Free Practice Exam 2

Correct Answer: C. Explanation: The correct answer is C. A home health nurse can monitor the client’s condition, provide education on managing heart failure, and intervene early to prevent readmission. (A) While a follow-up appointment is important, two weeks may be too late for high-risk clients. (B) Providing symptom information is helpful but insufficient without active monitoring. (D) Medication access is important but does not replace comprehensive follow-up care.

Correct Answer: A. Home modifications Explanation: Home modifications (A) are a critical component of the discharge plan to ensure the client’s safety and independence at home. Modifications may include ramps, grab bars, or adaptive equipment to accommodate physical limitations. Option B, job placement services, may be relevant later but is not the immediate priority. Option C, recreational therapy, can enhance quality of life but is not essential for immediate safety and independence. Option D, mental health counseling, is important but secondary to ensuring the physical environment is safe and accessible.

Correct Answer: B. Long-term acute care hospital (LTAC) Explanation: A long-term acute care hospital (LTAC) (B) is the most appropriate setting for this patient due to his complex medical needs, including dialysis, daily wound care, and close monitoring. LTACs specialize in managing patients who require prolonged hospital-level care. Option A, an acute rehabilitation facility, is focused on intensive therapy rather than medical management. Option C, a skilled nursing facility (SNF), provides less intensive care and may not have the necessary resources for dialysis and frequent monitoring. Option D, home health care, is insufficient for this patient’s complex medical needs.

Correct Answer: C. Explanation: The correct answer is C. Exploring the client’s barriers and collaborating on realistic goals promotes client engagement and adherence to the plan of care. Understanding the reasons behind the client’s difficulties allows for a personalized, achievable care plan. (A) A support group may help later, but addressing immediate challenges is a priority. (B) Creating a detailed plan without client input may lead to further frustration and poor adherence. (D) Weekly home visits may not be necessary unless there are significant complications or additional support needs.

Correct Answer: C. Gently redirecting the conversation and inviting other group members to contribute (C) is the best approach. This maintains a supportive environment while encouraging balanced participation. Option A is incorrect because it limits others’ opportunity to share. Option B is too abrupt and could embarrass the participant. Option D may be helpful but misses the chance to address the situation in real time.

Correct Answer: A. Pastoral care services (A) are most appropriate for providing emotional and spiritual guidance for clients nearing the end of life. Option B is intended for individuals dealing with grief after the loss of a loved one. Option C focuses on mental health but may not address spiritual concerns. Option D is practical for planning but does not provide emotional or spiritual support.

Correct Answer: D. Individual insurance policy negotiation Explanation: Individual insurance policy negotiation (D) involves customizing coverage to meet a specific patient’s needs, such as extending the number of home health visits beyond the standard coverage limit. Fee schedule adjustment (A) is focused on reimbursement rates for services, not coverage limits. Single case agreement (B) is a one-time contract for specific care. Prior authorization (C) is required for certain services but is not a negotiation process for expanding coverage limits.

Correct Answer: A Explanation: Option (A) is correct because the purpose of a health risk assessment is to identify high-risk patients and provide data-driven insights to develop targeted interventions, thereby improving outcomes and reducing costs. Option (B) is incorrect because health risk assessments support but do not replace clinical judgment. Option (C) is incorrect as comprehensive data collection is essential for accurate risk stratification. Option (D) is incorrect because patient engagement is crucial in care planning and improving outcomes.

Correct Answer: B. Explanation: The correct answer is B. The case manager should prioritize a discussion about the client’s goals of care and respect their wishes, ensuring that the family understands the focus on comfort and quality of life. (A) Emphasizing that stopping dialysis is not an option disregards the client’s preferences. (C) Continuing all treatments without considering the client’s wishes contradicts the principles of client-centered care. (D) Finding an alternative dialysis method is irrelevant if the client no longer wants curative treatment.

Correct Answer: B. It establishes predetermined reimbursement rates for specific services. Explanation: A fee schedule agreement (B) sets predetermined reimbursement rates for specific services, ensuring that providers are reimbursed at consistent and agreed-upon amounts. This helps control costs and reduce billing disputes. Option (A) is incorrect because not all billed charges are guaranteed to be reimbursed. Option (C) describes single case agreements rather than fee schedules. Option (D) is incorrect because fee schedule agreements apply to various settings, not just inpatient care.

Correct Answer: A Explanation: Option (A) is correct because control charts are used to track data over time, such as the percentage of accurate records each month, to detect variations in performance. Option (B) is incorrect because narrative descriptions are not quantifiable data for control charts. Option (C) is incorrect as staff opinions are qualitative data. Option (D) is incorrect because financial performance is unrelated to the specific focus of control charts for documentation accuracy.

Correct Answer: A. Explanation: The correct answer is A. Low acuity is appropriate because the client’s condition is generally well-managed with therapy and medication, despite occasional panic attacks. (B) Moderate acuity is unnecessary for a client with stable management. (C) High acuity would apply to clients with more frequent or debilitating symptoms. (D) Severe acuity requiring hospitalization is incorrect since the client is not in crisis.

