CDN EXAM 2026] QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
• Hemodialysis Principles and Procedures
• Peritoneal Dialysis Principles and Procedures
• Complications of Dialysis and Patient Management
• Chronic Kidney Disease (CKD) Pathophysiology and Management
• Pharmacology and Medication Management for Dialysis Patients
• Nutrition and Fluid Management for Dialysis Patients
• Psychosocial Aspects of Dialysis Care
• Infection Control and Safety in Dialysis Settings
• Ethical and Legal Issues in Dialysis Nursing
• Patient Education and Self-Management Support
Introduction
This comprehensive assessment is designed to evaluate the knowledge and practical decision-making
skills required for the Certified Dialysis Nurse (CDN) Examination. The exam covers foundational
nephrology nursing principles, applied clinical knowledge, and regulatory compliance. Using a multiple-
choice and scenario-based structure, it tests the candidate's ability to assess, plan, implement, and
evaluate care for patients with kidney disease. Successful completion demonstrates readiness to provide
safe, competent, and compassionate care to dialysis patients.
SECTION ONE: QUESTIONS 1–100
1. A patient with CKD reports muscle cramps and twitching. The nurse should suspect which
electrolyte abnormality?
A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hyperphosphatemia
C
RATIONALE: Hypocalcemia in CKD can cause neuromuscular irritability, manifesting as muscle
cramps, twitching, and paresthesias. This occurs due to decreased activation of vitamin D and secondary
hyperparathyroidism. Calcium supplementation and vitamin D analogs may be prescribed .
2. Which of the following is a risk factor for the development of CKD?
A. Diabetes mellitus
,B. Hypertension
C. Family history of kidney disease
D. All of the above
D
RATIONALE: Diabetes mellitus and hypertension are the two leading causes of CKD. A family
history of kidney disease also increases the risk of developing CKD .
3. The primary mechanism of solute removal in hemodialysis is:
A. Osmosis
B. Diffusion
C. Ultrafiltration
D. Active transport
B
RATIONALE: Diffusion is the primary mechanism of solute removal in hemodialysis. It involves the
movement of solutes from an area of higher concentration (the blood) to an area of lower concentration
(the dialysate) across a semipermeable membrane .
4. A patient with CKD is diagnosed with renal osteodystrophy. Which laboratory finding would the
nurse expect?
A. Elevated calcium
B. Elevated phosphorus
C. Decreased PTH
D. Decreased alkaline phosphatase
B
RATIONALE: Renal osteodystrophy is characterized by elevated phosphorus, low or normal
calcium, and elevated PTH. Alkaline phosphatase may be elevated due to increased bone turnover.
Management includes phosphorus restriction, phosphate binders, vitamin D analogs, and calcium
supplementation .
5. The nurse is teaching a patient with CKD about fluid restriction. Which statement by the patient
indicates understanding?
A. "I can drink as much as I want as long as I take my diuretics."
B. "I should limit my fluid intake to the amount prescribed by my healthcare provider."
C. "I only need to restrict fluids if I am on dialysis."
D. "Fluid restriction is not important in CKD."
B
RATIONALE: Fluid restriction is important in CKD to prevent fluid overload, hypertension, and
pulmonary edema. The prescribed fluid allowance is typically based on urine output plus insensible
losses. Patients should be educated on measuring and tracking their fluid intake .
6. Which of the following is a complication of CKD that affects the neurologic system?
A. Uremic encephalopathy
B. Peripheral neuropathy
C. Restless legs syndrome
D. All of the above
, D
RATIONALE: CKD can cause multiple neurologic complications including uremic encephalopathy
(altered mental status, confusion, seizures), peripheral neuropathy (sensory and motor changes in the
extremities), and restless legs syndrome (uncomfortable sensations and urge to move the legs). These are
often improved with dialysis .
7. A patient with CKD is prescribed sevelamer as a phosphate binder. The nurse should educate the
patient that this medication:
A. Contains calcium
B. Does not contain calcium or aluminum
C. Should be taken with aluminum-containing antacids
D. Should be taken on an empty stomach
B
RATIONALE: Sevelamer is a non-calcium, non-aluminum phosphate binder. It is preferred in
patients with hypercalcemia or vascular calcification risk. Calcium-containing binders (calcium acetate,
calcium carbonate) may contribute to calcium overload, and aluminum-containing binders (now rarely
used) carry the risk of aluminum toxicity .
8. A patient with CKD is experiencing pruritus. Which intervention is most appropriate?
A. Apply alcohol-based lotions
B. Encourage hot baths
C. Use cool compresses and gentle moisturizers
D. Administer oral antihistamines only
C
RATIONALE: Pruritus in CKD is managed with cool compresses, gentle moisturizers (fragrance-
free), and avoiding hot water and alcohol-based products. Oral antihistamines may provide some relief
but are not the primary intervention. Addressing underlying causes (hyperphosphatemia, inadequate
dialysis) is also important .
9. A patient undergoing hemodialysis develops hypotension. The nurse should:
A. Increase the ultrafiltration rate
B. Place the patient in Trendelenburg position
C. Administer a fluid bolus as prescribed
D. Increase the dialysate flow rate
C
RATIONALE: Hypotension during hemodialysis is a common complication. The nurse should place
the patient in a head-down (Trendelenburg) position and administer a fluid bolus as prescribed.
Decreasing the ultrafiltration rate is also appropriate. Increasing the dialysate flow rate would not directly
address hypotension.
