N E P H R O L O G Y N U R S I N G C E R T I F I C AT I O N · E D P N A
E N D - S T A G E R E N A L D I S E A S E N U R S I N G · 2 0 2 0 2 7 U P D AT E
EDPNA Exam
Test Questions
& Verified Answers
A comprehensive 150-question certification examination aligned
with the 2026–2027 EDPNA blueprint and current ANNA, KDOQI,
and CMS ESRD guidelines. Covers dialysis principles, patient
assessment, vascular access, complications, pharmacology,
nutrition, infection prevention, patient education, transplant and
alternative therapies, and integrated clinical scenarios.
150 10 A+
QU ES T I ON S S EC T I ON S G R A D ED
EXA M I N AT I ON A L I G N ED W I T H
ANNA · KDOQI · CMS ESRD Guidelines · 2026–2027
QUES T I ONS & ANS W ER S · VER I FI ED · GR AD ED A ED PNA · 2 02 6/2 02 7
,EDPNA Exam Test Questions · 2026/2027 Update · ANNA / KDOQI / CMS Aligned
Table of Contents
Examination Overview 2
Section 1: Principles of Dialysis (Hemodialysis & Peritoneal Dialysis) 2
Section 2: Patient Assessment and Monitoring 11
Section 3: Dialysis Access Management (Fistula, Graft, Catheter) 17
Section 4: Complications and Management (Intradialytic, Long-term) 22
Section 5: Pharmacology and Medication Administration 27
Section 6: Nutrition and Fluid Management 32
Section 7: Infection Prevention and Control 36
Section 8: Patient Education and Psychosocial Support 39
Section 9: Transplant and Alternative Therapies 43
Section 10: Integrated Clinical Scenarios and Critical Thinking 46
End-Stage Renal Disease Nursing Assessment — EDPNA Page 1
,EDPNA Exam Test Questions · 2026/2027 Update · ANNA / KDOQI / CMS Aligned
Examination Overview
This 150-question certification examination is aligned with the 2026/2027 EDPNA blueprint and current ANNA
(American Nephrology Nurses Association), KDOQI (Kidney Disease Outcomes Quality Initiative), and CMS ESRD
(Centers for Medicare & Medicaid Services End-Stage Renal Disease) guidelines. The exam is organized into ten sections
covering dialysis principles, patient assessment, vascular access, complications, pharmacology, nutrition, infection
prevention, patient education, transplant and alternative therapies, and integrated clinical scenarios. Each question includes
four options with one correct answer and a comprehensive rationale citing the relevant clinical guideline, pharmacologic
principle, or evidence-based practice.
Format: 70% scenario-based, 20% direct recall, 10% calculation. Cognitive levels: 25% recall, 55% application, 20%
analysis. Passing standard: Graded A performance requires mastery of dialysis principles, access assessment,
intradialytic complication management, pharmacology of anemia and bone disease, infection control, and ethical/legal
considerations in ESRD care.
Section 1: Principles of Dialysis (Hemodialysis & Peritoneal
Dialysis)
Questions 1 through 30
This section covers the principles of diffusion, osmosis, ultrafiltration, and convection; dialyzer types and membranes
(low-flux vs. high-flux); dialysate composition (sodium, potassium, calcium, magnesium, bicarbonate, glucose);
hemodialysis prescription parameters; peritoneal dialysis principles; adequacy measures (Kt/V, URR); and vascular access
overview.
Q1. A patient on maintenance hemodialysis has a serum potassium of 5.8 mEq/L prior to treatment.
Which dialysate potassium concentration is most appropriate to safely reduce serum potassium
without inducing arrhythmias?
A. 0 mEq/L (zero-K bath) to maximize removal
B. 1 mEq/L potassium bath
C. 2 mEq/L potassium bath [CORRECT]
D. 4 mEq/L potassium bath (same as serum)
Correct Answer: C
Rationale: KDOQI guidelines recommend a dialysate potassium of 2 mEq/L for moderate hyperkalemia to balance
effective removal with arrhythmia risk. A zero-K bath (option A) creates a steep diffusion gradient that can precipitate
ventricular arrhythmias and is reserved only for severe, life-threatening hyperkalemia. A 1 mEq/L bath (option B) may be
used in severe hyperkalemia but warrants cardiac monitoring. A 4 mEq/L bath (option D) would result in minimal
potassium removal and is appropriate only for patients with normal or low serum potassium.
Q2. During hemodialysis, solute removal occurs primarily through which mechanism, and what
determines the direction of solute movement across the semipermeable membrane?
