CERTIFIED DIALYSIS NURSE (CDN) ACTUAL EXAM
[QUESTION 1- 200] AND ANSWERS UPDATED 2026/2027| 100%
VERIFIED|DETAILED RATIONALES –PASS GUARANTEED
A+ GRADED |INSTANT DOWNLOAD
INTRODUCTION
The Certified Dialysis Nurse (CDN) credential is administered by the Nephrology Nursing
Certification Commission (NNCC) for registered nurses practicing in dialysis settings. The
certification validates specialized knowledge and clinical judgment in dialysis nursing, with
particular emphasis on chronic hemodialysis, kidney disease, dialysis-related complications,
medications, infection prevention, patient education, and interdisciplinary care. The current
NNCC examination blueprint was revised in April 2026 and became effective September 1,
2026.
Under the current NNCC requirements, applicants for the CDN examination must hold a full and
unrestricted U.S. registered-nurse license or equivalent qualifying status and meet the specified
nephrology nursing experience and continuing-education requirements. NNCC's 2026 program
update introduced revised eligibility requirements and a new examination blueprint.
CDN certification is professionally valuable because it demonstrates specialty competence in
caring for patients receiving dialysis. It can support professional development, specialty
recognition, quality-improvement work, staff education, and advancement within nephrology
nursing. Certification should be viewed as evidence of specialty knowledge and competence
rather than as a guarantee of employment or examination success.
The current CDN examination consists of 150 questions with a 3-hour testing period. The
current blueprint distributes content across seven objectives: Pathophysiology/Complications,
Intervention, Physiology/Technology, Teaching, Medications, Infection, and
Collaboration/Administration. Content is distributed across chronic hemodialysis for ESRD,
adult kidney disease concepts, chronic HD for AKI and delayed graft function, and water for
dialysis.
Core Domains Tested in Certified Dialysis Nurse (CDN)
Chronic Hemodialysis for End-Stage Kidney Disease
Concepts of Kidney Disease in Adults
Hemodialysis Physiology and Technology
Dialysis-Related Assessment and Clinical Interventions
Dialysis Medications and Pharmacology
Infection Prevention and Control
Patient and Family Education
Acute Kidney Injury and Delayed Graft Function
Water Treatment and Dialysis Water Quality
, Collaboration, Safety, Quality Improvement, and Administration
CONTENT AREA TABLE
% of Approx. # of
Content Domain Key Topics Covered
Exam Questions
Hemodialysis, vascular access, complications,
Chronic HD Unit
52% 77–78 medications, infection prevention, patient
(ESRD)
education, dialysis technology
Concepts of CKD, AKI, electrolyte disorders, acid-base
Kidney Disease in 32% 47–48 balance, renal pathophysiology, complications of
Adults kidney disease
AKI requiring dialysis, delayed graft function,
Chronic HD Unit
8% 11–12 indications for kidney replacement therapy,
(AKI & DGF)
hemodynamic management
Water treatment, microbial control, chemical
Water for Dialysis 8% 11–12
contaminants, monitoring, dialysis safety
Total 100% 150 All current CDN blueprint domains
*The percentages and item ranges above reflect the NNCC blueprint revised April 2026 and
effective September 1, 2026. *
QUESTIONS 1-200
Q1: A patient receiving maintenance hemodialysis has a predialysis serum potassium of 6.8
mEq/L, peaked T waves on ECG, and reports generalized weakness. Which action should
the nurse prioritize?
A) Begin dialysis using the patient's usual dialysate potassium concentration
B) Initiate emergency cardiac stabilization measures while preparing for urgent potassium
removal
C) Administer the patient's scheduled oral phosphate binder
D) Restrict dietary potassium and reassess the ECG in 4 hours
Correct Answer: B
Rationale: Severe hyperkalemia with ECG changes is immediately life-threatening. The nurse
should initiate emergency management, including cardiac membrane stabilization when
indicated, while arranging definitive potassium removal such as urgent dialysis. Simply
beginning routine dialysis without addressing the unstable cardiac state may delay essential
treatment. A phosphate binder does not acutely correct potassium, and dietary restriction is
insufficient for an immediate ECG-threatening hyperkalemia.
Q2: During hemodialysis, a patient's blood pressure falls from 146/78 to 82/48 mmHg and
the patient becomes pale and nauseated. Which intervention is most appropriate first?
