Certified Dialysis Nurse (CDN®) | CDN®
Certification Exam Study Guide & Prep 2026/2027
| NNCC Certified Dialysis Nurse Review,
Nephrology Nursing, Kidney Disease, Hemodialysis,
Peritoneal Dialysis, Dialysis Complications,
Vascular Access, Fluid & Electrolyte Management,
Dialysis Medications, Infection Control, Patient
Education, Transplant & Acute Therapies, Clinical
Practice, Practice Questions, Answers & Detailed
Rationales
Question 1: In the context of renal physiology, which structure in the nephron
is primarily responsible for the filtration of blood based on size and charge,
forming the initial filtrate?
A. Proximal convoluted tubule
B. Glomerulus
C. Loop of Henle
D. Collecting duct
CORRECT ANSWER: B. Glomerulus
Rationale: The glomerulus is a network of capillaries that acts as a semi-permeable
membrane, filtering plasma to create a filtrate. It retains large proteins and blood cells
based on size and charge, making it the primary site of blood filtration . The proximal
convoluted tubule is responsible for reabsorption, the Loop of Henle concentrates urine,
and the collecting duct collects urine and plays a role in water reabsorption .
Question 2: A patient with chronic kidney disease (CKD) is found to have a
serum potassium of 6.2 mEq/L and peaked T-waves on an ECG. Which of the
following interventions should the nurse anticipate to shift potassium into the
cells and lower serum potassium levels?
A. Oral calcium carbonate
B. IV sodium bicarbonate
C. IV glucose and insulin infusion
D. Oral kayexalate and sorbitol
CORRECT ANSWER: C. IV glucose and insulin infusion
Rationale: An IV infusion of glucose and insulin promotes the movement of potassium
from the extracellular space into the cells, effectively lowering serum potassium levels
acutely. This is a standard emergency treatment for hyperkalemia . While sodium
bicarbonate and kayexalate can also lower potassium, they do so through other
mechanisms (alkalosis and GI excretion, respectively). Calcium carbonate is used to
manage hyperphosphatemia, not hyperkalemia.
,Question 3: A nurse is preparing to administer a peritoneal dialysis exchange.
Which of the following actions is most important to prevent peritonitis, a
serious complication of this therapy?
A. Warming the dialysate solution to body temperature
B. Ensuring the patient is in a comfortable position
C. Using strict aseptic technique during the procedure
D. Measuring the patient's weight before the exchange
CORRECT ANSWER: C. Using strict aseptic technique during the procedure
Rationale: Peritonitis is a major complication of peritoneal dialysis and is caused by the
introduction of bacteria into the peritoneal cavity. Using strict aseptic technique during
the connection and disconnection procedure is the most critical nursing intervention to
prevent this life-threatening infection . While warming the solution improves comfort
and prevents cardiac arrhythmias , aseptic technique is the primary preventative
measure against infection.
Question 4: What is the primary purpose of the "break-in period" for a newly
placed peritoneal dialysis catheter?
A. To allow for the healing of the catheter exit site and prevent leakage
B. To initiate immediate dialysis treatment to reduce uremic symptoms
C. To monitor the patient's electrolyte levels and fluid balance
D. To assess the patient's residual renal function
CORRECT ANSWER: A. To allow for the healing of the catheter exit site and
prevent leakage
Rationale: The break-in period is a critical phase immediately after catheter placement.
It allows the surgical wound and the catheter exit site to heal and permits the
development of a secure, leak-proof seal around the catheter. This process typically
involves using small-volume, low-dose exchanges to prevent leakage of dialysate and
reduce the risk of infection .
Question 5: A patient on hemodialysis complains of severe muscle cramps
during the treatment. The nurse identifies that this complication is most often
related to which of the following?
A. Low calcium levels in the dialysate
B. A rapid rate of ultrafiltration
C. An allergic reaction to the dialyzer membrane
D. An air embolism in the extracorporeal circuit
CORRECT ANSWER: B. A rapid rate of ultrafiltration
Rationale: Muscle cramps during hemodialysis are a common complaint and are most
frequently associated with a high ultrafiltration rate. This leads to a rapid reduction in
intravascular volume and plasma osmolality, which can cause muscle cells to cramp .
