CERTIFIED NEPHROLOGY NURSE EXAM – PRACTICE QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
• Concepts of Renal Disease• Hemodialysis• Peritoneal Dialysis• Transplant and Alternative Therapies• Acute
Kidney Injury and Critical Care• Pharmacology and Nutrition• Quality Improvement and Safety• Professional
Practice and Standards
Introduction
The purpose of this comprehensive assessment is to evaluate the competency and clinical readiness of nurses
seeking certification in nephrology nursing. This exam covers a wide breadth of skills, ranging from the
physiological foundations of renal disease to the complex management of dialysis modalities and transplant
care. The structure utilizes multiple-choice questions, many of which are scenario-based to simulate clinical
encounters. There is a strong emphasis on real-world application, critical thinking, and ethical decision-making.
By testing knowledge of regulatory compliance and evidence-based practice, this assessment ensures that
candidates possess the specialized expertise required to provide high-quality care to patients with kidney
disease.
Section One: Questions 1–100
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a serum potassium level of 6.2
mEq/L. Which of the following ECG changes is the most likely initial finding?
A. Prominent U waves
B. ST-segment elevation
C. Peaked T waves
D. Prolonged QT interval
🟢 Correct answer: C. Peaked T waves
🔴 RATIONALE: Hyperkalemia, common in advanced CKD, typically manifests on an ECG as tall, peaked T
,waves initially. As potassium levels continue to rise, further changes such as PR prolongation and QRS
widening may occur.
2. During a hemodialysis session, a patient complains of sudden shortness of breath and chest pain. The
nurse notes the patient is cyanotic and hears a "mill-wheel" murmur over the precordium. What is the
priority nursing action?
A. Increase the blood flow rate
B. Place the patient in Trendelenburg position on the left side
C. Administer a bolus of normal saline
D. Administer sublingual nitroglycerin
🟢 Correct answer: B. Place the patient in Trendelenburg position on the left side
🔴 RATIONALE: The symptoms and "mill-wheel" murmur suggest an air embolism. Positioning the patient on
the left side in Trendelenburg helps trap the air in the apex of the right ventricle, preventing it from entering the
pulmonary artery.
3. Which of the following is the primary mechanism of solute removal during the process of hemodialysis?
A. Ultrafiltration
B. Convection
C. Diffusion
D. Osmosis
🟢 Correct answer: C. Diffusion
🔴 RATIONALE: Diffusion is the primary mechanism for removing metabolic waste products (solutes) in
hemodialysis. It involves the movement of solutes from an area of higher concentration (blood) to an area of
lower concentration (dialysate) across a semipermeable membrane.
4. A peritoneal dialysis patient presents with cloudy effluent and abdominal pain. Which of the following is the
most definitive diagnostic test for peritonitis in this setting?
,A. Abdominal X-ray
B. Serum white blood cell count
C. Effluent cell count with differential
D. Stool culture
🟢 Correct answer: C. Effluent cell count with differential
🔴 RATIONALE: Peritonitis is diagnosed in PD patients when the effluent cell count is greater than 100/mm³
with at least 50% polymorphonuclear neutrophils. Cloudy fluid is an early clinical sign, but the cell count
provides diagnostic confirmation.
5. In the context of renal osteodystrophy, what is the primary goal of administering phosphate binders?
A. To increase serum calcium levels directly
B. To prevent the absorption of dietary phosphorus in the gut
C. To stimulate the production of active Vitamin D
D. To lower parathyroid hormone levels by increasing renal excretion
🟢 Correct answer: B. To prevent the absorption of dietary phosphorus in the gut
🔴 RATIONALE: Phosphate binders are taken with meals to bind phosphorus in the gastrointestinal tract,
preventing its absorption into the bloodstream. This helps manage hyperphosphatemia, which is a major driver
of secondary hyperparathyroidism.
6. Which medication is considered the gold standard for treating anemia of chronic kidney disease by
stimulating erythropoiesis?
A. Ferrous sulfate
B. Epoetin alfa
C. Cyanocobalamin
D. Folic acid
🟢 Correct answer: B. Epoetin alfa
🔴 RATIONALE: Epoetin alfa is an erythropoiesis-stimulating agent (ESA) that mimics the function of
, endogenous erythropoietin, which the kidneys fail to produce sufficiently in CKD. Iron and vitamins are
supportive, but ESAs directly stimulate red blood cell production.
7. A patient with an arteriovenous (AV) fistula is taught to "feel the thrill." What does this clinical sign
represent?
A. The sound of blood rushing through the vessel
B. The vibration of blood flow through the access
C. The pressure of the arterial needle insertion
D. The pulse rate within the fistula
🟢 Correct answer: B. The vibration of blood flow through the access
🔴 RATIONALE: A "thrill" is the palpable vibration caused by the turbulent blood flow through a patent AV
access. Assessing for a thrill is a critical daily step for patients to ensure their access has not clotted.
8. According to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, which GFR range
defines Stage 3b Chronic Kidney Disease?
A. 60–89 mL/min
B. 45–59 mL/min
C. 30–44 mL/min
D. 15–29 mL/min
🟢 Correct answer: C. 30–44 mL/min
🔴 RATIONALE: Stage 3 CKD is divided into 3a (GFR 45–59) and 3b (GFR 30–44). This stage represents
moderate to severe decrease in GFR and requires close monitoring for complications.
