Certified Nephrology Nurse Flashcards

38-year-old Mike Smith, a man with diabetes mellitus, has been receiving hemodialysis for two years. The partner of Mike Smith reports that he has become more aloof and uninterested, napping for most of the day. Question: To manage his depression, Mike Smith has begun taking fluoxetine 20 mg daily, an SSRI. The patient claims no improvement after two weeks. The patient needs to be informed that:

Answer: Four to six weeks are needed to evaluate response

Selective Serotonin Reuptake Inhibitors (SSRIs) typically require a period of 4 to 6 weeks, and sometimes longer, to reach their full therapeutic effect. It is common for patients not to experience significant improvement in depressive symptoms after only two weeks of treatment. Informing the patient about this expected timeframe for medication efficacy is crucial for managing expectations and ensuring adherence.

Which non-pharmaceutical treatments may be most effective for the patient if they continue to have persistent episodes of depression while taking an SSRI for three months?

Answer: Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is a highly effective non-pharmacological treatment for persistent depression, often used in conjunction with or as an alternative to medication. CBT helps patients identify and change negative thought patterns and behaviors that contribute to depression. It is a well-established, evidence-based therapy for managing depressive episodes.

One hemodialysis patient may respond to difficulty with little outward stress and cope well. In contrast, another, like Mike Smith, may react to the same issue with intense tension and worry and have difficulty coping. This could be due to the individuals' different coping mechanisms.

Answer: Resilience

Resilience refers to an individual's ability to adapt well and recover quickly from difficulties, stress, or adversity. The scenario describes two individuals reacting differently to the same issue, with one coping well and the other struggling, which directly illustrates varying levels of resilience in their coping mechanisms. It encompasses the capacity to bounce back from challenging experiences.

Despite the adverse bodily reaction, Mike Smith has recently started skipping treatments and refusing to take recommended drugs. When questioned, the patient smiles and says he is alright but was "busy" and "forgot" about the treatments. The nurse should think about

Answer: Suicidal ideation

In a patient with chronic illness and depression, non-adherence to life-sustaining treatments and medication, coupled with a dismissive attitude, can be a significant indicator of suicidal ideation. This behavior might signal a passive desire to end life or a lack of will to live, rather than simple forgetfulness. Nurses should prioritize assessing for suicidal thoughts in such situations to ensure patient safety.

According to him, one of Mr Adler's main concerns is that he can no longer perform a full-time job but is not qualified for Medicaid. The patient worries that he will be unable to afford his insurance. The entity that might offer financial support is the

Answer: American Kidney Fund

The American Kidney Fund (AKF) is a national non-profit organization specifically dedicated to providing financial assistance to kidney patients. This includes help with health insurance premiums, co-pays, and other medical expenses. Given Mr. Adler's concerns about affording insurance due to kidney-related issues, the AKF is the most relevant and direct source of financial support.

Sanda Miller, a 46-year-old woman, underwent CAPD after developing chronic glomerulonephritis-related kidney failure. Question: A catheter-related mass has grown on Ms. Miller's body. The most frequent way to tell a hernia apart from a hematoma or seroma is to

Answer: Examine with an ultrasound

An ultrasound is the most effective and non-invasive diagnostic tool to differentiate between a hernia, hematoma, or seroma in a CAPD patient. Ultrasound imaging can clearly visualize internal structures, identify the presence of bowel loops (indicating a hernia), or fluid collections (seroma/hematoma), and assess their characteristics, providing a definitive diagnosis without more invasive procedures.

Martha Cage, a 46-year-old woman, underwent CAPD after developing chronic glomerulonephritis-related kidney failure. Question: Ms Cage undergoes contrast-associated CT after it is revealed that she has a hernia. The patient's peritoneal cavity is filled with 2 L of dialysate that contains 100 mL of the contrast agent (Omnipaque 300). The patient should follow up after installation.

Answer: Walk about or remain active for 2 hours and then have the CT

After instilling a contrast agent into the peritoneal cavity for a CT scan, it is recommended for the patient to ambulate or remain active for a period, typically 1-2 hours, before the scan. This activity helps to evenly distribute the contrast agent throughout the peritoneal cavity, improving the quality and diagnostic accuracy of the CT images for detecting a hernia by ensuring optimal visualization.