100 REAL TIME CASE MANAGER Multiple Choice Questions and Answers

CASE MANAGER Multiple Choice Questions and Answers :-

1.Which of the following is a responsibility of a case manager:

A. Avoid subject material in documentation.
B. Making medical decisions if the patient is unable to do so.
C. Obtain medical services for an incapacitated patient.
D. Obtain financial services for an incapacitated patient.

2. After obtaining work capacity documentation:

A. The case manager should perform job analysis.
B. The case manager should determine whether an IME is appropriate.
C. The case manager should determine appropriateness of work-hardening process.
D. The case manager should submit documentation to the employer and insurance company.

3. What is meant by annulus:

A. It is a sign of a herniated disc.
B. It is the outer portion of an intervertebral disc.
C. It is the inner portion of an intervertebral disc.
D. It is a medical procedure which is not common due to pain involved.

CASE MANAGER Multiple Choice Questions and Answers

CASE MANAGER Multiple Choice Questions and Answers

4. A meaning of the root word “myel” is:

A. Spinal cord
B. Muscle
C. Cartilage
D. Largeness

5. Which of the following are bisphosphonates used to prevent and treat osteoporosis in postmenopausal women?

A. Evista and fosamax
B. Alendronate and risedronate
C. Estrogen and raloxifene
D. Estrogen and alendronate

6. A transfer penalty:

A. Is only incurred if assets are given away to a spouse.
B. Is a period of time during which enrollee is not eligible for Medicaid.
C. Is incurred when enrollee has given away assets; enrollee is no longer eligible for Medicaid.
D. Is a penalty fine incurred when the enrollee has given away assets.

7. What is the Out of Area (OAC)?

A. Physicians who are located outside a prescribed geographic radius
B. Treatment that is only available at a facility that does not lie within the geographic radius included in the subscribed healthcare plan
C. The treatment received by a member of a health care plan when he/she is out of the network coverage area
D. Hospitals and facilities that are outside the geographic boundaries of the available approved providers

8. In which model is care only reimbursed when paneled providers are used?

A. EPO (Exclusive Provider Organization)
B. IPA (Independent Practice Association)
C. Group Model
D. Staff Model

9. What is meant by Functional impairment:?

A. It is an indicator of crisis likelihood.
B. It is the temporary exchange of roles to cope with a disability.
C. It is the ability of a client’s family to provide for the client’s needs and still function.
D. It is when overwhelming distress hinders coping ability.

10. The age group with the highest suicide rate:

A. Are people among the 10-24 year old age group.
B. Are white men over the age of 85.
C. Are people among the 10-14 year old age group.
D. Are people among the 15-24 year old age group.

11. Patient participation in pain treatment:

A. Is a maladaptive coping behavior.
B. Is not suggested by JCAHO.
C. Is only necessary if the patient is without an appropriate provider.
D. Is an adaptive coping mechanism.

12. In legal terms, define “discovery period.”

A. This is not a legal term
B. The time in which all material evidence has to be produced and exchanged
C. Time where mediation takes place
D. Time were all parties involved get together to resolve differences

13. What is a Transcranial Doppler:

A. Assesses extent or location of injured brain tissue.
B. Provides 3-dimensional pictures of tissues.
C. Is a lengthy process assessing cognitive abilities or deficits.
D. Assesses brain’s arterial circulation.

15. What is a nasal polyps?

A. Inflamed sinus
B. Inflamed rhinitis
C. Inflamed nasal cavity
D. Inflamed nasal mucosa

16. What is the fullform of CPT-4?

A. Caseworkers with Professional Training, 4th year
B. Current Procedural Terminology
C. Caregivers Professional Tribute, 4th year
D. Caseworkers with Physical Techniques, 4th year


17. What does a correlational study determine?

A. The relationship between two occurrences
B. The effects of A on B
C. Cause-effect
D. The effects of B on A

18. Which of the following is an accurate statement about prescription drug coverage for seniors:

A. Prescription drug coverage is expected to remain at its current situation, until reform is implemented.
B. Prescription drug coverage is expected to improve.
C. Prescription drug coverage is expected to decline.
D. Prescription drug coverage is a functioning benefit of Part B Medicare insurance.

