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COMMUNITY PUBLIC HEALTH NURSING 7TH EDITION NIES TESTBANK 100% CORRECT WITH EXPLAINED ANSWERS
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COMMUNITYPUBLIC HEALTH
NURSING 7 TH
EDITION NIES
TESTBANK 100%
CORRECT WITH
EXPLAINED
ANSWERS
,Chapter 09: Case Management
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A health care provider has charged more than what is allowed by a third-party payer. Which
would most likely be the result?
a.
Provider may be removed from the list of providers for the third-party payer.
b.
The third-party payer will reexamine the payment for that procedure.
c.
Provider would get the typical payment instead of what was charged to the
third-party payer.
d.
The third-party payer would be forced to increase its typical payment for
that procedure.
ANS: C
Client service use reflects a greater emphasis on health care costs. Third-party payers evaluate
the appropriate use and costs of health care resources. Therefore, at least on the first occasion,
the most probable result would be that the provider gets the listed payment, not what the
provider charged.
DIF: Cognitive Level: Apply (Application)
2. A nurse is explaining case management to a client. Which statement would be the most
appropriate for the nurse to make?
a.
“We assess, plan, facilitate, and advocate to save money as much as possible.”
b.
“We coordinate your care so you obtain needed services without incurring undue
costs.”
c.
“We seek the lowest cost provider to give you what care is necessary.”
d.
“We collaborate with you to coordinate your care for the best outcome.”
ANS: D
There is no single definition of case management. But it is a collaborative process to meet an
individual’s health needs through communication and available resources to promote quality
cost-effective outcomes. The response “with you” shows a collaborative approach to
coordinating care for the best outcome.
DIF: Cognitive Level: Apply (Application)
3. A hospital is going to start a care management program. Which group of clients would most
likely be selected to first receive such services?
a.
Clients who represent the most common diagnosis group to be admitted
b.
Clients who request such services from their local hospital
c.
Clients with chronic illnesses
d.
Clients with the least education
ANS: C
, The overall goal of care management is to improve the coordination of services provided to
clients who are enrolled in a care management program. Examples of groups of people who
may be served by care management services include the elderly, children from low-income
families who receive Medicaid services, and groups of people with chronic illnesses. The
other groups do not represent groups who are typically enrolled in a care management
program.
DIF: Cognitive Level: Apply (Application)
4. Who first created the idea of a continuum of care, which later evolved into the term “case
management”?
a.
Florence Nightingale, when she engaged in activities such as writing letters for
the wounded.
b.
Lillian Wald, who created health education programs for the whole community.
c.
Social workers, who function as discharge planners, use the term.
d.
Those who coordinated services for discharged psychiatric patients after World
War II (WWII) used the term.
ANS: D
The concept of continuum of care originated after WWII to describe the long-term services
required for discharged psychiatric patients. The term “case management” first appeared in
social welfare literature during the early 1970s. Nightingale, Wald, and social workers were
not involved in the creation of the idea of the continuum of care.
DIF: Cognitive Level: Remember (Knowledge)
5. Which best describes the aftermath of the deinstitutionalization of mentally ill patients into the
community during the 1970s?
a.
Community health centers were created and gave care to such clients.
b.
Families were eager to accept their family members back home.
c.
Many mentally ill clients without social skills ended up in nursing homes.
d.
Without follow-up care, many clients were readmitted to care.
ANS: D
Several problems resulted from deinstitutionalization of mentally ill patients, because there
was no follow-up or monitoring. Many were readmitted to state hospitals. Many ended up
homeless or in prison facilities, not in nursing homes or with their family members at home.
Community health centers were created to provide care to these patients, but the
deinstitutionalized were unable to meet their basic needs and receive proper follow-up and
health care monitoring. Thus, they were readmitted to care.
DIF: Cognitive Level: Understand (Comprehension)
6. Which elderly persons are often the targets of case management?
a.
Those who are homebound and have multiple complex problems
b.
Those who live alone without close relatives
c.
Those who show clear evidence of mental and physical decline
d.
Those with chronic long-term health problems needing pharmaceutical
intervention
ANS: A
, Many older people have special, population-specific health care needs. Case management
services frequently target the elderly population, specifically homebound individuals or those
with complex problems. However, not all older persons require a case manager. The other
elderly groups are not the primary target of case management services.
DIF: Cognitive Level: Understand (Comprehension)
7. Which best describes the purpose of case management from the client’s perspective?
a.
To help clients navigate a complex, fragmented, confusing health care system to
obtain appropriate care
b.
To help clients recognize that health care resources are limited and must be used
wisely
c.
To help clients understand their varied health problems and the best approach to
maintain their health
d.
To help clients obtain whatever care they need or desire
ANS: A
Client-centered case management assists the patient through a fragmented and often confusing
health care delivery system and to achieve specific client-centered goals. Systems-centered
processes recognize that health care resources are finite. Helping clients understand their
health problems is a responsibility of health education, not case management.
DIF: Cognitive Level: Understand (Comprehension)
8. Which best describes a key strategy that is used as part of care management?
a.
Align necessary services with the need of the population
b.
Implement services as soon as possible
c.
Request front line staff make appropriate referrals
d.
Utilize assigned case managers to complete this process
ANS: A
The purpose of care management is to reduce health risks and cost of care for a defined
population. AHRQ highlights three key strategies to enhance care management for target
populations: (1) Identify population(s) with modifiable risks; (2) Align CM services to the
needs of the population(s); and (3) Identify, prepare, and integrate appropriate personnel to
deliver the needed services.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best describes why utilization review departments are becoming case management
units?
a.
Funding is available for case management responsibilities.
b.
Monitoring service use alone does not improve patient outcomes.
c.
It facilitates using nurse experts for case management.
d.
It promotes the current trend of naming “utilization review” units “case
management.”
ANS: B
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