FREE Certified Nephrology Nurse Questions and Answers
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
Explanation:
The American Kidney Fund helps dialysis patients with financial needs through several programs.
-Grants Management System (GMS): Patients can apply directly for grants.
-Health Insurance Premium Program (HIPP): Assists with Medicare Part B, Medigap, COBRA, and other insurance premiums.
-Safety Net Grants: Assists with treatment-related expenses not covered by insurance.
-Sanofi Renal/Genzyme Patient Assistance Programs: Provides Renvela® and IV formulations of Hectorol® for those without prescription drug coverage.
-Prescription Drug Resources: Provides lists of drug companies with special programs and resources for those without prescription drug coverage.
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?
Explanation:
The non-pharmaceutical therapy that may be most effective in assisting the patient in coping if a patient on hemodialysis experiences regular periods of depression despite taking an SSRI is cognitive-behavioural therapy. CBT teaches patients techniques to replace negative thoughts with positive ones to improve how they think about things. The ability to identify automatic thoughts (cognitive distortions) such as all-or-nothing thinking, catastrophizing, "mind reading," and personalization is taught to patients. Treatment is typically only temporary (5 to 20 sessions).
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:
Explanation:
The patient should be informed that four to six weeks are required to assess response if an SSRI (fluoxetine 20 mg daily) prescribed for depression in a patient with ESKD and hemodialysis does not improve after two weeks. Tricyclic antidepressants are generally avoided due to their higher risk of side effects. Depression harms the quality of life and raises the dangers of morbidity and immorality. Patients with chronic renal disease frequently experience depression, and hemodialysis often worsens.
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.
Explanation:
Two litres of dialysate containing the contrast material (often Omnipaque 300) are injected into the peritoneal cavity if a patient has to have a contrast-associated CT to help show the extent of the hernia. The patient should be instructed to walk around or be active for two hours after installation. This encourages the dye to travel freely inside the peritoneal cavity and into the hernia. The hernia's location will determine if a CT scan is always required. For instance, an examination may reveal the full extent of an umbilical hernia.
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
Explanation:
Ultrasonography, which can reveal if a catheterized mass is fluid-filled, is the most common way to tell a hernia apart from a hematoma or seroma in patients who have developed such a mass. The ultrasound is non-invasive and reasonably priced. Up to 20% of individuals using peritoneal dialysis develop one or more hernias, including ventral, perineal, umbilical, inguinal, and femoral hernias. High-volume dialysate use, sitting, performing the Valsalva maneuver, obesity, and multiparity are risk factors.
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
Explanation:
The nurse should take suicidal ideation into account if a patient on hemodialysis with a history of ongoing depression has recently started skipping treatments and failing to take prescribed medications, despite adverse physical reactions, and the patient appears cheerful and insists he is fine but "busy" and "forgot" about the treatments. Hemodialysis patients risk their lives by skipping appointments and prescriptions, and doing so offers a quick way to commit suicide. Patients occasionally act happier or even upbeat once they have decided to kill themselves.
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.
Explanation:
One hemodialysis patient may cope well with a complication, whereas another response to the same issue with significant stress and worry and manages poorly. This may be due to the individuals' varying levels of resilience. The capacity for stability is the capacity to react to demanding circumstances positively and healthily—a patient who is resilient enough to handle things properly. Strength is frequently linked to an optimistic mindset, supportive families, and spirituality.