NNCC CNN-NP Certified Nephrology Nurse Practitioner

Per KDIGO 2024, chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function present for what minimum duration?

• AGreater than 1 month
• BGreater than 3 months
• CGreater than 6 months
• DGreater than 12 months

A patient has a stable eGFR of 50 mL/min/1.73 m² and an ACR of 250 mg/g persistent over 6 months. Per KDIGO staging, this patient is in which CKD category?

• AG2 A2
• BG3a A2
• CG3b A3
• DG4 A3

Which feature of the CKD-EPI 2021 creatinine equation differentiates it from the prior CKD-EPI 2009 equation?

• AIt includes a race coefficient for Black patients
• BIt removes the race coefficient and uses sex and creatinine only
• CIt requires cystatin C in all calculations
• DIt uses 24-hour urine creatinine clearance instead of serum creatinine

A CKD G4 patient has phosphorus 5.6 mg/dL, calcium 8.6 mg/dL, and intact PTH 420 pg/mL. According to KDIGO CKD-MBD guidance, which initial therapeutic step is most appropriate?

• AStart calcium-based phosphate binder with each meal
• BCounsel on dietary phosphate restriction and start a non-calcium phosphate binder if phos…
• CBegin cinacalcet immediately to lower PTH
• DStart IV calcitriol to suppress PTH

Per the KDIGO 2021 BP guideline, what is the recommended target systolic blood pressure for most adults with CKD not on dialysis?

• A<140 mmHg
• B<130 mmHg
• C<120 mmHg
• D<110 mmHg

A 58-year-old with type 2 diabetes, eGFR 38 mL/min/1.73 m², and ACR 600 mg/g is on maximally tolerated lisinopril. Which medication, supported by DAPA-CKD, should be added to slow CKD progression?

• AEmpagliflozin 10 mg daily
• BDapagliflozin 10 mg daily
• CPioglitazone 30 mg daily
• DGlipizide 10 mg daily

EMPA-KIDNEY enrolled patients with CKD down to which minimum eGFR threshold?

• AeGFR ≥45
• BeGFR ≥30
• CeGFR ≥25
• DeGFR ≥20

Which monitoring threshold defines a serum potassium level at which finerenone should NOT be initiated per FIDELIO-DKD/FIGARO-DKD protocols and FDA labeling?

• AK+ >4.5 mEq/L
• BK+ >4.8 mEq/L
• CK+ >5.0 mEq/L
• DK+ >5.5 mEq/L

FIDELIO-DKD and FIGARO-DKD studied which class of agents added to ACEi or ARB in patients with type 2 diabetes and CKD?

• ASteroidal mineralocorticoid receptor antagonists
• BNonsteroidal mineralocorticoid receptor antagonists
• CSGLT2 inhibitors
• DGLP-1 receptor agonists

For a non-dialysis CKD patient with iron deficiency, which iron studies thresholds typically warrant iron repletion before initiating an erythropoiesis-stimulating agent (ESA)?

• ATSAT <20% and ferritin <100 ng/mL
• BTSAT <30% and ferritin <500 ng/mL
• CTSAT <40% and ferritin <800 ng/mL
• DTSAT <50% and ferritin <1000 ng/mL

Per KDIGO anemia guidelines for CKD, what is the recommended hemoglobin range targeted by ESA therapy?

• A8-9 g/dL
• B9-10 g/dL
• C10-11 g/dL
• D12-13 g/dL

Typical starting dose of epoetin alfa subcutaneously for an anemic CKD patient who is iron-replete is approximately:

• A10-20 U/kg three times per week
• B50-100 U/kg three times per week
• C200-300 U/kg three times per week
• D500 U/kg three times per week

Darbepoetin alfa is typically administered at what frequency in CKD anemia management?

• AEvery dialysis session (three times weekly)
• BOnce every 1-2 weeks
• COnce monthly
• DOnce every 3 months

A non-dialysis CKD patient with metabolic acidosis (serum HCO3 19 mEq/L) is most appropriately managed with which intervention to slow CKD progression?

• ASodium bicarbonate to target HCO3 ≥22 mEq/L
• BIV saline to dilute the acid
• CSodium chloride tablets
• DLoop diuretic to enhance acid excretion

Which finding is most characteristic of uremic symptoms warranting consideration of dialysis initiation?

• AMild fatigue with normal mental status and adequate intake
• BPericardial friction rub, persistent nausea, encephalopathy, or refractory volume overload
• CIsolated stable eGFR of 14 mL/min/1.73 m² without symptoms
• DACR of 500 mg/g without uremic features

First-line workup for new-onset proteinuria identified on a random urine sample should include:

• ASpot urine albumin-to-creatinine ratio (ACR) and urine sediment
• B24-hour urine for catecholamines
• CRenal arteriogram
• DKidney biopsy as first step

A patient with type 2 diabetes, CKD G3a, and ACR 350 mg/g is on lisinopril and dapagliflozin. Which agent class has emerging evidence (FLOW trial) for kidney protection in this population?

