CMGT-BC Exam Prep: Nursing Case Management (ANCC) Study Guide + 2,100+ Practice Questions

A hospital-based case manager notices that discharge delays are frequently occurring because the durable medical equipment (DME) vendor does not receive timely authorizations from the insurance company. The case manager decides to address this systemic issue. Which collaborative action is most appropriate?

A local home health agency offers a case manager a financial incentive for every patient referred to their services. The agency is known for high-quality care, and many of the case manager’s patients could benefit from their programs.

A case manager is working with a patient whose primary language is not English. The patient’s teenage child is translating a complex consent form for a high-risk procedure. The patient is nodding but appears hesitant and confused.

An employer contacts a case manager requesting the full medical history of an employee who is returning to work after a back injury. The employer claims they need the information to determine if the employee can perform job duties.

During a utilization review, a payer denies a request for a specialized wheelchair for a patient with progressive neuromuscular disease, stating it is not a covered benefit. The patient currently uses a standard chair that causes skin breakdown.

A case manager at a community clinic is managing two patients who both require a single available slot for a specialized cardiac rehabilitation program. Patient A has private insurance and a stable home life, while Patient B has no insurance and limited social support.

A 72-year-old patient recovering from a stroke is being discharged from acute rehab. The patient lives alone in a multi-level home and insists on returning there despite a high fall risk assessment and the case manager’s recommendation for assisted living.

A large health system implements a new remote patient monitoring program for high-risk patients with heart failure to reduce emergency department visits. After the first month, the case management team gathers data to compare actual outcomes against the predicted goals as part of a PDSA cycle.

During a quarterly utilization review meeting, a case manager identifies a recurring pattern of delayed durable medical equipment delivery for patients transitioning from acute care to home. This delay has resulted in three safety-related incidents and increased length of stay in the past month.

A case manager on a busy orthopedic unit notes that the average length of stay for total hip arthroplasty patients is 0.6 days longer than the regional benchmark. The hospital’s strategic goal is to align with top-tier performance standards while maintaining high patient safety scores.

An outpatient surgery center experiences frequent delays in insurance authorizations, leading to a 20% cancellation rate on the day of scheduled procedures. The nurse case manager utilizes a Lean methodology to streamline the workflow and reduce waste within the pre-admission process.

A rural health system identifies that HCAHPS scores regarding “Care Transitions” are consistently below the national average for patients moving from acute care to home. The case management director wants to implement a performance measurement strategy to evaluate the effectiveness of a new discharge follow-up call program.

The 30-day readmission rate for patients with chronic obstructive pulmonary disease at an urban medical center has increased by 12% over the last two quarters. The case manager is tasked with leading a quality improvement initiative to identify the primary drivers of this trend before implementing new interventions.

In a long-term care facility, the interdisciplinary team is developing a care plan for a resident with declining cognitive function. The resident’s daughter wants her mother to remain as independent as possible, but the nursing staff is concerned about the high risk of falls. How should the case manager facilitate this discussion?

A case manager is working with a patient who has a history of frequent readmissions. The patient’s family expresses frustration that the medical team and the home care agency are not communicating effectively, leading to inconsistent care at home. What is the most effective way for the case manager to improve this collaboration?

A 68-year-old patient with chronic heart failure and limited health literacy is being prepared for discharge to home. The patient lives alone and has been hospitalized three times in the past six months for fluid overload. To ensure an effective transition and reduce the risk of readmission, which action should the case manager implement?

During an interdisciplinary team meeting at a sub-acute rehabilitation center, the occupational therapist and the speech-language pathologist disagree on the patient’s readiness for self-feeding. The disagreement is causing a delay in the patient’s nutritional goals. Which strategy should the case manager employ to resolve this professional conflict?

An outpatient case manager is managing a patient with multiple chronic conditions who recently transitioned from the hospital. The home health nurse reports that the patient is confused by conflicting instructions regarding activity levels provided by the cardiologist and the primary care provider. How should the case manager proceed to reconcile these instructions?

A case manager in an acute care setting is coordinating discharge for a patient with complex mobility needs. The physical therapist recommends a skilled nursing facility, while the social worker suggests home health care based on the family’s preference. The team is unable to reach a consensus during the morning huddle. Which action should the case manager take to ensure a safe and effective transition?

During a monthly utilization committee meeting, the case manager identifies a recurring trend where patients are experiencing delayed discharges due to a lack of available home oxygen equipment from local vendors. Which tool should the case manager use to document and analyze these delays for resource allocation improvement?

A utilization management nurse receives a request for an elective spinal fusion. Upon review, the documentation does not show evidence that the patient attempted conservative treatments, such as physical therapy or injections, which are required by the payer’s medical policy. What is the most appropriate next step for the nurse to take to ensure proper resource allocation?

A health system aims to reduce emergency department over-utilization among a cohort of high-risk patients with multiple chronic conditions and frequent social crises. The case manager is tasked with implementing a resource allocation model that focuses on proactive management and early intervention. Which strategy is most effective for this population?

A case manager is performing a review for a patient who was admitted for an acute exacerbation of chronic obstructive pulmonary disease. The patient has reached the expected length of stay based on evidence-based criteria, but the physician requests an additional two days because the patient still requires frequent nebulizer treatments and has not returned to their baseline functional status. Which type of utilization review is being conducted?

A 55-year-old patient with a chronic diabetic foot ulcer lives in a rural area without a personal vehicle and has no local support system. The treatment plan requires daily professional wound debridement and dressing changes to prevent systemic infection. Which resource allocation strategy best addresses both the clinical requirements and the patient’s geographic and social barriers?

A 72-year-old patient is recovering from a dense ischemic stroke and is medically stable but demonstrates significant functional deficits. The patient requires at least three hours of combined physical and occupational therapy daily to regain independence, but the family is requesting the patient return home immediately. Which level of care should the case manager advocate for to ensure appropriate resource allocation and optimal clinical outcomes?

A 62-year-old patient is being discharged following a major surgical procedure. The patient lives in a rural area, two hours away from the hospital, and reports feeling overwhelmed by the complex medication and wound care instructions. What is the case manager’s best approach to transition planning?

A case manager is planning the transition for an 80-year-old patient who has recovered from a stroke and is returning home with a new diagnosis of dysphagia. The patient’s daughter will be the primary caregiver but works full-time. Which coordination activity is most vital for a successful transition?

A 54-year-old patient with poorly controlled diabetes and a history of non-adherence is being discharged after treatment for a foot ulcer. The patient frequently uses the emergency department for primary care needs. To improve care coordination and health outcomes, which action should the case manager take?

A 72-year-old patient with a history of frequent falls and new-onset generalized weakness is being discharged from an acute rehabilitation unit. The patient’s spouse expresses significant anxiety about managing the patient’s mobility at home. What is the most appropriate intervention for the case manager to facilitate a safe transition?

A 45-year-old patient who is uninsured and lacks reliable transportation is ready for discharge following an emergency appendectomy. The patient requires follow-up wound care and a post-operative surgical consultation in two weeks. Which strategy best demonstrates effective care coordination for this individual?