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Certified Corrections Nurse Practice Test

ACA-CCN test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Code: ACA-CCN
Exam Name: ACA Certified Corrections Nurse
Issuing Organization: American Correctional Association (ACA)
Type: Computer-based or paper-based (depending on testing location).
Number of Questions: 200 multiple-choice questions
Time Limit: 240 minutes (4 hours)
Passing Score: Determined by a standard-setting process (exact passing percentage may vary).

- Correctional Nursing Fundamentals
- Role of the Correctional Nurse:
- Scope of practice
- ethical considerations
- professional standards
- Legal and Regulatory Issues:
- Constitutional rights of inmates (8th Amendment- deliberate indifference).
- HIPAA in corrections.
- PREA (Prison Rape Elimination Act).
- State and federal regulations.
- Documentation & Risk Management:
- Proper charting
- incident reporting
- liability prevention

- Patient Assessment & Triage
- Initial Health Screening: Intake assessments- suicide risk evaluation.
- Chronic Disease Management: Diabetes- hypertension- HIV/AIDS- hepatitis in incarcerated populations.
- Emergency Care: Recognizing life-threatening conditions (overdose- withdrawal- trauma).
- Mental Health Assessments: Identifying psychosis- depression- and suicidal ideation.

- Common Medical Conditions in Corrections
- Infectious Diseases:
- TB testing and prevention.
- HIV/AIDS management.
- Hepatitis B/C.
- MRSA and other infections.
- Chronic Illnesses: Managing asthma- COPD- cardiovascular disease.
- Women’s Health: Pregnancy- menstruation- and gynecological care.
- Geriatric Care: Age-related conditions in long-term inmates.

- Mental Health & Substance Abuse
- Behavioral Health Interventions:
- Crisis de-escalation techniques.
- Suicide prevention protocols.
- Substance Withdrawal Management:
- Alcohol withdrawal (CIWA protocol).
- Opioid withdrawal (COWS scale).
- Stimulant intoxication/withdrawal.
- Medication-Assisted Treatment (MAT):
- Methadone
- buprenorphine
- naltrexone

- Medication Administration & Pharmacology
- Formulary Restrictions: Limited medication options in corrections.
- Observed Therapy (DOT): Ensuring medication compliance.
- Controlled Substances: Security- diversion prevention.
- Side Effect Monitoring: Antipsychotics- opioids- and other high-risk medications.

- Emergency Preparedness & Crisis Response
- Code Blue/Medical Emergencies: Responding to cardiac arrest- seizures.
- Restraints & Use of Force: Medical monitoring during restraints.
- Environmental Hazards: Heat/cold exposure- cell extractions.

- Ethical & Cultural Considerations
- Patient Advocacy: Balancing security vs. healthcare needs.
- Cultural Competency: Working with diverse inmate populations.
- End-of-Life Care: Hospice in prison settings.

- Correctional Facility Operations
- Security Protocols: Escorts- lockdown procedures.
- Interdisciplinary Collaboration: Working with COs- mental health staff- and providers.
- Quality Improvement: Audits- infection control- and continuous improvement.

- Deliberate Indifference Failure to provide adequate medical care- violating 8th Amendment rights.
- PREA: Prison Rape Elimination Act (mandates reporting/response to sexual assaults).
- DOT: Directly Observed Therapy (e.g.- for TB treatment).
- CIWA/COWS: Clinical scales for alcohol/opioid withdrawal.
- Formulary: Approved medication list in corrections (often restrictive).
- Sick Call: Inmate request for medical attention.
- Use of Force Security actions requiring medical assessment post-event.