A) Increase the ultrafiltration rate to remove additional fluid
B) Stop ultrafiltration and place the patient in an appropriate position while assessing the
,cause
C) Administer the scheduled antihypertensive medication
D) Increase dialysate temperature
Correct Answer: B
Rationale: Acute intradialytic hypotension requires immediate reduction or cessation of
ultrafiltration and assessment of the patient. Positioning and a saline bolus may be needed
depending on the clinical picture and facility protocol. Increasing ultrafiltration worsens volume
depletion. Antihypertensive medication is inappropriate during hypotension, and increasing
dialysate temperature can worsen vasodilation.
Q3: A patient with a mature arteriovenous fistula reports that the usual buzzing sensation
is suddenly absent. The access remains warm and the skin is intact. What should the nurse
do first?
A) Apply a warm compress and reassess after dialysis
B) Proceed with cannulation because the access is still warm
C) Assess immediately for loss of bruit and thrill and notify the appropriate provider if
absent
D) Apply firm pressure over the fistula to restore circulation
Correct Answer: C
Rationale: Sudden loss of a bruit or thrill suggests access thrombosis or another acute access
complication and requires prompt evaluation. Warm skin does not establish patency.
Cannulating a potentially thrombosed access can cause injury and delay treatment. Firm
pressure could further compromise blood flow.
Q4: A patient develops severe muscle cramps during ultrafiltration. Blood pressure is
declining and the machine indicates that the prescribed ultrafiltration goal is nearly
complete. Which finding most strongly supports excessive intravascular volume removal?
A) Elevated serum phosphorus
B) Rapid decline in blood pressure accompanied by cramping
C) Increased predialysis serum sodium
D) Mildly elevated predialysis BUN
Correct Answer: B
Rationale: Intradialytic hypotension and painful muscle cramps are classic manifestations of
excessive or overly rapid ultrafiltration relative to plasma refilling. The immediate priority is to
address the hemodynamic instability. Phosphorus, sodium, and BUN do not specifically explain
the acute combination of hypotension and cramps.
Q5: A patient has a target postdialysis weight of 72 kg but repeatedly finishes treatment at
69 kg because of aggressive ultrafiltration. Between treatments, the patient develops
dizziness and poor oral intake. What is the most appropriate nursing concern?
A) The patient is demonstrating adequate volume management
B) The lower postdialysis weight will prevent all hypertension
C) The prescribed target weight may be below the patient's current physiologic dry-weight
requirement
D) The patient should have the ultrafiltration goal increased further
Correct Answer: C
, Rationale: Repeatedly ending substantially below the established target weight with symptoms of
volume depletion should prompt reassessment of the patient's prescribed target weight.
Excessive fluid removal can cause intradialytic hypotension, cramping, fatigue, and organ
hypoperfusion. Target weight should reflect clinical assessment rather than simply achieving the
lowest possible postdialysis weight.
Q6: A patient with ESRD has persistent hyperphosphatemia despite taking a phosphate
binder. Which assessment is most important before concluding that the medication is
ineffective?
A) Whether the medication is taken only after dialysis
B) Whether the binder is taken with meals and snacks containing phosphorus
C) Whether the patient takes the medication with water
D) Whether the patient takes the binder immediately before bedtime
Correct Answer: B
Rationale: Most phosphate binders work by binding dietary phosphorus in the gastrointestinal
tract and therefore must be taken with meals or phosphorus-containing snacks. Taking them at
unrelated times markedly reduces their effectiveness. Timing relative to meals is therefore a key
assessment before changing therapy.
Q7: A hemodialysis patient receiving erythropoiesis-stimulating therapy has persistent
anemia. Laboratory studies show low transferrin saturation and low ferritin. Which
problem should the nurse recognize?
A) Pure folate deficiency
B) Iron deficiency limiting the erythropoietic response
C) Excessive erythropoietin production
D) Dialysis-associated hypercalcemia
Correct Answer: B
Rationale: Iron deficiency can limit the effectiveness of erythropoiesis-stimulating agents. Low
transferrin saturation and low ferritin support depleted iron stores. In ESRD, anemia
management therefore requires assessment of iron status in addition to ESA therapy. Folate
deficiency and calcium abnormalities do not explain this laboratory pattern.
Q8: A patient with an AV fistula has prolonged bleeding after needle removal. Which
factor should the nurse evaluate first?
A) Serum albumin
B) Anticoagulation exposure and access-related abnormalities
C) Serum sodium
D) Predialysis bicarbonate
Correct Answer: B
Rationale: Prolonged postdialysis bleeding may result from excessive anticoagulation, platelet
dysfunction associated with kidney failure, elevated blood pressure, or access stenosis. The
nurse should evaluate anticoagulation and access characteristics promptly. Sodium,
bicarbonate, and albumin do not directly explain prolonged needle-site bleeding.
