Case Management Practice Test 1
Case Management NCLEX Practice Test
Case Management is a key topic within the NCLEX test plan, located under Safe and Effective Care Environment → Management of Care → Advocacy → Case Management. This section develops coordinated care strategies, ensuring smooth transitions and goal-directed nursing interventions. Each test contains 50 questions designed to mirror the difficulty and variety of the real exam.
This is the 1st part of the Case Management series. To explore all practice tests under this topic, use the “Back to Main Topic” button at the end of the page.
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In the Case Management Study Cards section, shared by real NCLEX candidates, you’ll find concise summaries and high-yield insights related to the most tested concepts. It’s a perfect space to reinforce challenging topics and sharpen your recall through quick, focused repetitions. Short, powerful, and repeatable!
Case Management Practice Test 1
A 72-year-old client with osteomyelitis requires a six-week course of intravenous antibiotics. In planning for home care, the most important action by the nurse is?
- Investigating the client's insurance coverage for home IV antibiotic therapy.
- Determining whether there are adequate hand-washing facilities in the home
- Assessing the client's ability to participate in self-care and/or the reliability of a caregiver.
- Selecting the appropriate venous access device
Explanation: Answer reason: Before arranging home IV therapy, the priority is assessing the client's and caregiver's ability and reliability to manage care safely at home; other considerations like insurance, facilities, or device choice are secondary.
The following is true of critical pathways in the case management approach to patient care?
- The nursing care plan has no relation to critical pathways.
- Nursing diagnoses are always incorporated into critical pathways.
- This approach is decreasing in popularity.
- Critical pathways emphasize early recognition of variances from the expected plan of care.
Explanation: Answer reason: Clinical (critical) pathways are interdisciplinary plans that standardize care and emphasize monitoring outcomes with early identification of variances to intervene promptly. The nursing care plan is related, nursing diagnoses are not always included, and the approach is not decreasing in use.
Which of the following is NOT a phase of a home visit?
- Initiative
- Pre-Visit Activities
- Activities During Home Visit
- Orientation
Explanation: Answer reason: Standard community-health home-visit phases include: (1) initiation/initiative, (2) pre-visit activities, (3) activities during the home visit, (4) termination, and (5) post-visit activities. “Orientation” is not included as a phase in the home-visit process, making it the correct answer.
Which action BEST reflects the primary role of the nurse case manager during hospitalization?
- Coordinating interdisciplinary services to meet the client’s ongoing care needs
- Performing daily physical assessments on all assigned clients
- Administering prescribed medications to reduce workload for staff nurses
- Determining the medical diagnosis and treatment plan
Explanation: Answer reason: The nurse case manager’s primary responsibility is to coordinate care across disciplines to ensure efficient, appropriate services that support patient outcomes and resource use. Diagnosis and medication administration remain provider and staff nurse roles.
A client with limited insurance coverage requires prolonged rehabilitation after a stroke. Which intervention by the case manager is MOST appropriate?
- Requesting an extension of the hospital stay until full recovery
- Discharging the client with written instructions only
- Transferring responsibility entirely to the physical therapy department
- Exploring community-based rehabilitation resources and insurance options
Explanation: Answer reason: Effective case management includes identifying cost-effective resources that meet patient needs while considering insurance limitations. Community programs and alternative funding support continuity of care without unnecessary hospitalization.
During discharge planning, which client situation MOST strongly indicates the need for case management involvement?
- A client scheduled for same-day discharge after an uncomplicated procedure
- A client with multiple chronic illnesses requiring services from several providers
- A client requesting clarification about medication administration times
- A client awaiting routine follow-up with a primary care provider
Explanation: Answer reason: Clients with complex, multisystem needs benefit most from case management to coordinate services, prevent fragmentation, and ensure continuity across settings.
Which outcome BEST indicates effective case management for a client with newly diagnosed heart failure?
- The client verbalizes the names of all prescribed medications
- Daily weights are recorded during hospitalization only
- Follow-up cardiology appointments and home health services are arranged before discharge
- Discharge teaching is completed the morning of discharge
Explanation: Answer reason: Effective case management ensures continuity beyond hospitalization by coordinating follow-up care and services prior to discharge. Education is important but does not replace arranging ongoing support and appointments.