19. What is DSM-IV?
A. Doctors Synthesis of Manuals- 4th edition
B. Diagnosis of Sexual Manifestations- 4th edition
C. Doctors Standards for Medications, 4th edition
D. Diagnostic and Statistical Manual of Mental Disorders


20. Which of the following statements is untrue regarding crisis?

A. There are two types of crisis; developmental and situational
B. Crises are either resolved positively or negatively in a brief period of time
C. A crisis is usually preceded by a particular identifiable event
D. There are three type of crisis; developmental, situational, and individual

21. The following is a high potency antipsychotic:

A. Clozaril
B. Thorazine
C. Mellaril
D. Haldol

22. The breathing capacity of the lungs is measured through:

A. Electromyography
B. Spirometry
C. Clinical observation
D. Fluorescent antinuclear antibody test

23. Time out of work under worker’s compensation may be included in the FMLA twelve week period:

A. Only if the employee is offered COBRA by the employer.
B. If the employee is out of work for a period over 18 months.
C. If the employee is notified in writing.
D. If the employer agrees to hold the employees position for more than the twelve-week period.

24. If a Medicare recipient does not enroll in Part B insurance when he enrolls in Part A insurance:

A. The recipient may purchase Part B Medicare afterward, but will experience a rise in Part B premiums until he enrolls in Part B.
B. The recipient may not purchase Part B Medicare afterward.
C. The recipient may purchase Part B Medicare afterward, and will not experience a rise in premiums.
D. The recipient may purchase Part B Medicare afterward, but will experience a rise in Part A premiums until he enrolls in Part B.

25. Of the following test instruments, which would give you the most reliable results?

B. Ruler
C. House-Tree-Person
D. Beck Depression Inventory

26. Which is not a category of mental disorder contained in the DSM IV?

A. Anxiety Disorders
B. Diagnostic Disorders
C. Cognitive Disorders
D. Mood disorders

27. An incomplete injury is one in which:

A. There is no communication between the outside body and the spinal cord.
B. There is some communication between the outside body and the spinal cord.
C. There is no signal whatsoever traveling through the site of injury.
D. There are some signals traveling through the site of injury.

28. Disability coverage programs:

A. May have limits of several years, or last until retirement age.
B. Typically end after a period of several years.
C. Invariably end after a two year duration.
D. Must continue until age of retirement.

29. The DSM-IV defines Anxiety as:

A. An impoverishment in thinking that is inferred from observing speech and language behavior
B. An inability to initiate and persist in goal-directed activities.
C. The apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension
D. Waxy flexibility-rigid maintenance of a body position over an extended period of time.

30. Client abandonment is:

A. Termination of case management services.
B. A case manager’s failure to annually renew criteria of consent for client.
C. Lack of sufficient termination notice resulting in harm to Client.
D. Lack of sufficient understanding of client necessity for additional services.


31. What is meant by Bed Days:?

A. The number of days a physician requires a client to remain on bed rest
B. The number of days a hospital will willingly provide a bed for a client
C. The number of actual days a client stays in hospital or another facility
D. The number of beds available in a hospital on any given day

32. The following statement is not true with regard to bipolar disorder :

A. Bipolar disorder is looked at as a biological disorder
B. Bipolar disorder runs in families
C. Prophylactic treatment is not typically warranted
D. The primary medication to treat bipolar disorder is lithium

33. When conflict is _______________, it is emotional and focused on personal incompatibilities or disputes.

A. High
B. Dysfunctional
C. Emotional
D. Beneficial

34. The low use of formal power had a strong _______________ effect on interdisciplinary team collaboration .

A. Influential
B. Negative
C. Collaborative
D. Positive

35. Which is not a requirement for states to receive Federal-matching funds?

A. AIDS screening for high-risk individuals
B. Medical and surgical dental services
C. Early and periodic screening, diagnosis and treatment services for people under 21 years of age
D. Inpatient hospital services

36. When a stressful situation is so overwhelming that it blocks the client’s effective coping ability:

A. It is called disruption of homeostasis.
B. It may be an indicator of a client’s ability to effectively handle disability.
C. It is called crisis.
D. It is called functional impairment.

