Ambulatory Care Test Ambulatory Care Care Coordination and Transitions 4

Question 1

A patient with schizophrenia is being transitioned from inpatient psychiatric care to an outpatient community mental health center. The MOST important care coordination priority is:

Accepted Answer

Ensuring the patient has a confirmed outpatient appointment before discharge

Answer

Confirming an outpatient appointment before psychiatric discharge is the highest priority to prevent care gaps that increase relapse and readmission risk.

Question 2

The Agency for Healthcare Research and Quality (AHRQ) IDEAL Discharge Planning model includes which key component?

Accepted Answer

Educating patients and families using plain language and teach-back

Answer

The IDEAL model emphasizes patient and family education using plain language and teach-back to ensure comprehension before discharge.

Question 3

A care coordinator identifies that a recently discharged patient has not attended any of three scheduled follow-up appointments. The BEST next step is:

Accepted Answer

Conduct outreach to identify and address specific barriers to attendance

Answer

Identifying and addressing the root cause of missed appointments (transportation, cost, work schedule) is the most effective approach before closing or reducing care.

Question 4

Which of the following BEST describes the role of a Patient-Centered Medical Home (PCMH) in care transitions?

Accepted Answer

Serving as the coordinating hub that tracks patients across all care settings

Answer

The PCMH model designates the primary care practice as the coordinating hub responsible for tracking and managing the patient across all transitions and care settings.

Question 5

A nurse practitioner is using motivational interviewing (MI) during a transition of care visit. Which statement BEST reflects an MI technique?

Accepted Answer

'What concerns do you have about starting this new medication?'

Answer

Asking open-ended questions to explore the patient's concerns is a core MI technique that builds autonomy and engagement rather than prescribing behavior.

Ambulatory Care Test Practice Test

Ambulatory Care Test Practice Test

Ambulatory Care Test Ambulatory Care Care Coordination and Transitions 4