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Exam Code: CNN

Exam Name: Certified Nephrology Nurse

Exam Type: Computer-based- multiple-choice questions.

Number of Questions: 150 scored questions + 25 unscored pretest questions.

Time Allotted: 3 hours (180 minutes).

Passing Score: Scaled score of 70 (on a 0-100 scale).



The Certified Nephrology Nurse (CNN) exam- administered by the Nephrology Nursing Certification Commission (NNCC)- assesses a registered nurses expertise in nephrology nursing across multiple domains. The exam consists of 150 questions- covering five key content areas- each with a specific percentage of the total test. Below is a detailed breakdown of the domains- their associated topics- and relevant terminologies based on the most current information available from the NNCC and other reliable sources.



1. Concepts of Kidney Disease (35%)



- Normal Kidney Function:

- Anatomy and physiology of the kidneys (e.g.- nephron structure- glomerular filtration- tubular reabsorption- and secretion).

- Regulation of fluid- electrolyte- and acid-base balance.

- Role of kidneys in blood pressure regulation (renin-angiotensin-aldosterone system- RAAS).



- Pathological Conditions and Complications:

- Chronic kidney disease (CKD): stages (1–5)- etiology (e.g.- diabetes- hypertension- glomerulonephritis)- and complications (e.g.- anemia- bone disease- cardiovascular issues).

- Acute kidney injury (AKI): causes (prerenal- intrarenal- postrenal)- diagnostic criteria (e.g.- RIFLE- AKIN)- and management.

- End-stage renal disease (ESRD): progression from CKD- symptoms- and preparation for renal replacement therapy.

- Diabetic nephropathy: pathophysiology- risk factors- and management.

- Polycystic kidney disease (PKD) and other genetic disorders.



- Monitoring Disease Progression:

- Laboratory values: glomerular filtration rate (GFR)- serum creatinine- blood urea nitrogen (BUN)- urine albumin-to-creatinine ratio.

- Diagnostic tests: renal ultrasound- kidney biopsy- and imaging studies.

- Residual kidney function preservation strategies (e.g.- dietary management- medication adjustments).



- Patient Management:

- Medication side effects: nephrotoxic drugs (e.g.- NSAIDs- aminoglycosides)- antihypertensive agents- and phosphate binders.

- Lifestyle interventions: dietary restrictions (e.g.- sodium- potassium- phosphorus)- fluid management- and smoking cessation.

- Patient education: self-management- symptom recognition- and adherence to treatment plans.



- Nephron

- glomerulus

- tubular reabsorption

- GFR

- RAAS

- CKD

- AKI

- ESRD

- azotemia

- uremia

- proteinuria

- hematuria

- oliguria

- anuria

- nephrotoxins

- hyperkalemia

- metabolic acidosis

- anemia of CKD

- mineral bone disorder (MBD)

- estimated GFR (eGFR).



2. Hemodialysis (30%)

This domain evaluates the nurses knowledge of hemodialysis principles- technical aspects- and patient care- including home dialysis and infection control.



- Physiological and Technical Principles:

- Principles of dialysis: diffusion- osmosis- ultrafiltration- and convection.

- Dialysis adequacy: Kt/V- urea reduction ratio (URR)- and target clearance goals.

- Dialyzer types: high-flux vs. low-flux- biocompatibility- and membrane characteristics.



- Water Treatment:

- Components of water treatment systems: reverse osmosis- deionization- and carbon filtration.

- Water quality standards: AAMI (Association for the Advancement of Medical Instrumentation) guidelines.

- Complications: endotoxemia- pyrogenic reactions- and chloramine exposure.



- Vascular Access:

- Types: arteriovenous fistula (AVF)- arteriovenous graft (AVG)- central venous catheter (CVC).

- Access care: cannulation techniques- monitoring for complications (e.g.- stenosis- thrombosis- infection).

- Maturation and exam: bruit- thrill- and Doppler studies.



- Infection Control:

- Protocols for preventing bloodstream infections and hepatitis transmission.

- Sterilization and disinfection of dialysis equipment.

- Isolation procedures for patients with infectious diseases (e.g.- MRSA- hepatitis B/C).



- Medication Administration:

- Common medications: erythropoiesis-stimulating agents (ESAs)- iron supplements- heparin- vitamin D analogs.

- Intradialytic medications: timing- dosing- and monitoring for side effects.



- Patient Care:

- Fluid volume status: exam of dry weight- interdialytic weight gain- and ultrafiltration goals.

- Complications: hypotension- cramping- dialyzer reactions- and air embolism.

- Home dialysis: patient training- equipment setup- and troubleshooting.



- Home Care Support:

- Caregiver education- remote monitoring- and emergency preparedness.

- Psychosocial support for patients transitioning to home dialysis.



- Hemodialysis

- Kt/V

- URR

- dialyzer

- ultrafiltration

- dry weight

- interdialytic weight gain

- AVF

- AVG

- CVC

- cannulation

- stenosis

- thrombosis

- endotoxemia

- AAMI standards

- ESAs

- heparin-induced thrombocytopenia

- dialyzer reaction

- vascular access infection

- intradialytic hypotension.



