Case management NCLEX-RN Practice Questions

Case management NCLEX-RN Practice Questions help you master the coordination, collaboration, and continuity of care skills essential to safe nursing practice. In the Management of Care domain, case management focuses on discharge planning, resource allocation, referrals, utilization review, transitions of care, and advocacy to achieve high-quality, cost-effective outcomes. This topic-wise question blog for NCLEX-RN Exams presents realistic, scenario-based MCQs that challenge you to prioritize needs, engage the interprofessional team, navigate insurance and regulations, and support patients across settings. Use these questions to sharpen your ability to align goals of care, prevent readmissions, ensure safe handoffs, and ethically address social determinants that impact recovery and access to services.

Q1. A hospital-based RN case manager begins discharge planning for a client with heart failure and limited health literacy. Which initial action best reduces risk for 30-day readmission?

• Arrange home health nursing to visit within 48 hours and deliver a scale
• Complete a comprehensive discharge needs assessment, including medication reconciliation and support services
• Schedule a primary care appointment in 4 weeks
• Obtain prior authorization for an elective sleep study

Correct Answer: Complete a comprehensive discharge needs assessment, including medication reconciliation and support services

Q2. When coordinating care for a client newly started on warfarin who will receive home health services, which information is most critical to include in the SBAR handoff to the home health nurse?

• Client’s favorite foods and dietary preferences
• Most recent INR value and target therapeutic range
• Presence of a roommate at home
• Time of the last influenza vaccine

Correct Answer: Most recent INR value and target therapeutic range

Q3. Which task related to discharge planning for a post-stroke client is appropriate for the RN to delegate to an experienced LPN/LVN?

• Perform the initial bedside swallow evaluation
• Provide initial teaching on insulin self-administration
• Reinforce transfer training using the physical therapist’s plan of care
• Develop a comprehensive home safety plan with equipment prescriptions

Correct Answer: Reinforce transfer training using the physical therapist’s plan of care

Q4. A client is being evaluated for home oxygen coverage. Which documented assessment supports Medicare qualification for long-term oxygen therapy at home?

• SpO2 of 91% on room air during ambulation only
• Resting SpO2 of 88% on room air confirmed by pulse oximetry
• PaO2 of 68 mm Hg on room air during sleep
• SpO2 of 89% on 2 L/min nasal cannula at rest

Correct Answer: Resting SpO2 of 88% on room air confirmed by pulse oximetry

Q5. A clinical pathway for community-acquired pneumonia anticipates discharge by hospital day 4. Which situation requires variance analysis by the case manager?

• Client requests an extra day for home preparation despite clinical readiness
• Discharge occurs on day 3 after rapid clinical improvement
• New atrial fibrillation on day 3 requires cardiology consult and extends stay to day 6
• Antibiotic changed due to culture sensitivity without affecting length of stay

Correct Answer: New atrial fibrillation on day 3 requires cardiology consult and extends stay to day 6

Q6. During discharge planning, which situation requires immediate referral to Adult Protective Services (APS)?

• Client refuses a walker despite high fall risk
• Frail older adult with pressure injuries returning to a caregiver suspected of neglect
• Family requests a second opinion on home health frequency
• Client declines a home-delivered meal program

Correct Answer: Frail older adult with pressure injuries returning to a caregiver suspected of neglect

Q7. A Spanish-speaking client is ready for discharge with new medications. Which action by the RN case manager best ensures safe communication?

• Provide written instructions in English and ask family to translate
• Use a bilingual staff member not trained as an interpreter
• Arrange a certified medical interpreter for all education using teach-back
• Speak slowly in English and demonstrate with gestures

Correct Answer: Arrange a certified medical interpreter for all education using teach-back

Q8. Which statement best describes the primary purpose of utilization review in case management?

• Ensuring the hospital meets all accreditation standards
• Verifying that care is necessary, efficient, and cost-effective while maintaining quality
• Maximizing hospital reimbursement for each episode of care
• Increasing the number of diagnostic tests to avoid litigation

Correct Answer: Verifying that care is necessary, efficient, and cost-effective while maintaining quality

Q9. The case manager is evaluating a client with advanced COPD for hospice. Which criterion most supports initiating a hospice referral?

