CCN Inmate Health Assessment & Chronic Care Management 2 — Questions and Answers
Question 1: During a chronic care clinic visit for an inmate with hypertension, the nurse notes a blood pressure of 178/112 mmHg despite reported medication adherence. What is the most appropriate immediate action?
- Reschedule the appointment for next month
- Assess for medication nonadherence and perform a focused cardiovascular assessment (Correct answer)
- Administer an extra dose of antihypertensive immediately
- Document and continue without intervention
Correct answer: Assess for medication nonadherence and perform a focused cardiovascular assessment
A significantly elevated BP requires immediate assessment for nonadherence, secondary causes, and cardiovascular risk before any medication changes.
Question 2: When screening a newly incarcerated individual for tuberculosis, which test is preferred for someone who has a history of BCG vaccination?
- Tuberculin skin test (TST)
- QuantiFERON-TB Gold Plus (IGRA) (Correct answer)
- Chest X-ray only
- Sputum culture only
Correct answer: QuantiFERON-TB Gold Plus (IGRA)
Interferon-gamma release assays (IGRAs) are preferred over TST in BCG-vaccinated individuals because they are not affected by BCG vaccination.
Question 3: An inmate with type 2 diabetes reports frequent hypoglycemic episodes occurring after meals. The nurse should first assess for which condition?
- Dawn phenomenon
- Somogyi effect
- Postprandial hypoglycemia related to insulin secretagogues (Correct answer)
- Renal insufficiency reducing insulin clearance
Correct answer: Postprandial hypoglycemia related to insulin secretagogues
Postprandial hypoglycemia is commonly caused by insulin secretagogues (sulfonylureas) stimulating excess insulin release after meals.
Question 4: A correctional nurse is conducting a chronic care review for a patient with hepatitis C. Which lab value most directly reflects current liver fibrosis progression?
- Alanine aminotransferase (ALT)
- Total bilirubin
- FIB-4 index or liver biopsy/elastography (Correct answer)
- Hepatitis C viral load
Correct answer: FIB-4 index or liver biopsy/elastography
The FIB-4 index and liver elastography are validated noninvasive tools for staging hepatic fibrosis in hepatitis C patients.
Question 5: During an intake health screening, an inmate discloses a history of opioid use disorder (OUD). Which action best aligns with evidence-based correctional health standards?
- Withhold medications until a full psychiatric evaluation is complete
- Initiate or continue medications for opioid use disorder (MOUD) if clinically indicated (Correct answer)
- Mandate abstinence-only treatment during incarceration
- Place the inmate in medical observation without pharmacotherapy
Correct answer: Initiate or continue medications for opioid use disorder (MOUD) if clinically indicated
NCCHC and evidence-based guidelines support continuation or initiation of MOUD (e.g., methadone, buprenorphine) in correctional settings.
Question 6: A nurse notes that an inmate with asthma has been requesting his rescue inhaler more than twice a week. According to NAEPP guidelines, how should asthma control be classified?
- Well-controlled
- Not well-controlled (Correct answer)
- Very poorly controlled
- Intermittent
Correct answer: Not well-controlled
Rescue inhaler use more than twice per week indicates asthma that is not well-controlled per NAEPP classification.
Question 7: When reviewing an inmate's medication list, the nurse finds that the patient with chronic kidney disease stage 3 is prescribed metformin. What is the most appropriate nursing action?
- Continue metformin as it is safe in all CKD stages
- Flag for provider review, as metformin is generally contraindicated below eGFR 30 and requires dose adjustment below 45 (Correct answer)
- Discontinue the medication without provider order
- Add sodium bicarbonate to counteract lactic acidosis risk
Correct answer: Flag for provider review, as metformin is generally contraindicated below eGFR 30 and requires dose adjustment below 45
Metformin requires dose adjustment when eGFR falls below 45 mL/min/1.73m² and is contraindicated below 30, requiring provider review.
CCN Inmate Health Assessment & Chronic Care Management 2
During a chronic care clinic visit for an inmate with hypertension, the nurse notes a blood pressure of 178/112 mmHg despite reported medication adherence.
What is the most appropriate immediate action?