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CCHP-RN practice questions

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Question 1Correctional Health Care Environment and Standards

Which constitutional amendment is the primary basis for the right of incarcerated persons to receive adequate health care in the United States?

  1. Fourth Amendment
  2. Eighth Amendment Correct answer.
  3. First Amendment
  4. Second Amendment

Explanation

The Eighth Amendment's prohibition on cruel and unusual punishment, as interpreted in Estelle v. Gamble, requires correctional officials not to be deliberately indifferent to serious medical needs. Other amendments do not supply the core constitutional health care standard in corrections.

Question 2Correctional Health Care Environment and Standards

When should the initial health screening of a newly admitted inmate be completed under national correctional health standards?

  1. Within 72 hours of the first clinic visit
  2. At arrival, before general population placement Correct answer.
  3. Only after the inmate submits a request
  4. Within 14 days of arrival

Explanation

National correctional health standards call for a brief receiving screening at the time of arrival, before placement in the general population, to identify urgent medical, mental health, and communicable disease concerns. A comprehensive health assessment is completed later, not the initial screening.

Question 3Correctional Health Care Environment and Standards

Which statement describes appropriate sharing of an inmate's protected health information with correctional officers?

  1. It may never be shared with custody staff under any circumstance.
  2. It may be shared with any officer who requests it.
  3. It may be posted where officers can review medications.
  4. It may be shared with staff with a need to know. Correct answer.

Explanation

Health information may be shared with custodial staff only on a need-to-know basis when necessary for care or safety, consistent with privacy law and correctional policy. Broad posting or unrestricted sharing violates confidentiality.

Question 4Correctional Health Care Environment and Standards

Which action is a registered nurse's responsibility during sick call in a correctional facility?

  1. Triaging and referring to the provider Correct answer.
  2. Prescribing antibiotics for a suspected wound infection
  3. Approving a lower-bunk restriction
  4. Deciding on disciplinary segregation

Explanation

The RN triages sick-call requests, performs nursing assessment, and refers to a provider or other discipline as indicated. Prescribing, approving restrictions, and deciding segregation are outside nursing scope or are custody functions.

Question 5Correctional Health Care Environment and Standards

Which action is required by standard precautions in a correctional health unit?

  1. Skipping hand hygiene whenever gloves are worn
  2. Wearing gloves when blood contact is anticipated Correct answer.
  3. Placing every coughing inmate in isolation
  4. Wearing a gown for every intake interview

Explanation

Standard precautions require gloves when contact with blood or other potentially infectious material is anticipated, and hand hygiene must still be performed. Gowns and isolation are based on anticipated exposure or specific transmission risks, not routine intake.

Question 6Correctional Health Care Environment and Standards

An inmate states during intake, 'I have nothing to live for.' What is the nurse's priority action?

  1. Place on continuous observation and notify staff Correct answer.
  2. Warn the inmate against making such statements
  3. Give a sedative from the emergency kit
  4. Document the statement and finish the intake

Explanation

A statement suggesting hopelessness or self-harm intent requires immediate suicide-risk precautions, continuous observation, and notification of mental health and custody staff. Sedatives are not a first-line safety intervention, and discipline is inappropriate.

Question 7Correctional Health Care Environment and Standards

Which practice is consistent with directly observed therapy for medications in a correctional facility?

  1. Observing ingestion and documenting administration Correct answer.
  2. Providing a 30-day supply to keep in the cell
  3. Letting the inmate choose when to take the dose
  4. Leaving the medication at the cell door

Explanation

Directly observed therapy means a nurse observes the inmate take and swallow the medication and documents the administration, reducing diversion and improving adherence. Supplying unobserved doses or letting the inmate choose timing defeats the purpose.

Question 8Correctional Health Care Environment and Standards

Which statement about health records in a correctional facility is most accurate?

  1. They belong to the inmate and may be removed on request.
  2. They may be kept in the inmate's cell with belongings.
  3. They are confidential, with access limited to authorized staff. Correct answer.
  4. They are destroyed at release for confidentiality.

Explanation

Health records are confidential clinical records maintained by the health authority, and access is limited to authorized staff with a legitimate need. Inmates do not keep health records in their cells, and records are not routinely destroyed at release.

Question 9Correctional Health Care Environment and Standards

An inmate reports severe chest pain. The nurse documents it but does not notify a provider or start an emergency evaluation. The inmate later is found to have had a myocardial infarction. This is best described as which of the following?

