CCN Inmate Health Assessment & Chronic Care Management 5 — Questions and Answers
Question 1: An inmate is receiving directly observed therapy (DOT) for latent tuberculosis infection (LTBI) with isoniazid. After 2 months, he reports right upper quadrant pain, nausea, and fatigue. What is the priority nursing action?
- Reassure the patient and continue treatment
- Hold isoniazid and notify the provider for liver function testing (Correct answer)
- Switch to rifampin without provider consultation
- Administer acetaminophen for symptom management
Correct answer: Hold isoniazid and notify the provider for liver function testing
Symptoms of hepatotoxicity during isoniazid therapy require immediate drug hold and liver function assessment before continuing treatment.
Question 2: A nurse is developing a chronic care protocol for inmates with mental illness who are also on antipsychotic medications. Which metabolic parameter must be monitored routinely due to medication side effects?
- Thyroid-stimulating hormone (TSH)
- Fasting blood glucose and lipid panel (Correct answer)
- Serum calcium and phosphorus
- Serum iron and ferritin
Correct answer: Fasting blood glucose and lipid panel
Atypical antipsychotics are associated with metabolic syndrome including weight gain, hyperglycemia, and dyslipidemia, requiring routine metabolic monitoring.
Question 3: An inmate presents to sick call with complaints of burning on urination and urinary frequency. The nurse collects a urine sample. Which finding on urinalysis would most strongly suggest a urinary tract infection (UTI)?
- Specific gravity of 1.025
- Leukocyte esterase positive and nitrites positive (Correct answer)
- pH of 6.5
- Trace protein
Correct answer: Leukocyte esterase positive and nitrites positive
Positive leukocyte esterase indicates pyuria and positive nitrites indicate gram-negative bacterial infection, together strongly suggesting UTI.
Question 4: A nurse is reviewing the health assessment of an elderly inmate (age 72). Which additional geriatric screening tool should be incorporated beyond standard chronic disease monitoring?
- AUDIT-C for alcohol use
- Mini-Cog or MMSE for cognitive impairment (Correct answer)
- CAGE questionnaire for opioid risk
- Edinburgh Postnatal Depression Scale
Correct answer: Mini-Cog or MMSE for cognitive impairment
Elderly incarcerated individuals have high rates of undiagnosed cognitive impairment, making cognitive screening with Mini-Cog or MMSE essential.
Question 5: During an annual chronic care review, a nurse finds that an inmate with hypertension and diabetes has not had a dilated eye exam in 3 years. According to ADA guidelines, how often should diabetic retinopathy screening occur?
- Every 5 years if initial exam is normal
- Annually or every 2 years based on risk and provider assessment (Correct answer)
- Only when the patient reports visual changes
- Every 6 months regardless of findings
Correct answer: Annually or every 2 years based on risk and provider assessment
ADA guidelines recommend annual dilated eye exams, with the option for biennial exams in those with consistently normal results and low risk.
Question 6: An inmate with chronic hepatitis B is newly prescribed tenofovir. What is the most important baseline assessment before initiating this medication?
- Fasting lipid panel
- Renal function (serum creatinine and eGFR) (Correct answer)
- Complete blood count
- Serum magnesium
Correct answer: Renal function (serum creatinine and eGFR)
Tenofovir is nephrotoxic and requires baseline and ongoing monitoring of renal function, including serum creatinine and eGFR.
Question 7: A correctional nurse is preparing transition-of-care documentation for an inmate being released after 5 years. Which element is most critical to include to ensure continuity of chronic disease management in the community?
- Disciplinary history and custody classification
- Current medication list, pending lab results, upcoming specialist appointments, and community referrals (Correct answer)
- Facility housing unit assignments
- Dietary preferences and food allergies only
Correct answer: Current medication list, pending lab results, upcoming specialist appointments, and community referrals
Comprehensive transition-of-care planning including medications, labs, referrals, and community resources is essential to prevent care gaps and adverse events after release.