- GENERAL/OFFENDER MANAGEMENT
- Communicating and working with offenders
- Verbal and nonverbal communication skills/techniques
- Diversity of correctional populations

- SECURITY/ENVIRONMENT
- Controlling offender behavior
- Contraband
- Searches
- Disciplinary actions
- Personal liability
- Security program
- Emergency response procedures
- Counts
- Transport of offenders

- STANDARDS AND ACCREDITATION
- Terminology: outcome measures- expected practices- process indications- protocols
- Elements of performance-based standards

- LEGAL
- Legal terminology
- Landmark Supreme Court decisions that affect correctional health care
- Civil Rights Act of 1964
- American with Disabilities Act (ADA)
- Prison Litigation Reform Act (PLRA)
- Fair Labor Standards Act (FLSA)
- Torts
- Habeas corpus
- Offender lawsuits
- Constitutional amendments affecting corrections
- Issues surrounding suicide

- NURSING PRACTICE
- Security training for nurses
- Health care training for correctional staff
- Roles and responsibilities for correctional nurses and private health care providers
- Offenders’ rights and level of health care
- Barriers to correctional health care
- Infectious diseases

- MENTAL HEALTH
- Mental health assessments
- Suicide issues
- Crisis intervention
- Mental health standards
- HEALTH CARE
- Health care issues in corrections
- History of correctional health care
- Health screening