  1. A custody matter, not a health care issue
  2. A minor documentation error
  3. Deliberate indifference to a serious need Correct answer.
  4. A reasonable exercise of nursing judgment

Explanation

Deliberate indifference requires that a clinician know of a serious medical need and fail to take reasonable steps to address it. Documenting chest pain without notifying a provider or initiating emergency evaluation can meet that standard.

Question 10Correctional Health Care Environment and Standards

Which element is included in the initial health screening of a newly admitted inmate?

  1. A tuberculosis skin test read in 48 to 72 hours
  2. Questions about chronic illness, medications, and symptoms Correct answer.
  3. A complete dental examination with radiographs
  4. A full psychological test battery

Explanation

The initial screening is brief and focuses on current symptoms, chronic illnesses, medications, mental health and suicide risk, and communicable disease risk. Dental examinations, psychological testing, and TB skin test reading occur later as indicated.

Question 11Correctional Health Care Environment and Standards

When an inmate is placed in medical restraints, which nursing action is most appropriate?

  1. Let custody staff decide when monitoring is needed
  2. Monitor circulation, skin, and vital signs regularly Correct answer.
  3. Remove the restraints whenever requested
  4. Check the restraints once per shift

Explanation

Medical restraints require regular clinical monitoring of circulation, skin integrity, and vital signs, with findings documented. Monitoring once per shift is insufficient, and custody staff do not determine clinical monitoring needs.

Question 12Correctional Health Care Environment and Standards

Which action is appropriate when a nurse screens newly incarcerated inmates for tuberculosis?

  1. Ask about cough, weight loss, and night sweats Correct answer.
  2. Obtain a chest x-ray for every inmate
  3. Assume a negative symptom review rules out infection
  4. Isolate all inmates until results return

Explanation

Tuberculosis screening begins with symptom and risk-factor questions, such as cough, weight loss, night sweats, and prior TB treatment, and refers for testing or isolation as indicated. Routine chest x-rays for all inmates and assumptions from a negative review are not appropriate.

Question 13Correctional Health Care Environment and Standards

Which nursing action is appropriate when a pregnant inmate is restrained for transport?

  1. Apply restraints tightly across the abdomen
  2. Delay prenatal care until after release
  3. Refuse all restraint use because the inmate is pregnant
  4. Use least restrictive restraint and avoid abdominal pressure Correct answer.

Explanation

Restraints on a pregnant inmate should be the least restrictive necessary and should not compress the abdomen. Pregnancy does not categorically prohibit restraints, but it requires accommodations to reduce risk to the patient and fetus.

Question 14Correctional Health Care Environment and Standards

An inmate reports a sexual assault by another inmate. What is the nurse's priority action during the medical examination?

  1. Provide emergency care, safety, and forensic options Correct answer.
  2. Determine whether the inmate consented
  3. Report the allegation only to the family
  4. Tell the inmate to shower before the examination

Explanation

After a reported sexual assault, the priority is emergency medical care, safety, and offering forensic examination and prophylaxis according to protocol. The inmate should not shower before a forensic examination, and consent determination is not the nurse's role.

Question 15Correctional Health Care Environment and Standards

A nurse completes a medical clearance before an inmate is placed in long-term restrictive housing. Which finding is most important to report?

  1. A history of childhood asthma
  2. A stated preference for a different housing unit
  3. Active suicidal ideation and serious mental illness Correct answer.
  4. A tattoo on the left forearm

Explanation

Serious mental illness and active suicidal ideation are key concerns when considering restrictive housing because segregation can worsen psychiatric symptoms and self-harm risk. These findings require communication with the placement team and often accommodation or exclusion.

Question 16Correctional Health Care Environment and Standards

An inmate files a health care grievance saying a medication was not given for two days. What is the nurse manager's best initial action?

  1. Wait until the inmate is released to investigate
  2. Tell the inmate to submit a sick call request instead
  3. Review the medication record and interview staff Correct answer.
  4. Discard the grievance because inmates cannot grieve care

Explanation

Health care grievances require a documented investigation, including review of records and interviews with involved staff and the inmate. Discarding the grievance or redirecting it without review fails the grievance process.

Question 17Correctional Health Care Environment and Standards

A jail charges inmates a co-payment for sick call. Which practice is consistent with correctional health standards?