A. Active transport; ATP availability
B. Diffusion; concentration gradient (solute moves from higher to lower concentration) [CORRECT]
C. Osmosis; hydrostatic pressure differential
End-Stage Renal Disease Nursing Assessment — EDPNA Page 2
, EDPNA Exam Test Questions · 2026/2027 Update · ANNA / KDOQI / CMS Aligned
D. Pinocytosis; membrane pore size
Correct Answer: B
Rationale: Diffusion is the primary mechanism of solute removal in hemodialysis, in which solutes move across a
semipermeable membrane from an area of higher concentration (blood) to lower concentration (dialysate) until
equilibrium is approached. Urea, creatinine, and potassium follow this gradient. Osmosis (option C) refers to water
movement, not solute movement. Active transport (option A) and pinocytosis (option D) are cellular processes not relevant
to the dialyzer membrane.
Q3. A patient receiving hemodialysis has 4 liters of excess fluid removed during a 4-hour treatment. By
which mechanism is this fluid primarily removed?
A. Diffusion across the membrane
B. Ultrafiltration driven by a transmembrane pressure gradient [CORRECT]
C. Osmosis into the dialysate
D. Active transport of water molecules
Correct Answer: B
Rationale: Ultrafiltration removes plasma water by creating a hydrostatic pressure gradient (transmembrane pressure, or
TMP) across the dialyzer membrane. The dialysis machine controls TMP to achieve the prescribed fluid removal rate.
Diffusion (option A) removes solutes, not water. Osmosis (option C) would require an osmotic gradient, which is not the
dominant mechanism in HD. Active transport (option D) does not apply to water movement across dialyzer membranes.
Q4. A nephrologist orders high-flux hemodialysis for a patient with a high β2-microglobulin level.
Which characteristic of high-flux membranes enables removal of larger middle molecules compared to
low-flux membranes?
A. Smaller pore size to retain albumin
B. Larger pore size allowing passage of molecules up to 20,000-50,000 Daltons [CORRECT]
C. Synthetic vs cellulose-based composition only
D. Higher surface area only
Correct Answer: B
Rationale: High-flux membranes have larger pores (ultrafiltration coefficient Kuf >20 mL/h/mmHg) allowing clearance
of middle molecules such as β2-microglobulin (~11,800 Da), which contributes to dialysis-related amyloidosis. Low-flux
membranes remove only small solutes like urea and creatinine. Pore size, not surface area or membrane material alone, is
the defining characteristic differentiating high-flux from low-flux dialysis. Excessive albumin loss can occur with very
high-flux membranes but is monitored.
Q5. Which dialysate bicarbonate concentration is most commonly prescribed for maintenance
hemodialysis to correct metabolic acidosis in ESRD patients?
A. 8-12 mEq/L
B. 20-24 mEq/L
C. 35-40 mEq/L [CORRECT]
D. 60-70 mEq/L
End-Stage Renal Disease Nursing Assessment — EDPNA Page 3
E N D - S T A G E R E N A L D I S E A S E N U R S I N G · 2 0 2 0 2 7 U P D AT E
EDPNA Exam
Test Questions
& Verified Answers
A comprehensive 150-question certification examination aligned
with the 2026–2027 EDPNA blueprint and current ANNA, KDOQI,
and CMS ESRD guidelines. Covers dialysis principles, patient
assessment, vascular access, complications, pharmacology,
nutrition, infection prevention, patient education, transplant and
alternative therapies, and integrated clinical scenarios.
150 10 A+
QU ES T I ON S S EC T I ON S G R A D ED
EXA M I N AT I ON A L I G N ED W I T H
ANNA · KDOQI · CMS ESRD Guidelines · 2026–2027
QUES T I ONS & ANS W ER S · VER I FI ED · GR AD ED A ED PNA · 2 02 6/2 02 7
,EDPNA Exam Test Questions · 2026/2027 Update · ANNA / KDOQI / CMS Aligned
Table of Contents
Examination Overview 2
Section 1: Principles of Dialysis (Hemodialysis & Peritoneal Dialysis) 2
Section 2: Patient Assessment and Monitoring 11
Section 3: Dialysis Access Management (Fistula, Graft, Catheter) 17
Section 4: Complications and Management (Intradialytic, Long-term) 22
Section 5: Pharmacology and Medication Administration 27
Section 6: Nutrition and Fluid Management 32
Section 7: Infection Prevention and Control 36
Section 8: Patient Education and Psychosocial Support 39
Section 9: Transplant and Alternative Therapies 43
Section 10: Integrated Clinical Scenarios and Critical Thinking 46
End-Stage Renal Disease Nursing Assessment — EDPNA Page 1
,EDPNA Exam Test Questions · 2026/2027 Update · ANNA / KDOQI / CMS Aligned
Examination Overview
This 150-question certification examination is aligned with the 2026/2027 EDPNA blueprint and current ANNA
(American Nephrology Nurses Association), KDOQI (Kidney Disease Outcomes Quality Initiative), and CMS ESRD
(Centers for Medicare & Medicaid Services End-Stage Renal Disease) guidelines. The exam is organized into ten sections
covering dialysis principles, patient assessment, vascular access, complications, pharmacology, nutrition, infection
prevention, patient education, transplant and alternative therapies, and integrated clinical scenarios. Each question includes
four options with one correct answer and a comprehensive rationale citing the relevant clinical guideline, pharmacologic
principle, or evidence-based practice.