37. According to the DSM IV, a poly substance dependence is:

A. A use of at least three substances simultaneously
B. A use of at least three substances in a short period
C. A use of at least three groups of substances in one year
D. A use of at least three substances in any given time frame


38. Which is true of a EPO?

A. Care is not reimbursed if non-panel/non-network physicians are used
B. Does not use gatekeeper approach services
C. It combines elements of HMO and Indemnity Plan
D. Subscriber pays little or nothing out-of-pocket

39. What is AAPCC?

A. Ambulatory Americans Paying Cost of Care
B. Americans for abortion classified committee
C. American Association of Physicians Concerned about Costs
D. Adjusted Area Per Capita Cost

40. Depression is an example of:

A. A long-term positive coping technique.
B. A short-term positive coping technique.
C. A stressor.
D. A maladaptive coping behavior.

41. What is Pooling?

A. The act of combing the risk of all the groups in several groups into one risk pool
B. The act of pooling resources of various individual subscribers so as to make the cost of healthcare more manageable for all members of the group
C. The act of pooling resources by a group of hospitals so as to better manage the cost of healthcare
D. The bundling together of various network providers so as to compile a more effective and varied list of providers

42. A concussion is:

A. An open injury
B. A type of skull fracture.
C. A violent shaking of the brain.
D. A bruise on brain tissue.

43. The AAPPCC is used by CMS

A. As a means of estimating outlier expenses in a hospital setting
B. as a basis of payments to managed care plans
C. To limit healthcare benefits to specific covered conditions
D. As a way to define who qualifies for health care under a particular managed care plan

44. Medicare is available to:

A. All US citizens or permanent residents with disabilities.
B. All US citizens or permanent residents over age 65 who have paid Medicare taxes, have a disability , or are diagnosed with kidney failure.
C. All US citizens or permanent residents without resources for medical payment.
D. All US citizens or permanent residents over age 65 who have paid Medicare taxes.

45. A quality system only _______________ the positives on what needs to be worked on.

A. Eliminates
B. Enhances
C. Submits to
D. Completes

46. Who most often provides rehabilitation services to Social Security beneficiaries?

A. County agencies
B. Private sector
C. Federal agencies
D. State rehabilitation agencies

47. The size of the lump sum payment to a hospital is based on

A. The relative weight of the particular DRG
B. The DRG
C. Prospective reimbursement payment
D. Omnibus budget reconciliation actions

48. An individual sustaining a sacral injury:

A. Will become a paraplegic and lose function of the chest, abdomen, and other areas.
B. May retain function of most areas, depending upon extent of injury.
C. Will become a quadriplegic and may require a ventilator.
D. May possibly be rendered paraplegic, depending upon extent of injury.

49. The reliability of an assessment tool is an indicator of:

A. Faking good or faking bad
B. Whether the assessment tool is measuring what it is supposed to measure
C. How dependable the assessment tool is
D. How effective the assessment tool is with different cultural populations

50. Which of the following statements regarding antidepressants is true?

A. When an individual feels better he/she can stop taking antidepressants
B. Antidepressants can make one feel “normal”
C. Antidepressants are very effective when taken without other forms of intervention
D. Antidepressants are addictive

51. What is meant by ICD-9CM?

A. Internal Causative Dictionary , with clinically modified explanations
B. Internal Classification of Disease the Clinical Modification
C. International Classified Dictionary of the 9 clinical moods
D. International Committee of Doctors, 9th clinical module