  1. Co-payment replaces the need for nursing triage
  2. Inmates who cannot pay are denied all provider access
  3. Emergency care is given regardless of ability to pay Correct answer.
  4. Co-payment is collected before emergency assessment

Explanation

Co-payments must not create a barrier to necessary care; emergency and serious conditions are evaluated and treated regardless of ability to pay. Co-payment collection cannot precede emergency assessment or replace triage.

Question 18Correctional Health Care Environment and Standards

A nurse collects a blood sample for forensic testing from an inmate involved in an assault. What action is essential for chain of custody?

  1. Hand the sample to any officer without documentation
  2. Store the sample in the inmate's property locker
  3. Label the specimen and document transfers Correct answer.
  4. Discard the sample if the inmate denies the assault

Explanation

Chain of custody requires labeling the specimen and documenting every transfer so the specimen's integrity can be traced. Handing it off undocumented, storing it in the inmate's property, or discarding it compromises the evidence.

Question 19Correctional Health Care Environment and Standards

During a chronic care visit, an inmate with diabetes says, 'I feel hopeless and don't want to check my sugars.' What is the nurse's best response?

  1. Tell the inmate diabetes is not a mental health issue
  2. Assess suicide risk and refer to mental health Correct answer.
  3. Focus only on diabetes and ignore the statement
  4. Document the statement and schedule a routine visit

Explanation

Hopelessness and loss of interest in self-care can signal depression or suicide risk, so the nurse should assess suicide risk and refer to mental health. Ignoring the statement or delaying referral misses a potentially urgent condition.

Question 20Correctional Health Care Environment and Standards

An inmate collapses in the dining hall. The nurse finds custody staff handcuffing the unresponsive inmate. What is the nurse's priority?

  1. Wait for custody to remove the handcuffs before assessing
  2. Begin emergency assessment and coordinate with custody Correct answer.
  3. Document the delay and leave the area
  4. Start CPR only after the inmate is moved to the health unit

Explanation

In a medical emergency, the nurse begins assessment and resuscitation while coordinating with custody for scene safety. Waiting for handcuffs to be removed or delaying CPR until movement to the health unit can worsen outcomes.

Question 21Correctional Health Care Environment and Standards

A correctional officer asks the nurse to reveal an inmate's HIV status so officers can 'be careful' on the unit. The nurse's response should follow which principle?

  1. Tell other inmates so they can protect themselves
  2. Disclose the full record because custody has unrestricted access
  3. Disclose only the minimum needed for safety Correct answer.
  4. Refuse all communication with custody staff

Explanation

Correctional health staff share protected health information with custody only on a need-to-know basis, disclosing the minimum necessary for safety or care. Unrestricted disclosure and telling other inmates violate confidentiality.

Question 22Correctional Health Care Environment and Standards

Which statement best reflects the significance of Brown v. Plata for correctional health care?

  1. It eliminated the need for mental health screening at intake
  2. It held that inmates have no constitutional right to health care
  3. It upheld a population-reduction order for unconstitutional care Correct answer.
  4. It created the co-payment system used in jails

Explanation

Brown v. Plata (2011) upheld a court-ordered prison population reduction in California after findings that overcrowding caused unconstitutional medical and mental health care. It did not create co-payments or remove intake screening.

Question 23Correctional Health Care Environment and Standards

Which inmate is at greatest risk for health deterioration in long-term restrictive housing?

  1. An inmate with a healed fracture and no complaints
  2. An inmate who requests extra recreation time
  3. An inmate with serious mental illness Correct answer.
  4. An inmate with well-controlled seizures seen monthly

Explanation

Inmates with serious mental illness are at heightened risk in long-term restrictive housing because isolation can exacerbate symptoms and self-harm risk. They require close monitoring, mental health input, and often exclusion or accommodation.

Question 24Correctional Health Care Environment and Standards

An unconscious inmate with a life-threatening condition arrives at the infirmary, and no family can be reached. How should the nurse proceed?

  1. Obtain consent from the ranking custody officer
  2. Withhold treatment until a court order is obtained
  3. Treat under the doctrine of implied consent Correct answer.
  4. Wait for the inmate to regain consciousness

Explanation

When a patient is unconscious and unable to consent, and delay would be harmful, emergency treatment may proceed under implied consent. Consent from a custody officer or a court order is not required for emergency care.

