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CNA Nephrology Nursing Certification Exam — Information & Free Practice

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About CNA Nephrology Nursing Certification Exam

CNA Nephrology Nursing Certification Exam · CA

Key exam facts

Provider
Canadian Nurses Association (CNA) owns the certification program and sets specialty examination standards. The blueprint was developed collaboratively with ASI and nephrology nurses. Meazure Learning supports testing and statistical analysis; ProctorU provides remote proctoring.
Format
Computer-based multiple-choice examination, written online at home with ProctorU or at a Meazure Learning test centre. Official presentation: 65–75% independent and 25–35% case-based questions.
Exam questions
Total questions: 160–165.
Time limit
Four hours (240 minutes) to complete the examination; this is the question-answering allowance, not a check-in or tutorial estimate.
Passing score
Criterion-referenced pass standard set by the specialty exam committee using a modified Angoff method and statistical review. CNA explicitly does not publish the pass mark; results are pass or unsuccessful.
Exam fee
CNA Canadian examination fee schedule ($): initial application $588 for CNA members or $780 for non-members, plus a separate appointment fee of $85 online or $110 in person, plus applicable taxes. Application fees include a $130 non-refundable administrative fee. Eligible unsuccessful candidates may rewrite for $378 member/$500 non-member during the next two calendar years; the separate appointment fee applies. The page uses $ without an explicit ISO currency code.

Topics covered

The authority publishes percentage ranges for each content area. The practice percentages below use the midpoint of each range, normalized to 100%; they are not exact percentages published by the authority. Practice question counts may differ slightly because of rounding.

  • Renal Anatomy and Physiology — Official range: 5–10% (Practice allocation: 6.49%)

    • Identifies normal renal anatomy, including the structure and characteristics of:
    • Identifies normal renal physiology including:
    • Kidneys
    • Urinary tract
    • Renal vasculature
    • Urine formation
    • Fluid balance
    • Electrolyte balance
    • Acid-base balance
    • Blood pressure regulation
    • Vitamin D synthesis
    • Secretion of various hormones (e.g., renin, erythropoietin)

  • Renal Disorders — Official range: 15–25% (Practice allocation: 17.32%)

    • Describes the etiology and pathophysiology of acute kidney injury:
    • Describes the diagnostic tests for a patient with acute kidney injury:
    • Describes the etiology and pathophysiology of chronic kidney disease:
    • Identifies the stages of chronic kidney disease: GFR = glomerular filtration rate (mL/min/1.73 m 2 )
    • Recognizes the effects of chronic kidney disease on the following aspects:
    • Describes the diagnostic tests for a patient with chronic kidney disease:
    • Prerenal
    • Intrarenal
    • Postrenal
    • Blood work (e.g., chemistry, hematology, virology, eGFR)
    • Urine tests (e.g., urinalysis, protein/creatinine ratio)
    • Renal biopsy
    • Vascular studies (e.g., renal scan)
    • Ultrasound studies
    • Renal MRI and CT
    • Diabetes
    • Nephrotic and nephritic syndromes
    • Interstitial diseases
    • Vascular diseases
    • Cystic diseases
    • Obstructive disorders
    • Infectious diseases
    • Toxic nephropathies
    • Renal disease in pregnancy
    • Neoplasms
    • Autoimmune disorders
    • Glomerular disorders
    • Congenital, developmental and genetic disorders
    • Hemolytic uremic syndrome
    • Growth and development
    • Cardiovascular
    • Neurological
    • Immunological
    • Gastrointestinal
    • Endocrine
    • Hematological
    • Integumentary
    • Pulmonary
    • Musculoskeletal
    • Reproductive (e.g., sexual function)
    • Genitourinary
    • Metabolic
    • Peripheral vascular
    • Psychosocial (e.g., cultural, psychological, support, financial)
    • Blood work (e.g., chemistry, hematology, virology, eGFR)
    • Urine tests (e.g., urinalysis, protein/creatinine ratio)
    • Renal biopsy
    • Vascular studies (e.g., renal scan, renal arteriogram, renal venogram, angiography)
    • Ultrasound studies
    • Radiologic studies (e.g., kidney, ureter and bladder (KUB), bone density)
    • Renal MRI and CT
    • Cystographic studies (e.g., cystogram, cystoscopy)
    • Stage 1 – Kidney damage with normal GFR or GFR ≥ 90
    • Stage 2 – Kidney damage with GFR = 60-89
    • Stage 3 – Moderate kidney damage with GFR = 30-59
    • Stage 4 – Severe kidney damage with GFR = 15-29
    • Stage 5 – Kidney failure with GFR < 15