52. Due to its short half-life, which of the following requires a divided dosing?

A. Paxil
B. Prozac
C. Elavil
D. Wellbutrin


53. Individual Identifiable Health Information refers to:

A. It also includes the provision of healthcare and payment for the provision of the insurance carrier
B. Health records from the time of birth
C. Any information related to a past, present or future physical or mental health condition
D. All vaccination records

54. _______________ or formal power is control of something or someone.
A. Dominance
B. Equal power
C. Conflict resolution
D. Unequal power

55. Which is NOT a requirement to be met for the Social Security Administration to consider a person “disabled”?

A. Physical or mental impairment
B. Cannot do substantial gainful work
C. Inability to get work
D. Unable to do previous work


56. The elements of consent criteria:

A. Must be initiated once, and renewed annually.
B. Must be initiated once, and renewed on a monthly basis.
C. Must be initiated once upon beginning case management.
D. Must be initiated once, and renewed at each subsequent meeting with case manager and client.

57. What is meant by Disability?

A. Refers to people who have a work history
B. Means that an individual cannot work
C. Refers to physical impairment only
D. Refers to physical or mental impairment that substantially limits one or more of the major life activities of the individual.

58. If an employer wants to discontinue health benefits for an employee who has taken leave for more than twelve weeks:

A. He may; according to FMLA the employer may discontinue health benefits at that point.
B. He may not; according to COBRA, the employer must provide healthcare benefits for terminated employees for up to 18 months.
C. He may; however, the employee must be notified in writing.
D. He may; however the employer must offer the employee the option to purchase insurance at his group rate.

59. Usually health insurance coverage for a employee begins:

A. Immediately upon selecting coverage
B. When the insurance provider receives the paper work
C. 3 months after they start work
D. 30 days after starting employment

60. Which of the following is a key component of Medicare’s partnership with the home care industry to monitor and facilitate improved home health care results?


61. An individual sustaining a lumbar injury:

A. Will become a paraplegic and lose function of the chest, abdomen, and other areas.
B. May retain function of most areas, depending upon extent of injury.
C. Will become a quadriplegic and may require a ventilator.
D. May possibly be rendered paraplegic, depending upon extent of injury.

62. Which is true of anxiety disorders?

A. PTSD and OCD are two forms of anxiety disorder.
B. Anorexia nervosa is a form of anxiety disorder.
C. They are defined by significant cognitive deficiencies.
D. They are often accompanied by somatic symptoms.

63. Cortisone injections:

A. Are used for neither diagnoses nor treatments.
B. Are used for both diagnoses and treatments.
C. Are only used for repetitive motion disorder diagnoses.
D. Are only used for repetitive motion disorder treatments.

64. State employment services offices employ:

A. The General Aptitude Test Battery
B. House-Tree-Person Test
C. The Symptom Checklist 90-R
D. Maslach Burnout Inventory

65. An assessment tool’s reliability is responsible for its:

A. Upper limit of validity
B. Lower limit of validity
C. Test-retest limits
D. Test-reliability limits

66. Which of the following would indicate a problem with color vision?

A. inability to distinguish red from green
B. inability to vocalize color names
C. inability to differentiate between shades of gray
D. lack of knowledge regarding relationships of tints and hues

67. Medicaid is funded by:

A. Federal governments.
B. Both federal and state governments.
C. Stage governments.
D. The CMS.

68. Defamation may be defined as:

A. Failure to take due care or carelessness.
B. Professional misconduct or negligence.
C. Taking from one’s reputation.
D. A civil injury committed against another person or their property.