,Managing fluid removal rates is a key nursing intervention to prevent this uncomfortable
complication.
Question 6: In the context of the Renin-Angiotensin-Aldosterone System
(RAAS), what is the direct effect of Angiotensin II on blood vessels?
A. Vasodilation
B. Increased vascular permeability
C. Vasoconstriction
D. Decreased peripheral resistance
CORRECT ANSWER: C. Vasoconstriction
Rationale: Angiotensin II is a potent vasoconstrictor that directly acts on blood vessels
to increase systemic vascular resistance and blood pressure. This is a key compensatory
mechanism in renal failure. It also stimulates the release of aldosterone, which promotes
sodium and water retention . Vasodilation is caused by other mediators and would not
be a direct effect of Angiotensin II.
Question 7: A dialysis patient is prescribed a phosphorus binder to manage
hyperphosphatemia. For the medication to be most effective, when should the
nurse instruct the patient to take it?
A. At bedtime
B. One hour before meals
C. One hour after meals
D. With or immediately after meals
CORRECT ANSWER: D. With or immediately after meals
Rationale: Phosphate binders work by binding to dietary phosphorus in the
gastrointestinal tract, preventing its absorption. For this to occur effectively, the binder
must be physically present in the stomach and intestines at the same time as the
ingested food. Therefore, the medication should be taken with or immediately after
meals to maximize its phosphorus-binding effect .
Question 8: A nurse is caring for a patient with end-stage renal disease (ESRD)
who is exhibiting signs of anemia, including fatigue and pallor. What is the
primary cause of anemia in this patient population?
A. Iron deficiency due to dietary restrictions
B. Chronic blood loss during dialysis treatments
C. Decreased production of erythropoietin by the kidneys
D. Folate deficiency related to poor appetite
CORRECT ANSWER: C. Decreased production of erythropoietin by the kidneys
Rationale: Anemia is a hallmark complication of kidney failure and generally worsens as
kidney function deteriorates. The major cause of this anemia is the decreased
production of erythropoietin (EPO), a hormone produced by healthy kidneys that
, stimulates red blood cell production in the bone marrow . While iron and folate
deficiencies can contribute, the primary cause is the loss of the endocrine function of
the kidney.
Question 9: A patient asks the nurse about the benefits of home hemodialysis.
Which of the following statements is an accurate benefit of this modality?
A. It requires no dietary or fluid restrictions.
B. It is associated with increased independence and better knowledge about one's
illness.
C. It eliminates the need for any vascular access.
D. It is significantly less expensive than in-center hemodialysis.
CORRECT ANSWER: B. It is associated with increased independence and better
knowledge about one's illness.
Rationale: Home hemodialysis offers significant psychosocial benefits to patients,
including increased independence, flexibility in scheduling, and a better understanding
and management of their disease and its treatment . It does not eliminate dietary
restrictions, requires a vascular access, and while it may have cost benefits, the primary
advantage for the patient is often the improved quality of life and autonomy.
Question 10: For a patient undergoing hemodialysis, which component of the
dialysate acts as a buffer to correct metabolic acidosis?
A. Sodium
B. Bicarbonate
C. Glucose
D. Calcium
CORRECT ANSWER: B. Bicarbonate
Rationale: Metabolic acidosis is a common complication of renal failure due to the
kidney's inability to excrete hydrogen ions and regenerate bicarbonate. During
hemodialysis, bicarbonate from the dialysate diffuses into the patient's blood,
replenishing the body's buffer stores and helping to correct the acidosis . Sodium helps
maintain osmotic balance, glucose provides osmotic pressure (especially in PD), and
calcium is used to manage calcium and phosphorus balance.
Question 11: The nurse is assessing a patient's arteriovenous (AV) fistula
during a predialysis assessment. Which of the following findings would
indicate a potential complication with the access?