Correct Answer: B. "It’s important to focus on what you can control. Let’s explore immediate resources to help with housing." (B) is the best response because it offers practical solutions while validating the client’s feelings and encouraging action. Option A is incorrect because it’s directive and does not provide immediate support. Option C is incorrect because it’s judgmental and may increase the client’s feelings of shame. Option D is incorrect because it’s dismissive and does not offer any assistance.

Correct Answer: B Explanation: To maintain confidentiality, the case manager must avoid discussing patient information in public areas. Moving to a private area (B) ensures that the conversation remains secure. Avoiding the patient’s name (A) does not eliminate the risk of someone overhearing sensitive information. Lowering the voice (C) may reduce, but not eliminate, the risk of being overheard. Sending patient information via text message (D) is generally not secure and can lead to a breach of confidentiality.

Correct Answer: B. Walking for 30 minutes a day, five days a week, and incorporating dietary changes (B) is a practical, evidence-based approach to reducing cholesterol and promoting cardiovascular health. Option A may be overwhelming for a sedentary individual and increase the risk of injury. Option C is incomplete without exercise. Option D is incorrect because physical activity is a key component of cholesterol management.

Correct Answer: C. Medical procedures and services Explanation: Current Procedural Terminology (CPT) codes (C) are used to document medical procedures and services for billing purposes, primarily in outpatient settings. Option (A) refers to ICD codes for diagnoses. Option (B) relates to DSM classifications for mental health disorders. Option (D) describes DRG classifications for inpatient hospital stays.

Correct Answer: B. The Mini-Mental State Examination (MMSE) (B) is the most appropriate tool to assess cognitive decline. It evaluates orientation, memory, attention, language, and visuospatial skills, making it an effective screening tool for dementia and cognitive impairment. Option A, the Geriatric Depression Scale (GDS), assesses depression but not cognitive function. Option C, the Functional Independence Measure (FIM), evaluates physical and functional independence, not cognitive status. Option D, the Glasgow Coma Scale (GCS), assesses consciousness after brain injury, not chronic cognitive decline.

Correct Answer: C. Lack of access to healthcare (C) is the key social determinant of health in this situation, as the absence of insurance limits the client’s ability to seek timely care. Option A, social support network, relates to emotional and practical support but does not directly affect insurance status. Option B, health literacy, concerns understanding health information, which is not the issue here. Option D, employment opportunities, may influence financial stability but is not the primary factor.

Correct Answer: C. Medicaid Explanation: Most individuals receiving Supplemental Security Income (SSI) (C) are automatically eligible for Medicaid, which provides comprehensive health coverage. TRICARE (A) is for military service members and their families, not SSI recipients. Medicare Part D (B) provides prescription drug coverage to individuals enrolled in Medicare, not SSI recipients unless they also qualify for Medicare. Private employer-sponsored insurance (D) is unrelated to SSI benefits.

Correct Answer: A. Acute rehabilitation program Explanation: An acute rehabilitation program (A) is the most appropriate for this patient, as it offers intensive physical, occupational, and speech therapy for individuals recovering from serious medical conditions such as a stroke. The goal is to help patients regain independence and improve functional abilities. Option B, a substance use rehabilitation program, focuses on addiction recovery and is not relevant in this case. Option C, school-based rehabilitation programs, are intended for children and adolescents with disabilities. Option D, a non-governmental support group, may provide emotional support but does not offer the intensive therapy needed for stroke recovery.

Correct Answer: A. Explanation: The correct answer is A. Assessing housing stability and access to community resources is essential for successful reintegration and preventing relapse. (B) Physical health is important but may not be the most immediate concern. (C) Education on relapse prevention is helpful but does not replace a comprehensive assessment of basic needs like housing. (D) Vocational training is beneficial but not a priority until basic needs are met.

Correct Answer: C Explanation: Facilitating connections and offering ongoing support (C) is the most appropriate advocacy action, ensuring the patient receives necessary assistance without being overwhelmed. Simply providing a list of resources (A) leaves the patient unsupported. Contacting the family (B) may violate confidentiality unless authorized by the patient. Referring the patient to the billing department (D) may help with specific financial questions but does not address comprehensive advocacy needs.

Correct Answer: C. Fee schedule Explanation: Workers’ compensation programs commonly use a fee schedule (C), which specifies the maximum allowable payment for each type of medical service or procedure. This ensures cost control and standardization. Bundled payment (A) is used for defined episodes of care, not typically in workers’ compensation. Capitation (B) is a fixed per-member, per-month payment for comprehensive care, which does not apply here. Value-based care (D) focuses on improving outcomes and efficiency but is not a primary payment method in workers’ compensation.

Correct Answer: A Explanation: Respecting the patient’s autonomy while ensuring they are well-informed is essential (A). Encouraging compliance without addressing the patient’s concerns (B) undermines the patient-centered approach. A psychological evaluation (C) is not appropriate unless there are signs of cognitive impairment. Escalating to administration (D) is unnecessary and could breach patient confidentiality.

