CNN (NEPHROLOGY NURSE) – PRACTICE QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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CORE DOMAINS
Physiological Mechanisms of Kidney Disease
Hemodialysis Principles and Practice
Peritoneal Dialysis Management
Transplantation and Post-Operative Care
Chronic Kidney Disease (CKD) Stages and Education
Pharmacological Interventions in Nephrology
Pediatric and Geriatric Nephrology Considerations
Professional Practice, Ethics, and Regulatory Standards
INTRODUCTION
This comprehensive assessment is designed to evaluate the proficiency and clinical
readiness of nursing professionals seeking certification in nephrology. The exam
covers a broad spectrum of critical knowledge areas, including fluid and electrolyte
balance, dialysis modalities, and the management of comorbid conditions associated
,with renal failure. Candidates will encounter a mix of foundational theory, regulatory
compliance, and scenario-based questions that require advanced clinical judgment.
By emphasizing real-world application and decision-making, this exam ensures that
practitioners possess the specialized skills necessary to provide high-quality,
evidence-based care to patients across the continuum of kidney disease. Each
question is paired with a detailed rationale to support professional development and
exam success.
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 most
likely to be observed first?
A. Prominent U waves
B. ST-segment elevation
🟢 C. Tall, peaked T waves
D. Prolonged QT interval
🔴 RATIONALE: Hyperkalemia, common in advanced CKD, typically manifests on an
ECG with tall, peaked T waves as the earliest sign of cardiac toxicity before
,progressing to QRS widening and P-wave flattening.
2. During a hemodialysis session, a patient complains of sudden chest pain and
dyspnea. The nurse notes the blood in the extracorporeal circuit appears dark
and "cherry red." What is the immediate priority action?
🟢 A. Clamp the venous line and stop the blood pump
B. Administer a 200 mL bolus of normal saline
C. Increase the blood flow rate to clear the circuit
D. Administer sublingual nitroglycerin
🔴 RATIONALE: These symptoms and the appearance of the blood suggest
hemolysis. The pump must be stopped and the line clamped immediately to prevent
the return of hemolyzed blood and potentially toxic levels of potassium to the patient.
3. Which of the following is a primary advantage of using a synthetic high-flux
membrane compared to a low-flux membrane in hemodialysis?
A. Reduced risk of heparin-induced thrombocytopenia
B. Improved clearance of small molecules like urea only
🟢 C. Increased removal of middle molecules such as Beta-2 microglobulin
D. Complete elimination of the need for water treatment
, 🔴 RATIONALE: High-flux membranes have larger pores, allowing for the clearance
of larger "middle molecules" (e.g., Beta-2 microglobulin) which are associated with
dialysis-related amyloidosis, whereas low-flux membranes primarily remove small
solutes.
4. A patient undergoing peritoneal dialysis (PD) presents with cloudy effluent and
abdominal pain. What is the gold standard for diagnosing PD-related peritonitis?
A. Visual inspection of the drainage bag only
🟢 B. Effluent cell count with differential and culture
C. Abdominal X-ray showing free air
D. Serum white blood cell count elevation
🔴 RATIONALE: Peritonitis is confirmed by an effluent white blood cell count of
>100/µL (after a dwell time of at least 2 hours) with at least 50% polymorphonuclear
neutrophils, alongside positive cultures.
5. According to the Kidney Disease Outcomes Quality Initiative (KDOQI)
guidelines, what is the target hemoglobin range for a patient on Erythropoiesis-
Stimulating Agents (ESAs)?
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF.
CORE DOMAINS
Physiological Mechanisms of Kidney Disease
Hemodialysis Principles and Practice
Peritoneal Dialysis Management
Transplantation and Post-Operative Care
Chronic Kidney Disease (CKD) Stages and Education
Pharmacological Interventions in Nephrology
Pediatric and Geriatric Nephrology Considerations
Professional Practice, Ethics, and Regulatory Standards
INTRODUCTION
This comprehensive assessment is designed to evaluate the proficiency and clinical
readiness of nursing professionals seeking certification in nephrology. The exam
covers a broad spectrum of critical knowledge areas, including fluid and electrolyte
balance, dialysis modalities, and the management of comorbid conditions associated
,with renal failure. Candidates will encounter a mix of foundational theory, regulatory
compliance, and scenario-based questions that require advanced clinical judgment.
By emphasizing real-world application and decision-making, this exam ensures that
practitioners possess the specialized skills necessary to provide high-quality,
evidence-based care to patients across the continuum of kidney disease. Each
question is paired with a detailed rationale to support professional development and
exam success.
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 most
likely to be observed first?
A. Prominent U waves
B. ST-segment elevation
🟢 C. Tall, peaked T waves
D. Prolonged QT interval
🔴 RATIONALE: Hyperkalemia, common in advanced CKD, typically manifests on an
ECG with tall, peaked T waves as the earliest sign of cardiac toxicity before
,progressing to QRS widening and P-wave flattening.
2. During a hemodialysis session, a patient complains of sudden chest pain and
dyspnea. The nurse notes the blood in the extracorporeal circuit appears dark
and "cherry red." What is the immediate priority action?
🟢 A. Clamp the venous line and stop the blood pump
B. Administer a 200 mL bolus of normal saline
C. Increase the blood flow rate to clear the circuit
D. Administer sublingual nitroglycerin
🔴 RATIONALE: These symptoms and the appearance of the blood suggest
hemolysis. The pump must be stopped and the line clamped immediately to prevent
the return of hemolyzed blood and potentially toxic levels of potassium to the patient.
3. Which of the following is a primary advantage of using a synthetic high-flux
membrane compared to a low-flux membrane in hemodialysis?
A. Reduced risk of heparin-induced thrombocytopenia
B. Improved clearance of small molecules like urea only
🟢 C. Increased removal of middle molecules such as Beta-2 microglobulin
D. Complete elimination of the need for water treatment
, 🔴 RATIONALE: High-flux membranes have larger pores, allowing for the clearance
of larger "middle molecules" (e.g., Beta-2 microglobulin) which are associated with
dialysis-related amyloidosis, whereas low-flux membranes primarily remove small
solutes.
4. A patient undergoing peritoneal dialysis (PD) presents with cloudy effluent and
abdominal pain. What is the gold standard for diagnosing PD-related peritonitis?
A. Visual inspection of the drainage bag only
🟢 B. Effluent cell count with differential and culture
C. Abdominal X-ray showing free air
D. Serum white blood cell count elevation
🔴 RATIONALE: Peritonitis is confirmed by an effluent white blood cell count of
>100/µL (after a dwell time of at least 2 hours) with at least 50% polymorphonuclear
neutrophils, alongside positive cultures.
5. According to the Kidney Disease Outcomes Quality Initiative (KDOQI)
guidelines, what is the target hemoglobin range for a patient on Erythropoiesis-
Stimulating Agents (ESAs)?
