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CNN-NP test Format | CNN-NP Course Contents | CNN-NP Course Outline | CNN-NP test Syllabus | CNN-NP test Objectives

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 specialists (e.g.- vascular surgeons- transplant coordinators)

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