CCN Inmate Health Assessment & Chronic Care Management 3 — Questions and Answers
Question 1: An inmate with HIV on antiretroviral therapy (ART) has a CD4 count of 185 cells/µL. Which prophylactic medication is indicated to prevent Pneumocystis jirovecii pneumonia (PCP)?
- Azithromycin 1200 mg weekly
- Trimethoprim-sulfamethoxazole (TMP-SMX) daily (Correct answer)
- Fluconazole 200 mg daily
- Isoniazid 300 mg daily
Correct answer: Trimethoprim-sulfamethoxazole (TMP-SMX) daily
TMP-SMX is the first-line prophylaxis for PCP when CD4 count falls below 200 cells/µL in HIV-positive patients.
Question 2: A correctional nurse is performing a health appraisal for a 55-year-old male inmate with a 30 pack-year smoking history. Which cancer screening is recommended per USPSTF guidelines?
- Colonoscopy only
- Low-dose CT scan of the chest for lung cancer (Correct answer)
- Annual PSA testing
- MRI of the chest
Correct answer: Low-dose CT scan of the chest for lung cancer
USPSTF recommends annual low-dose CT lung cancer screening for adults aged 50–80 with a 20 pack-year history who currently smoke or quit within 15 years.
Question 3: An inmate with epilepsy misses several doses of phenytoin because of lockdowns. Upon assessment, the nurse finds the patient confused and shaking. What is the priority action?
- Administer a double dose of phenytoin to catch up
- Obtain a stat phenytoin level and notify the provider immediately (Correct answer)
- Document and reassess in 4 hours
- Administer lorazepam as standing protocol
Correct answer: Obtain a stat phenytoin level and notify the provider immediately
Obtaining a serum phenytoin level and notifying the provider allows for informed clinical decision-making to prevent status epilepticus.
Question 4: During chronic care follow-up, a nurse assesses an inmate with chronic obstructive pulmonary disease (COPD). Which finding indicates disease exacerbation requiring escalated care?
- FEV1/FVC ratio of 0.68 on spirometry
- Increased dyspnea, change in sputum color, and decreased oxygen saturation (Correct answer)
- Mild seasonal cough without dyspnea at rest
- Stable peak flow readings over the past month
Correct answer: Increased dyspnea, change in sputum color, and decreased oxygen saturation
Increased dyspnea, purulent sputum, and decreased SpO2 are classic signs of a COPD exacerbation requiring prompt treatment.
Question 5: A nurse is reviewing an inmate's chronic care record and notices the patient's HbA1c has increased from 7.2% to 9.8% over 6 months despite no medication changes. What factor most commonly contributes to this change in a correctional setting?
- Spontaneous remission of diabetes
- Medication hoarding for trading or diversion (Correct answer)
- Seasonal variation in insulin resistance
- Increased dietary fiber intake from facility meals
Correct answer: Medication hoarding for trading or diversion
Medication diversion or hoarding is a significant cause of apparent treatment failure in correctional settings and must be assessed.
Question 6: When documenting a chronic care encounter for an inmate with coronary artery disease, which SOAP note element should include the patient's report of chest pain frequency and exercise tolerance?
- Assessment
- Plan
- Subjective (Correct answer)
- Objective
Correct answer: Subjective
The Subjective section captures the patient's own description of symptoms, including chest pain frequency and functional limitations.
Question 7: An inmate with sickle cell disease presents to the infirmary during a pain crisis. In addition to opioid analgesia, which supportive intervention is critical?
- Fluid restriction to prevent pulmonary edema
- Adequate IV hydration and supplemental oxygen (Correct answer)
- Immediate packed red blood cell transfusion
- Aspirin 325 mg for antiplatelet effect
Correct answer: Adequate IV hydration and supplemental oxygen
Hydration and oxygen are essential supportive measures during sickle cell crisis to reduce sickling and promote tissue oxygenation.
CCN Inmate Health Assessment & Chronic Care Management 3
An inmate with HIV on antiretroviral therapy (ART) has a CD4 count of 185 cells/µL.
Which prophylactic medication is indicated to prevent Pneumocystis jirovecii pneumonia (PCP)?