COORDINATION PRACTICE EXAMINATION
2026 QUESTIONS WITH ANSWERS
GRADED A+
◍ What is the recommended follow-up time for primary care or specialist
visits after discharge?.
Answer: Within 7 days to reduce readmission rates.
◍ What is the Richmond Health and Wellness Program (RHWP)?.
Answer: A community-based, interprofessional care coordination model
designed to address social determinants of health.
◍ What is the Transitional Care Model (TCM)?.
Answer: A nurse-led model aimed at facilitating older adult patients'
transition from hospital to home.
◍ How does the complexity of an individual's healthcare needs affect care
coordination?.
Answer: Individuals with minimal needs may require less coordination,
while those with complex needs require more extensive coordination among
multiple healthcare team members.
◍ What are social determinants of health?.
Answer: Conditions in which people are born, grow, live, work, and age that
affect health outcomes.
◍ How is communication managed in care coordination?.
Answer: Information is exchanged across services and team members before
and after interactions, using standardized approaches and electronic health
records.
, ◍ Who often coordinates community-based models of care?.
Answer: Local or state agencies, such as area agencies on aging or county
social service agencies.
◍ Why is self-management education important for patients?.
Answer: It empowers patients to manage their chronic conditions,
particularly in medication management.
◍ What act identifies care coordination as fundamental to healthcare reform?.
Answer: The Patient Protection and Affordable Care Act (ACA).
◍ What is a barrier to implementing the Transitional Care Model?.
Answer: Challenges related to reimbursement for services.
◍ What are the defining attributes of care coordination?.
Answer: It involves linking patients and families to community resources
and ensuring comprehensive care.
◍ What does a proactive plan of care involve?.
Answer: It is created, documented, executed, and updated, and developed
and shared across providers.
◍ What are nursing interventions in self-management?.
Answer: Education, preventive health measures, and creating a
patient-centered plan of care that respects patient wishes.
◍ What are the six actionable steps for nurses in care coordination initiatives?.
Answer: Patient engagement, competency of nurses, teamwork,
documentation and HIT, quality measurement, and payment.
◍ What is the national patient safety goal related to medication reconciliation?.
Answer: To ensure proper management of patient medications by comparing
prescribed medications with those the patient is actually using.
◍ What does the National Quality Forum (NQF) define care coordination as?.
Answer: The deliberate synchronization of activities and information to
improve health outcomes by ensuring care recipients' and families' needs are
met over time.