Question 25Correctional Health Care Environment and Standards

Which activity best illustrates continuous quality improvement in correctional health care?

  1. Posting the mission statement in the health unit
  2. Tracking screening timeliness and improving practice Correct answer.
  3. Conducting one audit at accreditation and taking no action
  4. Filing incident reports without reviewing them

Explanation

Continuous quality improvement involves ongoing measurement of processes or outcomes, analysis of the data, and implementation of changes to improve care. A single accreditation audit or filing reports without review is not CQI.

Question 26Correctional Health Care Environment and Standards

Which legal standard governs whether an inmate's medical care violates the Eighth Amendment?

  1. Ordinary negligence under state malpractice law
  2. Deliberate indifference to serious medical needs Correct answer.
  3. Breach of the facility's internal policies
  4. Strict liability for every poor clinical outcome

Explanation

Estelle v. Gamble established that the Eighth Amendment prohibits deliberate indifference to serious medical needs, not mere negligence or disagreement with treatment. The standard requires that officials know of and disregard an excessive risk to inmate health.

Question 27Correctional Health Care Environment and Standards

An inmate at pill line refuses a prescribed antihypertensive medication and returns to the housing unit. What is the nurse's most appropriate action?

  1. Instruct custody staff to escort the inmate back to pill line
  2. Crush the medication and place it in the inmate's food
  3. Document the refusal and notify the prescribing provider Correct answer.
  4. Withhold all future medications until the inmate agrees

Explanation

Inmates retain the right to refuse treatment, so the nurse documents the refusal, notifies the prescribing provider, and monitors for clinical consequences. Coercion or concealed administration is inappropriate.

Question 28Correctional Health Care Environment and Standards

A correctional officer asks the nurse to perform a strip search of an inmate suspected of hiding contraband. What is the nurse's best response?

  1. State that searches are a custody function, not nursing Correct answer.
  2. Perform a visual search only if the inmate consents in writing
  3. Conduct the search because the officer has authority to order it
  4. Ask the provider for a written order before searching the inmate

Explanation

Searches for contraband are a security function performed by custody staff, not a health care task. The nurse should maintain the clinical role and refer the officer to security personnel.

Question 29Correctional Health Care Environment and Standards

Which situation most likely constitutes deliberate indifference by a correctional nurse?

  1. Scheduling a follow-up visit for an inmate with a chronic cough
  2. Denying insulin to a disruptive inmate with type 1 diabetes Correct answer.
  3. Assessing a swollen ankle, applying ice, and referring the inmate to a provider
  4. Documenting a medication refusal and notifying the prescribing provider

Explanation

Deliberate indifference requires knowledge of a serious medical need and disregard of an excessive risk to the inmate's health. Withholding insulin from an inmate with type 1 diabetes creates a foreseeable risk of diabetic ketoacidosis and meets that standard.

Question 30Patient Care and Clinical Nursing Practice in Custody

A man is booked into jail at 2 a.m., has no visible injuries, and denies any medical problems. According to correctional health care standards, when must his comprehensive health assessment be completed?

  1. Within 14 days of arrival Correct answer.
  2. Within 24 hours of arrival
  3. Within 7 days of arrival
  4. Before he is assigned to a housing unit

Explanation

Initial health screening is done on arrival, before housing, to catch urgent needs; it is a brief check, not a full appraisal. The comprehensive health assessment, including history, physical examination, and plan of care, is then completed within 14 days. Assigning a deadline of 24 hours or 7 days confuses the screening with the full assessment.

Question 31Patient Care and Clinical Nursing Practice in Custody

Which practice best reflects accepted suicide-prevention standards during booking?

  1. Screen every newly arrived person for suicide risk regardless of appearance Correct answer.
  2. Defer suicide screening until the person submits a sick-call request
  3. Screen only people who volunteer thoughts of self-harm during booking questions
  4. Rely on officers to refer anyone who looks depressed

Explanation

Suicide risk screening is a required part of intake for every person, because many at-risk individuals do not disclose ideation and may appear calm. Screening identifies need for observation level, housing assignment, and referral. Spotting risk only when someone volunteers it, or waiting for a sick-call request, misses the majority of at-risk arrivals.

Question 32Patient Care and Clinical Nursing Practice in Custody

A nurse is about to irrigate a large, bleeding scalp laceration. Which protection is required in addition to gloves?