A client with frequent hospital readmissions expresses difficulty affording medications. Which action by the case manager is MOST appropriate?
- Identifying medication assistance programs and lower-cost alternatives
- Instructing the client to discuss costs with the pharmacist after discharge
- Requesting the provider to discontinue all nonessential medications
- Documenting the concern for the next outpatient visit
Explanation: Answer reason: Case managers proactively address financial barriers by connecting clients to assistance programs and cost-effective options, reducing readmissions and improving adherence.
During interdisciplinary rounds, which information provided by the case manager MOST supports timely discharge planning?
- The client’s preferred discharge time
- Nursing shift staffing levels
- Results of the most recent laboratory tests
- Availability of post-acute care placements and required authorizations
Explanation: Answer reason: Knowledge of placement availability and authorization requirements directly affects discharge timing. Preferences and labs are important but do not determine readiness for transition across settings.
Which action by the case manager MOST directly reduces the risk of hospital readmission?
- Providing additional bedside education on the day of discharge
- Ensuring the client has transportation arranged for follow-up appointments
- Asking the provider to simplify the medication list
- Scheduling discharge earlier in the day
Explanation: Answer reason: Missed follow-up visits are a major contributor to readmissions. Securing transportation removes a common barrier to continuity, supporting adherence to post-discharge care.
During discharge planning, which situation requires the case manager’s IMMEDIATE involvement?
- The client requests a copy of discharge instructions
- The client’s vital signs are stable for 24 hours
- The provider completes the discharge summary
- Insurance authorization for post-acute placement is pending
Explanation: Answer reason: Pending authorization can delay or derail safe transitions. Case managers expedite approvals and coordinate alternatives to prevent unnecessary length of stay.
A client with limited health literacy will be discharged on multiple new therapies. Which case management strategy BEST supports safe transition?
- Coordinating teach-back education and confirming community support services
- Providing detailed written instructions with medical terminology
- Scheduling education sessions only after discharge
- Deferring education to outpatient providers
Explanation: Answer reason: Teach-back verifies understanding, and community supports reinforce care after discharge—both reduce errors and improve adherence in clients with limited health literacy.
Which resource should the nurse use to coordinate and track TB treatments for migrant workers?
- Agency for Healthcare Research and Quality (AHRQ)
- Migrant Clinicians Network (MCN)
- Centers for Disease Control and Prevention (CDC)
- U.S. Preventive Services Task Force (USPSTF)
Explanation: Answer reason: The Migrant Clinicians Network (MCN) operates programs such as TBNet specifically designed to coordinate care and track tuberculosis treatment for mobile populations, including migrant workers, to support treatment completion across locations. This directly matches the need for continuity of care and tracking for a highly mobile client group. AHRQ focuses on healthcare quality research, USPSTF provides preventive screening recommendations, and CDC offers guidance and surveillance resources but is not the primary care-coordination tracking network for individual migrant patients.
A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this family to?
- Medicaid
- Medicare
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program
- Women, Infants, and Children (WIC) program
Explanation: Answer reason: WIC is specifically designed to provide supplemental nutritious foods and nutrition support to low-income pregnant/postpartum clients and children up to age 5, matching this family’s needs. Medicaid and Medicare are health insurance programs and do not primarily provide food assistance. EPSDT is a Medicaid benefit focused on screening, diagnosis, and treatment for children, not supplemental food supplies. Therefore, WIC is the most appropriate referral for nutritional supplementation.
A professional practice system that manages clinical care of patients across a continuum using managed care concept and tools is called ------?
- Modular nursing
- Differentiated practice
- Case management
- Primary nursing
Explanation: Answer reason: Uses managed-care tools such as care pathways, utilization review, and coordination of services to ensure continuity from admission through discharge and follow-up. It aligns one accountable professional (often a nurse case manager) to integrate interdisciplinary planning and resource management along the care continuum. By contrast, modular nursing and primary nursing primarily describe unit-based staffing and assignment patterns rather than system-level management across episodes of care. Differentiated practice focuses on role delineation by education/competency, not longitudinal coordination across settings.
A nurse is assessing the community for a program about heart health. Which of the following actions would the nurse do as a primary data source?
