CMGT-BC Dumps CMGT-BC Braindumps
CMGT-BC Real Questions CMGT-BC Practice Test CMGT-BC Actual Questions
killexams.com
ANCC Nursing Case Management Certification
https://killexams.com/pass4sure/exam-detail/CMGT-BC
Which of the following best defines evidence-based practice in nursing case management?
Implementing standardized clinical guidelines for patient care.
Conducting population health initiatives for risk reduction.
ntegrating the best available research with clinical expertise and patien rences.
wer: D
anation: Evidence-based practice in nursing case management involve rating the best available research evidence with clinical expertise and nt preferences. It emphasizes the use of current, relevant research find form and guide decision-making in patient care. This approach ensure ventions and treatments are based on scientific evidence, tailored to idual patient needs, and aligned with the expertise and judgment of hcare providers. While implementing standardized clinical guidelines, ucting population health initiatives, and monitoring patient outcomes rtant components of nursing case management, evidence-based practi beyond these activities by emphasizing the use of research evidence t m decision-making and improve patient outcomes.
Monitoring and evaluating patient outcomes for quality improvement.
I t
prefe Ans
Expl s
integ
patie ings
to in s that
inter indiv healt
cond are
impo ce
goes o
infor
Which of the following is an essential aspect of patient education in nursing case management?
Readiness for change assessment.
Coordinating benefits and reimbursements.
Social drivers/determinants of health evaluation.
Answer: A
ness and willingness to make behavioral changes that promote their h ell-being. By assessing readiness for change, case managers can tail educational interventions to meet the patient's individual needs, rences, and readiness to adopt new behaviors or treatment plans. This sment helps case managers identify potential barriers to change, addr nt concerns, and provide the necessary support and resources to facilit essful behavior change. While coordinating benefits and reimburseme
drivers/determinants of health evaluation, and conducting evidence- cal trials are important activities in case management, they are not fically associated with patient education.
rsing case manager is responsible for coordinating the transition of ca ient from a hospital to a skilled nursing facility. The case manager's ary role in this process is to:
an and facilitate the transfer of medical records and relevant informat
Explanation: Readiness for change assessment is an essential aspect of patient education in nursing case management. Patient education goes beyond providing information and instructions; it involves assessing the patient's
readi ealth
and w or
their prefe
asses ess
patie ate
succ nts,
social based
clini speci
A nu re for
a pat prim
pl ion.
assess the patient's needs and preferences for the transition of care.
ensure the patient's insurance coverage includes the required level of care.
evaluate the quality of care provided at the skilled nursing facility. Answer: B
Explanation: When coordinating the transition of care for a patient from a
ds, evaluating the quality of care at the skilled nursing facility, and ring insurance coverage are all important aspects of care coordination, sing the patient's needs and preferences takes precedence in this conte
ch of the following nursing interventions is associated with patient ation in case management?
isk-reduction strategies. edication reconciliation. ealth equity initiatives. oordination of benefits.
wer: B
anation: Medication reconciliation is a nursing intervention associated
hospital to a skilled nursing facility, the nursing case manager's primary role is to assess the patient's needs and preferences for the transition of care. This involves understanding the patient's medical condition, functional abilities, social support, and personal preferences to ensure a smooth and patient- centered transition. By assessing the patient's needs and preferences, the case manager can collaborate with the healthcare team and the patient to develop an appropriate care plan, address any potential barriers or concerns, and facilitate a successful transition. While planning and facilitating the transfer of medical recor
ensu
asses xt.
Whi educ
R
M
H
C
Ans
Expl with
patient education in case management. Medication reconciliation involves comparing the medications a patient is currently taking with those prescribed by healthcare providers to identify discrepancies, ensure accuracy, and promote patient safety. In the context of case management, patient education plays a vital role in helping patients understand the importance of medication reconciliation, the potential risks of drug interactions, and the proper use of their medications. By providing education on medication reconciliation, case
managers empower patients to actively participate in managing their medications, prevent medication errors, and enhance medication adherence. While risk-reduction strategies, health equity initiatives, and coordination of benefits are important aspects of case management, they are not specifically associated with patient education.
context of case management, what is the primary role of utilization agement?
anaging authorizations, denials, and appeals. onducting screenings and risk stratifications. acilitating the coordination of benefits for patients. roviding patient education on health literacy.
wer: A
anation: The primary role of utilization management in case manage anage authorizations, denials, and appeals. Utilization management
ves assessing the appropriateness, necessity, and efficiency of healthc ces and treatments. Case managers who specialize in utilization agement work closely with healthcare providers, insurance companies, nts to ensure that the requested medical services meet the criteria for rage and reimbursement. They review and approve authorization requ
In the man
M
C
F
P
Ans
Expl ment
is to m
invol are
servi
man and
patie
cove ests,
handle denials and appeals, and help navigate the complex process of obtaining necessary healthcare services while optimizing resource utilization and cost- effectiveness. While coordination of benefits, screenings, and patient education are important aspects of case management, managing authorizations, denials, and appeals is the primary focus of utilization management.