  1. No additional protection
  2. Eye and face protection Correct answer.
  3. A second pair of gloves
  4. A gown only

Explanation

Standard precautions require gloves whenever contact with blood or body fluids is anticipated. When splashing or spraying is likely, as with irrigation of a bleeding wound, eye and face protection plus a gown are added. Doubling gloves does not protect the mucous membranes of the eyes, nose, and mouth.

Question 33Patient Care and Clinical Nursing Practice in Custody

Four inmates are waiting at sick call. Which one should the nurse assess first?

  1. An inmate with a spreading rash on the forearm for three days
  2. An inmate requesting a replacement eyeglass prescription
  3. An inmate reporting crushing chest pain with sweating Correct answer.
  4. An inmate with a mild ankle sprain from recreation

Explanation

Sick-call triage sorts by urgency, with airway, breathing, circulation, and potentially life-threatening complaints seen first. Crushing chest pain with diaphoresis suggests an acute coronary event and requires immediate assessment and emergency response. Rash, eyeglass requests, and minor sprains are stable complaints that can safely wait.

Question 34Patient Care and Clinical Nursing Practice in Custody

Which action should the nurse take when administering a medication that has a high potential for diversion in the jail setting?

  1. Ask a cellmate to confirm that the medication was swallowed
  2. Allow the inmate to keep a seven-day supply in his property
  3. Observe the inmate swallow the dose and check the mouth afterward Correct answer.
  4. Leave the dose at the cell door for the inmate to take later

Explanation

For medications with abuse or diversion potential, directly observed administration with a mouth check confirms the drug was actually ingested rather than cheeking or passing it. Leaving doses unattended or permitting stockpiles creates diversion and overdose risk. Cellmates cannot serve as verifiers of ingestion.

Question 35Patient Care and Clinical Nursing Practice in Custody

A custody officer asks the nurse to read an inmate's chart aloud so the officer knows what is going on. What is the nurse's best response?

  1. Write the diagnosis in the officer's station log
  2. Read the entire chart entry to the officer
  3. Share only the information the officer needs to keep the unit safe Correct answer.
  4. Refuse to provide any health information under any circumstance

Explanation

Health information is disclosed to custody staff on a need-to-know basis, limited to what is necessary for safety, security, and continuity of care, such as activity restrictions or observation level. Diagnoses and treatment details unrelated to those needs stay confidential. Blanket refusal ignores legitimate safety needs, and posting diagnoses in a log exposes information to many people.

Question 36Patient Care and Clinical Nursing Practice in Custody

An inmate is found unresponsive with pinpoint pupils and slow, shallow breathing. Which medication should the nurse prepare to administer?

  1. Naloxone Correct answer.
  2. Dextrose 50%
  3. Atropine
  4. Flumazenil

Explanation

Pinpoint pupils with respiratory depression is the classic opioid toxidrome, and naloxone is the opioid antagonist used to reverse it while ventilation is supported. Flumazenil reverses benzodiazepines, which do not cause pinpoint pupils. Atropine and dextrose treat other problems entirely.

Question 37Patient Care and Clinical Nursing Practice in Custody

Which nursing entry meets the standard for objective documentation?

  1. Inmate acting like his usual self.
  2. Inmate faking chest pain again.
  3. At 2100 inmate reported chest pressure 8/10, diaphoretic; BP 158/94, pulse 104. Correct answer.
  4. Inmate was drunk and obnoxious at 2100.

Explanation

Objective documentation records what was observed and measured, in quotes where relevant, along with the time and vital signs. Judgments such as drunk, obnoxious, or faking are conclusions that belong nowhere in a clinical record. Vague phrases like usual self cannot be verified by another reader.

Question 38Patient Care and Clinical Nursing Practice in Custody

A man with a long history of heavy drinking arrives with tremor, sweating, and a heart rate of 118 about 14 hours after his last drink. Which action is most appropriate?

  1. House him in the general population so cellmates can watch him
  2. Give a PRN antipsychotic and reassess at the next shift
  3. Reassure him that symptoms will pass and recheck in 24 hours
  4. Begin structured withdrawal monitoring and notify the provider for medication orders Correct answer.

Explanation

Alcohol withdrawal typically begins 6 to 24 hours after the last drink, with seizures and delirium tremens following in the ensuing days, so early structured monitoring and benzodiazepine therapy are the standard. Reassurance without monitoring allows progression to a life-threatening state. General population housing removes the observation he requires.

