CCN Inmate Health Assessment & Chronic Care Management 4 — Questions and Answers
Question 1: A nurse in a correctional facility is evaluating an inmate's risk for cardiovascular disease using the ACC/AHA pooled cohort equations. Which combination of factors increases calculated 10-year risk most significantly?
- Female sex, age 35, non-smoker, LDL 110 mg/dL
- Male sex, age 58, smoker, systolic BP 155, total cholesterol 240 mg/dL (Correct answer)
- Male sex, age 40, controlled hypertension, non-smoker
- Female sex, age 50, non-smoker, well-controlled diabetes
Correct answer: Male sex, age 58, smoker, systolic BP 155, total cholesterol 240 mg/dL
Older male sex, active smoking, elevated blood pressure, and hypercholesterolemia are the strongest drivers of the pooled cohort risk score.
Question 2: During intake screening, a nurse asks an inmate about history of head trauma. This question is most relevant to identifying the risk for which chronic condition?
- Hypertension
- Traumatic brain injury with long-term neurological sequelae (Correct answer)
- Hepatitis C
- Diabetes mellitus
Correct answer: Traumatic brain injury with long-term neurological sequelae
Incarcerated populations have high rates of prior head trauma, which is associated with chronic neurological, cognitive, and psychiatric sequelae.
Question 3: An inmate with chronic pain is requesting increasing doses of opioid medication. The nurse observes that the patient shows no functional improvement and demonstrates drug-seeking behavior. Which tool is most appropriate for structured risk reassessment?
- CAGE questionnaire
- Opioid Risk Tool (ORT) (Correct answer)
- PHQ-9
- AUDIT-C
Correct answer: Opioid Risk Tool (ORT)
The Opioid Risk Tool (ORT) is validated for assessing risk of opioid misuse and aberrant behaviors in patients on long-term opioid therapy.
Question 4: A nurse is reviewing lab results for an inmate with hypertension who was started on an ACE inhibitor 2 weeks ago. Which lab finding requires immediate provider notification?
- Serum potassium of 5.8 mEq/L (Correct answer)
- Serum sodium of 138 mEq/L
- BUN of 18 mg/dL
- Creatinine decrease of 0.1 mg/dL
Correct answer: Serum potassium of 5.8 mEq/L
ACE inhibitors can cause hyperkalemia; a potassium level of 5.8 mEq/L is elevated and requires urgent provider notification to prevent cardiac arrhythmia.
Question 5: An inmate with a history of homelessness and IV drug use is newly diagnosed with infective endocarditis. Chronic care planning should include screening for which co-occurring infections?
- Influenza A and B only
- HIV, hepatitis B, and hepatitis C (Correct answer)
- Herpes simplex virus and cytomegalovirus
- Clostridium difficile and MRSA colonization
Correct answer: HIV, hepatitis B, and hepatitis C
IV drug use is a major risk factor for HIV, hepatitis B, and hepatitis C co-infection, all of which require screening and management.
Question 6: A nurse identifies that an inmate with depression has not been attending chronic care visits for diabetes. What is the most evidence-based approach to address this?
- Discontinue diabetes medication due to noncompliance
- Integrate mental health and chronic disease care and use motivational interviewing to engage the patient (Correct answer)
- File a disciplinary report for missed medical appointments
- Switch all care to self-administered treatment without nursing oversight
Correct answer: Integrate mental health and chronic disease care and use motivational interviewing to engage the patient
Co-locating mental health and chronic disease services and using motivational interviewing improves engagement for dually diagnosed patients.
Question 7: During a chronic care visit, an inmate with COPD is found to have peripheral edema, jugular venous distension, and an elevated BNP. These findings suggest which complication?
- Pulmonary embolism
- Cor pulmonale (right heart failure from pulmonary hypertension) (Correct answer)
- Left ventricular systolic dysfunction
- Decompensated liver cirrhosis
Correct answer: Cor pulmonale (right heart failure from pulmonary hypertension)
Cor pulmonale is right heart failure secondary to pulmonary hypertension, commonly seen in severe COPD, presenting with peripheral edema and elevated BNP.
CCN Inmate Health Assessment & Chronic Care Management 4
A nurse in a correctional facility is evaluating an inmate's risk for cardiovascular disease using the ACC/AHA pooled cohort equations.
Which combination of factors increases calculated 10-year risk most significantly?