69. The best way for a Case Manager to obtain the most accurate data from a client is to:

A. Review the client’s chart
B. Use close-ended questions
C. Retrieve information from the client’s caregiver and ask if they concur with the findings
D. Use open-ended questions

70. Which is true of Medicare?

A. It pays 100% of rehabilitative services and other hospital services and supplies for the first year in a skilled nursing facility
B. It does not cover hospice care
C. It pays 100% of approved amount for durable medical equipment as part of a home care treatment
D. It pays 100% of approved amount for home health care

71. “Sedentary” is:

A. A vocationally qualified level
B. A skill level
C. An exertion level
D. An educational level

72. Defense mechanisms:

A. Are adaptive coping mechanisms.
B. Are neither adaptive or maladaptive but hinder adaptation.
C. May be maladaptive or adaptive.
D. Are maladaptive coping mechanisms.

73. Injury or illness is an example of:

A. A long-term positive coping technique.
B. A maladaptive coping behavior.
C. A short-term positive coping technique.
D. A stressor.

74. Which of the following is not one of the knowledge domains elaborated by Michael Leahy of Michigan State University in his 1992 national study?

A. Case Management Concepts Factor
B. Life Career Planning
C. Physical and Psychosocial Aspects Factor
D. Benefit Systems and Cost Benefit Analysis Factor

75. An individual sustaining a cervical neck injury:

A. May possibly be rendered paraplegic, depending upon extent of injury.
B. Will become a quadriplegic and may require a ventilator.
C. Will become a paraplegic and lose function of the chest, abdomen, and other areas.
D. May retain function of most areas, depending upon extent of injury.

76. Which is true of the Outcomes and Assessment Information Set (OASIS)?

A. It represents the core items of a comprehensive assessment for adult home care.
B. It is a forum for assessing the cost effectiveness of particular medications
C. It was developed as a comprehensive assessment tool for quality of care
D. It is a productivity quotient, assessing the productivity of any given group of healthcare workers in any given day

77. A form of hepatitis, producing infections only when HBV is present and exists at the expense of Hepatitis B, it’s host, is named?

A. Hepatitis D
B. Hepatitis E
C. Hepatitis C
D. Hepatitis G

78. The purpose for using clinical level of care criteria as guidelines to support the case management process is so that:
A) patients can be discharged as early as possible.
B) patients can be treated at the most appropriate level of care as their condition changes.
C) hospitals can profit from the DRG arrangement.
D) physicians can follow the patients more efficiently from their offices rather than in the hospital.

79. The case manager’s identification of potential problems or barriers to cost-effective, quality care begins :
A) during the assessment phase.
B) throughout the case management process.
C) before discharge.
D) after completion of the case selection process.


80. CPAP, continuous positive airway pressure, is most often utilized in the home for:
A) ventilator dependent patients
B) chronic obstructive lung disease.
C) obstructive sleep apnea.
D) cystic fibrosis.

81. A case manager is developing a plan for a client without an established support system, who is being discharged home from a skilled nursing facility, following a stroke. The knowledge area that will best assist the case manager during this phase of the case management process is:
A) cost-benefit analysis.
B) insurance principles.
C) community resources and support programs.
D) psychosocial aspects of chronic illness and disability.

82. It is important for the case manager to be aware of Medicare’s definition of part-time or intermittent, when recommending ongoing services. Combined skilled nursing and home health aide services cannot total more than ____ hours per week.
A) 20
B) 24
C) 28
D) 30

83. A case manager is working with a client diagnosed with terminal metastatic cancer and in need of money to pay for medical care and living expenses. Selling a life insurance policy at 50-80% of its face value is:
A) not a viable option.
B) called a viatical settlement.
C) an option frequently recommended by case managers.
D) not ethical.