A nursing case manager is responsible for benefit management in a healthcare organization. Benefit management primarily involves:
managing cost sharing and financial arrangements.
coordinating the reimbursement process with payors.
egotiating contracts with healthcare providers for preferred rates.
wer: A
anation: Benefit management primarily involves managing cost sharin inancial arrangements in a healthcare organization. This includes seeing the administration of benefits, such as deductibles, copayments, surance, and ensuring that the financial aspects of healthcare services a opriately managed. Benefit management aims to optimize the use of hcare resources while maintaining cost-effective care for patients. Wh dinating reimbursement with payors, ensuring coordination of benefits tiating contracts with healthcare providers are all important aspects of fit management, managing cost sharing and financial arrangements ta edence as it directly impacts the financial aspects of patient care.
ensuring coordination of benefits between multiple insurance providers.
n
Ans
Expl g
and f
over and
coin re
appr
healt ile
coor , and
nego
bene kes
prec
A nursing case manager is working with a patient who has limited health literacy. To effectively communicate with the patient, the case manager should:
utilize complex medical terminology to ensure accuracy.
provide written information for the patient to review.
encourage the patient to ask questions and seek clarification.
use plain language and avoid medical jargon.
Answer: D
ner, avoiding complex medical terminology and jargon that may confu atient. Providing written information for the patient to review can als ul, but it should be presented in a clear and simplified format. uraging the patient to ask questions and seek clarification promotes a
cipation and understanding. Utilizing complex medical terminology w er effective communication and further compound the patient's challe mprehending the information.
rsing case manager is involved in a population health initiative aimed cing the risk of cardiovascular disease in a community. Which of the wing strategies would best align with this initiative?
eveloping evidence-based clinical guidelines for managing cardiovasc se.
romoting health equity and addressing social drivers/determinants of h.
Explanation: When working with a patient who has limited health literacy, the nursing case manager should use plain language and avoid medical jargon to effectively communicate. Limited health literacy refers to a patient's difficulty understanding and using health-related information. By using plain language, the case manager can convey information in a clear and easily understandable man se
the p o be
helpf
Enco ctive
parti ould
hind nges
in co
A nu at
redu follo
D ular
disea
P
healt
Implementing regular health screenings and risk stratification for community members.
Coordinating benefits and cost sharing for community members in need of cardiovascular treatments.
Answer: C
fications, or medical interventions to mitigate their cardiovascular ris e promoting health equity, addressing social drivers/determinants of h, developing clinical guidelines, and coordinating benefits and cost ng are all important components of population health initiatives, ementing screenings and risk stratification directly contributes to ifying and reducing the risk of cardiovascular disease in the communi
ch of the following is a key focus of population health initiatives in nu anagement?
onducting motivational interviewing sessions. dministering evidence-based clinical guidelines. mplementing health equity initiatives.
creening and risk stratification.
wer: D
Explanation: In a population health initiative aimed at reducing the risk of cardiovascular disease in a community, implementing regular health screenings and risk stratification for community members would best align with the initiative. Regular screenings and risk stratification help identify individuals who may be at risk for cardiovascular disease or its risk factors, allowing for early intervention and targeted prevention strategies. This approach enables healthcare providers to identify those in need of further assessment, lifestyle modi k.
Whil healt shari impl
ident ty.
