Case Management

Front 1

An agreement by a doctor or provider to be
paid directly from Medicare and accept the
payment amount Medicare approves for the
service is called:

Back 1

Assignment

Front 2

A primary prevention service to reduce the
incidence of HIV/AIDS within a community
would be:

Back 2

Public service announcements that
provide information on how HIV
can be transmitted

Front 3

When is a certificate of medical necessity
needed under Medicare Parts A and B?

Back 3

When ordering oxygen equipment
and supplies

Front 4

An example of a secondary prevention
service related to hypertension would be:

Back 4

Blood pressure screenings to identify
people with hypertension

Front 5

If a case manager suspects a colleague is
intoxicated at work, all of the following actions
would be appropriate except:

Back 5

Verifying the colleague is impaired

Front 6

All of the following are mainstay therapeutic
approaches for patients with moderate-tosevere
chronic pain, EXCEPT:

Back 6

Deep brain stimulation (DBS)

Front 7

In the Case Management Certification Code
of Professional Conduct, a process that promotes
beneficence, justice, and autonomy
for clients is known as:

Back 7

Advocacy

Front 8

Establishing reinsurance dollar
Amounts represent purposes or
goals of case management
(T or F)

Back 8

F

Front 9

What factors
can complicate transitions of care?

Back 9

An abrupt transition
Communication breakdown
Unrealistic expectations from the
patient's family

Front 10

Case management is considered to have its
roots in:

Back 10

Public health nursing

Front 11

Health assessment screening tools are
intended to measure a patient's:

Back 11

Perceived health status

Front 12

The date of accident or injury on a claim is
often abbreviated as:

Back 12

DOI

Front 13

A 37-year-old carpenter is unable to return
to his previous job and continues to fail in
following through with potential job leads
provided by his counselor. At this point the
case manager would:

Back 13

Assess the client's job readiness

Front 14

A patient usually reaches MMI when:

Back 14

All of the healing benefits possible
from medical treatment have been
achieved

Front 15

Outcomes in case management reporting
are used to:

Back 15

Measure patient satisfaction, quality
of care, and cost savings

Front 16

In the past fee-for-service environment,
health care services were:

Back 16

Reactive-oriented, based on illness
or injury needs

Front 17

The responsibility to develop an exposure
control plan under OSHA's Bloodborne
Pathogen Regulations in the hospital is that
of:

Back 17

The risk management department

Front 18

Components of medical care coordination
include all of the following :

Back 18

Minimizing the recovery period
while promoting medical stability
Establishing a case management
treatment plan
Identifying physician specialists for
post-acute care

Front 19

Under the American with Disabilities Act
(ADA), being disabled is partially defined as

Back 19

Anyone having a physical, mental,
or emotional impairment that substantially
limits major life activities

Front 20

The most important identified need of the
family of a traumatic brain injury (TBI)
patient in the initial acute phase following
injury would be:

Back 20

Consistent, clear updates in information
regarding potential behavioral
patterns

Front 21

Discrimination against persons with disabilities
is disallowed under:

Back 21

Title I of the ADA

Front 22

Ergonomics is intended to:

Back 22

Adapt the work environment to
meet the wellness needs of the
employee

Front 23

The rehabilitation case manager is successful
when:

Back 23

A meaningful lifestyle has been
achieved by the patient

Front 24

The ADA requires an accessible path of at
least ____ alongside a public telephone.

Back 24

48 ft

Front 25

In no-fault auto liability claims, individuals
recover damages from:

Back 25

Their own no-fault insurance,
regardless of who was at fault

Front 26

According to OSHA standards, medical
records of an employee must include any
Hepatitis B vaccination status, exam, testing,
follow-up results, and:

Back 26

A copy of the physician's written
opinion

Front 27

A patient is being discharged from the
hospital following a colon resection
with a left colostomy. The case manager
knows that the patient understands the
discharge teaching about care of her
colostomy when she says:

Back 27

My stoma should be red and
slightly raised.

Front 28

The party responsible for tracking and
monitoring re-employment of an injured
employee under workers' compensation
is the:

Back 28

Workers' compensation carrier

Front 29

When an injured employee is receiving
workers' compensation benefits, health
insurance benefits are:

Back 29

Secondary to workers' compensation
Benefits

Front 30

Under federal law, workers' compensation
benefits are:

Back 30

Treated as nontaxable income

Front 31

Clinical pathways represent a benchmark
of care charted on an axis that includes:

Back 31

Time on one axis and specific
interventions on the other axis

Front 32

A mother of an adolescent with diabetes
calls the diabetes case manager to seek
assistance for her son, who has missed
school due to sluggishness and oversleeping.
During the conversation, the mother
informs the case manager that her son is
not sticking to the diet and has had high
sugar levels over the past week. The case
manager uses what skill(s) to address this
problem of nonadherence?