Format: 70% scenario-based, 20% direct recall, 10% calculation. Cognitive levels: 25% recall, 55% application, 20%
analysis. Passing standard: Graded A performance requires mastery of dialysis principles, access assessment,
intradialytic complication management, pharmacology of anemia and bone disease, infection control, and ethical/legal
considerations in ESRD care.
Section 1: Principles of Dialysis (Hemodialysis & Peritoneal
Dialysis)
Questions 1 through 30
This section covers the principles of diffusion, osmosis, ultrafiltration, and convection; dialyzer types and membranes
(low-flux vs. high-flux); dialysate composition (sodium, potassium, calcium, magnesium, bicarbonate, glucose);
hemodialysis prescription parameters; peritoneal dialysis principles; adequacy measures (Kt/V, URR); and vascular access
overview.
Q1. A patient on maintenance hemodialysis has a serum potassium of 5.8 mEq/L prior to treatment.
Which dialysate potassium concentration is most appropriate to safely reduce serum potassium
without inducing arrhythmias?
A. 0 mEq/L (zero-K bath) to maximize removal
B. 1 mEq/L potassium bath
C. 2 mEq/L potassium bath [CORRECT]
D. 4 mEq/L potassium bath (same as serum)
Correct Answer: C
Rationale: KDOQI guidelines recommend a dialysate potassium of 2 mEq/L for moderate hyperkalemia to balance
effective removal with arrhythmia risk. A zero-K bath (option A) creates a steep diffusion gradient that can precipitate
ventricular arrhythmias and is reserved only for severe, life-threatening hyperkalemia. A 1 mEq/L bath (option B) may be
used in severe hyperkalemia but warrants cardiac monitoring. A 4 mEq/L bath (option D) would result in minimal
potassium removal and is appropriate only for patients with normal or low serum potassium.
Q2. During hemodialysis, solute removal occurs primarily through which mechanism, and what
determines the direction of solute movement across the semipermeable membrane?
A. Active transport; ATP availability
B. Diffusion; concentration gradient (solute moves from higher to lower concentration) [CORRECT]
C. Osmosis; hydrostatic pressure differential
End-Stage Renal Disease Nursing Assessment — EDPNA Page 2
, EDPNA Exam Test Questions · 2026/2027 Update · ANNA / KDOQI / CMS Aligned
D. Pinocytosis; membrane pore size
Correct Answer: B
Rationale: Diffusion is the primary mechanism of solute removal in hemodialysis, in which solutes move across a
semipermeable membrane from an area of higher concentration (blood) to lower concentration (dialysate) until
equilibrium is approached. Urea, creatinine, and potassium follow this gradient. Osmosis (option C) refers to water
movement, not solute movement. Active transport (option A) and pinocytosis (option D) are cellular processes not relevant
to the dialyzer membrane.
Q3. A patient receiving hemodialysis has 4 liters of excess fluid removed during a 4-hour treatment. By
which mechanism is this fluid primarily removed?
A. Diffusion across the membrane
B. Ultrafiltration driven by a transmembrane pressure gradient [CORRECT]
C. Osmosis into the dialysate
D. Active transport of water molecules
Correct Answer: B
Rationale: Ultrafiltration removes plasma water by creating a hydrostatic pressure gradient (transmembrane pressure, or
TMP) across the dialyzer membrane. The dialysis machine controls TMP to achieve the prescribed fluid removal rate.
Diffusion (option A) removes solutes, not water. Osmosis (option C) would require an osmotic gradient, which is not the
dominant mechanism in HD. Active transport (option D) does not apply to water movement across dialyzer membranes.
Q4. A nephrologist orders high-flux hemodialysis for a patient with a high β2-microglobulin level.
Which characteristic of high-flux membranes enables removal of larger middle molecules compared to
low-flux membranes?
A. Smaller pore size to retain albumin
B. Larger pore size allowing passage of molecules up to 20,000-50,000 Daltons [CORRECT]
C. Synthetic vs cellulose-based composition only
D. Higher surface area only
Correct Answer: B
Rationale: High-flux membranes have larger pores (ultrafiltration coefficient Kuf >20 mL/h/mmHg) allowing clearance
of middle molecules such as β2-microglobulin (~11,800 Da), which contributes to dialysis-related amyloidosis. Low-flux
membranes remove only small solutes like urea and creatinine. Pore size, not surface area or membrane material alone, is
the defining characteristic differentiating high-flux from low-flux dialysis. Excessive albumin loss can occur with very
high-flux membranes but is monitored.
Q5. Which dialysate bicarbonate concentration is most commonly prescribed for maintenance
hemodialysis to correct metabolic acidosis in ESRD patients?
A. 8-12 mEq/L
B. 20-24 mEq/L
C. 35-40 mEq/L [CORRECT]
D. 60-70 mEq/L
End-Stage Renal Disease Nursing Assessment — EDPNA Page 3