- Review state data on heart disease rankings
- Interview people in the community
- Determine how many are affected by heart disease in the community
- Rank the social economic status of the community
Explanation: Answer reason: g., clients, families, or community members). Conducting interviews obtains current perceptions, behaviors, needs, barriers, and resources from the people who will be served, which is essential for an accurate community assessment. Reviewing existing state rankings is secondary data because it was collected by someone else for another purpose. Counts of affected individuals and socioeconomic rankings are typically derived from existing records or datasets unless the nurse is directly collecting those measures, so they are not the best example of a primary data source here.
The homeless client is being discharged from the hospital. The client has no family support or resources. To which service should the nurse refer the client?
- The Social Security office
- Homeless shelter facility
- Public health clinic
- Parish nursing program
Explanation: Answer reason: A shelter provides the most direct, urgent placement option for a person who is homeless and has no supports, reducing risk for exposure, injury, and inability to follow the care plan. The Social Security office may help with longer-term benefits but will not address the immediate need for a safe place to stay tonight. Public health clinics and parish nursing programs can support follow-up care, but they generally do not provide emergency housing and are secondary once basic shelter is arranged.
Which component of the multidisciplinary health care team has been shown, in multiple studies, to decrease clients’ length of stay in health care facilities, decrease the cost of health care to the client, and improve continuity of care?
- Outcomes management.
- Risk management.
- Case management.
- Infection control.
Explanation: Answer reason: The core principle is that coordinated, goal-directed care across settings reduces duplication, prevents delays, and supports safe transitions. Case management provides assessment, planning, facilitation, and advocacy to align services with patient needs, which improves continuity and streamlines discharge planning. By coordinating interdisciplinary resources and addressing barriers early (e.g., equipment, home services, follow-up), it commonly reduces length of stay and overall costs. Risk management focuses on liability and incident prevention rather than continuity and LOS, and infection control targets transmission prevention rather than system-level care coordination outcomes.
The nurse knows that the case management model of client care is?
- Implemented throughout a client’s entire hospital stay or episode of illness.
- Implemented only during a client’s acute phase of illness.
- Implemented if a client is unable to recover from an episode of illness within the expected time frame of the client’s specific disease process.
- Focused on the cost of care delivered to a client.
Explanation: Answer reason: Case management is a coordinated, interdisciplinary approach that follows the client across the full continuum of care for a defined episode, from admission through discharge planning and follow-up needs. It emphasizes outcomes, quality, and resource coordination to ensure services are timely and appropriate throughout the stay. Limiting it to only the acute phase misses the ongoing coordination needed for transitions and post-acute services. While cost containment can be a consideration, is broader than cost alone and centers on coordination and outcomes.
The client is admitted for coronary artery bypass surgery (CABG) with an anticipated admission to the coronary care unit (CCU). In preparation for the client’s hospital admission, implementation of which component will best predict the sequence and timing of care, and direct the course of the client’s hospital stay?
- A clinical pathway
- A client education plan
- HCP-initiated interventions
- Discharge planning at the time of admission
Explanation: Answer reason: For CABG, this structure anticipates typical ICU/CCU progression, key assessments, therapies, and recovery targets, which directly determines sequencing and timing of interventions. Education plans and provider-initiated orders are components of care but do not, by themselves, map the entire course and expected daily outcomes. Discharge planning should begin early, but it does not primarily function as the tool that predicts and directs the day-to-day inpatient trajectory.
The nurse is planning the discharge of the pediatric burn victim to the child’s home. The child is able to ambulate with assistance but is cognitively and developmentally unable to function at the age-appropriate milestones due to asphyxiation. Which intervention is most important to include in the discharge planning of this child?
- Identify support groups for the child’s parents.
- Initiate referrals for the child’s rehabilitation.
- Assess the child’s home to ensure it is safe.
- Contact the school regarding the child’s needs.
Explanation: Answer reason: Discharge planning prioritizes continuity of care to address the child’s highest-risk, ongoing functional deficits after injury. Significant cognitive and developmental impairment from asphyxiation requires coordinated multidisciplinary rehabilitation (e.g., PT/OT/speech/cognitive therapy) to maximize recovery, prevent complications like contractures and deconditioning, and train caregivers for safe mobility and ADLs. Early case management referrals ensure services and equipment are arranged before discharge, reducing gaps that could lead to injury, delayed progress, or readmission. While home safety assessment and school coordination are important, they are downstream of securing the essential rehab plan and services needed to meet the child’s complex care needs at home.