Q9: A patient receiving unfractionated heparin during hemodialysis develops a platelet
count that falls by more than 50% after several days of exposure and develops a new access
[QUESTION 1- 200] AND ANSWERS UPDATED 2026/2027| 100%
VERIFIED|DETAILED RATIONALES –PASS GUARANTEED
A+ GRADED |INSTANT DOWNLOAD
INTRODUCTION
The Certified Dialysis Nurse (CDN) credential is administered by the Nephrology Nursing
Certification Commission (NNCC) for registered nurses practicing in dialysis settings. The
certification validates specialized knowledge and clinical judgment in dialysis nursing, with
particular emphasis on chronic hemodialysis, kidney disease, dialysis-related complications,
medications, infection prevention, patient education, and interdisciplinary care. The current
NNCC examination blueprint was revised in April 2026 and became effective September 1,
2026.
Under the current NNCC requirements, applicants for the CDN examination must hold a full and
unrestricted U.S. registered-nurse license or equivalent qualifying status and meet the specified
nephrology nursing experience and continuing-education requirements. NNCC's 2026 program
update introduced revised eligibility requirements and a new examination blueprint.
CDN certification is professionally valuable because it demonstrates specialty competence in
caring for patients receiving dialysis. It can support professional development, specialty
recognition, quality-improvement work, staff education, and advancement within nephrology
nursing. Certification should be viewed as evidence of specialty knowledge and competence
rather than as a guarantee of employment or examination success.
The current CDN examination consists of 150 questions with a 3-hour testing period. The
current blueprint distributes content across seven objectives: Pathophysiology/Complications,
Intervention, Physiology/Technology, Teaching, Medications, Infection, and
Collaboration/Administration. Content is distributed across chronic hemodialysis for ESRD,
adult kidney disease concepts, chronic HD for AKI and delayed graft function, and water for
dialysis.
Core Domains Tested in Certified Dialysis Nurse (CDN)
Chronic Hemodialysis for End-Stage Kidney Disease
Concepts of Kidney Disease in Adults
Hemodialysis Physiology and Technology
Dialysis-Related Assessment and Clinical Interventions
Dialysis Medications and Pharmacology
Infection Prevention and Control
Patient and Family Education
Acute Kidney Injury and Delayed Graft Function
Water Treatment and Dialysis Water Quality
, Collaboration, Safety, Quality Improvement, and Administration
CONTENT AREA TABLE
% of Approx. # of
Content Domain Key Topics Covered
Exam Questions
Hemodialysis, vascular access, complications,
Chronic HD Unit
52% 77–78 medications, infection prevention, patient
(ESRD)
education, dialysis technology
Concepts of CKD, AKI, electrolyte disorders, acid-base
Kidney Disease in 32% 47–48 balance, renal pathophysiology, complications of
Adults kidney disease
AKI requiring dialysis, delayed graft function,
Chronic HD Unit
8% 11–12 indications for kidney replacement therapy,
(AKI & DGF)
hemodynamic management
Water treatment, microbial control, chemical
Water for Dialysis 8% 11–12
contaminants, monitoring, dialysis safety
Total 100% 150 All current CDN blueprint domains
*The percentages and item ranges above reflect the NNCC blueprint revised April 2026 and
effective September 1, 2026. *
QUESTIONS 1-200
Q1: A patient receiving maintenance hemodialysis has a predialysis serum potassium of 6.8
mEq/L, peaked T waves on ECG, and reports generalized weakness. Which action should
the nurse prioritize?
A) Begin dialysis using the patient's usual dialysate potassium concentration
B) Initiate emergency cardiac stabilization measures while preparing for urgent potassium
removal
C) Administer the patient's scheduled oral phosphate binder
D) Restrict dietary potassium and reassess the ECG in 4 hours
Correct Answer: B
Rationale: Severe hyperkalemia with ECG changes is immediately life-threatening. The nurse
should initiate emergency management, including cardiac membrane stabilization when
indicated, while arranging definitive potassium removal such as urgent dialysis. Simply
beginning routine dialysis without addressing the unstable cardiac state may delay essential
treatment. A phosphate binder does not acutely correct potassium, and dietary restriction is
insufficient for an immediate ECG-threatening hyperkalemia.
Q2: During hemodialysis, a patient's blood pressure falls from 146/78 to 82/48 mmHg and
the patient becomes pale and nauseated. Which intervention is most appropriate first?
A) Increase the ultrafiltration rate to remove additional fluid
B) Stop ultrafiltration and place the patient in an appropriate position while assessing the
,cause
C) Administer the scheduled antihypertensive medication
D) Increase dialysate temperature
Correct Answer: B
Rationale: Acute intradialytic hypotension requires immediate reduction or cessation of
ultrafiltration and assessment of the patient. Positioning and a saline bolus may be needed
depending on the clinical picture and facility protocol. Increasing ultrafiltration worsens volume
depletion. Antihypertensive medication is inappropriate during hypotension, and increasing
dialysate temperature can worsen vasodilation.
