CCN Medication Administration & Emergency Response 5 — Questions and Answers
Question 1: An inmate with type 1 diabetes refuses breakfast but has already received his morning insulin. Which complication is the nurse's primary concern?
- Hyperglycemia
- Diabetic ketoacidosis
- Hypoglycemia (Correct answer)
- Hyperosmolar hyperglycemic state
Correct answer: Hypoglycemia
Insulin administration without adequate carbohydrate intake creates an imbalance that leads to hypoglycemia, a potentially life-threatening emergency.
Question 2: A nurse is drawing up two insulin types (NPH and regular) into one syringe. What is the correct sequence?
- Draw NPH first, then regular insulin
- Draw regular (clear) insulin first, then NPH (cloudy) insulin (Correct answer)
- It does not matter which is drawn first
- Mix both vials and draw from the combined solution
Correct answer: Draw regular (clear) insulin first, then NPH (cloudy) insulin
The mnemonic 'clear before cloudy' (regular before NPH) prevents contamination of the clear insulin vial with the cloudy NPH insulin.
Question 3: During a facility lockdown after a riot, an inmate requires an emergency dose of an anticonvulsant. What is the nurse's best course of action?
- Wait until the lockdown is lifted before administering any medications
- Coordinate with custody staff to safely access and administer the medication under escort (Correct answer)
- Instruct the inmate to self-administer from a personal supply
- Skip the dose and double it at the next scheduled administration
Correct answer: Coordinate with custody staff to safely access and administer the medication under escort
Time-sensitive medications such as anticonvulsants must be administered even during lockdowns, requiring coordination with custody for safe nurse access.
Question 4: An inmate reports they have been saving their prescribed antidepressants for several weeks. The nurse should be most concerned about which risk?
- Drug tolerance from inconsistent dosing
- Potential overdose attempt using the stockpiled medication (Correct answer)
- Financial diversion to other inmates
- Therapeutic failure from missed doses
Correct answer: Potential overdose attempt using the stockpiled medication
Medication hoarding (cheeking) in correctional settings raises the primary concern of self-harm or suicide via intentional overdose with accumulated medication.
Question 5: A nurse is defibrillating an inmate in ventricular fibrillation with an AED. Which action is most critical immediately before delivering the shock?
- Administer 1 mg epinephrine IV
- Ensure all rescuers are clear of the patient (Correct answer)
- Perform 2 rescue breaths
- Check the carotid pulse
Correct answer: Ensure all rescuers are clear of the patient
Before AED shock delivery, the operator must verbally and visually confirm that no rescuer is in contact with the patient to prevent accidental electrocution.
Question 6: A correctional nurse discovers that the medication count for oxycodone does not match the medication administration record at the end of the shift. What is the immediate required action?
- Recount and document the discrepancy in the next shift's notes
- Notify the supervisor, lock down the medication room, and initiate a controlled substance discrepancy investigation immediately (Correct answer)
- Assume a counting error occurred and adjust the count
- Wait for the outgoing nurse to return to resolve the issue
Correct answer: Notify the supervisor, lock down the medication room, and initiate a controlled substance discrepancy investigation immediately
A controlled substance count discrepancy is a serious security and regulatory matter requiring immediate supervisor notification and formal investigation per DEA and facility protocols.
Question 7: Which of the following best describes the nurse's ethical obligation when a correctional officer instructs the nurse not to administer a medically necessary medication as punishment for an inmate's behavior?
- Comply with the officer's order to maintain security cooperation
- Defer the medication until the next scheduled nursing supervisor review
- Refuse the instruction, administer the medication, and report the incident through appropriate channels (Correct answer)
- Document the refusal and have the inmate sign an AMA form
Correct answer: Refuse the instruction, administer the medication, and report the incident through appropriate channels
Withholding medically necessary treatment as punishment constitutes cruel and unusual punishment; nurses must refuse such orders, provide care, and report through proper channels.
CCN Medication Administration & Emergency Response 5
An inmate with type 1 diabetes refuses breakfast but has already received his morning insulin.
Which complication is the nurse's primary concern?