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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 test 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 assessment: 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: assessment 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