Correct Answer: A. Arranging for family counseling (A) is the most effective intervention, as it addresses the client’s emotional distress and promotes open communication with family members. Option B is important but does not address the client’s emotional needs. Option C may increase the client’s feelings of isolation. Option D may provide physical support but does not address the underlying psychosocial issues.

Correct Answer: B. Trackball mouse Explanation: A trackball mouse (B) is an excellent option for individuals with arthritis, as it reduces the need for wrist and arm movement while allowing precise control using fingers. Option A, a joystick mouse, requires more hand movement and may cause fatigue. Option C, an eye-tracking device, is usually reserved for individuals with extreme physical limitations and would be an unnecessarily complex solution in this case. Option D, a standard touchpad, may also be uncomfortable for prolonged use due to continuous hand movement.

Correct Answer: C. The best response is to provide the client with information about local domestic violence resources (C). Case managers must respect the autonomy of the client while prioritizing safety and offering support. Providing resources empowers the client to seek help on her terms. Option A is incorrect because while documentation is essential, it does not offer the client any immediate support. Option B may not be appropriate since the client explicitly expressed a desire not to involve law enforcement. Option D is incorrect because contacting law enforcement without the client’s consent may breach confidentiality unless there is immediate danger or a legal mandate to report.

Correct Answer: B. Service-connected disability or veteran status Explanation: Eligibility for VHA services (B) is based on veteran status and, in some cases, the presence of a service-connected disability. TRICARE Prime (A) is for active-duty service members and their families, not veterans. Current active-duty status (C) makes individuals eligible for TRICARE, not VHA. Medicare Part B (D) is unrelated to VHA eligibility but may complement VHA services for eligible veterans.

Correct Answer: A Explanation: Option (A) is correct because tracking care transitions and follow-up appointment completion rates provides meaningful data on care coordination effectiveness. Option (B) is incorrect as financial performance does not reflect care coordination. Option (C) is incorrect because a one-time survey provides limited information. Option (D) is incorrect as staff productivity based on hours worked does not assess care coordination quality.

Correct Answer: C. Explanation: The correct answer is C. A skilled nursing facility provides comprehensive nursing care and support for clients with advanced conditions like Parkinson’s disease who need assistance with daily activities and frequent medical monitoring. (A) Home with family support may not provide adequate supervision and medical care. (B) Assisted living facilities offer less intensive care and are more suited for individuals with minimal medical needs. (D) Inpatient rehabilitation is for short-term therapy to improve functional abilities and is not a long-term solution.

Correct Answer: A. Referring the client to a primary care provider who specializes in LGBTQ+ health (A) is the most appropriate response, as it ensures the client receives culturally competent care in a supportive environment. Option B is dismissive of the client’s concerns. Option C places the burden on the client without addressing the systemic issue. Option D is incorrect because not all providers are trained in LGBTQ+ health, and the client’s concerns are valid.

Correct Answer: B. "Start by walking for 5 minutes daily, and we’ll increase the duration as you feel comfortable." (B) promotes goal-setting by breaking the task into manageable steps, fostering a sense of achievement and progress. Option A is unrealistic for someone starting an exercise routine. Option C encourages overexertion, which can be harmful. Option D is overly cautious and may delay the client’s engagement in physical activity.

Correct Answer: B. $500 Explanation: An out-of-pocket maximum (B) is the maximum amount a patient must pay for covered services in a plan year. Once the patient reaches this limit, the insurance covers 100% of additional costs for covered services. Since the patient has already paid $4,500, they will only need to pay $500 more to reach the $5,000 maximum. Option (A) does not account for the out-of-pocket limit. Option (C) and (D) are incorrect calculations.

Correct Answer: A. Demonstrating how to use the inhaler and having the client practice (A) ensures they can use it correctly and allows for immediate correction of errors. Option B may supplement the demonstration but is not sufficient on its own. Option C may be helpful but does not provide real-time feedback. Option D delays the necessary education and does not ensure immediate understanding.

Correct Answer: B Explanation: It is the case manager’s professional responsibility to report unethical or unlicensed practices (B). Ignoring the issue (A) could lead to harm and legal repercussions. Confronting the colleague directly (C) may not be effective or appropriate without proper investigation. Discussing it at a team meeting (D) could violate confidentiality and professionalism.

Correct Answer: A Explanation: Advocacy involves supporting a patient’s right to make autonomous decisions, including refusing treatment (A). Ensuring strict adherence to the care plan (B) may not respect the patient’s individual preferences. Prioritizing organizational goals over patient welfare (C) is unethical. Documenting only successful interventions (D) does not reflect transparency and accuracy in case management documentation.

Correct Answer: A Explanation: Option (A) is correct because The Joint Commission requires comprehensive medication reconciliation to prevent errors during care transitions. Option (B) is incorrect as unverified medication lists increase the risk of errors. Option (C) is incorrect because while family involvement is helpful, medication reconciliation must be conducted by healthcare professionals. Option (D) is incorrect as skipping this step compromises patient safety and violates Joint Commission standards.

