CCHP Managing Chronic and Infectious Diseases 2 — Questions and Answers
Question 1: A correctional nurse discovers that a newly admitted inmate has an HbA1c of 10.2%. What is the most appropriate initial management step?
- Immediately start insulin therapy without further assessment
- Conduct a comprehensive diabetes assessment including current medications, complications, and self-management history (Correct answer)
- Defer diabetes management until after the 30-day intake period
- Refer directly to an outside endocrinologist before initiating any treatment
Correct answer: Conduct a comprehensive diabetes assessment including current medications, complications, and self-management history
A comprehensive assessment of the inmate's diabetes history, current regimen, and complications is essential before adjusting or initiating treatment.
Question 2: Which hepatitis C treatment consideration is MOST relevant in a correctional setting?
- Treatment should be withheld until release to reduce costs
- Direct-acting antivirals (DAAs) are contraindicated in incarcerated populations
- Sufficient sentence length to complete a full treatment course is an important eligibility factor (Correct answer)
- Inmates must demonstrate sobriety for five years before treatment eligibility
Correct answer: Sufficient sentence length to complete a full treatment course is an important eligibility factor
Ensuring inmates have adequate time remaining in their sentence to complete DAA therapy (typically 8–12 weeks) is a key eligibility consideration in correctional settings.
Question 3: An inmate with HIV has a viral load of 2,500 copies/mL despite reporting adherence to ART. What is the most likely explanation?
- The inmate's HIV has naturally progressed beyond treatment
- Medication non-adherence, drug resistance, or drug-drug interactions should be evaluated (Correct answer)
- ART is ineffective for viral loads above 1,000 copies/mL
- The viral load result is within acceptable limits and no action is needed
Correct answer: Medication non-adherence, drug resistance, or drug-drug interactions should be evaluated
A detectable viral load despite reported adherence warrants evaluation for covert non-adherence, resistance mutations, or pharmacokinetic interactions.
Question 4: What is the recommended tuberculin skin test (TST) reading timeframe in a correctional facility?
- Immediately after placement
- 12–24 hours after placement
- 48–72 hours after placement (Correct answer)
- 96–120 hours after placement
Correct answer: 48–72 hours after placement
TST results must be read 48–72 hours after intradermal placement to ensure accurate induration measurement.
Question 5: Which of the following best describes the 'booster effect' in tuberculin skin testing and why it matters in correctional facilities?
- A false-positive caused by BCG vaccination that requires no follow-up
- A waning immune response that can make a truly positive TST appear negative on first testing, corrected by two-step testing (Correct answer)
- An allergic reaction that invalidates the TST result permanently
- An enhanced immune response seen only in HIV-positive inmates
Correct answer: A waning immune response that can make a truly positive TST appear negative on first testing, corrected by two-step testing
Two-step TST identifies boosted responders whose first test appeared negative due to waning immunity, preventing future false conversions.
Question 6: An inmate with hypertension consistently has blood pressure readings above goal despite three antihypertensive medications. What correctional-specific factor should be prioritized in the assessment?
- Genetic predisposition to treatment-resistant hypertension
- Pill-hoarding or medication diversion leading to inconsistent ingestion (Correct answer)
- Laboratory error in blood pressure measurement equipment
- Natural resistance to antihypertensives in incarcerated populations
Correct answer: Pill-hoarding or medication diversion leading to inconsistent ingestion
Medication diversion is a significant concern in corrections; directly observed therapy (DOT) should be considered to ensure actual ingestion.
Question 7: Which bloodborne pathogen transmission route is of GREATEST concern during a correctional facility outbreak investigation involving multiple cases of acute hepatitis B?
- Airborne droplet transmission via shared ventilation
- Sharing of contaminated tattooing or piercing equipment (Correct answer)
- Contaminated food service equipment
- Mosquito vector transmission within the facility
Correct answer: Sharing of contaminated tattooing or piercing equipment
Unregulated tattooing and piercing with shared, unsterilized equipment is a primary route of hepatitis B (and C) transmission in correctional settings.
CCHP Managing Chronic and Infectious Diseases 2
A correctional nurse discovers that a newly admitted inmate has an HbA1c of 10.2%.
What is the most appropriate initial management step?