Question 39Patient Care and Clinical Nursing Practice in Custody

A newly booked man has coughed for three weeks, reports night sweats and weight loss, and his chest x-ray shows an upper-lobe infiltrate. Which action should the nurse take?

  1. House him in the general dormitory until sputum results return
  2. Place a surgical mask on him and use airborne precautions pending evaluation Correct answer.
  3. Place a tuberculosis skin test and wait 48 hours for the reading
  4. Ask custody to put him in a single cell with the door open for airflow

Explanation

A chronic cough with night sweats, weight loss, and an upper-lobe infiltrate suggests active pulmonary tuberculosis, which spreads by airborne droplet nuclei. The person should wear a surgical mask, staff should use an N95 respirator, and he should be housed in an airborne infection isolation room pending sputum testing. A skin test does not diagnose active disease and does not replace isolation.

Question 40Patient Care and Clinical Nursing Practice in Custody

An inmate is placed in four-point restraints after violent behavior. Which nursing action is required?

  1. Tighten the restraints hourly to prevent escape
  2. Assess circulation, sensation, and range of motion at set intervals and document Correct answer.
  3. Leave him alone to reduce stimulation
  4. Check the restraints once per shift

Explanation

Restraint monitoring includes frequent checks of circulation, sensation, range of motion, hydration, and positioning, with each assessment documented. Checks are performed at short, defined intervals, typically every 15 minutes for violent restraint episodes. Tightening restraints or leaving the person unobserved increases the risk of nerve injury, falls, and death.

Question 41Patient Care and Clinical Nursing Practice in Custody

Which practice reduces the risk of sudden death during a physical restraint?

  1. Placing a spit hood on the inmate and leaving it in place for the shift
  2. Keeping the inmate prone after control is achieved
  3. Repositioning to a seated or side-lying position as soon as control is achieved Correct answer.
  4. Applying body weight to the back while the inmate lies prone

Explanation

Compression and positional asphyxia occur when body weight is applied to the back or chest or a person is left prone, restricting breathing. Once control is achieved the person should be moved promptly to a seated or side-lying position and monitored continuously. Spit hoods left in place add suffocation and aspiration risk.

Question 42Patient Care and Clinical Nursing Practice in Custody

An inmate with diabetes is sweating, shaky, and confused. His blood glucose is 52 mg/dL. Which action should the nurse take first?

  1. Give nothing by mouth and recheck the glucose in one hour
  2. Administer his scheduled dose of long-acting insulin
  3. Give a fast-acting oral carbohydrate if he can swallow safely Correct answer.
  4. Encourage him to lie down and rest

Explanation

A glucose of 52 mg/dL with sweating, tremor, and confusion is hypoglycemia, which is corrected with about 15 grams of fast-acting oral carbohydrate when the person can swallow safely, followed by a recheck in 15 minutes. Insulin would worsen the hypoglycemia dramatically. Oral intake is withheld only when swallowing is impaired, in which case IV dextrose or glucagon is used.

Question 43Patient Care and Clinical Nursing Practice in Custody

An inmate begins a generalized tonic-clonic seizure. Which action should the nurse take?

  1. Protect his head, move objects away, and turn him on his side when movements stop Correct answer.
  2. Restrain his arms and legs to stop the movements
  3. Place a padded tongue blade between his teeth
  4. Leave the cell and check back after the seizure ends

Explanation

During a seizure the nurse protects the head, removes hazards, and does not restrain or insert anything into the mouth, because the jaw can clamp down and cause injury or airway obstruction. After the movements stop, the person is turned to the side to protect the airway and is monitored for respiratory depression. Someone must stay with the person throughout.

Question 44Patient Care and Clinical Nursing Practice in Custody

A nurse sustains a needlestick with a needle used on an inmate. What should she do first?

  1. Finish the medication pass before reporting the injury
  2. Wash the site with soap and water and report the exposure immediately Correct answer.
  3. Squeeze the site forcefully and apply bleach
  4. Wait for the inmate's HIV test result before washing the site

Explanation

Immediate care for a percutaneous exposure is thorough washing with soap and water, followed by prompt reporting so post-exposure prophylaxis and source evaluation can begin quickly. Bleach and forceful squeezing are not recommended and may damage tissue. Post-exposure prophylaxis is time sensitive, so reporting cannot wait for errands or test results.

