Certified Nephrology Nurse (CNN) Exam Review

The Certified Nephrology Nurse (CNN) is a healthcare professional who has attained specialized education, along with meeting the certification requirements, to provide care to the patient with renal disease. This includes monitoring patients with acute and chronic kidney disease as well as providing education to the patient and their families or caregivers regarding their disease.

In order to take the Certified Nephrology Nurse Exam, the applicant must be a licensed Registered Nurse with a Bachelor's Degree or Master's Degree. At least 50% of the RN's job responsibilities should involve providing direct patient care to patients who suffer from renal disease. In addition, at least 30 contact hours in nephrology should have been completed over the past 3 years.

CNN exams are scheduled in various cities and states throughout the country and are hosted by local chapters of the American Nephrology Nurses' Association (ANNA). The CNN exam costs $250 the first time it is taken, but the price is reduced to $125 if it is taken a second time. ANNA members pay a discounted fee of $200 for the initial exam sitting and $100 if the CNN exam is repeated a second time.

Approximately one-third of the exam tests the RN's knowledge of hemodialysis. The physiology of renal failure makes up approximately one-third of the exam, with concepts in peritoneal dialysis and renal transplant making up the rest of the exam. The CNN exam contains 200 questions total.

The Certified Nephrology Nurse certification is valid for 3 years. In order to renew the certification, the RN must have completed at least 1,000 hours, at least one-half of their employment hours, in providing direct patient care to renal patients over the previous 3 years. In addition, at least 45 continuing education hours focused on nephrology care should be completed. Alternatively, the RN may retake the CNN examination instead of maintaining the continuing education hours. The cost for renewal of the Certified Nephrology Nurse certification is $200 for ANNA members and $225 for non-members.

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Certified Nephrology Nurse (CNN) Practice Questions

1. Diabetic nephropathy results from an elevation of blood pressure, increasing the workload of the glomeruli. The glomeruli thicken and allow serum albumin to pass into the urine. Which of the following signs and symptoms indicate diabetic nephropathy?

  1. Edema around the eyes upon awakening, progressing to general swelling of the legs and body
  2. Weight gain, malaise, fatigue, and frothy urine
  3. Rust-colored urine, weight loss, and back pain
  4. A and C
  5. A and B

2. What steps need to be taken to diagnose and eliminate the problem of dialysate leakage during peritoneal dialysis?

  1. Use a Dextrostick to ascertain the presence of glucose.
  2. Resuture the exit site, and stabilize or replace the catheter.
  3. LDiscontinue peritoneal dialysis to allow for healing, or decrease the infusion time with the patient lying on the left side.
  4. Both A and B are true.
  5. Both B and C are true.

3. Certain precautions must be followed when performing dialysis on a recent transplant recipient. All of the following statements regarding dialysis for the post-transplant patient are true EXCEPT:

  1. Close observation is necessary for hypotension because of the risk of internal bleeding in first 24 hours postsurgery; a physician must be alerted if hypotension occurs.
  2. Hypotension must be avoided to prevent ischemia of the newly transplanted kidney, even if fluid removal during dialysis is compromised.
  3. High-dose heparin must be used to prevent postoperative clotting;
  4. Observation is necessary for electrolyte imbalance, especially hyperkalemia.

4. A patient is admitted with the following signs and symptoms: edema around the eyes upon awakening, progressing to general swelling of the legs and body; weight gain; fatigue; headache; nausea; vomiting; frequent hiccoughs; and itching. A urine specimen is obtained, and the urine is frothy. The patient has a history of insulin-dependent diabetes (type 1 diabetes), which is poorly controlled, and high blood pressure, and his blood work comes back showing an elevated cholesterol level. Which of the following disease processes would you suspect?

  1. Nephrosclerosis
  2. Diabetic nephropathy
  3. Polycystic kidney disease
  4. Amyloidosis

5. Damaged kidneys lose their ability to produce erythropoietin, a hormone that stimulates the formation of red blood cells. What is usually prescribed to stimulate erythropoiesis in patients with chronic kidney disease?

  1. Epoetin alfa (Epogen, Procrit)
  2. Cinacalcet HCl (Sensipar)
  3. Furosemide (Lasix) or bumetanide (Bumex)
  4. Sevelamer hydrochloride (Renagel)

Certified Nephrology Nurse (CNN) Answer Key

1. Answer: E

Symptoms and signs of diabetic nephropathy include edema around the eyes upon awakening, progressing to general swelling of the legs and body, weight gain, frothy urine, malaise, fatigue, nausea and vomiting, headache, hiccoughs, and pruritus. Serum creatinine and blood urea nitrogen levels elevate at this stage. The additional diagnosis of retinopathy may be evident.

2. Answer: D

Steps that need to be taken include: (1) use a Dextrostick to ascertain the presence of glucose, (2) resuture the exit site, (3) discontinue peritoneal dialysis for a minimum of 2 weeks to allow healing, (3) if unable to stop therapy, decrease volume with automated peritoneal dialysis in supine position; and (4) stabilize or replace the catheter.

3. Answer: C

The main precautions that must be followed when performing dialysis on a recent transplant recipient are:

(1) Observe for hypotension as a result of the risk of internal bleeding in first 24 hours postsurgery, and then alert the physician if hypotension occurs. (2) Avoid hypotension to prevent ischemia of the newly transplanted kidney, even if fluid removal during dialysis is compromised. (3) Maintain the integrity of the surgical incision site. (4) Use heparin-free or minimal anticoagulation therapy for newly postoperative patients and for those who have had a percutaneous renal biopsy. (5) Observe for an electrolyte imbalance, especially hyperkalemia.

4. Answer: B

Diabetic nephropathy is the most common cause of chronic kidney disease in Western countries. It affects insulin-dependent diabetics, or type 1 diabetes, and non-insulin dependent diabetics, or type 2 diabetes. Those with poorly controlled blood sugar levels, uncontrolled high blood pressure, and elevated cholesterol levels are at highest risk. This disease process involves an increase in the blood flow to the kidney, caused by hyperglycemia. This results in an elevation of blood pressure, increasing the workload of the glomeruli. The glomeruli thicken and allow serum albumin to pass into the urine (albuminuria). This sign is detectable only by medical testing and begins several years before symptoms are apparent. At this stage, kidney biopsy confirms the diagnosis. Nephrosclerosis is the hardening of the arterioles of the kidneys caused by uncontrolled high blood pressure. Polycystic kidney disease is a genetic disorder in which fluid-filled cysts replace normal healthy kidney tissue. Amyloidosis refers to a condition in which proteins (amyloid proteins) have been altered and become insoluble, then deposit in various organs.

5. Answer: A

Recombinant human erythropoietin, or epoetin alfa, (Epogen, Procrit) is used to stimulate red blood cell production in patients with end state renal disease. Cinacalcet HCl (Senispar) is a drug used for lowering the level of parathyroid in the blood. Furosemide (Lasix) and bumetanide (Bumex) are commonly used diuretics. Sevelamer hydrochloride (Renagel) is one of the latest drugs used for phosphate-binding.

Certified Nephrology Nurse Exam Blueprint and Breakdown

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Last Updated: 04/18/2018


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