3. Peritoneal Dialysis (20%)

This domain assesses the nurses ability to manage and teach peritoneal dialysis (PD) therapy- including its complications and patient education.



- Principles of Peritoneal Dialysis:

- Mechanisms: diffusion and osmosis across the peritoneal membrane.

- Types: continuous ambulatory peritoneal dialysis (CAPD)- automated peritoneal dialysis (APD).

- Dialysate solutions: dextrose concentrations- calcium levels- and additives (e.g.- heparin- antibiotics).



- Catheter Management:

- PD catheter types: Tenckhoff catheter- placement techniques- and care.

- Exit-site care and infection prevention.

- Complications: catheter migration- blockage- and pericatheter leaks.



- Therapy Management:

- Dwell time- exchange schedules- and ultrafiltration goals.

- Monitoring dialysis adequacy: peritoneal equilibration test (PET)- Kt/V.

- Fluid balance: managing hypervolemia and hypovolemia.



- Complications:

- Peritonitis: diagnosis (cloudy effluent- abdominal pain)- treatment (intraperitoneal antibiotics)- and prevention.

- Other complications: hernias- encapsulating peritoneal sclerosis- and ultrafiltration failure.



- Patient Education:

- Training for CAPD/APD: sterile technique- exchange procedures- and troubleshooting.

- Lifestyle adaptations: dietary recommendations- activity restrictions- and travel planning.

- Recognizing signs of infection or complications.



- Peritoneal dialysis

- CAPD

- APD

- Tenckhoff catheter

- dwell time

- PET

- Kt/V

- peritonitis

- ultrafiltration failure

- encapsulating peritoneal sclerosis

- dialysate

- exit-site infection

- intraperitoneal antibiotics

- effluent

- hypervolemia

- hypovolemia.



4. Transplant (10%)

This domain covers the nursing care of kidney transplant recipients- including pre-transplant evaluation- post-transplant care- and immunosuppression management.



- Pre-Transplant Evaluation:

- Candidate selection: medical- psychosocial- and immunological criteria.

- Donor types: living-related- living-unrelated- deceased (brain-dead or donation after circulatory death).

- Compatibility testing: ABO blood typing- human leukocyte antigen (HLA) matching- crossmatching.



- Post-Transplant Care:

- Immediate post-operative care: monitoring for graft function- fluid balance- and surgical complications.

- Delayed graft function (DGF) and acute rejection: diagnosis and management.

- Long-term care: monitoring for chronic allograft nephropathy and cardiovascular risk.



- Immunosuppression:

- Medications: calcineurin inhibitors (e.g.- tacrolimus- cyclosporine)- antimetabolites (e.g.- mycophenolate)- corticosteroids.

- Side effects: nephrotoxicity- infection risk- and malignancy.

- Adherence strategies: patient education and monitoring drug levels.



- Complications:

- Rejection: hyperacute- acute- and chronic.

- Infections: cytomegalovirus (CMV)- BK virus- and opportunistic infections.

- Other: post-transplant diabetes- lymphoproliferative disorders- and graft loss.



- Patient Education:

- Medication adherence- infection prevention- and follow-up care.

- Lifestyle modifications: diet- exercise- and sun protection.



- Kidney transplant

- HLA matching

- crossmatching

- DGF

- acute rejection

- chronic allograft nephropathy

- calcineurin inhibitors

- immunosuppression

- CMV

- BK virus

- post-transplant diabetes

- graft survival

- living donor

- deceased donor

- ABO incompatibility.



5. Acute Therapies (5%)

This domain focuses on acute renal replacement therapies and apheresis- typically used in critical care or inpatient settings.



- Continuous Renal Replacement Therapy (CRRT):

- Modalities: continuous venovenous hemofiltration (CVVH)- hemodiafiltration (CVVHDF)- hemodialysis (CVVHD).

- Indications: AKI in critically ill patients- fluid overload- and severe electrolyte imbalances.

- Technical aspects: vascular access- anticoagulation (e.g.- citrate- heparin)- and circuit monitoring.

- Complications: bleeding- filter clotting- and hemodynamic instability.



- Sustained Low-Efficiency Dialysis (SLED):

- Hybrid therapy combining features of CRRT and intermittent hemodialysis.

- Indications and patient selection.

- Monitoring and troubleshooting.



- Apheresis:

- Types: plasmapheresis- therapeutic plasma exchange (TPE)- and leukapheresis.

- Indications: autoimmune disorders (e.g.- Goodpastures syndrome- myasthenia gravis)- transplant rejection- and thrombotic microangiopathies.

- Procedure: vascular access- replacement fluids- and monitoring for complications (e.g.- hypocalcemia- allergic reactions).



- Patient Care:

- Monitoring: vital signs- fluid balance- and laboratory values during therapy.

- Patient and family education: explaining procedures and expected outcomes.

- Psychosocial support: addressing anxiety and critical illness.



- CRRT

- CVVH

- CVVHDF

- CVVHD

- SLED

- apheresis

- plasmapheresis

- TPE

- citrate anticoagulation

- filter clotting

- hemodynamic instability

- thrombotic microangiopathy

- hypocalcemia

- replacement fluid

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