Q3: A patient with a mature arteriovenous fistula reports that the usual buzzing sensation
is suddenly absent. The access remains warm and the skin is intact. What should the nurse
do first?
A) Apply a warm compress and reassess after dialysis
B) Proceed with cannulation because the access is still warm
C) Assess immediately for loss of bruit and thrill and notify the appropriate provider if
absent
D) Apply firm pressure over the fistula to restore circulation
Correct Answer: C
Rationale: Sudden loss of a bruit or thrill suggests access thrombosis or another acute access
complication and requires prompt evaluation. Warm skin does not establish patency.
Cannulating a potentially thrombosed access can cause injury and delay treatment. Firm
pressure could further compromise blood flow.
Q4: A patient develops severe muscle cramps during ultrafiltration. Blood pressure is
declining and the machine indicates that the prescribed ultrafiltration goal is nearly
complete. Which finding most strongly supports excessive intravascular volume removal?
A) Elevated serum phosphorus
B) Rapid decline in blood pressure accompanied by cramping
C) Increased predialysis serum sodium
D) Mildly elevated predialysis BUN
Correct Answer: B
Rationale: Intradialytic hypotension and painful muscle cramps are classic manifestations of
excessive or overly rapid ultrafiltration relative to plasma refilling. The immediate priority is to
address the hemodynamic instability. Phosphorus, sodium, and BUN do not specifically explain
the acute combination of hypotension and cramps.
Q5: A patient has a target postdialysis weight of 72 kg but repeatedly finishes treatment at
69 kg because of aggressive ultrafiltration. Between treatments, the patient develops
dizziness and poor oral intake. What is the most appropriate nursing concern?
A) The patient is demonstrating adequate volume management
B) The lower postdialysis weight will prevent all hypertension
C) The prescribed target weight may be below the patient's current physiologic dry-weight
requirement
D) The patient should have the ultrafiltration goal increased further
Correct Answer: C
, Rationale: Repeatedly ending substantially below the established target weight with symptoms of
volume depletion should prompt reassessment of the patient's prescribed target weight.
Excessive fluid removal can cause intradialytic hypotension, cramping, fatigue, and organ
hypoperfusion. Target weight should reflect clinical assessment rather than simply achieving the
lowest possible postdialysis weight.
Q6: A patient with ESRD has persistent hyperphosphatemia despite taking a phosphate
binder. Which assessment is most important before concluding that the medication is
ineffective?
A) Whether the medication is taken only after dialysis
B) Whether the binder is taken with meals and snacks containing phosphorus
C) Whether the patient takes the medication with water
D) Whether the patient takes the binder immediately before bedtime
Correct Answer: B
Rationale: Most phosphate binders work by binding dietary phosphorus in the gastrointestinal
tract and therefore must be taken with meals or phosphorus-containing snacks. Taking them at
unrelated times markedly reduces their effectiveness. Timing relative to meals is therefore a key
assessment before changing therapy.
Q7: A hemodialysis patient receiving erythropoiesis-stimulating therapy has persistent
anemia. Laboratory studies show low transferrin saturation and low ferritin. Which
problem should the nurse recognize?
A) Pure folate deficiency
B) Iron deficiency limiting the erythropoietic response
C) Excessive erythropoietin production
D) Dialysis-associated hypercalcemia
Correct Answer: B
Rationale: Iron deficiency can limit the effectiveness of erythropoiesis-stimulating agents. Low
transferrin saturation and low ferritin support depleted iron stores. In ESRD, anemia
management therefore requires assessment of iron status in addition to ESA therapy. Folate
deficiency and calcium abnormalities do not explain this laboratory pattern.
Q8: A patient with an AV fistula has prolonged bleeding after needle removal. Which
factor should the nurse evaluate first?
A) Serum albumin
B) Anticoagulation exposure and access-related abnormalities
C) Serum sodium
D) Predialysis bicarbonate
Correct Answer: B
Rationale: Prolonged postdialysis bleeding may result from excessive anticoagulation, platelet
dysfunction associated with kidney failure, elevated blood pressure, or access stenosis. The
nurse should evaluate anticoagulation and access characteristics promptly. Sodium,
bicarbonate, and albumin do not directly explain prolonged needle-site bleeding.
Q9: A patient receiving unfractionated heparin during hemodialysis develops a platelet
count that falls by more than 50% after several days of exposure and develops a new access