9. What is the most common cause of death in patients receiving chronic dialysis?
A. Infection/Sepsis
B. Malignancy
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
• Concepts of Renal Disease• Hemodialysis• Peritoneal Dialysis• Transplant and Alternative Therapies• Acute
Kidney Injury and Critical Care• Pharmacology and Nutrition• Quality Improvement and Safety• Professional
Practice and Standards
Introduction
The purpose of this comprehensive assessment is to evaluate the competency and clinical readiness of nurses
seeking certification in nephrology nursing. This exam covers a wide breadth of skills, ranging from the
physiological foundations of renal disease to the complex management of dialysis modalities and transplant
care. The structure utilizes multiple-choice questions, many of which are scenario-based to simulate clinical
encounters. There is a strong emphasis on real-world application, critical thinking, and ethical decision-making.
By testing knowledge of regulatory compliance and evidence-based practice, this assessment ensures that
candidates possess the specialized expertise required to provide high-quality care to patients with kidney
disease.
Section One: Questions 1–100
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a serum potassium level of 6.2
mEq/L. Which of the following ECG changes is the most likely initial finding?
A. Prominent U waves
B. ST-segment elevation
C. Peaked T waves
D. Prolonged QT interval
🟢 Correct answer: C. Peaked T waves
🔴 RATIONALE: Hyperkalemia, common in advanced CKD, typically manifests on an ECG as tall, peaked T
,waves initially. As potassium levels continue to rise, further changes such as PR prolongation and QRS
widening may occur.
2. During a hemodialysis session, a patient complains of sudden shortness of breath and chest pain. The
nurse notes the patient is cyanotic and hears a "mill-wheel" murmur over the precordium. What is the
priority nursing action?
A. Increase the blood flow rate
B. Place the patient in Trendelenburg position on the left side
C. Administer a bolus of normal saline
D. Administer sublingual nitroglycerin
🟢 Correct answer: B. Place the patient in Trendelenburg position on the left side
🔴 RATIONALE: The symptoms and "mill-wheel" murmur suggest an air embolism. Positioning the patient on
the left side in Trendelenburg helps trap the air in the apex of the right ventricle, preventing it from entering the
pulmonary artery.
3. Which of the following is the primary mechanism of solute removal during the process of hemodialysis?
A. Ultrafiltration
B. Convection
C. Diffusion
D. Osmosis
🟢 Correct answer: C. Diffusion
🔴 RATIONALE: Diffusion is the primary mechanism for removing metabolic waste products (solutes) in
hemodialysis. It involves the movement of solutes from an area of higher concentration (blood) to an area of
lower concentration (dialysate) across a semipermeable membrane.
4. A peritoneal dialysis patient presents with cloudy effluent and abdominal pain. Which of the following is the
most definitive diagnostic test for peritonitis in this setting?
,A. Abdominal X-ray
B. Serum white blood cell count
C. Effluent cell count with differential
D. Stool culture
🟢 Correct answer: C. Effluent cell count with differential
🔴 RATIONALE: Peritonitis is diagnosed in PD patients when the effluent cell count is greater than 100/mm³
with at least 50% polymorphonuclear neutrophils. Cloudy fluid is an early clinical sign, but the cell count
provides diagnostic confirmation.
5. In the context of renal osteodystrophy, what is the primary goal of administering phosphate binders?
A. To increase serum calcium levels directly
B. To prevent the absorption of dietary phosphorus in the gut
C. To stimulate the production of active Vitamin D
D. To lower parathyroid hormone levels by increasing renal excretion
🟢 Correct answer: B. To prevent the absorption of dietary phosphorus in the gut
🔴 RATIONALE: Phosphate binders are taken with meals to bind phosphorus in the gastrointestinal tract,
preventing its absorption into the bloodstream. This helps manage hyperphosphatemia, which is a major driver
of secondary hyperparathyroidism.
6. Which medication is considered the gold standard for treating anemia of chronic kidney disease by
stimulating erythropoiesis?
A. Ferrous sulfate
B. Epoetin alfa
C. Cyanocobalamin
D. Folic acid
🟢 Correct answer: B. Epoetin alfa
🔴 RATIONALE: Epoetin alfa is an erythropoiesis-stimulating agent (ESA) that mimics the function of
, endogenous erythropoietin, which the kidneys fail to produce sufficiently in CKD. Iron and vitamins are
supportive, but ESAs directly stimulate red blood cell production.
7. A patient with an arteriovenous (AV) fistula is taught to "feel the thrill." What does this clinical sign
represent?
A. The sound of blood rushing through the vessel
B. The vibration of blood flow through the access
C. The pressure of the arterial needle insertion
D. The pulse rate within the fistula
🟢 Correct answer: B. The vibration of blood flow through the access
🔴 RATIONALE: A "thrill" is the palpable vibration caused by the turbulent blood flow through a patent AV
access. Assessing for a thrill is a critical daily step for patients to ensure their access has not clotted.
8. According to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, which GFR range
defines Stage 3b Chronic Kidney Disease?
A. 60–89 mL/min
B. 45–59 mL/min
C. 30–44 mL/min
D. 15–29 mL/min
🟢 Correct answer: C. 30–44 mL/min
🔴 RATIONALE: Stage 3 CKD is divided into 3a (GFR 45–59) and 3b (GFR 30–44). This stage represents
moderate to severe decrease in GFR and requires close monitoring for complications.
9. What is the most common cause of death in patients receiving chronic dialysis?
A. Infection/Sepsis
B. Malignancy
