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Format: Computer-based testing (CBT) at PSI Testing Centers or paper-and-pencil testing (if requested).

Number of Questions: 175 multiple-choice questions.

Duration: 4 hours.

Passing Score: A standard score of 95, achieved by correctly answering at least 70% of the questions (approximately 123 questions)

1. Concepts of Kidney Disease (Approximately 10–14% of the Exam)

This section assesses foundational knowledge of renal anatomy, physiology, and pathophysiology, as well as the management of kidney disease.

Renal Anatomy and Physiology:

Structure and function of the kidneys (e.g., nephron, filtration, reabsorption, secretion)

Regulation of fluid, electrolyte, and acid-base balance

Hormonal functions of the kidney (e.g., erythropoietin, renin, vitamin D activation)

Pathophysiology of Kidney Diseases:

Acute冰: Acute kidney injury (AKI), chronic kidney disease (CKD), end-stage renal disease (ESRD)

Glomerular diseases (e.g., glomerulonephritis, nephrotic syndrome)

Tubulointerstitial diseases

Genetic disorders (e.g., polycystic kidney disease)

Secondary causes of kidney disease (e.g., diabetes, hypertension, autoimmune disorders)

Assessment and Diagnosis:

Clinical presentation of kidney diseases

Diagnostic tools (e.g., urinalysis, serum creatinine, glomerular filtration rate (GFR) estimation, imaging, biopsy)

Staging and classification of kidney disease (e.g., CKD stages 1–5)

Management Principles:

Non-dialytic management of CKD (e.g., dietary modifications, blood pressure control, glycemic control)

Patient education on disease progression and lifestyle modifications

2. Hemodialysis (Approximately 25–30% of the Exam)

This section focuses on the principles and management of hemodialysis, a common kidney replacement therapy.

Principles of Hemodialysis:

Dialysis process (e.g., diffusion, ultrafiltration)

Vascular access types (e.g., arteriovenous fistula, graft, catheter)

Dialyzer types and characteristics

Patient Management:

Pre-dialysis test (e.g., weight, vital signs, access evaluation)

Monitoring during dialysis (e.g., blood pressure, fluid removal, complications like hypotension or cramping)

Post-dialysis evaluation and follow-up

Complications and Interventions:

Access-related complications (e.g., infection, thrombosis, stenosis)

Dialysis-related complications (e.g., disequilibrium syndrome, amyloidosis)

Medication management (e.g., anticoagulants, erythropoiesis-stimulating agents)

Pharmacology:

Medications commonly used in hemodialysis patients (e.g., phosphate binders, calcimimetics, iron supplements)

Drug dosing adjustments for reduced renal function

3. Peritoneal Dialysis (Approximately 15–20% of the Exam)

This section covers the management of patients undergoing peritoneal dialysis, an alternative to hemodialysis.

Principles of Peritoneal Dialysis:

Types (e.g., continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD))

Peritoneal membrane characteristics and transport rates

Dialysate composition and dwell times

Patient Management:

Catheter placement and care

Training patients for home dialysis

Monitoring for adequacy (e.g., Kt/V, peritoneal equilibration test)

Complications and Interventions:

Infectious complications (e.g., peritonitis, exit-site infections)

Non-infectious complications (e.g., hernias, membrane failure)

Fluid and electrolyte imbalances

Pharmacology:

Antibiotics for peritonitis

Adjustments for peritoneal dialysis patients

4. Kidney Transplantation (Approximately 10–15% of the Exam)

This section evaluates knowledge of kidney transplantation processes and post-transplant care.

Pre-Transplant Evaluation:

Candidate selection and workup

Donor evaluation (living vs. deceased donors)

Immunologic considerations (e.g., HLA matching, crossmatching)

Transplant Procedure:

Surgical considerations

Immunosuppressive therapy initiation

Post-Transplant Management:

Monitoring for rejection (acute and chronic)

Immunosuppressive regimens (e.g., calcineurin inhibitors, corticosteroids, antimetabolites)

Complications (e.g., infection, malignancy, cardiovascular disease)

Long-term follow-up and graft survival

Pharmacology:

Immunosuppressants (e.g., tacrolimus, mycophenolate, prednisone)

Prophylactic medications (e.g., antivirals, antifungals)

5. Acute Therapies (Approximately 5–10% of the Exam)

This section addresses acute kidney injury and therapies used in critical care settings.

Acute Kidney Injury (AKI):

Causes (e.g., prerenal, intrinsic, postrenal)

Diagnostic evaluation (e.g., fractional excretion of sodium, ultrasound)

Management (e.g., fluid resuscitation, avoidance of nephrotoxins)

Continuous Renal Replacement Therapies (CRRT):

Modalities (e.g., continuous venovenous hemofiltration (CVVH), hemodiafiltration (CVVHDF))

Indications (e.g., AKI in critically ill patients, sepsis)

Anticoagulation strategies

Other Acute Therapies:

Plasmapheresis for renal-related conditions (e.g., glomerulonephritis, transplant rejection)

Management of electrolyte emergencies (e.g., hyperkalemia, hyponatremia)

6. Pharmacology (Integrated Across All Sections, Approximately 10–15%)

Pharmacology is a cross-cutting topic, with questions integrated into the above sections. Key areas include:

Medications for Kidney Disease:

Antihypertensives (e.g., ACE inhibitors, ARBs)

Diuretics

Phosphate binders, vitamin D analogs, and calcimimetics for mineral and bone disorders

Erythropoiesis-stimulating agents and iron therapy for anemia

Dosing Adjustments:

Adjustments for reduced renal clearance

Dialyzability of medications

Adverse Effects and Interactions:

Nephrotoxicity of drugs (e.g., NSAIDs, aminoglycosides)

Drug-drug interactions in patients with comorbidities

7. Professional Practice and Patient Education (Approximately 5–10%)

This section covers the nurse practitioners role in patient care and professional responsibilities.

Patient Education:

Teaching patients about disease processes, treatment options, and lifestyle modifications

Supporting adherence to dialysis schedules and medications

Providing resources for transplant preparation and follow-up

Ethical and Legal Considerations:

Informed consent for procedures

End-of-life care and advance directives in ESRD

Scope of practice for nephrology nurse practitioners

Collaboration:

Working with interdisciplinary teams (e.g., nephrologists, dietitians, social workers)

Referrals to certified (e.g., vascular surgeons, transplant coordinators)

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