chap 13 CH – Flashcards
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MULTIPLE CHOICE 1. Case management differs from care management in that case management is: a. A tool of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate
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: C Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system.
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: Cognitive Level: Knowledge REF: p. 238 2. Why is planning care for an individual so challenging in today's health care system? a. Because today's clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client treatment d. Because so many different health care providers are in the acute care setting today
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: B Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client's continuum of care.
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: Cognitive Level: Knowledge REF: p. 238 3. What is the primary problem that can result from health care today being given by many different care providers? a. Clients are not sure which provider to see first. b. Health care providers have to take the time to make referrals and fax records to other care providers. c. Clients sometimes are not sure who their primary provider is. d. Overuse, underuse, or gaps in care may result.
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: D A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication.
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: Cognitive Level: Knowledge REF: p. 238 4. Which of these public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 2-year-old who has a master's degree in public health b. A 3-year-old who will be moving from a large city c. A 4-year-old who was born and raised in the community d. A 5-year-old who, until recently, was a member of the community's school board
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: B Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict-resolution skills; critical-thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills.
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: Cognitive Level: Application REF: p. 238 5. If case management is so helpful to both the client and the health care system, why doesn't every client receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers.
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: A Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses' caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet.
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: Cognitive Level: Application REF: p. 239 6. The nurse suggests use of telehealth to assess how a client is progressing. What resource must be available for continuing care to be implemented? a. A physician who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic
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: C Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client's health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phone bank location.
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: Cognitive Level: Application REF: p. 240 7. A nurse wants a rural agency to use CareMaps to maximize patient care outcomes. Because the agency has not previously used such tools, the nurse uses a CareMap from an urban hospital nearby for one client. What is the most likely outcome of this CareMap being used? a. CareMaps are integrated into all standard care plans in the agency. b. The CareMap from the urban hospital does not really fit the local situation and hence is not very helpful. c. The client is grateful for the additional resources and shares the family's satisfaction with everyone involved. d. The nurse receives both a commendation and a salary increase for contribution to improving care in the community.
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: B Many CareMaps are not evidence-based but developed on expert knowledge applicable to a specific agency. Hence a CareMap from one agency may not be adequate or appropriate for use in another agency. Instead, the CareMap would need to be adapted to the local situation.
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: Cognitive Level: Application REF: p. 241 8. A client spends a great deal of his time on the Internet or reading articles related to diabetes and its long-term effects. One day the client asks why the nurse has not suggested a life care plan. What is the best response by the nurse? a. "Life care plans are only for young persons who are newly diagnosed." b. "Life care plans are primarily used to determine long-term financial needs for legal reasons." c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." d. "I was waiting for you to express interest in having a life care plan."
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: C Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice. Other who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging.
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: Cognitive Level: Application REF: p. 242 9. Several states are beginning to use case management for selected clients who receive Medicaid. Which groups of clients are usually the first to receive this planning? a. Elderly persons, because they require more care than young persons b. Persons receiving rehabilitation following an injury c. Persons who have high-cost chronic diseases d. Persons with acute illnesses who are expected to fully recover
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: C Some states, through their Medicaid programs, are developing disease management programs for high-cost chronic diseases among their populations, such as asthma and diabetes.
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: Cognitive Level: Knowledge REF: p. 243 10. What is the goal or priority of the nurse in advocacy? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client's rights and self-determination
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: D In today's practice, the nurse advocate makes the client's rights the priority. Thus the goal of advocacy is to promote self-determination in a constituency or client group.
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: Cognitive Level: Knowledge REF: p. 244 11. A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Why would the nurse suggest changing the goal from obtaining appropriate long-term care placement to ensuring that the client's convalescence is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client's family considered most important
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: C One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable. To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences.
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: Cognitive Level: Application REF: p. 245 (Box 13-6) 12. What role is being served by the case manager who advocates for a client by helping an insurer understand client needs and desires and by helping the client understand programs and benefits offered by the insurer? a. Arbitrator b. Counselor c. Mediator d. Negotiator
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: D Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. Mediating is the process of assisting parties to understand each other's concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome.
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: Cognitive Level: Application REF: p. 246 13. A nurse reviews with the client what the client can expect during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, "You've got my care all mapped out." What is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management
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: B Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measureable outcomes. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves 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.
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: Cognitive Level: Application REF: p. 238 (Box 13-1) 14. Besides ensuring quality health care, what is the primary goal of case management? a. To ensure that the best possible care provider is assigned to care for the client b. To emphasize evidence-based clinical decision making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care
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: C The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision making, guideline use, and disease-management programs; and control expenses by managing care processes and outcomes. You can exclude options 1 and 2 because both of these would be included in the goal of ensuring quality health care, which is already stated in the question stem.
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: Cognitive Level: Knowledge REF: p. 238 15. The problem identification phase of the case management process corresponds to which phase of the nursing process? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase
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: B The diagnosis phase of the nursing process is analogous to identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment.
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: Cognitive Level: Knowledge REF: p. 238 (Table 13-1) 16. Which activity would represent the case management advocacy activity corresponding to the implementation phase of the nursing process? a. Nurse asks the family members what is most important to them. b. Nurse asks the family members whether they feel that their decisions have been honored. c. Nurse assures the family that their wishes will be supported. d. Nurse determines the order in which actions will occur.
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: C Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking family members what is most important is a way to illuminate values, which occurs in the assessment phase. Asking whether they feel their decisions have been honored is a way to evaluate advocacy, so it occurs in the evaluation phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase.
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: Cognitive Level: Application REF: p. 238 (Table 13-1) 17. The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. What would this process be called? a. Assertiveness b. Collaboration c. Cooperation d. Compromising
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: B In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties.
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: Cognitive Level: Knowledge REF: p. 246 (Box 13-7) 18. Which action would be a primary prevention level activity of a case manager? a. Advocating for the client whose values conflict with those of the medical service provider b. Collaborating between nursing and occupational health personnel c. Educating a group regarding community services that are available if ever needed d. Resolving conflict between a primary care clinic and a tertiary health care facility
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: C Primary prevention involves the use of the information exchange process to increase the client's understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed.
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: Cognitive Level: Knowledge REF: p. 238 MULTIPLE RESPONSE 1. What are some appropriate actions for case managers to minimize their exposure to possible law suits? Select all that apply. a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Communicate, communicate, communicate. d. Confirm credentials and capabilities of providers or agencies to give care. e. Keep all family members informed of decisions and reasons behind them. f. Share client information with the other involved providers and agencies.
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: A, B, C, D Elements that reduce risk exposure include clear documentation of the extent of participation in decision making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources—which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with HIPAA, no nurse is allowed to share information with others without written consent of the client.
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: Cognitive Level: Application REF: p. 248 (Box 13-9)
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