A. A palpable thrill over the fistula site
B. An audible bruit that has a high-pitched, continuous sound
C. A change in the pitch of the bruit from low to high
D. The presence of a pulse distal to the fistula
CORRECT ANSWER: C. A change in the pitch of the bruit from low to high
Certification Exam Study Guide & Prep 2026/2027
| NNCC Certified Dialysis Nurse Review,
Nephrology Nursing, Kidney Disease, Hemodialysis,
Peritoneal Dialysis, Dialysis Complications,
Vascular Access, Fluid & Electrolyte Management,
Dialysis Medications, Infection Control, Patient
Education, Transplant & Acute Therapies, Clinical
Practice, Practice Questions, Answers & Detailed
Rationales
Question 1: In the context of renal physiology, which structure in the nephron
is primarily responsible for the filtration of blood based on size and charge,
forming the initial filtrate?
A. Proximal convoluted tubule
B. Glomerulus
C. Loop of Henle
D. Collecting duct
CORRECT ANSWER: B. Glomerulus
Rationale: The glomerulus is a network of capillaries that acts as a semi-permeable
membrane, filtering plasma to create a filtrate. It retains large proteins and blood cells
based on size and charge, making it the primary site of blood filtration . The proximal
convoluted tubule is responsible for reabsorption, the Loop of Henle concentrates urine,
and the collecting duct collects urine and plays a role in water reabsorption .
Question 2: A patient with chronic kidney disease (CKD) is found to have a
serum potassium of 6.2 mEq/L and peaked T-waves on an ECG. Which of the
following interventions should the nurse anticipate to shift potassium into the
cells and lower serum potassium levels?
A. Oral calcium carbonate
B. IV sodium bicarbonate
C. IV glucose and insulin infusion
D. Oral kayexalate and sorbitol
CORRECT ANSWER: C. IV glucose and insulin infusion
Rationale: An IV infusion of glucose and insulin promotes the movement of potassium
from the extracellular space into the cells, effectively lowering serum potassium levels
acutely. This is a standard emergency treatment for hyperkalemia . While sodium
bicarbonate and kayexalate can also lower potassium, they do so through other
mechanisms (alkalosis and GI excretion, respectively). Calcium carbonate is used to
manage hyperphosphatemia, not hyperkalemia.
,Question 3: A nurse is preparing to administer a peritoneal dialysis exchange.
Which of the following actions is most important to prevent peritonitis, a
serious complication of this therapy?
A. Warming the dialysate solution to body temperature
B. Ensuring the patient is in a comfortable position
C. Using strict aseptic technique during the procedure
D. Measuring the patient's weight before the exchange
CORRECT ANSWER: C. Using strict aseptic technique during the procedure
Rationale: Peritonitis is a major complication of peritoneal dialysis and is caused by the
introduction of bacteria into the peritoneal cavity. Using strict aseptic technique during
the connection and disconnection procedure is the most critical nursing intervention to
prevent this life-threatening infection . While warming the solution improves comfort
and prevents cardiac arrhythmias , aseptic technique is the primary preventative
measure against infection.
Question 4: What is the primary purpose of the "break-in period" for a newly
placed peritoneal dialysis catheter?
A. To allow for the healing of the catheter exit site and prevent leakage
B. To initiate immediate dialysis treatment to reduce uremic symptoms
C. To monitor the patient's electrolyte levels and fluid balance
D. To assess the patient's residual renal function
CORRECT ANSWER: A. To allow for the healing of the catheter exit site and
prevent leakage
Rationale: The break-in period is a critical phase immediately after catheter placement.
It allows the surgical wound and the catheter exit site to heal and permits the
development of a secure, leak-proof seal around the catheter. This process typically
involves using small-volume, low-dose exchanges to prevent leakage of dialysate and
reduce the risk of infection .
Question 5: A patient on hemodialysis complains of severe muscle cramps
during the treatment. The nurse identifies that this complication is most often
related to which of the following?
A. Low calcium levels in the dialysate
B. A rapid rate of ultrafiltration
C. An allergic reaction to the dialyzer membrane
D. An air embolism in the extracorporeal circuit
CORRECT ANSWER: B. A rapid rate of ultrafiltration
Rationale: Muscle cramps during hemodialysis are a common complaint and are most
frequently associated with a high ultrafiltration rate. This leads to a rapid reduction in
intravascular volume and plasma osmolality, which can cause muscle cells to cramp .