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ACA-CCN
ACA Certified Corrections Nurse - 2026
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Question: 640
A 30-year-old female inmate with a history of depression is prescribed sertraline. Which of the following
side effects should she be closely monitored for during the first few weeks of therapy?
A. Weight gain
B. Suicidal ideation
C. Hypertension
D. Gastrointestinal bleeding
Answer: B
Explanation: Monitoring for suicidal ideation is crucial during the initiation of antidepressant therapy,
particularly in younger patients, as there is an increased risk of worsening depression and suicidal
thoughts.
Question: 641
A 46-year-old male inmate with schizophrenia is prescribed haloperidol 5 mg twice daily. The facility�s
formulary restricts atypical antipsychotics. During a medication pass, the nurse observes the inmate
exhibiting muscle stiffness and a shuffling gait. His vital signs are: BP 140/90 mmHg, HR 88 bpm, and
temperature 99.8�F. What is the most appropriate action for the nurse to take?
A. Continue haloperidol and monitor symptoms
B. Administer a PRN dose of ibuprofen
C. Notify the provider for possible extrapyramidal symptoms
D. Encourage stretching exercises
Answer: C
Explanation: Haloperidol, a typical antipsychotic, is associated with extrapyramidal symptoms (EPS)
such as muscle stiffness and shuffling gait. These symptoms require prompt evaluation, as they may
progress to severe dystonia or parkinsonism. Notifying the provider for possible dose adjustment or
adjunctive therapy (e.g., benztropine) is the most appropriate action. Continuing the medication risks
worsening EPS, ibuprofen does not treat EPS, and exercises are ineffective for this condition.
Question: 642
A 37-year-old male inmate with chronic HBV (HBeAg positive, HBV DNA 1,000,000 IU/mL) develops
jaundice and fatigue. His ALT is 500 U/L, and ultrasound shows no cirrhosis. The formulary includes
TDF and entecavir. What is the most appropriate antiviral therapy?
A. Entecavir 0.5 mg daily
B. Entecavir 1 mg daily
C. Tenofovir disoproxil fumarate 300 mg daily
D. Tenofovir disoproxil fumarate 300 mg and entecavir 0.5 mg daily
Answer: C
Explanation: High HBV DNA and elevated ALT indicate active chronic HBV requiring therapy. TDF is
preferred for HBeAg-positive patients due to high potency and low resistance. Entecavir 0.5 mg is for
treatment-na�ve, but 1 mg is for lamivudine-experienced. Combination therapy is not standard.
Question: 643
You are auditing infection control practices in a correctional facility and find that hand hygiene
compliance is 60% among healthcare staff. The facility�s Clostridium difficile infection rate is 8 cases
per 1,000 patient-days, above the national benchmark of 5. Which intervention should you prioritize?
A. Implement a mandatory hand hygiene training program with compliance monitoring.
B. Install additional hand sanitizer dispensers in clinical areas.
C. Increase antibiotic stewardship to reduce C. difficile infections.
D. Conduct monthly environmental cleaning audits to reduce contamination.
Answer: A
Explanation: Low hand hygiene compliance is a primary driver of C. difficile transmission. Mandatory
training with monitoring directly improves adherence, aligning with CDC guidelines. Additional
dispensers are secondary, antibiotic stewardship addresses a different factor, and cleaning audits are less
impactful without hand hygiene improvement.
Question: 644
A 30-year-old female inmate presents with signs of severe anxiety, including rapid heart rate and
hyperventilation. Which assessment tool would best aid the nurse in quantifying the severity of her
anxiety symptoms?
A. Hamilton Anxiety Rating Scale (HAM-A)
B. Generalized Anxiety Disorder 7-item scale (GAD-7)
C. Patient Health Questionnaire (PHQ-9)
D. Beck Anxiety Inventory (BAI)
Answer: B
Explanation: The GAD-7 is specifically designed to assess the severity of generalized anxiety disorder
symptoms, making it suitable for this scenario.
Question: 645
In evaluating an inmate for potential alcohol withdrawal, which laboratory value is most critical for the
nurse to assess to prevent complications?
A. Serum creatinine
B. Serum electrolytes, particularly sodium
C. Blood alcohol level
D. Liver function tests
Answer: B
Explanation: Monitoring serum electrolytes, particularly sodium, helps prevent complications such as
seizures or delirium tremens, which can occur during alcohol withdrawal.
Question: 646
An inmate with a history of IV drug use presents with a fever (39�C), murmur, and vegetation on
echocardiogram, suggestive of infective endocarditis. Blood cultures are pending, and the provider orders
vancomycin 1 g IV every 12 hours. Per ACA standards for infection management, what is the most
critical nursing action to ensure safe antibiotic administration?
A. Verify vancomycin trough level before the third dose
B. Monitor for red man syndrome during infusion
C. Check renal function before initiating therapy
D. Confirm blood culture results before starting vancomycin
Answer: C
Explanation: Vancomycin is nephrotoxic, and ACA standards require assessing renal function (e.g.,