Correct Answer: B. Lawton Instrumental Activities of Daily Living (IADL) Explanation: The Lawton IADL (B) is the most appropriate assessment tool for evaluating a client’s ability to perform complex daily tasks such as managing finances, preparing meals, and handling transportation. These tasks require higher-level cognitive and functional abilities. Option A, the Barthel Index, assesses physical function in basic ADLs but not complex tasks. Option C, the Katz Index of ADL, is limited to self-care tasks. Option D, the Clock Drawing Test, is a cognitive screening tool but does not assess functional capacity.

Correct Answer: A. Enrolling the client in a medication management program (A) is the most appropriate recommendation. These programs offer structured support, such as medication reminders and monitoring, which can help improve adherence and reduce hospital readmissions. Option B may provide emotional support but does not directly address the client’s medication adherence. Option C is helpful but insufficient for a client struggling with consistency. Option D may not be reliable if the client does not have family members available to help regularly.

Correct Answer: C. Explanation: The correct answer is C. Observation status is an outpatient service used for short-term evaluation and monitoring to determine whether the client needs to be admitted as an inpatient or can be discharged. (A) Observation status is not considered an inpatient admission for billing purposes; it falls under outpatient services. (B) Observation often involves diagnostic testing and monitoring, but it is intended for a short duration. (D) Medicare coverage for observation status differs from inpatient benefits, including differences in cost-sharing and eligibility for skilled nursing facility care.

Correct Answer: B Explanation: Reviewing the subpoena with legal counsel (B) ensures that the case manager responds appropriately while protecting patient confidentiality and complying with legal requirements. Immediately releasing records (A) without review can lead to breaches of confidentiality. Refusing to release records (C) may result in legal consequences. Providing a verbal summary (D) does not fulfill the requirements of a subpoena.

Correct Answer: B. Explanation: The correct answer is B. Applying for a medication assistance program can help the client access affordable medications and improve adherence. (A) Financial counseling may help with budgeting but is less immediate in addressing medication access. (C) Weekly visits for medication administration are not a practical or cost-effective solution for affordability issues. (D) Education alone does not address the underlying financial barrier.

Correct Answer: A. Providers share financial risks and rewards based on patient outcomes and cost efficiency. Explanation: Accountable care organizations (ACOs) are designed to improve patient care by promoting coordination among providers and sharing financial risks and rewards based on performance metrics (A). This model encourages providers to collaborate and achieve better outcomes at a lower cost. Fee-for-service (B) focuses on volume without considering outcomes, which contrasts with ACO principles. Option (C) is incorrect because ACOs emphasize shared responsibility and collaboration. Capitation (D) is associated with managed care, not ACOs.

Correct Answer: A. Referring the client to a home health care agency (A) is the best option to ensure the client receives appropriate support with daily activities during recovery. Option B may be costly and not feasible for the client. Option C is unreliable and does not guarantee consistent care. Option D is unsafe and could lead to complications or delayed recovery.

Correct Answer: C. Skilled nursing care and physical therapy Explanation: Home care benefits typically cover skilled nursing care and therapies such as physical therapy (C) provided in the home. Inpatient hospital care (A) is not part of home care services. Custodial care (B) and long-term care in a nursing facility (D) are usually not covered under standard home care benefits but may be covered under specific long-term care policies.

Correct Answer: B. School-based rehabilitation program Explanation: A school-based rehabilitation program (B) is the best option for a student needing physical and occupational therapy. These services help students participate in educational activities and promote independence. Option A, an acute rehabilitation program, focuses on short-term, intensive therapy for medical conditions. Option C, a medical rehabilitation program, addresses physical recovery but is typically provided in hospitals or clinics, not schools. Option D, a return-to-work program, is not relevant for a student.

Correct Answer: C. The priority is to develop a relapse prevention plan that includes cognitive-behavioral therapy (CBT) (C). CBT is an evidence-based approach that helps clients manage anxiety and reduce the risk of relapse by teaching coping skills. Option A is incorrect because prescribing benzodiazepines can increase the risk of dependence, particularly in clients with a history of substance use disorder. Option B is supportive but insufficient as the main strategy. Option D is incorrect because waiting six months for follow-up is too long for a high-risk client.

Correct Answer: A Explanation: Option (A) is correct because NQF is a key organization that endorses evidence-based quality measures, ensuring they meet rigorous standards for reliability and validity before they are widely adopted. Option (B) is incorrect because CMS implements and tracks measures but does not endorse them. Option (C) is incorrect as URAC is an accreditation body, not a measure endorsement organization. Option (D) is incorrect because AHRQ focuses on research and developing clinical guidelines rather than endorsing measures.

Correct Answer: B. Explanation: The correct answer is B. Hospice care focuses on symptom management, emotional support, and improving the client’s quality of life, especially when curative treatment is no longer desired or effective. (A) Hospice care does not provide curative treatments. (C) Hospice services can be offered in various settings, including home, hospice facilities, and nursing homes. (D) Not all medications and treatments are discontinued; medications that promote comfort and symptom control are continued.