10. Which of the following is a sign of fluid overload in a hemodialysis patient?
A. Hypotension
B. Decreased jugular venous pressure
C. Pulmonary edema
D. Decreased weight
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
• Hemodialysis Principles and Procedures
• Peritoneal Dialysis Principles and Procedures
• Complications of Dialysis and Patient Management
• Chronic Kidney Disease (CKD) Pathophysiology and Management
• Pharmacology and Medication Management for Dialysis Patients
• Nutrition and Fluid Management for Dialysis Patients
• Psychosocial Aspects of Dialysis Care
• Infection Control and Safety in Dialysis Settings
• Ethical and Legal Issues in Dialysis Nursing
• Patient Education and Self-Management Support
Introduction
This comprehensive assessment is designed to evaluate the knowledge and practical decision-making
skills required for the Certified Dialysis Nurse (CDN) Examination. The exam covers foundational
nephrology nursing principles, applied clinical knowledge, and regulatory compliance. Using a multiple-
choice and scenario-based structure, it tests the candidate's ability to assess, plan, implement, and
evaluate care for patients with kidney disease. Successful completion demonstrates readiness to provide
safe, competent, and compassionate care to dialysis patients.
SECTION ONE: QUESTIONS 1–100
1. A patient with CKD reports muscle cramps and twitching. The nurse should suspect which
electrolyte abnormality?
A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hyperphosphatemia
C
RATIONALE: Hypocalcemia in CKD can cause neuromuscular irritability, manifesting as muscle
cramps, twitching, and paresthesias. This occurs due to decreased activation of vitamin D and secondary
hyperparathyroidism. Calcium supplementation and vitamin D analogs may be prescribed .
2. Which of the following is a risk factor for the development of CKD?
A. Diabetes mellitus
,B. Hypertension
C. Family history of kidney disease
D. All of the above
D
RATIONALE: Diabetes mellitus and hypertension are the two leading causes of CKD. A family
history of kidney disease also increases the risk of developing CKD .
3. The primary mechanism of solute removal in hemodialysis is:
A. Osmosis
B. Diffusion
C. Ultrafiltration
D. Active transport
B
RATIONALE: Diffusion is the primary mechanism of solute removal in hemodialysis. It involves the
movement of solutes from an area of higher concentration (the blood) to an area of lower concentration
(the dialysate) across a semipermeable membrane .
4. A patient with CKD is diagnosed with renal osteodystrophy. Which laboratory finding would the
nurse expect?
A. Elevated calcium
B. Elevated phosphorus
C. Decreased PTH
D. Decreased alkaline phosphatase
B
RATIONALE: Renal osteodystrophy is characterized by elevated phosphorus, low or normal
calcium, and elevated PTH. Alkaline phosphatase may be elevated due to increased bone turnover.
Management includes phosphorus restriction, phosphate binders, vitamin D analogs, and calcium
supplementation .
5. The nurse is teaching a patient with CKD about fluid restriction. Which statement by the patient
indicates understanding?
A. "I can drink as much as I want as long as I take my diuretics."
B. "I should limit my fluid intake to the amount prescribed by my healthcare provider."
C. "I only need to restrict fluids if I am on dialysis."
D. "Fluid restriction is not important in CKD."
B
RATIONALE: Fluid restriction is important in CKD to prevent fluid overload, hypertension, and
pulmonary edema. The prescribed fluid allowance is typically based on urine output plus insensible
losses. Patients should be educated on measuring and tracking their fluid intake .
6. Which of the following is a complication of CKD that affects the neurologic system?
A. Uremic encephalopathy
B. Peripheral neuropathy
C. Restless legs syndrome
D. All of the above
, D
RATIONALE: CKD can cause multiple neurologic complications including uremic encephalopathy
(altered mental status, confusion, seizures), peripheral neuropathy (sensory and motor changes in the
extremities), and restless legs syndrome (uncomfortable sensations and urge to move the legs). These are
often improved with dialysis .
7. A patient with CKD is prescribed sevelamer as a phosphate binder. The nurse should educate the
patient that this medication:
A. Contains calcium
B. Does not contain calcium or aluminum
C. Should be taken with aluminum-containing antacids
D. Should be taken on an empty stomach
B
RATIONALE: Sevelamer is a non-calcium, non-aluminum phosphate binder. It is preferred in
patients with hypercalcemia or vascular calcification risk. Calcium-containing binders (calcium acetate,
calcium carbonate) may contribute to calcium overload, and aluminum-containing binders (now rarely
used) carry the risk of aluminum toxicity .
8. A patient with CKD is experiencing pruritus. Which intervention is most appropriate?
A. Apply alcohol-based lotions
B. Encourage hot baths
C. Use cool compresses and gentle moisturizers
D. Administer oral antihistamines only
C
RATIONALE: Pruritus in CKD is managed with cool compresses, gentle moisturizers (fragrance-
free), and avoiding hot water and alcohol-based products. Oral antihistamines may provide some relief
but are not the primary intervention. Addressing underlying causes (hyperphosphatemia, inadequate
dialysis) is also important .
9. A patient undergoing hemodialysis develops hypotension. The nurse should:
A. Increase the ultrafiltration rate
B. Place the patient in Trendelenburg position
C. Administer a fluid bolus as prescribed
D. Increase the dialysate flow rate
C
RATIONALE: Hypotension during hemodialysis is a common complication. The nurse should place
the patient in a head-down (Trendelenburg) position and administer a fluid bolus as prescribed.
Decreasing the ultrafiltration rate is also appropriate. Increasing the dialysate flow rate would not directly
address hypotension.
10. Which of the following is a sign of fluid overload in a hemodialysis patient?
A. Hypotension
B. Decreased jugular venous pressure
C. Pulmonary edema
D. Decreased weight