Whi rsing
case m
C
A
I
S
Ans
Explanation: Screening and risk stratification is a key focus of population health initiatives in nursing case management. Population health initiatives aim to improve the health outcomes of specific populations by identifying individuals at risk for certain conditions, implementing preventive measures, and providing targeted interventions. Case managers play a vital role in conducting screenings to identify individuals who may be at risk, stratifying
their risk levels based on various factors, and implementing appropriate interventions to reduce those risks. By engaging in screening and risk stratification, case managers can better allocate resources, implement early interventions, and promote the overall health and well-being of the population they serve. While motivational interviewing, clinical guidelines, and health equity initiatives are important components of case management, they are not the primary focus of population health initiatives.
ch of the following is an example of a government health care regulati ase managers need to be knowledgeable about?
isk stratification algorithms. ealth literacy assessment tools.
otivational interviewing techniques. edicare reimbursement guidelines.
wer: D
anation: Medicare reimbursement guidelines are an example of a rnment health care regulation that case managers need to be wledgeable about. Medicare is a federal health insurance program in th ed States that provides coverage to specific populations, such as indivi
he age of 65 and those with certain qualifying conditions. Case mana a crucial role in ensuring that patients receive appropriate and
Whi on
that c
R
H
M
M
Ans Expl
gove
kno e
Unit duals
over t gers
play
reimbursable services within the guidelines set forth by Medicare. By being knowledgeable about Medicare reimbursement guidelines, case managers can help patients navigate the complexities of the program, optimize reimbursement, and ensure compliance with regulatory requirements. Health literacy assessment tools, motivational interviewing techniques, and risk stratification algorithms are important tools and approaches used in case management but are not specific government health care regulations.
Which of the following activities is part of transition of care management in nursing case management?
Conducting screenings for specific diseases.
dministering evidence-based clinical guidelines. oordinating home healthcare services.
wer: D
anation: Coordinating home healthcare services is an activity that is p ition of care management in nursing case management. Transition of c agement involves planning, facilitating, and evaluating the transfer of nts from one healthcare setting to another, such as from a hospital to h om a rehabilitation facility to a long-term care facility. Case managers cial role in coordinating the necessary services and resources to ensur oth transition and continuity of care. Coordinating home healthcare ser rticularly important in facilitating a patient's transition from a healthca ty to their home, where they may require ongoing medical care, assist onitoring. While conducting screenings, administering clinical guideli ssessing social drivers/determinants of health are all important activit
anagement, they do not specifically fall under the category of transi re management.
Assessing social drivers/determinants of health.
A
C
Ans
Expl art of
trans are
man
patie ome
or fr play
a cru e a
smo vices
is pa re
facili ance,
or m nes,
and a ies in
case m tion
of ca
A nursing case manager is responsible for navigating government health care regulations in a healthcare organization. The primary purpose of navigating these regulations is to:
advocate for patient rights and access to care.
maximize reimbursement and financial sustainability.
streamline administrative processes and reduce paperwork.
ensure compliance with legal requirements and standards. Answer: D
rnment health care regulations in a healthcare organization is to ensur pliance with legal requirements and standards. Government health car ations encompass a wide range of laws, policies, and guidelines lished by regulatory bodies to ensure patient safety, quality of care, a
rence to legal and ethical standards. Navigating these regulations invo rstanding and applying the relevant rules and requirements to ensure t ealthcare organization and its practices comply with the applicable la e maximizing reimbursement, streamlining administrative processes, a cating for patient rights and access to care are all important goals, ens
pliance with legal requirements and standards is the fundamental purp vigating government health care regulations.
ch of the following is an example of a resource coordination activity i ng case management?
Explanation: The primary purpose of a nursing case manager navigating gove e
com e
regul
estab nd
adhe lves
unde hat
the h ws.
Whil nd
advo uring
com ose
of na
Whi n
nursi
Conducting screenings for a specific disease.
Coordinating referrals to community healthcare providers.
Administering evidence-based clinical guidelines.
Assessing patient readiness for change.
Answer: B
dinating these referrals, case managers ensure that patients have acces esources they need to manage their health conditions effectively. Whil ucting screenings, administering clinical guidelines, and assessing pat ness for change are important aspects of case management, they do n fically fall under the category of resource coordination.
rsing case manager is working with a patient who is preparing for nced care planning. The case manager's role in this process is to:
ssess the patient's health literacy and readiness for change. oordinate referrals to palliative care and hospice services. nsure accurate medication reconciliation and management.
cilitate discussions and provide information about treatment options a rences.