  • Kidney Disease Management — Official range: 15–20% (Practice allocation: 15.15%)

    • Integrates the plan of care in collaboration with the patient in acute kidney injury during the:
    • Integrates the plan of care in collaboration with the patient with respect to:
    • Educates and supports the patient regarding:
    • Initiating stage
    • Oliguric stage
    • Diuretic stage
    • Recovery stage
    • Blood pressure management
    • Diabetes management
    • Dietary management
    • Fluid management
    • Anemia management
    • Hyperlipidemia management
    • Renal osteodystrophy management
    • Pain management
    • Cardiac management
    • Immunologic and serologic status (e.g., hepatitis, HIV)
    • MRSA/VRE status
    • Integumentary care (e.g., foot care)
    • Infection prevention
    • Psychosocial issues (e.g., cultural, psychological, support, financial)
    • Sexual function
    • Access assessment, creation, placement and care
    • Health promotion and kidney function
    • Self-management (e.g., building capacity, chronic illness management models)
    • Strategies to delay kidney disease progression
    • Treatment options for kidney disease (e.g., renal replacement therapies, conservative management, palliative care, end-of-life care)

  • Renal Replacement Therapies: Nursing Management of the Peritoneal Dialysis Patient — Official range: 15–20% (Practice allocation: 15.15%)

    • Educates the patient regarding self-management of peritoneal dialysis
    • Explains the principles of peritoneal dialysis with respect to solvent and solute removal/transport (e.g., diffusion, osmosis, convection, clearance)
    • Identifies the contraindications and selection considerations for peritoneal dialysis (e.g., previous abdominal surgeries, physical/psychosocial limitations, support)
    • Demonstrates the proper care of peritoneal dialysis catheters (e.g., abdominal, pre- sternal)
    • Identifies the indications, advantages and disadvantages for the following peritoneal dialysis modalities:
    • Identifies the elements and implications of the peritoneal dialysis prescription:
    • Assesses the peritoneal dialysis patient with respect to:
    • Initiates the plan of care in collaboration with the peritoneal dialysis patient for:
    • Demonstrates nursing strategies for the prevention and management of the following complications of peritoneal dialysis:
    • Continuous ambulatory peritoneal dialysis (CAPD)
    • Intermittent peritoneal dialysis (IPD)
    • Continuous cyclic peritoneal dialysis (CCPD)
    • Tidal peritoneal dialysis (TPD)
    • Composition of peritoneal dialysis solutions (e.g., osmotic agents, amino acids, buffers)
    • Number of exchanges
    • Volume of exchanges
    • Timing of exchanges
    • Dialysate temperature
    • Clinical assessment (e.g., history, physical)
    • Adequacy (e.g., Kt/V, PET, CrCl)
    • Fluid volume balance
    • Nutritional status
    • Metabolic status
    • Immunologic and serologic status (e.g., hepatitis, HIV)
    • MRSA/VRE status (e.g., antibiotic-resistant organisms)
    • Anemia management
    • Catheter (e.g., function, appearance, exit site)
    • Peritoneal catheter care (e.g., newly inserted, established, buried)
    • Prescription management (e.g., fluid balance, preparation of solutions, medications)
    • Nutritional management
    • Infection control measures
    • Identification and management of complications
    • Equipment preparation (e.g., dialysate, tubing)
    • Fluid volume imbalances
    • Ultrafiltration failure
    • Metabolic imbalances
    • Membrane inadequacy or failure (e.g., encapsulating peritoneal sclerosis)
    • Malnutrition (e.g., protein)
    • Hyper/Hypoglycemia
    • Pain (e.g., non-infectious, infectious)
    • Infection (e.g., peritonitis, exit site, tunnel)
    • Catheter complications (e.g., malfunction, malposition, cuff extrusion)
    • Leaks (e.g., pericatheter, extraperitoneal)
    • Hemoperitoneum
    • Increased intra-abdominal pressure
    • Hernias
    • Alterations in gastrointestinal function (e.g., constipation)
    • Psychosocial impact
    • Psychosocial response (e.g., coping, prescription adherence/fatigue, behaviour management issues)
    • Educational needs (e.g., physical environment, promotion of self- management)
    • Failed kidney transplant (e.g., immunosuppressive medications)