• Home oxygen at 2 L/min for exertional dyspnea
• Two hospitalizations in the past year for COPD exacerbations
• Client chooses comfort-focused care and the provider estimates life expectancy of 6 months or less
• Body mass index of 22 kg/m² with stable weight

Correct Answer: Client chooses comfort-focused care and the provider estimates life expectancy of 6 months or less

Q10. A client after hip fracture repair needs daily physical therapy, medication management, and assistance with ADLs. The spouse cannot provide care at home. What is the most appropriate discharge disposition?

• Home with home health aide only
• Acute inpatient rehabilitation requiring 3 hours of therapy/day
• Skilled nursing facility for nursing care and rehabilitation
• Immediate independent living with outpatient PT

Correct Answer: Skilled nursing facility for nursing care and rehabilitation

Q11. Which intervention is the highest priority for medication safety during transition from hospital to home?

• Complete and share a reconciled medication list with the client and all outpatient providers
• Send the discharge summary within 14 days
• Provide brand-name samples to prevent cost barriers
• Ask the pharmacy to substitute medications as needed

Correct Answer: Complete and share a reconciled medication list with the client and all outpatient providers

Q12. An insurer denies authorization for an inpatient MRI despite clinical necessity. What is the RN case manager’s best next step?

• Document the denial and cancel the MRI
• Coordinate a peer-to-peer review between the ordering provider and the insurer with supporting clinical evidence
• Discharge the client and arrange an outpatient MRI
• Escalate to hospital legal counsel immediately

Correct Answer: Coordinate a peer-to-peer review between the ordering provider and the insurer with supporting clinical evidence

Q13. Which component is essential in a heart failure discharge bundle to reduce readmissions?

• Schedule an outpatient follow-up visit within 7 days of discharge
• Provide a low-sodium cookbook
• Arrange a weight check in 30 days
• Offer a gym membership

Correct Answer: Schedule an outpatient follow-up visit within 7 days of discharge

Q14. Which durable medical equipment (DME) order typically requires documentation of mobility limitation affecting activities of daily living (ADLs) to qualify for coverage?

• Home blood pressure monitor
• Lightweight manual wheelchair for home mobility
• Nonmedical bedside table
• Shower curtain

Correct Answer: Lightweight manual wheelchair for home mobility

Q15. A client has a valid DNR order, but family requests “do everything” during discharge planning. What is the RN case manager’s best action?

• Void the DNR until the family agrees
• Verify the DNR, advocate for honoring client autonomy, and convene a goals-of-care meeting with the team
• Document the family’s wishes as the new code status
• Transfer the client to another facility

Correct Answer: Verify the DNR, advocate for honoring client autonomy, and convene a goals-of-care meeting with the team

Q16. When arranging transition to an outpatient hemodialysis center, which information is most critical to include in the referral?

• Preferred meal times during dialysis
• Type and location of vascular access with date of last use and any infection history
• Religious affiliation
• Immunization history only

Correct Answer: Type and location of vascular access with date of last use and any infection history

Q17. A client hospitalized after a suicide attempt is being discharged. Which plan best promotes safety during transition?

• Provide a list of community support groups
• Schedule a follow-up visit in 3 weeks
• Confirm a written safety plan with means restriction and arrange a same- or next-day mental health appointment
• Advise the client to call 911 if feeling worse

Correct Answer: Confirm a written safety plan with means restriction and arrange a same- or next-day mental health appointment

Q18. A client missed chemotherapy due to a transportation voucher error and presents with disease progression. What is the RN case manager’s priority action?

• Immediately arrange transport for the next available treatment and notify the oncology team
• Complete an incident report and wait for leadership guidance
• Call the insurer to request retroactive coverage
• Remove the client from the schedule to prevent further errors

Correct Answer: Immediately arrange transport for the next available treatment and notify the oncology team

Q19. During interfacility transfer, which item is most critical to communicate to the receiving team?

• Last bowel movement date
• Current code status and any advance directives
• Family visitation preferences
• Religious dietary preferences

Correct Answer: Current code status and any advance directives

Q20. A client with low health literacy needs discharge teaching for a new heart failure regimen. Which strategy is most effective?

• Provide a detailed medication monograph packet
• Use plain language with pictorial aids and verify understanding with teach-back
• Ask the client to read and sign the instructions
• Refer all teaching to the pharmacist without the nurse present

Correct Answer: Use plain language with pictorial aids and verify understanding with teach-back

Q21. For home infusion therapy informed consent, what is the RN’s appropriate role?