• ADPP-4 inhibitors
• BSulfonylureas
• CGLP-1 receptor agonists (semaglutide)
• DAlpha-glucosidase inhibitors

Per KDIGO lipid management guidance for CKD, which patients with non-dialysis CKD aged ≥50 years should receive statin therapy?

• AOnly those with LDL >190 mg/dL
• BAll adults age ≥50 with non-dialysis CKD regardless of baseline LDL
• COnly those with prior MI
• DOnly those with diabetes and CKD

A CKD patient on lisinopril has a baseline creatinine of 1.6 mg/dL (eGFR 45). After initiation, creatinine rises to 1.9 mg/dL (eGFR 38) at 2-week recheck. What is the most appropriate next step?

• ADiscontinue lisinopril immediately
• BContinue lisinopril and recheck — a rise <30% from baseline is acceptable
• CDouble the lisinopril dose
• DSwitch to spironolactone

For a hemodialysis patient with persistent hyperphosphatemia despite dietary counseling, which non-calcium phosphate binder also delivers iron?

• ASevelamer carbonate
• BLanthanum carbonate
• CFerric citrate
• DSucroferric oxyhydroxide

Which calcimimetic is administered intravenously at the end of each hemodialysis session for secondary hyperparathyroidism?

• ACinacalcet
• BEtelcalcetide
• CParicalcitol
• DCalcitriol

An ESRD patient on hemodialysis presents with itching, brittle nails, and PTH of 1100 pg/mL. Calcium 9.0, phosphorus 6.5. Initial therapy should include:

• AAggressive vitamin D analog without addressing phosphate
• BPhosphate-lowering measures (binders, dietary) plus calcimimetic and/or vitamin D analog…
• CParathyroidectomy as first-line therapy
• DCalcium gluconate IV bolus

A CKD G5 patient elects conservative (non-dialysis) kidney management. The CNN-NP's role primarily includes:

• ARefusing to manage the patient since dialysis was declined
• BSymptom-focused care, advance care planning, and coordination with palliative care
• CMandating peritoneal dialysis catheter placement
• DDiscontinuing all medications

Which statement best describes Continuous Ambulatory Peritoneal Dialysis (CAPD)?

• AA machine performs exchanges during the night while the patient sleeps
• BThe patient performs 4-5 manual exchanges throughout the day with a long overnight dwell
• CDialysis is performed in-center three times per week
• DDialysis is continuous through a central venous catheter

A peritoneal dialysis patient calls reporting cloudy effluent and abdominal pain. Effluent WBC count is 350/μL with 75% neutrophils. Per ISPD guidance, the diagnosis and management is:

• ALikely peritonitis; obtain effluent cell count, Gram stain, and cultures, then start empi…
• BLikely catheter malfunction; flush catheter with saline
• CLikely constipation; administer laxative
• DLikely exit-site infection; treat with topical mupirocin

Per ISPD peritonitis criteria, which of the following thresholds defines presumptive peritonitis in a PD patient with abdominal pain and cloudy effluent (after at least 2 hours of dwell)?

• AEffluent WBC >50/μL with any neutrophil percentage
• BEffluent WBC >100/μL with >50% polymorphonuclear cells (PMNs)
• CEffluent WBC >500/μL with >25% lymphocytes
• DEffluent eosinophils >10%

A common empiric intraperitoneal antibiotic regimen for PD peritonitis covers:

• AAnaerobes only
• BGram-positive only with vancomycin
• CGram-positive (vancomycin or cefazolin) plus Gram-negative (ceftazidime or aminoglycoside)
• DAntifungals only

Per KDOQI vascular access guidelines, the preferred initial vascular access for hemodialysis is:

• ATunneled central venous catheter
• BArteriovenous graft (AVG)
• CArteriovenous fistula (AVF)
• DNon-tunneled temporary catheter

When should pre-emptive vascular access referral typically be made for a CKD patient progressing toward ESRD?

• AWhen eGFR drops below 60 mL/min/1.73 m²
• BWhen eGFR is 20-30 mL/min/1.73 m² with progressive decline
• COnly after dialysis initiation
• DWhen albuminuria appears

An AVF is considered mature and ready for cannulation when which 'Rule of 6s' criteria are met?

• ADiameter ≥6 mm, depth ≤6 mm, flow ≥600 mL/min, ~6 weeks post-creation
• BDiameter ≥10 mm, depth any, flow ≥300 mL/min, 2 weeks post-creation
• CDiameter ≥3 mm, depth ≥10 mm, flow ≥1500 mL/min
• DNo criteria; cannulate anytime after surgery

A patient with a left forearm AVF develops swelling of the ipsilateral arm and engorged collateral veins on the chest wall. The most likely diagnosis is:

• ASteal syndrome
• BCentral venous stenosis
• CAVF aneurysm
• DAortic dissection

Per KDIGO AKI criteria, AKI Stage 1 is defined as:

• AIncrease in serum creatinine ≥0.3 mg/dL within 48 hours OR ≥1.5-1.9× baseline within 7 da…
• BIncrease in serum creatinine ≥2.0× baseline only
• CNeed for renal replacement therapy
• DAnuria for 12 hours

A hospitalized patient on furosemide develops AKI. FENa is 3.5%. The clinician suspects pre-renal azotemia. Which urine index is more reliable in this scenario?