Correct Answer: A. Referring the client to a community food pantry (A) is the most appropriate recommendation to address immediate food insecurity. Food pantries provide essential support for clients with limited access to nutritious food. Option B is incorrect because reducing portions does not address the underlying issue and may negatively impact the client’s health. Option C is incorrect because relying on family support may not be feasible or sustainable. Option D is incorrect because processed foods are often low in nutrients and could worsen the client’s health.

Correct Answer: B. "Let’s take a break and discuss what would help you feel more comfortable." (B) reflects a trauma-informed approach by prioritizing the client’s emotional safety and seeking to understand their needs. Option A is directive and may increase the client’s distress. Option C pressures the client and risks retraumatization. Option D is not ideal because it suggests abandoning necessary care rather than finding a more supportive approach.

Correct Answer: B. Explanation: The correct answer is B. Observation care allows for short-term monitoring to ensure that the client remains stable before being discharged home. (A) Inpatient hospitalization is unnecessary because the client’s condition improved with initial treatment. (C) Outpatient follow-up would not provide immediate monitoring. (D) Long-term acute care is not appropriate for this acute episode.

Correct Answer: B. Care coordination and chronic disease management programs Explanation: Managed care plans often implement care coordination and chronic disease management programs (B), which help patients manage their conditions and reduce unnecessary emergency department visits. Incentives for high-cost treatments (A) would increase costs, not reduce them. Unlimited access to providers (C) reduces care coordination and control. Retrospective reimbursement (D) does not directly improve outcomes or reduce visits.

Correct Answer: B. Encouraging the client to write down questions and bring them to medical appointments (B) promotes self-advocacy and ensures the client’s concerns are addressed. Option A is incorrect because simply providing materials without encouraging interaction limits engagement. Option C is incorrect because it discourages active participation in care planning. Option D is incorrect because making decisions for the client disempowers them and contradicts the principles of shared decision-making.

Correct Answer: B. Explanation: The correct answer is B. A follow-up phone call within 48 hours and ensuring access to prescribed medications are essential steps in preventing readmission and addressing any immediate post-discharge concerns. (A) While written discharge instructions and a follow-up appointment are necessary, six weeks is too long to wait for follow-up. (C) Encouraging the client to return to the emergency department is reactive rather than proactive. (D) Medication reconciliation is important but insufficient as the sole intervention for a safe transition of care.

Correct Answer: B Explanation: The No Surprises Act protects patients from unexpected medical bills for emergency services provided by out-of-network providers (B). The ACA (A) focuses on improving healthcare access and coverage. The ADA (C) addresses disability rights, and the FMLA (D) provides job-protected leave for family or medical reasons.

Correct Answer: D. Video Relay Service (VRS) Explanation: Video Relay Service (D) is the most appropriate adaptive technology for individuals with profound hearing loss who need real-time communication with hearing individuals. VRS uses sign language interpreters to facilitate conversations between the hearing-impaired user and hearing individuals, making it highly effective for workplace communication. Option A, a cochlear implant, is a medical device that might not be suitable for all individuals and may not fully restore normal hearing. Option B, a Text Telephone (TTY) device, is outdated and primarily used for text-based communication, which may not be as efficient for dynamic work settings. Option C, an amplified telephone, is useful for individuals with mild to moderate hearing loss but would not meet the needs of someone with profound hearing loss.

Correct Answer: B. The sale of a life insurance policy for less than its face value to obtain immediate funds Explanation: A viatical settlement (B) allows a terminally ill individual to sell their life insurance policy to a third party for immediate cash, which can be used to cover medical expenses or other financial needs. The buyer then becomes the policy beneficiary and collects the full death benefit upon the individual’s passing. Option (A) is incorrect because it is not a government grant. Option (C) describes a loan, which is not the same as a viatical settlement. Option (D) is unrelated, as viatical settlements are not savings plans.

Correct Answer: B. Explanation: The correct answer is B. The WIC program provides nutritional support for pregnant women and connects them with prenatal services. (A) Mental health counseling is valuable but does not address food insecurity and prenatal care. (C) Childbirth education is useful later in pregnancy but does not solve immediate nutritional needs. (D) Admission to a maternity ward is unnecessary unless there are medical complications.

Correct Answer: C. Explanation: The correct answer is C. A Comprehensive Advance Directive combines elements of a living will and a Durable Power of Attorney for Health Care, covering both treatment preferences and the appointment of a decision-maker. (A) A living will focuses only on treatment preferences for specific situations. (B) A Durable Power of Attorney for Health Care designates a decision-maker but does not outline treatment preferences. (D) A DNR order addresses CPR decisions only and is not a comprehensive planning document.

Correct Answer: B Explanation: Contacting the patient and assisting with scheduling follow-up care (B) is the most proactive approach to reducing the risk of readmission. Simply documenting and waiting (A) does not address the immediate need. Notifying the physician and closing the case (C) leaves the risk unmitigated. Referring the patient to a community health program (D) may be helpful but does not resolve the immediate need for follow-up.

