Case Management NCLEX practice

Case Management NCLEX Practice

Case Study

You are a case manager in the hospital working with a client that is to be discharged in 2 days. They are a 76-year-old woman with arthritis and a significant visual impairment. They have Type 1 Diabetes Mellitus and require frequent blood glucose monitoring and insulin injections. They live alone in a subsidized senior living apartment.

Multiple Choice

You are the case manager working with this client. What would be your first action when initiating care of this client?

• Research blood glucose meters that read the result out loud due to their visual impairment.

• Ask the patient what services or adaptive equipment they are currently using.

• Arrange for a home health agency to provide a home health aide and physical therapy.

• Teach the client how to check their blood glucose and inject insulin before each meal.

You are the case manager working with this client. What would be your first action when initiating care of this client?

Correct Answer: Ask the patient what services or adaptive equipment they are currently using.

Rationale: Case management should follow the nursing process, so Assessment should come first. Asking the client which services they are already using is an assessment. We cannot move on to the other steps of the nursing process if we do not know what is or is not already in place. The other options were Planning and Implementation.

Multiple Select

What assessments by the case manager indicate need to intervene for the client? Select all that apply.

• The client states their decreasing visual acuity has made them unable to drive and they have no means of transportation to appointments.

• The client has a new diagnosis of pneumonia on this admission and is requiring 2L of oxygen per nasal cannula to maintain oxygen saturation above 95%.

• The client plans to continue attending a weekly class for older adults provided in their apartment complex.

• The client is asking about information on advance directives.

• The client has had Type 1 Diabetes Mellitus since the age of 12 requiring continued subcutaneous insulin injections.

What assessments by the case manager indicate need to intervene for the client? Select all that apply.

Correct Answers: (A)The client states their decreasing visual acuity has made them unable to drive and they have no means of transportation to appointments. (B) The client has a new diagnosis of pneumonia on this admission and is requiring 2L of oxygen per nasal cannula to maintain oxygen saturation above 95%. (D) The client is asking about information on advance directives.

Rationale: Case management works with clients on support services such as transportation for those with disabilites, home oxygen therapy, and advance directives. The client already has adequate services and support through the weekly class for seniors and has been caring for her Type 1 Diabetes for many years without indication of need for improved treatment regimen.

Multiple Choice

While assessing this client, the case manager learns that the client has recently had difficulty in keeping their apartment clean. What would be an appropriate intervention by the case manager?

• Inform the physician that the patient is having difficulty with housekeeping.

• Call the client's apartment managment and report that housekeeping is an issue.

• Discuss client's support network of family members or friends who may be willing to help the patient with twice weekly cleaning.

• Teach the client how to more effectively clean their apartment.

While assessing this client, the case manager learns that the client has recently had difficulty in keeping their apartment clean. What would be an appropriate intervention by the case manager?

Correct Answer: Discuss client's support network of family members or friends who may be willing to help the patient with twice weekly cleaning.

Rationale: Helping the client to find a support network to assist with housekeeping would be most appropriate to their needs as their medical conditions are likely keeping them from being able to effectively clean. Because of change in health status, teaching the, to clean is unlikely to help improve the situation. Involving the apartment management or the physician is unnecessary.

Fill in the Blank

While evaluating the progress of this patient, the case manager is using the hospital's critical pathway for community-acquired pneumonia patients. The case manager notes that the patient's discharge was delayed overnight to determine if they tolerated the move from intravenous to oral antibiotics. The critical pathway states, "Patients do not need to be kept overnight for observation following the switch to oral antibiotic therapy." The case manager recognizes that this represents a(n) ________ in the critical pathway.

While evaluating the progress of this patient, the case manager is using the hospital's critical pathway for pneumonia patients. The case manager notes that the patient's discharge was delayed overnight to determine if they tolerated the move from intravenous to oral antibiotics. The critical pathway states, "Patients do not need to be kept overnight for observation following the switch to oral antibiotic therapy." The case manager recognizes that this represents a ________ in the critical pathway.

Correct Answer: variance

Rationale: Deviations from the critical pathway are considered variances.

Multiple Choice

The case manager is working with a new member of their department who is training as a case manager. They know that there is a need for further teaching when the trainee states:

• I will need to familiarize myself with the community resources available for my patients.

• When patients will be discharged to a long-term care center, I will work with that organization to facilitate discharge.

• I will be focused on the direct nursing care of patients throughout their hospital stay.

• I will be using critical pathways to help track a patient's progress toward discharge.

The case manager is working with a new member of their department who is training as a case manager. They know that there is a need for further teaching when the trainee states:

Correct Answer: I will be focused on the nursing care of patients throughout their hospital stay.

Rationale: Case managers collaborate with multidisciplinary caregivers to coordinate and plan care. Their focus may include more areas than nursing.