Back 32

Conflict resolution and problem
solving

Front 33

Which governing agency regulates drugs
used in homeopathy?

Back 33

Food and Drug Administration

Front 34

In the case management model, enabling
families means to:

Back 34

Create opportunities for the family
to become more competent and independent
in meeting their needs

Front 35

To avoid stress or burnout, case managers
generally need to see themselves as:

Back 35

Successful in helping clients
achieve progress

Front 36

It is important for the case manager to
Determine and utilize:

Back 36

The maximum allowable care for
a client

Front 37

Who is appointed by the Court to speak
for the abused child?

Back 37

The certified life care planner

Front 38

EAHCA is federal legislation pertaining to:

Back 38

The distribution of Medicaid
funding state-by-state

Front 39

A 33-year-old man is transported unconscious
to the emergency department, and
it is determined that imminent surgery
is needed. Since informed consent must
be obtained from his next of kin, the
sequence in which the next of kin would
be asked for the consent would be:

Back 39

Parent, spouse, adult child, sibling

Front 40

SSDI payments are meant to:

Back 40

Replace part of earnings lost
because of an impairment that prevents
an individual from working

Front 41

The Family and Medical Leave Act of 1993
is enforced by:

Back 41

The Social Security Administration

Front 42

The approach used for case management
is a:

Back 42

Evidence-based medicine
Approach

Front 43

The case manager facilitates outcomes by:

Back 43

Being a coordinator, a collaborator,
an educator, and an advocate

Front 44

In a stated contract form used by the
provider delivering services, it is implied
that:

Back 44

The provider will be paid for
services rendered

Front 45

A way to enhance the working relationship
between the case manager and the
physician is to:

Back 45

Assure the physician that findings,
concerns, and suggestions will be
presented for review

Front 46

Life care plans are based upon:

Back 46

A comprehensive analysis of the
client's medical needs during his
or her lifetime, including physical,
mental and socio-economic
challenges

Front 47

Under the Patient Protection and Affordable
Care Act (ACA), the Medical Loss Ratio
Rule (80/20 rule) dictates that insurers in
the individual and small group markets
must:

Back 47

Spend at least 80% of the premiums
received on health care
services and activities to improve
health care quality

Front 48

Subrogation is defined as:

Back 48

The legal process by which an
insurance company seeks from a
third party, who has caused a loss,
recovery of the amount paid to the
policyholder

Front 49

For each episode of illness, a skilled
nursing facility is covered under Part A of
Medicare for:

Back 49

Skilled nursing services delivered
to the patient

Front 50

Managed care organizations have case
management programs that triage
patients for appropriate care. The first step
in this process is the:

Back 50

Identification of high-risk/high
cost cases

Front 51

The following are viewed as important
members of the care coordination
team and an active part of the ongoing
decision-making process:

Back 51

All members of the interprofessional
Team

Front 52

A coordination-of-benefits provision
is included in group medical insurance
policies to:

Back 52

Allow costs to be shared between
two health care policies

Front 53

A 45-year-old patient has a permanent
colostomy. Which of the following foods
should he avoid?

Back 53

Corn beef and cabbage and boiled
potatoes

Front 54

Facility-based case management has its
roots in:

Back 54

Episodic case management

Front 55

Sub-standard risk is defined as:

Back 55

An individual who, because of
health history or physical limitations,
does not meet the qualifications
of a standard risk

Front 56

The Health Insurance Portability and Accountability
Act (HIPAA) provides:

Back 56

Capability for an employee to
move to a new employer health
plan without denial or exclusion
of benefits if there is no break in
group health coverage exceeding
62 days

Front 57

Under the Health Information Technology
for Economic and Clinical Health (HITECH)
Act of 2009, providers electing not to participate
in "meaningful use" of electronic
health records would see reductions in
payments from Medicare starting in:

Back 57

2015

Front 58

Under the Americans with Disabilities
Act, the employer may defend a charge of
disability discrimination on the basis that
an individual's disability:

Back 58

Poses a significant risk to the
health and safety of others

Front 59

Prior to performing an assessment of the
patient, the case manager must obtain
authorization from:

Back 59

The patient

Front 60

The case manager of a patient diagnosed
with amyotrophic lateral sclerosis needs
to understand that the patient will likely
experience the following symptoms during
his/her disease process:

Back 60

Muscular weakness, atrophy, spasticity
and hyper-reflexia

Front 61

Overutilization is defined as:

Back 61

A pattern or practice of overusing
or overprescribing medical
services

Front 62

Benchmarking is a process of:

Back 62

Determining the measurement
of cost savings, quality and
satisfaction

Front 63

The primary reason to conduct a job
analysis is to:

Back 63

Identify specific work activities
necessary to perform the job

Front 64

An 8-week-old infant has been diagnosed
with gastroesophageal reflux. The home
care case manager is teaching the infant's
mother to care for the infant at home.
Which of the following statements by the
case manager is appropriate regarding the
infant's home care?

Back 64

Play activities should be carried
out before, instead of after,
feedings.

Front 65

One reason substance abuse in clients
with disabilities is ignored is that:

Back 65

When the abuse pre-dates the disability,
it is not part of the current
treatment plan

Front 66

Gainful employment under workers'
compensation is determined by:

Back 66

The injured worker's past work
History

Front 67

According to the CCMC's Case Management
Body of Knowledge (CMBOK), "care
coordination" falls under which of the
following phases of the case management
process?

Back 67

Implementing

Front 68

Death benefits provide:

Back 68

Payment to beneficiaries upon the
policyholder's death

Front 69

Viatical settlements provide:

Back 69

Accelerated death benefits that
can be used by the life insurance
policy holder prior to his/her death

Front 70

Discharge teaching for a patient with
congestive heart failure should include
instruction to call the physician if the
patient notices a 2-lb weight gain in a 24-
hour period, which may indicate:

Back 70

Decreasing cardiac output

Front 71

The design or modification of the workplace
to match human characteristics and
capabilities is called:

Back 71

Ergonomics

Front 72

Guardianship falls into two basic categories:

Back 72

Guardianship of person and guardianship
of trust

Front 73

Dysphagia implies difficulty:

Back 73

Swallowing

Front 74

Professional liability coverage written on
an occurrence basis applies to

Back 74

Incidents that occur during the
policy period, regardless of when
they are filed

Front 75

A 30-year-old patient has just been
treated in the ED for bruises and abrasions
to her face and a broken arm from domestic
violence. The ED case manager assesses
the patient as being very anxious, fearful,
bewildered, and feeling helpless as she
states. I don't know what to do, I'm afraid
to go home. The best response by the case
manager would be:

Back 75

Let's talk about people and
resources available to you so that
you don't have to go home.

Front 76

The ultimate goal of a comprehensive
rehabilitation program is to:

Back 76

Reduce the physical, emotional,
and economic effects of a disability
on the injured or ill individual

Front 77

A facility utilized to provide short-term
rehabilitation for a patient requiring
hospital discharge, but too weak to care
for himself/herself is:

Back 77

A sub-acute care facility

Front 78

The hospital case manager's first responsibility
is to:

Back 78

Uphold ethical practices to protect
the patient's autonomy and
self-determination

Front 79

A 16-year-old client with anorexia
nervosa is on an inpatient psychiatric
unit. She has a fear of gaining weight and
is refusing to eat sufficient amounts to
maintain body weight for her age, height,
and stature. To assist with the problem of
powerlessness, the case manager uses the
following strategy:

Back 79

Establish a structured environment
with routine tasks and activities,
and serve meals at the same time
each day

Front 80

The case management activity which
could most likely result in liability for the
case manager is:

Back 80

Determining the level of appropriate
medical care

Front 81

A proactive case manager can best ensure
that a patient who has been newly
diagnosed with a chronic illness receives
timely intervention through all of the
following except:

Back 81

Developing a life care plan

Front 82

In case management, cost savings are
only claimed when the:

Back 82

Case manager is directly responsible
for coordinating the savings

Front 83

When planning care for the passive-aggressive
patient in a rehabilitation facility,
the case manager includes the following
goal:

Back 83

Encourage the patient to express
anger by using I messages, such as
I was angry when ... etc.