Question 45Patient Care and Clinical Nursing Practice in Custody

An inmate asks the nurse to crush his sustained-release tablets because he has trouble swallowing pills. What should the nurse do?

  1. Crush the tablets and mix them in applesauce
  2. Tell him to chew the tablets thoroughly
  3. Check with the pharmacist whether the formulation can be crushed and request an alternative if not Correct answer.
  4. Split the tablets in half rather than crushing them

Explanation

Extended-release and delayed-release formulations must not be crushed or chewed, because doing so releases the full dose at once and can cause toxicity or loss of effect. The nurse verifies the formulation with the pharmacist and requests a liquid or immediate-release alternative. Splitting is also unsafe for many sustained-release products.

Question 46Patient Care and Clinical Nursing Practice in Custody

An older inmate becomes acutely confused at night, is disoriented to place, and has a new tremor. Which interpretation is correct?

  1. The behavior is expected at night and needs no action until morning
  2. New confusion in custody is usually malingering and can be ignored
  3. It represents a new chronic psychiatric diagnosis
  4. Acute fluctuating confusion suggests a medical cause such as delirium and needs prompt evaluation Correct answer.

Explanation

Delirium has an acute onset with fluctuating level of awareness, inattention, and disorientation, and it usually signals an underlying medical problem such as infection, hypoxia, hypoglycemia, or withdrawal. It is a medical emergency that requires prompt assessment, not watchful waiting. Chronic psychiatric illness has a different, typically stable course.

Question 47Patient Care and Clinical Nursing Practice in Custody

A pregnant inmate at 34 weeks' gestation reports a sudden gush of clear fluid. What is the priority action?

  1. Give her a pad and schedule a sick-call visit for the next morning
  2. Arrange emergency transfer for obstetric evaluation and notify the provider Correct answer.
  3. Have her walk in the dayroom to see whether contractions begin
  4. Withhold all oral fluids until the provider makes rounds

Explanation

A gush of fluid at 34 weeks suggests preterm premature rupture of membranes, which carries risks of cord prolapse, chorioamnionitis, and preterm delivery. The person needs immediate obstetric evaluation and transfer, with fetal and maternal monitoring en route. Delaying to observe at the facility or in the dayroom places mother and fetus at risk.

Question 48Patient Care and Clinical Nursing Practice in Custody

An inmate with newly diagnosed hypertension refuses his medication and declines teaching. What should the nurse do?

  1. Explain the risks of untreated hypertension, document the refusal and teaching, and continue monitoring Correct answer.
  2. Tell him he will lose privileges unless he takes the medication
  3. Hide the medication in his food so he receives it anyway
  4. Document the refusal and take no further action

Explanation

A competent adult may refuse treatment; the nurse's obligation is to educate about the consequences, ensure the refusal is informed, document it carefully, and keep monitoring for deterioration. Concealing medication violates consent, and threats tied to privileges are coercion. Simply documenting without further nursing action falls short of the duty to inform.

Question 49Patient Care and Clinical Nursing Practice in Custody

Which task may an RN delegate to an unlicensed nursing assistant working in the clinic?

  1. Measuring and recording a blood pressure on a stable inmate Correct answer.
  2. Teaching a newly diagnosed diabetic about insulin technique
  3. Performing the initial intake health assessment
  4. Interpreting an inmate's report of chest pain

Explanation

Delegation to unlicensed staff covers tasks that are stable, predictable, and have a standard procedure, such as measuring vital signs on a stable person. Assessment, interpretation of findings, and client teaching are nursing responsibilities that require an RN or licensed nurse. Delegation always includes clear direction and follow-up.

Question 50Patient Care and Clinical Nursing Practice in Custody

An inmate says he was choked by another inmate six hours ago. He has no visible marks but has a hoarse voice and pain on swallowing. What is the most appropriate action?

  1. Document the absence of external marks and return him to his cell
  2. Arrange urgent evaluation for airway and neck vessel injury Correct answer.
  3. Have him sign a refusal if he does not want to be examined
  4. Apply an ice pack and recheck in 24 hours

Explanation

Strangulation can injure the airway and carotid arteries without leaving external marks, and deterioration from swelling or vascular injury may be delayed by hours or days. Hoarseness, dysphagia, and neck pain after a choke hold require urgent medical evaluation. Documenting a lack of marks and returning the person to the cell risks an unrecognized fatal injury.