Correct Answer: A Explanation: Option (A) is correct because predictive modeling helps case managers identify high-risk patients early, allowing for proactive interventions that can improve outcomes. Option (B) is incorrect because care should be individualized based on risk stratification. Option (C) is incorrect as follow-up care is crucial regardless of predictive risk identification. Option (D) is incorrect because predictive modeling supports but does not replace clinical assessments.

Correct Answer: C. The client is in the preparation stage (C), which involves planning and taking initial steps toward behavior change. Purchasing tools and setting a start date are indicators of readiness to act. Option A, precontemplation (A), is incorrect because that stage involves no intention to change. Option B, contemplation (B), is incorrect because it refers to thinking about change without making concrete plans. Option D, action (D), is incorrect because the client has not yet implemented the new behavior.

Correct Answer: B. Facilitating a family meeting to explore the client’s wishes and find a compromise (B) is the best approach. It ensures the client’s preferences are respected while addressing family concerns. Option A prioritizes the family over the client’s autonomy. Option C dismisses the client’s cultural practices, which may lead to disengagement from care. Option D may be useful later but is not the immediate best response.

Correct Answer: A Explanation: Using visual aids and simple language (A) is the best approach to help a patient with limited literacy understand their care plan. Providing written instructions (B) may not be helpful if the patient cannot read well. Referring to an educational program (C) may be useful later but does not address immediate needs. Assuming understanding based on body language (D) risks significant miscommunication.

Correct Answer: B. Explanation: The correct answer is B. A health care surrogate is authorized to make medical decisions only when the client is unable to do so, ensuring that the client’s wishes are respected. (A) Financial decisions require a financial power of attorney, not a health care surrogate. (C) A living will cannot be modified without the client’s consent. (D) Estate planning and asset distribution are legal matters handled through a will or trust, not by a health care surrogate.

Correct Answer: A. Explanation: The correct answer is A. Physical therapy and pain management may help delay or avoid surgery, reducing costs while maintaining the client’s quality of life. (B) Surgery may be necessary, but conservative treatments should be tried first. (C) Skilled nursing facilities are expensive and unnecessary for preoperative care. (D) Prior authorization ensures coverage but does not address alternative cost-saving options.

Correct Answer: C. Job coaching and supported employment Explanation: Job coaching and supported employment (C) are the most appropriate interventions for individuals with cognitive impairments who need a structured environment and ongoing support. This approach ensures the client can perform job tasks with assistance. Option A, placement in a competitive job, may be too challenging without appropriate support. Option B, referral to a sheltered workshop, is more restrictive and may not promote independence. Option D, vocational training, is helpful but may not provide the on-the-job support the client needs.

Correct Answer: A Explanation: Option (A) is correct because NCQA standards stress continuous quality improvement through patient feedback and satisfaction surveys. These tools help organizations identify gaps and enhance services. Option (B) is incorrect because reducing staff training compromises care quality. Option (C) is incorrect because eliminating services for chronic disease patients goes against NCQA's focus on quality management and care coordination. Option (D) is incorrect as engaging patients in their care is essential for quality outcomes and is not prohibited by privacy regulations when done properly.

Correct Answer: A. A cancer-specific support group (A) is the best resource, as it offers peer support from individuals who are facing similar challenges, helping the client feel less isolated. Option B may be helpful for deeper emotional issues but does not provide peer support. Option C is focused on employment, not emotional support. Option D can offer general advice but lacks the structure and reliability of an organized support group.

Correct Answer: B. Explanation: The correct answer is B. Home safety modifications and a personal emergency response system allow the client to maintain independence while reducing fall risk. (A) Taking no action would put the client at continued risk. (C) Encouraging the client to reconsider assisted living may be appropriate later but should not be the initial focus. (D) A skilled nursing facility is not necessary unless the client’s condition significantly worsens.

Correct Answer: A Explanation: Option (A) is correct because lower readmission rates and improved satisfaction indicate that the benefits outweigh the costs, demonstrating a positive cost-benefit ratio. Option (B) is incorrect because increased hospitalization rates suggest a negative impact. Option (C) is incorrect because high costs without measurable outcomes indicate poor value. Option (D) is incorrect because longer stays and delayed care are associated with higher costs and worse outcomes.

Correct Answer: B. Explanation: The correct answer is B. Outpatient pulmonary rehabilitation and self-management education are evidence-based strategies that improve symptom control, reduce hospitalizations, and lower healthcare costs. (A) Monthly follow-ups may help but do not directly reduce hospitalizations as effectively as pulmonary rehabilitation. (C) Referring the client to the emergency department increases costs and does not promote proactive management. (D) Medication adherence is essential but insufficient as the sole intervention for preventing exacerbations.

Correct Answer: B. Explanation: The correct answer is B. Integrating the nurse’s and dietitian’s recommendations ensures a comprehensive approach to managing the client’s chronic heart failure. (A) Prioritizing one recommendation overlooks the importance of multidisciplinary input. (C) Medication management alone is insufficient for managing heart failure effectively. (D) Referring the client back to the physician without addressing the recommendations misses an opportunity for proactive care management.