Front 84

The Dictionary of Occupational Titles is
used primarily to assist in identifying a
worker's:

Back 84

Skills

Front 85

Prolonged use of antimicrobials is known
to cause:

Back 85

Drug resistance

Front 86

Autonomic dysreflexia is exhibited by:

Back 86

A pounding headache, diaphoresis,
and bradycardia

Front 87

utonomic dysreflexia generally presents
in the spinal cord injured patient with a
spinal cord lesion at:

Back 87

T6 or above

Front 88

The successful treatment of back pain will
be determined largely by:

Back 88

The length of time the patient is
Disabled

Front 89

The Family and Medical Leave Act of 1993
allows for:

Back 89

Unpaid leave for up to 12 weeks
for eligible employees

Front 90

The case manager is assessing a patient
treated for depression with a monoamine
oxidase (MAO) antidepressant. The most
serious side effect associated with this
antidepressant and the ingestion of
tyramine in aged foods may be:

Back 90

Hypertensive crisis

Front 91

Clinical pathways based on case management
plans were developed to:

Back 91

Show specific interventions that
should occur in a stated time
frame

Front 92

A common psychological disorder in older
clients often misdiagnosed as dementia,
actually is:

Back 92

Depression

Front 93

The ethical principle of autonomy states
that the case manager should:

Back 93

Respect the wishes of the patient

Front 94

The most important consideration when
measuring the success of medical case
management efforts is:

Back 94

Medical stabilization and decrease
in funds spent for medical care

Front 95

The Patient Protection and Affordable Care
Act (ACA) mandates all of the following
except:

Back 95

Vital settlements will be
Eliminated

Front 96

A community health case manager has
coordinated a special preschool program
for a 4-year-old child with Down's
syndrome. The case manager's primary
goal is to:

Back 96

Facilitate optimal development of
the child

Front 97

The most critical variable in the success of
case management is the:

Back 97

Skill of the case manager

Front 98

The 80/20 rule in the Patient Protection
and Affordable Care Act (ACA) is also
known as the:

Back 98

Medical Loss Ratio rule

Front 99

Carpal tunnel syndrome refers to a specific
pattern of numbness, pain and:

Back 99

Paresthesia

Front 100

Case closure for a patient with a workers'
compensation injury is determined when:

Back 100

The client has reached maximum
medical improvement

Front 101

The case manager's primary responsibility
is to:

Back 101

The patient/client

Front 102

Medicaid can be provided on a case-bycasebasis, without considering income oreligibility rules, under the:

Back 102

Rehabilitation Act of 1973

Front 103

One of ERISA's responsibilities is to:

Back 103

Oversee pension plans

Front 104

Apparent or suspected drug and chemicalabuse in the workplace should beaddressed initially by the:

Back 104

Employer

Front 105

A 55-year-old man recently diagnosedwith hypertension is prescribed a lowsodium diet by his physician. When asked,What does salt have to do with highblood pressure?, the case manager's bestresponse would be:

Back 105

Large amounts of salt in yourdiet can cause you to retainfluid, which increases your bloodpressure.

Front 106

Quality of life issues in hospice care shouldinclude pain management treatmentplans because:

Back 106

Pain can affect all dimensions of apatient's quality of life

Front 107

The case manager in the best positionto identify a treatment plan for a newlydiagnosed pediatric patient with asthmawho has been hospitalized is the:

Back 107

Acute care-based case manager

Front 108

A managed care organization's primarygoal is to:

Back 108

Enhance the quality of care of itsmembers though a coordinatednetwork

Front 109

Section 502 of the Rehabilitation Actpertains to:

Back 109

Governance and accessibility lawswritten by the ATBCB

Front 110

Epilepsy developed subsequent to atraumatic brain injury:

Back 110

Can slow or reverse the recoveryProcess

Front 111

Discharge recommendations for aparaplegic should include consideration ofthe following environmental factor:

Back 111

Temperature

Front 112

Re-employment assessments are useful inworkers' compensation claims when:

Back 112

The patient is medically stable and
able to return to work

Front 113

Pregnant women with diabetes often
have problems related to the effectiveness
of insulin in controlling their glucose
levels during their second-trimester of
pregnancy. The high risk pregnancy case
manager teaches the client that this is
due to:

Back 113

Increased human placental lactogen
Levels

Front 114

Among the most effective aversion therapies
for alcoholism is:

Back 114

Behavioral modification

Front 115

Functional capacity evaluations can be
used to measure:

Back 115

Antabuse

Front 116

The stated objectives for pain management
programs are to:

Back 116

Reduce and/or terminate drug
Therapy

Front 117

According to the World Health Organization
definition, the disadvantage a given
individual faces subsequent to impairment
or disability, which limits fulfillment
of roles normal for that individual, is
defined as:

Back 117

A handicap

Front 118

The mentally ill patient on a medication
regimen has her blood drawn every two
weeks to check her lithium levels. Lithium
toxicity will be indicated in a blood
lithium level greater than:

Back 118

2.2

Front 119

Return-to-employment in workers' compensation
is most often hampered by the
patient's own:

Back 119

Behavioral issues

Front 120

Retrograde amnesia refers to:

Back 120

The period of memory loss prior
to the onset of the injury

Front 121

A 6-month-old infant has developmental
delays, with a weight below the 5th
percentile when plotted on a growth
chart. A diagnosis of failure-to-thrive is
made. What behaviors might indicate the
possibility of maternal deprivation?

Back 121

Uncomforted by touch, refuses
Bottle

Front 122

Right hemisphere CVA is associated with
the following deficit(s):

Back 122

Spatial deficits and impulsivity

Front 123

The failure to recognize familiar symbols
is defined as:

Back 123

Agnosia

Front 124

A disorder in which the muscles of speech
are weak and speech sounds are slurred,
but comprehension is intact is:

Back 124

Dysarthric speech

Front 125

Immediately after reaching maximum
medical improvement (MMI), the client
with a workers' compensation injury
should receive:

Back 125

A notice of job reinstatement

Front 126

A 19-year-old patient has sustained a C-7
fracture, which resulted in his spinal cord
being partially transected. By 2-weeks
post injury, his neck has been surgically
stabilized, and he has been transferred
from the intensive care unit. A potential
life-threatening potential complication is:

Back 126

Autonomic dysreflexia

Front 127

Disability insurance payments can still be
collected along with workers' compensation
wage losses when the:

Back 127

Disability insurance is long-term
Disability

Front 128

A complete spinal cord lesion is described
as an:

Back 128

Injury with no preservation of
voluntary motor function and
sensation below the level of the
injury

Front 129

Resource management/stewardship
includes all but which of the following?

Back 129

Identification of treatment goals
upon hospital admission

Front 130

The clinic physician recommends an immediate hospital admission for a patient with a severe leg ulcer. The patient informs the clinic case manager that, It's not so easy for me to just go right to thehospital like that. Which approach by thecase manager would be best?

Back 130

Explore with the patient her perceptions of why she is unable to go to the hospital

Front 131

The purpose of a therapeutic cushion for a patient confined to a wheelchair is to:

Back 131

Prevent pressure ischemic ulcers

Front 132

Transitions of care does not include:

Back 132

Transition from the home to the doctor's office

Front 133

Body image is a component of whichaspect of self-concept?

Back 133

Self-esteem

Front 134

The major hallmark of restrictive lungdisease is:

Back 134

Narrowing of airways

Front 135

Managed care case managers may be involvedin all of the following roles except:

Back 135

Formulary decision-making

Front 136

Educational services should be consideredin a workers' compensation plan of carefor a permanently disabled individualwho is not gainfully employed when:

Back 136

The disabled person does not havetransferable skills that can lead togainful employment

Front 137

The major program designed to assistdisabled individuals with acquiring vocationalcompetency is:

Back 137

The state/federal vocational rehabilitationsystem

Front 138

When providing dietary teaching to an
individual who has type 2 diabetes, the
diabetes case manager reinforces the importance
of consuming the recommended
daily allowance of which of the following electrolytes

Back 138

magnesium

Front 139

The key to determining the benefits of architectural
barrier removal would include
which of the following considerations?

Back 139

Functional use

Front 140

External case managers may expect referrals
from all of the insurance benefit areas
except which of the following?

Back 140

Life insurance companies

Front 141

The concept of the interdisciplinary team
in rehabilitation is a requirement by which
of the following organizations?

Back 141

Joint Commission

Front 142

A 79-year-old patient with Alzheimer's
disease in a long-term care (LTC) facility
is exhibiting significant memory impairment,
extremely impaired judgment in
social situations, and agitation when
placed in a new situation or around
unfamiliar people. The LTC case manager
should include which strategy in the
patient's care plan?

Back 142

Maintain routines and usual structure,
and adhere to schedules

Front 143

The benefits of using a transdisciplinary
model of care delivery include which of
the following?