  • Renal Replacement Therapies: Nursing Management of the Hemodialysis Patient — Official range: 15–20% (Practice allocation: 15.15%)

    • Explains the components of hemodialysis:
    • Describes the advantages, disadvantages and selection considerations for hemodialysis:
    • Describes the indications, advantages and disadvantages for the following hemodialysis access:
    • Describes the arteriovenous fistula/graft assessment (e.g., auscultation, palpation, appearance, maturation)
    • Differentiates cannulation techniques (e.g., rotating sites, buttonhole, rope ladder)
    • Identifies arteriovenous fistula/graft complications (e.g., infections, steal syndrome, thrombosis, aneurysm)
    • Implements nursing strategies for preventing and managing arteriovenous fistula/graft complications (e.g., site rotation, aseptic technique, cannulation, pressure)
    • Identifies the indications and tools available for access surveillance
    • Indicates advantages and disadvantages for single needle dialysis
    • Describes the central venous catheter assessment (e.g., exit/insertion site, position)
    • Demonstrates an understanding of central venous catheter complications (e.g., infection, central vein stenosis, catheter malfunction)
    • Implements nursing strategies for preventing and managing central venous catheter complications (e.g., aseptic technique, aspiration, flushing, securement)
    • Demonstrates an understanding of the importance of the hemodialysis prescription:
    • Assesses the hemodialysis patient with respect to:
    • Implements nursing strategies for the prevention and management of hemodialysis complications:
    • Integrates the plan of care in collaboration with the hemodialysis patient for:
    • Ultrafiltration
    • Osmosis
    • Hydrostatic pressure
    • Backfiltration
    • Clearance
    • Diffusion
    • Convection
    • Water quality
    • Transmembrane pressure
    • In-centre (e.g., conventional, nocturnal, short daily, self-care)
    • Home (e.g., conventional, nocturnal, short daily)
    • Satellite/community
    • Native arteriovenous fistula
    • Arteriovenous graft (e.g., PTFE, saphenous vein)
    • Central venous catheter (e.g., tunnelled, non-tunnelled)
    • Access flow monitoring/recirculation studies (e.g., in-line dialysance, crit-line monitor, ultrasound dilution technique, blood work)
    • Angiography (e.g., fistulogram, fistuloplasty)
    • Structure and characteristics of the dialyzer
    • Composition of dialysate
    • Frequency and length of treatment
    • Blood flow and dialysate flow rate
    • Anticoagulation therapy
    • Dialysate temperature
    • Dialysate conductivity
    • Ultrafiltration profiling
    • Sodium profiling
    • Dry weight (e.g., target, goal)
    • Clinical assessment (e.g., history, pre/post vital signs, chest auscultation, fluid volume, vascular access)
    • Adequacy (e.g., Kt/V, PRU)
    • Nutritional and metabolic status
    • Isolation status (e.g., MRSA, VRE, hepatitis B)
    • Anemia management
    • Psychosocial response (e.g., coping, prescription adherence/fatigue, behaviour management issues)
    • Educational needs (e.g., dietary, vascular access, promotion of self-management)
    • Pre-, intra- and post-dialysis monitoring (e.g., vascular access pressures, patient symptoms)
    • Failed kidney transplant (e.g., immunosuppressive medications)
    • Air embolism
    • Hemolysis
    • Bleeding, hemorrhage and exsanguination
    • Blood leak
    • Blood loss due to clotting
    • Dialyzer reactions
    • Pyrogenic reactions
    • Disequilibrium syndrome
    • Muscle cramps and restless leg syndrome
    • Blood pressure management
    • Nausea, vomiting and dizziness
    • Cardiac events (e.g., dysrhythmias, angina, uremic pericarditis)
    • Infections
    • Seizures
    • Hypoxemia
    • Self-management (e.g., empowerment, informed decision-making, self- cannulation)
    • Vascular access management
    • Prescription management (e.g., fluid balance, medication, adherence)
    • Nutritional management (e.g., oral supplements, parental nutrition)
    • Infection control measures
    • Identification and management of hemodialysis complications
    • Dialysis schedule management (e.g., adherence, transportation, finances)
    • Equipment preparation (e.g., dialysate and extracorporeal circuit)
    • Advance care planning