Explanation: Coordinating referrals to community healthcare providers is an example of a resource coordination activity in nursing case management. Resource coordination involves connecting patients with appropriate healthcare resources and services within the community. This includes identifying and referring patients to specialists, clinics, support groups, and other community- based organizations that can provide the necessary care and support. By
coor s to
the r e
cond ient
readi ot
speci
A nu adva
a
c
e
fa nd
prefe Answer: D
Explanation: When working with a patient who is preparing for advanced care planning, the nursing case manager's role in this process is to facilitate discussions and provide information about treatment options and preferences. Advanced care planning involves making decisions about future medical care preferences, including end-of-life care. The case manager plays a crucial role in
guiding the patient through this process, facilitating discussions, and providing relevant information to help the patient make informed decisions. While coordinating referrals to palliative care and hospice services, ensuring accurate medication reconciliation, and assessing health literacy and readiness for change are all important aspects of care, facilitating discussions and providing information about treatment options and preferences is the primary responsibility in the context of advanced care planning.
ase management role, one of the key responsibilities related to utiliza agement is:
onducting patient assessments and developing care plans. oordinating referrals to specialists and other healthcare providers. btaining prior authorizations for medical procedures and treatments. onitoring and evaluating patient outcomes and quality of care.
wer: C
anation: One of the key responsibilities related to utilization manage ase management role is obtaining prior authorizations for medical edures and treatments. Utilization management involves reviewing an aging the appropriate use of healthcare services to ensure they are cally necessary and cost-effective. Obtaining prior authorizations is a
In a c tion
man
c
c
o
m
Ans
Expl ment
in a c
proc d
man medi
crucial step in this process, as it helps ensure that the recommended procedures or treatments meet the criteria established by the healthcare payer for coverage. While conducting patient assessments, developing care plans, coordinating referrals, and monitoring patient outcomes are all important aspects of case management, obtaining prior authorizations specifically focuses on utilization management.
Which healthcare provider at a rehabilitation facility addresses the cognitive, behavioral, and psychological problems that result following a patient's traumatic brain injury?
Medical social worker.
sychologist. eurosurgeon.
wer: C
anation: A psychologist is the healthcare provider who primarily addr ognitive, behavioral, and psychological problems that occur as a resul matic brain injury. They specialize in assessing and treating mental an ional disorders, including those associated with brain injuries. hologists use various therapeutic approaches to help patients manage t ptoms, improve their cognitive function, and cope with emotional enges. While other healthcare providers, such as medical social worke opsychiatrists, and neurosurgeons, may play a role in the overall care nt, it is the psychologist who specifically focuses on addressing the itive and psychological aspects of the traumatic brain injury.
Neuropsychiatrist.
P
N
Ans
Expl esses
the c t of a
trau d
emot
Psyc heir
sym
chall rs,
neur of the
patie cogn
A nursing case manager is working with a patient who requires multiple medications for a complex medical condition. The case manager's primary responsibility in terms of patient education is to:
provide education on health literacy and effective communication strategies.
ensure that the patient has access to comprehensive medication
reconciliation services.
assess the patient's readiness for change and motivation to adhere to the medication regimen.
facilitate advanced care planning discussions with the patient and their family.
anation: When working with a patient who requires multiple medicati complex medical condition, the nursing case manager's primary onsibility in terms of patient education is to assess the patient's readin hange and motivation to adhere to the medication regimen. This invol rstanding the patient's willingness and ability to follow the prescribed cation regimen, as well as identifying any potential barriers or challen
ay face. By assessing readiness for change and motivation, the case ager can tailor the education and support provided to the patient to en cation adherence and optimize their health outcomes. While ensuring ss to medication reconciliation services, providing education on health cy and communication strategies, and facilitating advanced care plan ussions are important aspects of patient education, assessing readiness ge takes precedence in this scenario.
rsing case manager is reviewing a patient's care plan and wants to ens
Answer: C
Expl ons
for a
resp ess
for c ves
unde
medi ges
they m
man hance
medi acce
litera ning
disc for
chan
A nu ure
that the interventions are based on the best available evidence. Which of the following actions would be most appropriate?
Conducting a literature review of research articles.
Consulting evidence-based clinical practice guidelines.
Seeking expert opinions from other healthcare providers.
Implementing interventions based on personal experience andexpertise.
Answer: B
matically developed recommendations based on a thorough review of nt evidence and scientific research. They provide a standardized appr re based on the most up-to-date and reliable evidence. By consulting t elines, the case manager can ensure that the interventions in the care p with the best available evidence and promote optimal patient outcom e conducting a literature review, seeking expert opinions, and relying onal experience and expertise can also provide valuable insights, cons ence-based clinical practice guidelines is the most reliable and standar oach to ensure evidence-based care.
Explanation: When reviewing a patient's care plan and aiming to ensure that the interventions are based on the best available evidence, the most appropriate action for the nursing case manager is to consult evidence-based clinical practice guidelines. Evidence-based clinical practice guidelines are
syste the
curre oach
to ca hese
guid lan
align es.
Whil on
pers ulting
evid dized
appr