Back 143

Holistic care of the patient

Front 144

The practice of external nursing case
management differs from that of facility based
nursing case management in which
way?

Back 144

Hands-on bioassessment through
the nursing process may be part of
the facility-based case manager's
responsibilities but is not typically
conducted by the external case
manager

Front 145

Which of the following areas of concern
is not significant to the case manager in
formulating an initial rehabilitation plan
of care for the patient?

Back 145

The patient's educational
Background

Front 146

Which health screening tool is often used
when assessing the alcoholic patient?

Back 146

BASIS

Front 147

When educating a patient whose condition
is complicated by metabolic alkalosis,
the case manager should:

Back 147

Explain that the patient should
guard against activities that would
cause hyperventilation

Front 148

Care plan goals for the oncology patient
may include all but which of the following?

Back 148

Limiting discussion about end-of life
issues

Front 149

Medicare is a:

Back 149

Federally-funded program which
provides hospital and medical
insurance to those 65 and older, as
well as some disabled individuals

Front 150

A psychotic client who believes that he is
Godlike and rules the universe is experiencing
which type of delusion?

Back 150

Grandiose

Front 151

Reasonable and customary charges refer
to:

Back 151

Health care fees consistent with
average rates or charges for
similar services in a specific geographic
area

Front 152

An outcome captured by the emergency
department case manager when coordinating
community-based services for
a patient who frequents the Emergency
Department is:

Back 152

Decrease in the number of visits
to the ED

Front 153

A patient diagnosed with bipolar disorder
continues to be hyperactive and to lose
weight. Which of the following nutritional
interventions would be most therapeutic
for him at this time?

Back 153

Small, frequent feedings of foods
that can be carried

Front 154

Workers' compensation is a:

Back 154

State-governed, no-fault insurance
System

Front 155

A long-term goal for the case manager
in planning care for a depressed, suicidal
patient would be to:

Back 155

Assist him to develop more effective
coping mechanisms

Front 156

Which of the following outcomes could be
considered a hard savings outcome of case
management?

Back 156

Reduction in the amount of
monthly diabetes supplies

Front 157

Depression is a:

Back 157

Common complication among
patients with multiple sclerosis

Front 158

Common attributes of risk management
and quality improvement include all but
which of the following?

Back 158

Both are based upon clinical
guidelines

Front 159

Under the own occupation (own occ) rule
in disability insurance, a person can:

Back 159

File a claim of wage-loss disability
based on an inability to perform
any one aspect of the person's job

Front 160

The predominant symptoms of depression
include all but the following:

Back 160

Persistent frightening thoughts
and memories

Front 161

Primary prevention is described as:

Back 161

Interventions for people who are
at high risk for a specific disease

Front 162

Patients who may be identified for case
management interventions include all
but:

Back 162

The child with asthma who is
stable on medication

Front 163

The case manager who manages the
patient with a dual diagnosis of depression
and PTSD needs to:

Back 163

Be vigilant of the comorbid
depression and the likelihood that
the depression will cause a greater
barrier in self-care strategies

Front 164

The most important goal for a case
manager to achieve when working with
an autistic adolescent is:

Back 164

To establish trust with the
adolescent

Front 165

Clinical guidelines are tools designed to:

Back 165

Assist clinicians and patients
alike to make decisions about appropriate
health care for specific
conditions

Front 166

The following medications were noted by
a case manager performing medication
reconciliation of the client's home medication
profile. Which medication would
most likely potentiate digitalis toxicity?

Back 166

Thyroid agents

Front 167

Ethical principles are:

Back 167

Guidelines for members of the
care coordination team to refer to
in daily practice

Front 168

Which of the following is not a complication
from a stroke?

Back 168

Proteinuria

Front 169

Clinical manifestations seen in left-sided
rather than in right-sided heart failure
are:

Back 169

Decreased peripheral perfusion
and rales

Front 170

Elements of a Patient Centered Medical
Home (PCMH) include all of the following
except:

Back 170

Individualized variances in practice
Parameters

Front 171

Hematotympanum and otorrhea are associated
with which of the following head
injuries?