creatinine) before initiation to adjust dosing and prevent toxicity, especially in high-risk patients like IV
drug users. Trough levels guide maintenance, red man syndrome is infusion-related, and delaying
antibiotics risks worsening endocarditis.
Question: 647
A 65-year-old male inmate presents with worsening dyspnea and a history of smoking. His spirometry
shows an FEV1/FVC ratio of 55%. Which diagnosis is most consistent with these findings?
A. Asthma
B. Restrictive lung disease
C. Interstitial lung disease
D. Chronic obstructive pulmonary disease (COPD)
Answer: D
Explanation: An FEV1/FVC ratio of less than 70% indicates obstructive lung disease, with COPD being
the most likely diagnosis given the patient�s smoking history.
Question: 648
A 33-year-old male inmate presents with agitation, diaphoresis, and dilated pupils 48 hours after last
using cocaine. His vital signs are BP 150/90 mmHg, HR 100 bpm, and temp 99.6�F. The facility
protocol for stimulant withdrawal emphasizes supportive care. Which intervention is most appropriate to
manage his symptoms?
A. Provide hydration and monitor for depression
B. Initiate propranolol 20 mg PO to control tachycardia
C. Administer haloperidol 2 mg IM for agitation
D. Administer lorazepam 1 mg PO to reduce agitation
Answer: A
Explanation: Cocaine withdrawal typically involves agitation followed by depression and fatigue.
Supportive care with hydration and monitoring for mood changes is appropriate, as symptoms are self-
limiting. Benzodiazepines or antipsychotics are not routinely needed, and beta-blockers are
contraindicated due to potential cardiovascular risks.
Question: 649
A 47-year-old female inmate with chronic hepatitis C virus (HCV) genotype 1a infection is evaluated for
treatment in a correctional facility. Her liver function tests show ALT 80 U/L, AST 65 U/L, and a FIB-4
score of 1.8, indicating moderate fibrosis. She has no history of decompensated cirrhosis. The facility�s
formulary includes sofosbuvir/velpatasvir and glecaprevir/pibrentasvir. According to AASLD/IDSA
guidelines, which of the following is the most appropriate treatment regimen for this patient?
A. Sofosbuvir/velpatasvir 400/100 mg daily for 12 weeks
B. Sofosbuvir/velpatasvir 400/100 mg daily for 8 weeks
C. Glecaprevir/pibrentasvir 300/120 mg daily for 8 weeks
D. Glecaprevir/pibrentasvir 300/120 mg daily for 12 weeks
Answer: C
Explanation: For HCV genotype 1a with moderate fibrosis (FIB-4 1.8), AASLD/IDSA guidelines
recommend glecaprevir/pibrentasvir for 8 weeks in treatment-na�ve patients without cirrhosis, as it is
highly effective and shorter, improving adherence in corrections. Sofosbuvir/velpatasvir for 12 weeks is
also effective but longer. The 8-week sofosbuvir/velpatasvir regimen is not standard, and 12-week
glecaprevir/pibrentasvir is unnecessary.
Question: 650
A 30-year-old male inmate is restrained during a use-of-force incident involving a taser. He is brought to
the infirmary with a small burn mark on his chest and reports chest pain. EKG shows sinus rhythm, and
troponin is <0.01 ng/mL. The facility�s protocol requires a post-taser medical evaluation. What is the
most appropriate documentation and management to ensure ACA compliance?
A. Administer lidocaine cream and reassess in 12 hours
B. Order a chest X-ray and complete a use-of-force injury report
C. Clean the burn, monitor for 24 hours, and document findings
D. Perform an echocardiogram and notify the supervisor
Answer: C
Explanation: ACA standards mandate medical evaluation and documentation after taser use to rule out
serious injury. The burn requires cleaning, and chest pain with normal EKG/troponin suggests no cardiac
injury, warranting observation. A detailed injury report is required. Chest X-ray or echocardiogram is
unnecessary without clinical indications, and lidocaine cream is not indicated for minor burns.
Question: 651
A 67-year-old female inmate with a history of hypertension and diabetes has been complaining of
shortness of breath. Her vitals show a BP of 160/90 mmHg and a respiratory rate of 28 breaths per
minute. Which of the following guidelines should be prioritized in her management plan?
A. Monitor for signs of heart failure and adjust antihypertensive medication.
B. Administer bronchodilators for COPD management.
C. Initiate insulin therapy immediately.
D. Schedule her for a gynecological exam.
Answer: A
Explanation: In this scenario, monitoring for signs of heart failure is critical due to the patient�s
hypertension, diabetes, and respiratory distress, indicating potential cardiovascular complications.
Question: 652
A 35-year-old male inmate with a history of IV drug use presents with fever, chills, and a heart murmur.
An echocardiogram reveals a 1.5 cm vegetation on the mitral valve, and blood cultures grow
Staphylococcus aureus. The facility�s protocol restricts IV antibiotics due to security concerns about
infusion lines. How should you advocate for his care?
A. Administer oral antibiotics and monitor in the facility to comply with protocol.
B. Coordinate with security and infectious disease certified for secure IV antibiotic administration.