Correct Answer: B. Explanation: The correct answer is B. Providing transportation assistance and connecting the client with community resources addresses barriers to care and ensures access to prenatal services. (A) Home visits by a midwife may not be feasible or appropriate for all aspects of prenatal care. (C) Nutritional education is important but does not solve the access-to-care issue. (D) Referral to a high-risk obstetrician is unnecessary unless there are clinical indications for high-risk management.

Correct Answer: C. Prior authorization Explanation: Prior authorization (C) is a type of prospective review that verifies medical necessity and approves or denies coverage before a procedure is performed. Concurrent review (A) occurs during treatment. Retrospective review (B) happens after the service is completed. Discharge planning (D) focuses on coordinating post-discharge care and is unrelated to verifying medical necessity before a procedure.

Correct Answer: C. Explanation: The correct answer is C. Case management services prioritize clients at high risk for poor outcomes or frequent readmissions because these individuals benefit most from coordinated care interventions. (A) Length of hospital stay is a consideration but not a sole criterion for case management. (B) Not all chronic conditions require case management; it depends on severity and risk level. (D) Age and insurance coverage alone do not indicate a need for case management unless the individual has risk factors.

Correct Answer: C Explanation: Accessing a patient’s medical record without authorization or assignment is a clear violation of privacy and organizational policies (C). Helping a colleague (A) does not justify unauthorized access. It is not a minor breach (B) but a serious issue that must be addressed. Even if no information is shared (D), the act of accessing the record is a violation.

Correct Answer: A Explanation: Option (A) is correct because 30-day readmission rates are a key metric in evaluating the effectiveness of transitional planning and its impact on patient outcomes, a core component of value-based care. Option (B) is incorrect because staff training numbers do not directly measure outcomes. Option (C) is incorrect because patient satisfaction scores unrelated to discharge planning do not reflect the effectiveness of transitional planning. Option (D) is incorrect because inpatient revenue is not an indicator of quality in value-based care.

Correct Answer: C Explanation: Reporting the incident to the supervisor (C) ensures that the issue is addressed through proper channels and that the integrity of the documentation is maintained. Ignoring the entry (A) is unethical and can lead to further issues. Discussing it with the colleague (B) may be appropriate in some situations, but it does not replace the need for formal reporting. Correcting the documentation (D) without authorization could lead to legal and professional consequences.

Correct Answer: B. Concurrent review Explanation: Concurrent review (B) involves the ongoing evaluation of a patient’s care while they are still receiving treatment to determine if the services provided are appropriate and necessary. This allows for real-time intervention to ensure proper utilization of resources. Prospective review (A) occurs before services are provided. Retrospective review (C) is conducted after services are completed to assess appropriateness and compliance. Peer review (D) typically involves an evaluation by healthcare professionals to assess clinical decision-making and is not focused on real-time care.

Correct Answer: B. "We can find a healthcare provider who has experience working with non-binary individuals." (B) is the best strategy to ensure the client receives care in a safe and affirming environment. Option A is incorrect because avoiding care can lead to negative health outcomes. Option C minimizes the client’s experiences. Option D places too much responsibility on the client without offering practical support.

Correct Answer: B Explanation: Arranging for a certified medical interpreter (B) ensures accurate communication and avoids potential misinterpretation. Using family members (A) as interpreters can lead to errors and breaches of confidentiality. Providing written materials in English (C) does not address the language barrier. Non-verbal communication (D) is insufficient for conveying complex medical information.

Correct Answer: C. Promoting realistic goals and educating the client on energy conservation (C) supports independence and enhances quality of life by allowing the client to remain active while managing symptoms. Option A is incorrect because complete avoidance of physical activity can worsen overall health. Option B is incorrect because the approach encourages active involvement, not passivity. Option D is incorrect because while the approach may reduce some complications, it does not eliminate the need for future medical interventions entirely.

Correct Answer: B Explanation: Seeking professional support and developing a personal self-care plan (B) is the most effective approach to address compassion fatigue and promote well-being. Taking a vacation (A) may provide temporary relief but does not address the root cause. Working harder (C) can exacerbate burnout. Minimizing contact with clients (D) may compromise the quality of care and is not a sustainable solution.

Correct Answer: B. The veteran can receive medications through VA pharmacies or the VA mail-order pharmacy. Explanation: Veterans enrolled in VHA services can access prescription medications through VA pharmacies and the VA mail-order pharmacy (B), ensuring they receive affordable medications. Option (A) is incorrect because prescription drugs are a key benefit of VHA services. Veterans do not need to purchase separate insurance (C). Option (D) is incorrect because the VA primarily dispenses medications through its own facilities, although some community pharmacy options are available for certain circumstances.