Case managers use clinical pathways in the process of evaluating and coordinating client care with the multidisciplinary team. A clinical pathway is?
- A decision-making flowchart that uses the “if, then” method to address client responses to treatment.
- A set of practice guidelines developed by a professional medical organization such as the American Nurses Association or the American College of Surgeons.
- A standardized set of preprinted physician orders for client care, which expedite the order process and can be customized to individual clients.
- A set of practice guidelines based on a specific client diagnosis, which provides an overview of the multidisciplinary plan of care.
Explanation: Answer reason: Clinical pathways are diagnosis- or procedure-specific, time-sequenced care plans that standardize expected multidisciplinary interventions and outcomes to improve coordination, quality, and efficiency. This definition matches a guideline framework that outlines the team’s plan of care for a particular condition and supports case management across settings. A decision-tree “if/then” tool is more characteristic of an algorithm, not a pathway. Preprinted order sets and broad professional practice guidelines are related tools but do not capture the diagnosis-linked, coordinated, multidisciplinary roadmap central to clinical pathways.
The nurse knows that case management is?
- The process of managing the outcomes of client care by quality improvement measures and involvement of the interdisciplinary team.
- The process of client assessment and direct client care by the primary nurse, utilizing the nursing process and nursing diagnoses to guide delivery of care.
- The process used by the health care facility’s legal or risk management department to evaluate legal claims filed against the facility or employees of the facility.
- The process of overseeing and organizing client care in collaboration with the client’s primary health care provider and consulting physicians.
Explanation: Answer reason: Case management centers on coordinating and integrating services to ensure continuity, appropriate resource use, and goal-directed care across providers and settings. This option best reflects the coordinator role: organizing care and facilitating collaboration among the primary provider, consultants, and the broader team to meet client needs efficiently. Option A is closer to quality improvement/monitoring outcomes at a systems level rather than the client-focused coordination function of case management. Option B describes primary nursing and direct care delivery, not the coordination and navigation responsibilities emphasized in case management.
A friend brings the older adult homeless client to a free health screening clinic. The friend is unable to continue administering the client’s morning and evening insulin dose for treating type 1 DM. When advocating for this client, which action by the nurse is most appropriate?
- Notify Adult Protective Services about the client’s condition and living situation.
- Ask where the client lives and whether someone else could administer the insulin.
- Arrange with a local homeless shelter to have someone give the insulin injections.
- Have the client return to the screening clinic morning and evening to receive the injections.
Explanation: Answer reason: This option reflects effective advocacy by ensuring continuity of essential, life-sustaining treatment (insulin) in a realistic and sustainable way for a homeless client. Coordinating with community resources such as shelters supports safe medication administration and addresses the client’s social determinants of health. Option A is premature without evidence of abuse or neglect. Option B is only assessment, not advocacy. Option D is impractical and unlikely to ensure adherence.
In the multidisciplinary approach to client care, all members of the health care team have the goal of collaborative client care. Which member of the multidisciplinary team oversees and coordinates the care delivery process and organizes the delivery of health care services to the client?
- The clinical nutritionist.
- The primary nurse each shift.
- The primary care physician.
- The case manager.
Explanation: Answer reason: The case manager is responsible for coordinating and overseeing the overall plan of care, ensuring that services are organized, efficient, and aligned with the client’s needs across disciplines. This role focuses on continuity of care, resource utilization, and communication among team members. Other team members contribute to care but do not manage the entire coordination process.
After a review of colostomy care, a client tells the nurse he doesn’t know if he’ll be able to care for himself at home without help. What is the most appropriate intervention by the nurse?
- Review care with the client again.
- Provide written instructions for the client.
- Ask the client if there’s anyone who can help.
- Arrange for home health care to visit the client.
Explanation: Answer reason: The client is expressing uncertainty about managing care independently after discharge, which indicates a need for coordinated support services. Arranging home health care ensures continuity, reinforces education, and provides hands-on assistance in the home. This reflects appropriate care coordination rather than simply repeating instructions or informally assessing support.
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