• AFENa
• BFEUrea
• CUrine osmolality
• DUrine specific gravity

Which intervention has the strongest evidence for preventing contrast-associated AKI in a patient with eGFR 38 undergoing IV contrast CT?

• AIV isotonic crystalloid (saline or bicarbonate) before and after contrast
• BOral N-acetylcysteine (NAC)
• CProphylactic dialysis after contrast
• DIV mannitol

Indications for urgent renal replacement therapy initiation are commonly remembered with the AEIOU mnemonic. Which of the following is NOT in AEIOU?

• AAcidosis (refractory metabolic)
• BElectrolyte abnormalities (severe hyperkalemia)
• CIngestion (toxic alcohol or dialyzable toxin)
• DHyperalbuminemia

An ICU patient has AKI with serum creatinine increase to 2.8× baseline (no UOP data, no urgent indication). Per AKIKI and STARRT-AKI evidence, the appropriate timing of RRT initiation is:

• AImmediately upon meeting Stage 2 criteria, regardless of clinical status
• BWatchful waiting with close monitoring; initiate RRT when conventional indications develo…
• CMandatory CRRT within 24 hours of any AKI
• DDaily IHD until creatinine normalizes

A 35-year-old presents with hematuria, ACR 1800 mg/g, BP 158/95, and an episode of gross hematuria after a recent URI. Renal biopsy shows mesangial IgA deposits. Most likely diagnosis:

• AMembranous nephropathy
• BIgA nephropathy
• CMinimal change disease
• DLupus nephritis class V

Primary membranous nephropathy is associated with which target autoantibody in the majority of cases?

• AAnti-PLA2R
• BAnti-GBM
• CANCA (MPO or PR3)
• DAnti-dsDNA

FSGS in a young Black patient with rapidly progressive proteinuria is associated with risk variants in which gene?

• APKD1
• BAPOL1
• CCOL4A5
• DPKHD1

Lupus nephritis class III/IV induction therapy commonly includes which combination?

• ASteroids alone
• BIV methylprednisolone pulse + mycophenolate mofetil (MMF) OR IV cyclophosphamide; with co…
• CPlasmapheresis only
• DTacrolimus monotherapy

A 60-year-old presents with rapidly progressive glomerulonephritis (RPGN), positive c-ANCA/anti-PR3, and pulmonary infiltrates. Which induction therapy is supported by the RAVE trial?

• APlasmapheresis monotherapy
• BRituximab plus glucocorticoids (non-inferior to cyclophosphamide)
• CMMF monotherapy
• DHydroxychloroquine

Autosomal dominant polycystic kidney disease (ADPKD) with rapidly progressive decline can be treated with which oral agent that slows kidney function decline?

• ATolvaptan (vasopressin V2 receptor antagonist)
• BLithium
• CSpironolactone
• DHydrochlorothiazide

Alport syndrome is most commonly caused by mutations in which gene?

• ACOL4A5 (X-linked)
• BPKD1
• CMYH9
• DWT1

A patient with diabetic nephropathy has eGFR 35 and ACR 800 mg/g on lisinopril. Which add-on agent has the strongest evidence for slowing CKD progression in diabetic CKD with albuminuria?

• AA thiazide diuretic
• BAn SGLT2 inhibitor (e.g., empagliflozin or dapagliflozin)
• CA beta-blocker
• DA calcium channel blocker

A patient on hemodialysis presents with K+ 6.8 mEq/L and peaked T waves on ECG. The first medication to administer is:

• AIV calcium gluconate to stabilize the cardiac membrane
• BOral sodium polystyrene sulfonate (Kayexalate)
• CSubcutaneous insulin alone
• DFurosemide IV

Which oral potassium binder is a non-absorbed sodium-zirconium silicate that exchanges sodium and hydrogen for potassium throughout the GI tract?

• APatiromer
• BSodium zirconium cyclosilicate (SZC, Lokelma)
• CSodium polystyrene sulfonate (SPS, Kayexalate)
• DSevelamer

A patient presents with serum sodium 118 mEq/L, urine osmolality 450 mOsm/kg, urine sodium 60 mEq/L, normal volume status, and normal thyroid/cortisol. Most likely diagnosis:

• AHypovolemic hyponatremia from GI losses
• BSIADH (syndrome of inappropriate antidiuresis)
• CDiabetes insipidus
• DPseudohyponatremia