advlitemv-vCORRECTvANSWER-
guardianshipvappointedvtovrepresentvavchildvwhenvthevparentsvconflictvorvinvsituationsvsuchv
asvabuse.

adultsv-vCORRECTvANSWER-
Thesevlearnersvarevautonomous,vgoalvandvrelevancyvoriented,vhavevexperience,vcarevabo
utvwhatvisvpracticalvandvneedvrespect.

advancedvdirectivev-vCORRECTvANSWER-
writtenvstatementvofvmedicalvwishesvinvthevfuturevinvtheveventvtheyvarevunablevtovmakevdeci
sionsvforvthemselves.vItvincludesvavlivingvwillvorvavdurablevpowervofvattorney.

affordablevcarevactv-vCORRECTvANSWER-
thisvlawvinv2010vcreatedvthevinnovationvcentervwithvinvthevcentervforvmedicarevandvmedicaid
vservicesvwhichvassistsvwithvresearchvregardingvquality.




aggregatevdatav-vCORRECTvANSWER-
datavthatvhasvavcommonvvariable.vAnvexamplevwouldvbevdiabetes.

allvpatientvrefinedvdiagnosisvrelatedvgroupsv(APDRG)v-vCORRECTvANSWER-
typevofvpaymentvwithv2vsubclassesvbasedvonv1.vseverityvofvillnessv(organvsystemvfailurevorvl
ossvofvfuntionvandv2.vriskvofvmortality

Americansvwithvdisabilitiesvactv-vCORRECTvANSWER-
thisvactvestablishedvinv1990vhasv5vtitles.v
companiesvcannotvdiscriminatevandvmustvmakevreasonablevaccommodationsvifvtheyvhavev
15vorvmorevemployees,vmustvhavevaccessvtovpublicvtransportation,vhavevaccessvtovteleco
mmunicationvdevices,vandvseekvrestitutionvforvdamagevcausedvbyvinaccessibilityvofvservice
s.

, Appealv-vCORRECTvANSWER-
Avformalvwayvofvlodgingvavdisagreementvwithvavclaimvpaymentvorvbenefitvdenial

arthritisvimpactvmeasurementvscalesv-vCORRECTvANSWER-
healthvriskvassessment:vDisease-specificvmeasurevofvphysical,vsocial,vandvemotionalvwell-
beingvdesignedvasvavmeasurevofvoutcomevinvarthritis.
-
scales:vmobility,vphysicalvactivityv(walking,vbending,vlifting),vdexterity,vhouseholdvactivityv(
managingvmoneyvandvmedications,vhousekeeping),vsocialvactivities,vactivitiesvofvdailyvlivin
g,vpain,vdepression,vandvanxiety.v

Scorevrange:vRangevisv0-10vforveachvsection.vTotalvhealthvscorev0-60.
-->vZerovrepresentsvgoodvhealthvstatus,v10vandv60vrepresentvpoorvhealthvstatus.

Assess,vplan,vimplement/intervention,vmonitor/evaluationv-vCORRECTvANSWER-
4vstagesvofvcasevmanagement

assultv-vCORRECTvANSWER-
anvintentionalvtort/actvofvthreateningvorvattemptingvtovtouchvwithoutvconsent.

autonomyv-vCORRECTvANSWER-
respectingvthevindividual'svrightvtovmakevtheirvownvdecisions

Autonomyvvs.vshamev-vCORRECTvANSWER-Ericksonv1v1/5-3

Bv-vCORRECTvANSWER-WhatvpartvofvMedicarevcoversvdurablevmedicalvequipment?

balancedvbudgetvactv-vCORRECTvANSWER-
actvthatvgivesvmedicarevandvmedicaidvservicesvauthorityvtovestablishvandvoverseevavprogra
mvthatvallowsvprivate,vnationalvaccreditedvorganizationsvtov"deem"vweathervorvnotvavmedica
revadvantagevorganizationvisvcompliantvwithvmedicarevrequirements.vexample:vJCAHOvan
dvNCQA

BalancedvBudgetvActv-vCORRECTvANSWER-
Lawvenactedvinv1977vthatvcreatedvthevmedicarevpartvCv+vchoicevprogram,valsovknowsvasvth
evmedicarevadvantagevplan,visvavmanagedvcarevoptionvthatvallowsvnewvtypesvofvhealthvplan
svundervprivatevcompaniesvtovcovervmedicarevbenefitsvatvavcapitatedv(pervenrollee)vamount
vtovincludevhospitalvandvmedical,vpartsvAvandvB.




BASIS-32v-vCORRECTvANSWER-healthvriskvassessment:v32-
itemvBehaviorvandvSymptomvIdentificationvScale.vbehavioralvhealthvassessmentvtool.
-vmeasuresvthevchangevinvself-
reportedvsymptomvandvproblemvdifficultyvovervthevcoursevofvtreatment.
-
vassesses:vRelationvtovSelfvandvOthers,vDepressionvandvAnxiety,vDailyvLivingvandvRolevFu

nctioning,vImpulsivevandvAddictivevBehavior,vPsychosis.

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