• Explain all risks, benefits, and alternatives as the primary educator
• Witness the client’s voluntary signature and verify the provider has explained risks, benefits, and alternatives
• Sign the consent form on behalf of the client if the client is tired
• Determine the client’s medical decision-making capacity

Correct Answer: Witness the client’s voluntary signature and verify the provider has explained risks, benefits, and alternatives

Q22. The case manager must prioritize same-day home health visits. Which newly discharged client requires the most urgent visit?

• Client with a new tracheostomy and oxygen dependence without a trained caregiver
• Client with stable diabetes requesting diet counseling
• Client with chronic back pain requesting refill guidance
• Client with controlled hypertension started on a thiazide diuretic

Correct Answer: Client with a new tracheostomy and oxygen dependence without a trained caregiver

Q23. A client with type 2 diabetes admits to food insecurity affecting glucose control. Which referral best addresses this barrier?

• Provide a generic low-carb diet handout
• Refer to social services for SNAP enrollment and Meals on Wheels, plus diabetes education linkage
• Prescribe more expensive insulin pens
• Schedule a clinic appointment in 2 months

Correct Answer: Refer to social services for SNAP enrollment and Meals on Wheels, plus diabetes education linkage

Q24. A client with metastatic cancer wants to continue dialysis but is considering hospice. What is the most appropriate case management recommendation?

• Request a palliative care consult to align goals while continuing disease-directed treatments
• Enroll in hospice immediately and stop dialysis
• Continue all treatments without addressing goals of care
• Discharge without referrals to avoid overwhelming the client

Correct Answer: Request a palliative care consult to align goals while continuing disease-directed treatments

Q25. During a 48-hour post-discharge call, which question best assesses medication adherence?

• “Did you get all your prescriptions?”
• “Are you taking your pills?”
• “Please tell me how and when you are taking each of your new medications.”
• “Do you have any side effects?”

Correct Answer: “Please tell me how and when you are taking each of your new medications.”

Q26. A client with severe asthma lacks home electricity for a nebulizer due to utility shutoff. What is the RN case manager’s best action?

• Advise the client to go to the emergency department for each treatment
• Tell the client to borrow a neighbor’s outlet
• Coordinate with social services for utility medical-necessity restoration and arrange battery-powered or inhaler-based alternatives
• Delay discharge until the bill is fully paid

Correct Answer: Coordinate with social services for utility medical-necessity restoration and arrange battery-powered or inhaler-based alternatives

Q27. When leaving a voicemail for a client about a follow-up appointment, which action complies with HIPAA?

• State the client’s diagnosis and test results for clarity
• Leave only your name, role, callback number, and appointment time without disclosing clinical details
• Ask the neighbor to pass on a message with details
• Include the full medication list to ensure adherence

Correct Answer: Leave only your name, role, callback number, and appointment time without disclosing clinical details

Q28. A post-stroke client is medically stable, motivated, and can tolerate 3 hours of therapy per day. Which discharge destination is most appropriate?

• Home with outpatient PT twice weekly
• Skilled nursing facility with low-intensity therapy
• Acute inpatient rehabilitation facility for intensive therapy
• Long-term acute care hospital

Correct Answer: Acute inpatient rehabilitation facility for intensive therapy

Q29. Which approach best promotes shared decision-making during an interprofessional care conference?

• Present the plan and ask the client to sign agreement
• Invite the client and key caregivers, elicit goals and preferences, and confirm understanding with teach-back
• Allow only clinicians to attend to avoid confusion
• Use only medical terminology to maintain precision

Correct Answer: Invite the client and key caregivers, elicit goals and preferences, and confirm understanding with teach-back

Q30. A client post-splenectomy is preparing for discharge. Which case management action best prevents future infectious complications?

• Provide a general hand hygiene brochure
• Coordinate administration of recommended vaccines (pneumococcal, Hib, meningococcal) before discharge and schedule boosters
• Advise avoiding crowded places for one week
• Recommend daily vitamin C supplementation

Correct Answer: Coordinate administration of recommended vaccines (pneumococcal, Hib, meningococcal) before discharge and schedule boosters

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