Correct Answer: A. Explanation: The correct answer is A. Coordinating with a pain management specialist and substance use treatment program ensures comprehensive and safe management of opioid use disorder while addressing chronic pain. (B) Discontinuing opioids immediately without supervision can lead to withdrawal and unmanaged pain. (C) Non-pharmacological techniques are helpful but should be part of a comprehensive plan, not the sole focus. (D) Advising self-management with over-the-counter medications is inadequate for managing chronic pain and opioid use disorder.

Correct Answer: A Explanation: Option (A) is correct because understanding the demographics and diagnoses of program participants helps identify utilization patterns and plan services effectively. Option (B) is incorrect as individual outcomes do not provide population-level insights. Option (C) is incorrect because budget data alone does not reflect service utilization. Option (D) is incorrect because staff satisfaction, while important, does not reveal utilization trends.

Correct Answer: D Explanation: State laws vary on the mandatory reporting of domestic violence in adults; however, if the state mandates reporting, the case manager must report the situation to adult protective services (D). Simply documenting the refusal (A) may not fulfill legal requirements. Contacting law enforcement (B) is not always legally required unless the patient is in immediate danger. Informing family members (C) may violate the patient’s right to confidentiality.

Correct Answer: A. The Confusion Assessment Method (CAM) (A) is the most appropriate tool for detecting delirium, given the client’s rapid onset of symptoms and fluctuating levels of alertness. Option B, the MMSE, is used for general cognitive assessment but is not specific to delirium. Option C, the GDS, assesses depression, not acute confusion. Option D, the Barthel Index, evaluates functional independence, not cognitive status.

Correct Answer: B. The client is in the contemplation stage (B) of the Transtheoretical Model of Change, which is characterized by awareness of the problem and consideration of making changes, but no specific action has been taken. This stage involves the evaluation of pros and cons, often leading to a decision to act. Option A is incorrect because the precontemplation stage (A) involves no intention to change behavior in the foreseeable future. Option C is incorrect because the preparation stage (C) includes planning and taking initial steps toward change, such as setting goals or making arrangements. Option D is incorrect because the action stage (D) represents the implementation of new behaviors.

Correct Answer: B. Explanation: The correct answer is B. Home health services and adaptive equipment help the client maintain independence at home, aligning with their preference. (A) Inpatient rehabilitation is not necessary for long-term care if the client can be supported at home. (C) Short-term physical therapy is insufficient for a client with a spinal cord injury that causes permanent limitations. (D) An assisted living facility may be an option but should not be the first recommendation if the client can remain at home with appropriate support.

Correct Answer: A Explanation: Option (A) is correct because patient satisfaction surveys are specifically designed to assess client experience in areas such as communication, access, and care coordination. Option (B) is incorrect as clinical outcomes reflect health status, not client experience. Option (C) is incorrect because financial performance is not an indicator of client experience. Option (D) is incorrect as staff productivity focuses on workload and efficiency, not patient perceptions of care.

Correct Answer: B. Acute rehabilitation facility Explanation: An acute rehabilitation facility (B) is the best setting for this patient because it provides intensive, multidisciplinary therapy for medically stable individuals who need to regain functional independence. Patients in acute rehab receive at least three hours of therapy per day. Option A, an LTAC, is for medically complex patients who require extended hospital-level care. Option C, a skilled nursing facility (SNF), offers less intensive rehabilitation services and may not provide the daily therapy this patient requires. Option D, home health care, is suitable for patients with less intensive therapy needs and more independence.

Correct Answer: B. Explanation: The correct answer is B. Collaborating with the client to identify personal goals and coping strategies empowers the client and ensures the care plan reflects their priorities and strengths. (A) Psychiatric hospitalization is reserved for acute crises and not a core element of routine care planning. (C) Medication evaluation may be part of the plan but should be integrated with other therapeutic approaches. (D) Family therapy can be helpful but is not a necessary core component unless family dynamics are a significant factor in the client’s condition.

Correct Answer: B. Explanation: The correct answer is B. Arranging transportation and coordinating with the dialysis center helps address the client’s immediate barrier to care and ensures consistent treatment. (A) Providing a list of dialysis centers does not solve the transportation issue. (C) Education is important but insufficient without addressing the transportation barrier. (D) Referral to a nephrologist is unnecessary unless there are clinical concerns about dialysis treatment.

Correct Answer: A. Asking the client to explain how and when they take their insulin (A) is an example of the teach-back method, a proven strategy for assessing health literacy and understanding. Option B is incorrect because providing a detailed explanation does not confirm comprehension. Option C may be useful but does not directly assess the client’s current level of understanding. Option D is helpful but should follow an assessment of the client’s needs.

Correct Answer: B. Explanation: The correct answer is B. The Chronic Care Model (CCM) focuses on improving outcomes for individuals with chronic conditions by emphasizing self-management support, coordinated care, and the use of community resources. (A) Reducing the number of providers does not align with the model’s goal of multidisciplinary care. (C) Frequent hospital visits contradict the model’s emphasis on community-based care and prevention. (D) Exclusively relying on primary care providers limits the effectiveness of the care model, which supports a team-based approach.