,Managing fluid removal rates is a key nursing intervention to prevent this uncomfortable
complication.
Question 6: In the context of the Renin-Angiotensin-Aldosterone System
(RAAS), what is the direct effect of Angiotensin II on blood vessels?
A. Vasodilation
B. Increased vascular permeability
C. Vasoconstriction
D. Decreased peripheral resistance
CORRECT ANSWER: C. Vasoconstriction
Rationale: Angiotensin II is a potent vasoconstrictor that directly acts on blood vessels
to increase systemic vascular resistance and blood pressure. This is a key compensatory
mechanism in renal failure. It also stimulates the release of aldosterone, which promotes
sodium and water retention . Vasodilation is caused by other mediators and would not
be a direct effect of Angiotensin II.
Question 7: A dialysis patient is prescribed a phosphorus binder to manage
hyperphosphatemia. For the medication to be most effective, when should the
nurse instruct the patient to take it?
A. At bedtime
B. One hour before meals
C. One hour after meals
D. With or immediately after meals
CORRECT ANSWER: D. With or immediately after meals
Rationale: Phosphate binders work by binding to dietary phosphorus in the
gastrointestinal tract, preventing its absorption. For this to occur effectively, the binder
must be physically present in the stomach and intestines at the same time as the
ingested food. Therefore, the medication should be taken with or immediately after
meals to maximize its phosphorus-binding effect .
Question 8: A nurse is caring for a patient with end-stage renal disease (ESRD)
who is exhibiting signs of anemia, including fatigue and pallor. What is the
primary cause of anemia in this patient population?
A. Iron deficiency due to dietary restrictions
B. Chronic blood loss during dialysis treatments
C. Decreased production of erythropoietin by the kidneys
D. Folate deficiency related to poor appetite
CORRECT ANSWER: C. Decreased production of erythropoietin by the kidneys
Rationale: Anemia is a hallmark complication of kidney failure and generally worsens as
kidney function deteriorates. The major cause of this anemia is the decreased
production of erythropoietin (EPO), a hormone produced by healthy kidneys that
, stimulates red blood cell production in the bone marrow . While iron and folate
deficiencies can contribute, the primary cause is the loss of the endocrine function of
the kidney.
Question 9: A patient asks the nurse about the benefits of home hemodialysis.
Which of the following statements is an accurate benefit of this modality?
A. It requires no dietary or fluid restrictions.
B. It is associated with increased independence and better knowledge about one's
illness.
C. It eliminates the need for any vascular access.
D. It is significantly less expensive than in-center hemodialysis.
CORRECT ANSWER: B. It is associated with increased independence and better
knowledge about one's illness.
Rationale: Home hemodialysis offers significant psychosocial benefits to patients,
including increased independence, flexibility in scheduling, and a better understanding
and management of their disease and its treatment . It does not eliminate dietary
restrictions, requires a vascular access, and while it may have cost benefits, the primary
advantage for the patient is often the improved quality of life and autonomy.
Question 10: For a patient undergoing hemodialysis, which component of the
dialysate acts as a buffer to correct metabolic acidosis?
A. Sodium
B. Bicarbonate
C. Glucose
D. Calcium
CORRECT ANSWER: B. Bicarbonate
Rationale: Metabolic acidosis is a common complication of renal failure due to the
kidney's inability to excrete hydrogen ions and regenerate bicarbonate. During
hemodialysis, bicarbonate from the dialysate diffuses into the patient's blood,
replenishing the body's buffer stores and helping to correct the acidosis . Sodium helps
maintain osmotic balance, glucose provides osmotic pressure (especially in PD), and
calcium is used to manage calcium and phosphorus balance.
Question 11: The nurse is assessing a patient's arteriovenous (AV) fistula
during a predialysis assessment. Which of the following findings would
indicate a potential complication with the access?
A. A palpable thrill over the fistula site
B. An audible bruit that has a high-pitched, continuous sound
C. A change in the pitch of the bruit from low to high
D. The presence of a pulse distal to the fistula
CORRECT ANSWER: C. A change in the pitch of the bruit from low to high