Back 171

Basilar skull fracture

Front 172

A patient with a C-4 injury has been
stabilized and is ready for discharge. Because
this patient is at risk for autonomic
dysreflexia, he and his family should be
instructed to assess for:

Back 172

Headache and facial flushing

Front 173

Three essential elements of an Accountable
Care Organization include all but the
following:

Back 173

Primary care physicians to serve
as gatekeepers of medical services

Front 174

An example of lifestyle drugs that can
be important to a patient's health but
excluded or placed on a higher tier in
insurance company formularies includes:

Back 174

Weight loss drugs

Front 175

An example of durable medical equipment
(DME) for the home typically
covered by DME benefits of health insurance
carriers includes all of the following
categories except:

Back 175

Contraceptive and hormonal supplies,
such as condoms, cervical
rings and pregnancy tests

Front 176

A patient takes warfarin orally, 15 mg
daily. A monitoring lab value to evaluate
the medication's effectiveness is the:

Back 176

Prothrombin time (PT)

Front 177

Algorithms are defined as:

Back 177

Systematic procedures that follow
a logical progression based on additional
information or a patient's
response to an intervention to
reach a solution for a specific
problem

Front 178

A patient with fibromyalgia syndrome
(FMS) is characterized by the following
symptoms:

Back 178

Generalized pain, musculoskeletal
tenderness, fatigue and morning
stiffness

Front 179

Pain in the fibromyalgia patient is most
commonly associated with:

Back 179

Tender points in the sub-occipital
area of the neck, shoulder, chest
wall, elbows, knees, hips, and
back

Front 180

Which of the following statements is not
a regular component of the Medicare
Prescription Drug Improvement and
Modernization Act (MMA) of 2003?

Back 180

Prescription Drug Plans (PDP) are
run by state exchanges financed
by tax revenues

Front 181

Modeling is a basic tool in pharmacoeconomics
that can be used to:

Back 181

Draw conclusions or make predictions
in a pharmacoeconomic
analysis

Front 182

In the initial contact phase, a disability
management case manager will make
contact with:

Back 182

The client, the plaintiff attorney (if
any), and the claims adjuster

Front 183

Which of the following statements about
TRICARE is incorrect?

Back 183

Medicaid-eligible TRICARE
beneficiaries have open access to
Medicaid formularies

Front 184

One resource used by the vocational
specialist to complete a Transferable Skills
Analysis is the:

Back 184

Dictionary of Occupational Titles

Front 185

Ethical principles in case management
include all of the following except:

Back 185

Quality

Front 186

The elements of professional negligence
that must be proven before case management
malpractice can exist include all but
the following:

Back 186

Perceived harm

Front 187

Risk management focuses on:

Back 187

Loss prevention of adverse patient
outcomes

Front 188

One way to optimize outcomes in disease
management is to:

Back 188

Target high-cost, high-risk individuals
at the earliest stage possible
to minimize treatment costs
and maximize quality

Front 189

Which of the following is not a consequence
of poor transitions of care?

Back 189

Cultural barriers and beliefs

Front 190

A well-written cost-benefit analysis by
the case manager will show:

Back 190

Cost effectiveness of the equipment
or services to the plan of
care

Front 191

Variance tracking is most effective when
the case manager is allowed to:

Back 191

Systematically identify and document
who (by category) caused
the variance

Front 192

Utilization management focuses on:

Back 192

Use of prior authorization and
concurrent review to evaluate
medical necessity

Front 193

Which statement about the advantages
and disadvantages of switching to a
managed care plan for Part C of Medicare
is true?

Back 193

Patients may not be able to maintain
their current provider

Front 194

A paraplegic can be assisted to a standing
position with:

Back 194

A standing board

Front 195

The following key principles for promoting
population health include all of the
following except:

Back 195

A heterogeneous view to aggregate
patient characteristics and
societal influences

Front 196

The Patient Protection and Affordable Care
Act (ACA) requires individuals who are
not enrolled in a public health program or
commercial insurance to purchase health
insurance. Provisions to assist individuals
in finding affordable health insurance
include:

Back 196

Establishing state-based
Exchanges

Front 197

The Patient Protection and Affordable Care
Act (ACA) describes an Accountable Care
Organization (ACO) as:

Back 197

A group of providers working
together to be accountable for a
defined population using measurable
outcomes

Front 198

The goal of a root cause analysis is to:

Back 198

Identify the adverse event, find
out what lead up to its occurrence,
and what can be done to prevent it
from recurring

Front 199

Root cause analyses have the following
characteristic:

Back 199

The review is singular and linear
in nature in order to identify the
individual or system process causing
the adverse event