  • Renal Replacement Therapies: Nursing Management of the Transplant Patient — Official range: 15–20% (Practice allocation: 15.15%)

    • Identifies transplant options available for kidney disease patients:
    • Assesses the potential transplant recipient with respect to:
    • Identifies the potential contraindications for renal transplantation:
    • Assesses the potential living kidney donor with respect to:
    • Demonstrates nursing strategies for preventing and managing the following complications of renal transplantation:
    • Integrates the plan of care in collaboration with the renal transplant recipient in respect to:
    • Living donor (e.g., related, unrelated)
    • Deceased donor (e.g., single vs. double kidney, kidney-pancreas)
    • Living Donor Paired Exchange (LDPE)
    • Kidney disease stage and progression
    • Clinical assessment and history (e.g., physical, psychosocial)
    • Laboratory tests (e.g., ABO, HLA typing, antibody status, serology)
    • Diagnostic tests (e.g., cardiac, radiologic, vascular)
    • Educational needs (e.g., promotion of self-management)
    • Malignancy
    • Infection (e.g., active, chronic)
    • Severe comorbidities (e.g., cardiac, hepatic, vascular, active autoimmune)
    • Severe hyperparathyroidism, untreated
    • Morbid obesity
    • Non-adherence
    • Ongoing substance abuse
    • Unstable psychiatric status
    • Social and cultural issues
    • Clinical assessment and history (e.g., physical, psychosocial)
    • Laboratory tests (e.g., ABO, HLA typing, antibody status, serology)
    • Diagnostic tests (e.g., cardiac, radiologic, vascular)
    • Educational needs (e.g., promotion of self-management)
    • Delayed graft function (e.g., acute tubular necrosis)
    • Surgical complications (e.g., lymphocele, renal artery stenosis, urine leaks)
    • Rejection (i.e., hyperacute, acute, chronic)
    • Immunosuppression-related (e.g., infection, malignancy)
    • Steroid-related (e.g., diabetes, psychosis, bone disease, weight gain)
    • Blood value abnormalities
    • Blood pressure management
    • Sexual function
    • Psychosocial impact
    • Graft function
    • Blood pressure management
    • Diagnostics (e.g., blood work, biopsy, radiology)
    • Medication management
    • Fluid management
    • Nutritional management
    • Educational needs (e.g., promotion of self-management)
    • Psychosocial support

  • Advance Care Planning, Conservative Management and Palliative Care — Official range: 5–10% (Practice allocation: 6.49%)