C. Request a hospital transfer for surgical evaluation before starting antibiotics.
D. Document the findings and delay treatment until security protocols are revised.
Answer: B
Explanation: Infective endocarditis with S. aureus requires IV antibiotics for 4�6 weeks to prevent
mortality. Coordinating with security and certified ensures safe administration within the facility,
balancing clinical and security needs. Oral antibiotics are inadequate, surgical evaluation is premature,
and delaying treatment risks sepsis.
Question: 653
A 27-year-old female inmate with opioid use disorder is prescribed buprenorphine/naloxone 8 mg/2 mg
daily. She reports taking an extra dose from another inmate, resulting in sedation and slurred speech. Her
respiratory rate is 10/min, and oxygen saturation is 92%. What is the most appropriate immediate
intervention?
A. Intubate the patient to secure the airway
B. Provide oxygen via nasal cannula and observe for 4 hours
C. Administer flumazenil 0.2 mg IV to reverse sedation
D. Administer naloxone 0.4 mg IV and monitor respiratory status
Answer: D
Explanation: Extra buprenorphine can cause respiratory depression, especially in combination with other
substances. Naloxone reverses opioid-induced sedation and hypoventilation. Oxygen is supportive but
insufficient, flumazenil is for benzodiazepines, and intubation is premature without further deterioration.
Question: 654
A 46-year-old male inmate with COPD presents with increased dyspnea and productive cough. His SpO2
is 88%, and arterial blood gas shows pH 7.38, pCO2 50 mmHg, and HCO3 28 mEq/L. Chest X-ray is
clear. The facility has albuterol, ipratropium, and prednisone available. What is the most appropriate
treatment?
A. Administer albuterol and ipratropium via nebulizer and start prednisone
B. Administer oxygen at 2 L/min and monitor SpO2
C. Start prednisone 40 mg daily and recheck ABG
D. Administer albuterol via inhaler and refer to pulmonology
Answer: A
Explanation: The patient�s symptoms and ABG findings (chronic CO2 retention with compensated
respiratory acidosis) indicate a COPD exacerbation. Nebulized albuterol and ipratropium provide
bronchodilation, and prednisone reduces inflammation. Oxygen alone does not address the exacerbation,
prednisone without bronchodilators is incomplete, and referral is unnecessary as treatment can be
initiated in the facility.
Question: 655
A 35-year-old male with a history of opioid use disorder is stabilized on a buprenorphine regimen. He
expresses interest in transitioning to naltrexone. Which factor must be confirmed before this transition
can occur?
A. The patient must have a CIWA score of less than 5
B. The patient should have no history of seizures
C. The patient must be opioid-free for at least 3 days
D. The patient should have completed a detox program
Answer: C
Explanation: The patient must be opioid-free for an appropriate duration (usually 7-10 days) to avoid
precipitating withdrawal symptoms when starting naltrexone.
Question: 656
A correctional facility is revising its PREA-compliant sexual assault response protocol. A nurse suggests
including a time limit for forensic evidence collection. Based on the latest PREA standards and forensic
guidelines, what is the recommended timeframe for collecting evidence post-assault?
A. Within 72 hours for optimal evidence recovery
B. Within 24 hours to ensure DNA viability
C. Within 120 hours per national forensic standards
D. Within 7 days for trace evidence detection
Answer: A
Explanation: PREA aligns with national forensic guidelines recommending forensic evidence collection
within 72 hours post-sexual assault to maximize DNA and trace evidence recovery. Beyond 72 hours,
evidence degrades significantly. The 24-hour limit is too restrictive, 120 hours is extended but less
reliable, and 7 days is excessive.
Question: 657
According to the Prison Rape Elimination Act (PREA), which of the following is a mandated
requirement for staff when an inmate reports a sexual assault?
A. Document the inmate's statement without further action
B. Report the incident to the facility's medical staff only
C. Conduct a personal interview with the inmate in private
D. Ensure the inmate is separated from the alleged perpetrator only
Answer: C
Explanation: PREA mandates that reports of sexual assault be taken seriously, requiring staff to conduct a
thorough and private interview with the inmate to gather detailed information, ensuring the inmate's
safety and the integrity of the investigation.
Question: 658
When assessing an inmate with a history of chronic obstructive pulmonary disease (COPD), the nurse
notes a SpO2 practicing of 88%. What should be the nurse's immediate intervention based on the patient's
condition?
A. Notify the physician for potential intubation
B. Document the finding and reassess in one hour
C. Encourage the patient to perform deep breathing exercises
D. Administer supplemental oxygen as per protocol
Answer: D
Explanation: Administering supplemental oxygen is a critical intervention to address hypoxia and
improve oxygen saturation levels in a patient with COPD.
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