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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