    • Respects the patient’s decision regarding:
    • Assesses patient readiness to participate in discussion regarding advance care planning and end-of-life care
    • Maximizes disease management while minimizing symptoms
    • Implements the plan of care in collaboration with the patient:
    • Initiating/not initiating dialysis
    • Withdrawal from dialysis
    • Resuscitation
    • Advance care planning
    • End-of-life comfort measures (e.g., pain control, fluid management, spiritual and cultural beliefs)

  • Pharmacology — Official range: 5–10% (Practice allocation: 6.49%)

    • Understands considerations within the following medication classifications (e.g., dialyzability, side effects, cost, indication, dosage adjustment, route, dosing schedule, interactions, missed dose):
    • Anti-infectives (e.g., antimicrobials, antivirals, vaccines)
    • Antineoplastics (e.g., cyclophosphamide [Cytoxan])
    • Anemia therapy (e.g., erythropoiesis-stimulating agents, iron supplements)
    • Anticoagulants (e.g., fibrinolytics, thrombolytics)
    • Cardiovascular (e.g., antihypertensives, antihypotensives, antiarrhythmics)
    • Diuretics (e.g., thiazides, loop diuretics)
    • Dermatologic (e.g., antihistamines, emollients)
    • Diagnostic and contrast media (e.g., iodine-based radiopaque dye, gadolinium)
    • Endocrine (e.g., insulin/hyperglycemic agents, hormones)
    • Gastrointestinal (e.g., antiemetics, laxatives, stool softeners)
    • Immunosuppressive (e.g., calcineurin inhibitors, corticosteroids, antiproliferatives)
    • Vitamins (e.g., water soluble, fat soluble)
    • Bone metabolism (e.g., phosphate binders, calcimimetics, vitamin D analogs)
    • Central nervous system (e.g., analgesics, antidepressants, sedatives)
    • Local anesthetics (e.g., subcutaneous, topical)
    • Electrolytes (e.g., chelating agents, cation-exchange resins, potassium)
    • Minerals (e.g., calcium, magnesium, phosphate)
    • Nutritional supplements (e.g., enteral, parenteral, oral)
    • Blood products (e.g., albumin, packed red blood cells, immune globulin)

  • Adjunctive and Complementary Alternative Health Care — Official range: 1–5% (Practice allocation: 2.6%)

    • Respects individual choices related to complementary alternative health care (e.g., acupuncture, homeopathy, herbal therapy)
    • Identifies advantages and disadvantages in the use of adjunctive and complementary alternative health care specific to kidney disease
    • Facilitates patient learning regarding the importance of reporting the use of complementary alternative health care (e.g., antioxidants, vitamins, herbal remedies)

How to prepare

Work through the topics, read the explanation after each answer, and revisit the areas where you miss questions. Use the official outline and reference materials below to guide your study.

These independent practice questions are not actual exam items and do not guarantee a passing result.

Frequently asked questions

What is the exam format?

Computer-based multiple-choice examination, written online at home with ProctorU or at a Meazure Learning test centre. Official presentation: 65–75% independent and 25–35% case-based questions.

How many questions are on the exam?

Total questions: 160–165.

How long is the exam?

Four hours (240 minutes) to complete the examination; this is the question-answering allowance, not a check-in or tutorial estimate.

What is the passing score?

Criterion-referenced pass standard set by the specialty exam committee using a modified Angoff method and statistical review. CNA explicitly does not publish the pass mark; results are pass or unsuccessful.

How much does the exam cost?

CNA Canadian examination fee schedule ($): initial application $588 for CNA members or $780 for non-members, plus a separate appointment fee of $85 online or $110 in person, plus applicable taxes. Application fees include a $130 non-refundable administrative fee. Eligible unsuccessful candidates may rewrite for $378 member/$500 non-member during the next two calendar years; the separate appointment fee applies. The page uses $ without an explicit ISO currency code.

Official sources and references

Confirm current exam arrangements with the exam provider.