84. Best practices are predicted to do all the following EXCEPT:
A) Improve clinical outcomes
B) Increase health care costs
C) Enhance administrative efficiency
D) Increase patient satisfaction

85. Demand management, which provides risk appraisals, telephone health information services, and prevention and wellness initiatives, involves:
A) a health professional contacting the client at prespecified intervals.
B) the client calling an independent call center, a center set up by the health plan, or a number made available by the provider.
C) the client initiating a call for emergency needs when the case manager is unavailable.
D) None of the above

86. Upon meeting your client, a 40-year-old Asian woman, you note that throughout the assessment process she avoids eye contact. Your study of various cultural practices helps you understand that the behavior in this case is related to:
A) embarrassment about her health problem.
B) passivity.
C) language barrier.
D) a sign of deference.

89. The root cause of problems such as malnutrition, social isolation, alcohol abuse, and not adhering to treatment in the elderly population, is most frequently associated with:
A) dementia.
B) Alzheimer’s disease.
C) depression.
D) endocrine imbalance.

90. The Glasgow Outcome Scale was commonly used prior to the development of the Rancho Los Amigos levels. Which of its five levels describes the stage where the client is able to follow commands but requires assistance for activities of daily living?
A) Gross disability
B) Severe disability
C) Moderate disability
D) Mild disability

91. The most appropriate objective for conducting a job analysis, which includes an in-depth review of the purpose of the job, related tasks, and the frequency of the tasks, in association with a disabled client in a return-to-work program, is to:
A) evaluate whether a job description requires modifications.
B) best match job functions, expectations or requirements, with abilities and limitations.
C) determine when an individual should be promoted.
D) comply with ADA (American Disabilities Act).

92. Which is the most appropriate strategy for promoting behavioral changes among adolescents with obesity?

A. Age-matched, self-help group discussions
B. Family-centered group discussions
C. Individualized nutrition counseling
D. Lectures on esteem enhancement

93. As a member of an interdisciplinary cardiac rehabilitation team, a nurse case manager’s primary responsibility is to:

A. communicate with families or significant others in meeting the client’s care objectives.
B. consult with health care professionals to coordinate resources and arrange referrals.
C. coordinate with health insurance providers to formulate care plans and meet predetermined outcomes.
D. document and disseminate assessment information from the team of health care professionals.

94. A child who is ventilator-dependent and has a gastrostomy button is scheduled to be discharged to home with visits from a home health nurse. Prior to discharge, the nurse case manager’s most critical action is to:

A. assess the child’s long-term home care needs.
B. procure the required home medical equipment.
C. secure funding sources for home health care.
D. verify that the child is being discharged to a safe environment.

95. Which type of authorization is generated when services are rendered?

A. Concurrent
B. Prospective
C. Retrospective
D. Subauthorization

96. Managing clinical outcomes, studying variance trends, and evaluating actions taken to correct deviations from critical pathways are components of:

A. performance improvement.
B. risk management.
C. the nursing process.
D. utilization review.

97. During an annual gynecologic examination, a 28-year-old female client with two small children requests a resupply of oral contraceptives. The patient confides that her husband is scheduled to be laid off next month and the family cannot afford health insurance. The nurse case manager’s most appropriate intervention is to:

A. ask the clinic business office to arrange special payment for the client.
B. direct the client to the local Planned Parenthood clinic for her gynecologic and contraceptive needs.
C. recommend that the client change her contraceptive method to condoms.
D. refer the client to local social services agencies.

98. To avoid hospital readmission, a patient requires services at a specialty clinic. Since the services are not covered under the patient’s health care plan, a nurse case manager intercedes with the patient’s insurance company. In this situation, the nurse case manager is acting in the role of:

A. broker.
B. consultant.
C. negotiator.
D. provider.

99. When using a utilization tool to perform a concurrent review, a nurse case manager recognizes that:

A. clients have a right to set length of stay without incurring nonreimbursable costs.
B. discharge is required whenever the tool so indicates.
C. exceptions exist because utilization tools reflect only average circumstances.
D. the use of utilization tools guarantees payment for services.

100. Ideally, case management planning identifies goals that are:

A. anticipated, acceptable, and appropriate.
B. challenging and timely.
C. patient-focused and cost-effective.
D. realistic, measurable, and specific.

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