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Exam Review

Key Facts: CDN Exam

150

Exam Questions

NNCC

70%

Passing Score

Scaled score 95

3 hrs

Exam Duration

NNCC

$350

Exam Fee

NNCC

52%

Chronic HD Unit (ESRD)

Largest section

3 years

Certification Validity

NNCC

The CDN exam has 150 questions in 3 hours; a standard score of 95 (70% correct) passes. The blueprint effective September 1, 2026 has four content areas: Chronic HD Unit (ESRD) 52%, Concepts of Kidney Disease in Adults 32%, Chronic HD Unit (AKI & DGF) 8%, and Water for Dialysis 8%. It requires an RN license, 2,500 hours of in-center hemodialysis nursing experience and 30 nephrology contact hours in the prior 2 years. Certification is valid for 3 years. The exam fee is $350 ($300 for members of partner organizations such as ANNA).

Sample CDN Practice Questions

Try these sample questions to review concepts for the CDN exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1Which of the following best describes the pathophysiology of chronic kidney disease (CKD)?
A.Acute reversible damage to renal tubules
B.Progressive and irreversible loss of nephron function over time
C.Sudden obstruction of the renal artery causing ischemia
D.Autoimmune destruction of glomerular basement membrane
Explanation: CKD is defined as progressive and irreversible loss of nephron function over a period of months to years. The loss of nephrons is permanent and leads to declining glomerular filtration rate (GFR).
2A patient with CKD stage 4 has a GFR of 28 mL/min/1.73m². What is the most accurate description of this stage?
A.Kidney damage with normal or high GFR
B.Mild decrease in GFR
C.Moderate decrease in GFR
D.Severe decrease in GFR
Explanation: CKD Stage 4 is defined as severe decrease in GFR with a range of 15-29 mL/min/1.73m². At this stage, patients require preparation for renal replacement therapy.
3Which laboratory finding is most consistent with acute kidney injury (AKI) in the oliguric phase?
A.Serum creatinine decreasing by 0.5 mg/dL per day
B.BUN:creatinine ratio of 10:1
C.Rising serum potassium and phosphate levels
D.Dilute urine with low specific gravity
Explanation: During the oliguric phase of AKI, the kidneys cannot excrete potassium and phosphate, leading to hyperkalemia and hyperphosphatemia. BUN and creatinine rise, and urine output is low.
4Which of the following is the primary cause of anemia in patients with CKD?
A.Iron deficiency from poor dietary intake
B.Decreased erythropoietin production by the kidneys
C.Chronic blood loss through dialysis circuit
D.Vitamin B12 deficiency from restricted diet
Explanation: The primary cause of anemia in CKD is decreased erythropoietin (EPO) production by the damaged kidneys. EPO stimulates red blood cell production in the bone marrow.
5A dialysis patient presents with bone pain and fractures. Which mineral bone disorder is most likely responsible?
A.Osteoporosis from steroid use
B.Osteitis fibrosa cystica from secondary hyperparathyroidism
C.Osteomalacia from vitamin D intoxication
D.Paget disease of bone
Explanation: Renal osteodystrophy includes osteitis fibrosa cystica caused by secondary hyperparathyroidism due to phosphate retention, low calcium, and decreased vitamin D activation in CKD.
6Which medication should be held before administering intravenous contrast to a patient with CKD?
A.Erythropoietin stimulating agents
B.Metformin
C.Calcium carbonate
D.Sevelamer
Explanation: Metformin should be held before and after contrast administration due to the risk of lactic acidosis if contrast-induced nephropathy occurs.
7What is the recommended protein intake for a stable hemodialysis patient?
A.0.6 g/kg/day
B.0.8 g/kg/day
C.1.0-1.2 g/kg/day
D.2.0 g/kg/day
Explanation: Hemodialysis patients require higher protein intake (1.0-1.2 g/kg/day) to compensate for amino acid losses during dialysis and maintain nutritional status.
8Which electrolyte abnormality is most dangerous in AKI and requires immediate intervention?
A.Hyponatremia with sodium of 128 mEq/L
B.Hyperkalemia with potassium of 6.8 mEq/L
C.Hypocalcemia with calcium of 8.0 mg/dL
D.Hyperphosphatemia with phosphate of 5.5 mg/dL
Explanation: Severe hyperkalemia (K+ >6.5 mEq/L) can cause life-threatening cardiac arrhythmias and requires immediate treatment with calcium, insulin/glucose, and dialysis.
9A patient with diabetic nephropathy asks about the earliest sign of kidney damage. What should the nurse explain?
A.Elevated serum creatinine
B.Decreased urine output
C.Microalbuminuria
D.High blood pressure
Explanation: Microalbuminuria (30-300 mg/day) is the earliest marker of diabetic nephropathy and indicates increased permeability of the glomerular basement membrane.
10Which of the following is a modifiable risk factor for progression of CKD?
A.Age over 65 years
B.Family history of polycystic kidney disease
C.Uncontrolled hypertension
D.Male gender
Explanation: Uncontrolled hypertension is a major modifiable risk factor for CKD progression. Maintaining BP <130/80 mmHg can slow progression of kidney disease.

About the CDN Exam

The CDN (Certified Dialysis Nurse) exam validates expertise in hemodialysis nursing care. Its blueprint effective September 1, 2026 covers the chronic hemodialysis unit (ESRD), concepts of kidney disease in adults, hemodialysis for patients with AKI or post-transplant delayed graft function, and water for dialysis. It tests hemodialysis principles and procedures, vascular access care, complications, medications, infection control, patient education, and collaboration in dialysis settings.

Exam sponsor: NNCC (Nephrology Nursing Certification Commission). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

150 questions

Time Limit

3 hours

Passing Score

Standard score 95 (70% correct)

Exam / Certification Fees

$350 ($300 with ANNA membership)

Exam sponsor website

Reported exam pass rate: 65%. 2025 CDN pass rate (NNCC 2025-2026 Annual Report) This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

52%

Chronic HD Unit (ESRD)

Hemodialysis principles and procedures, vascular access, extracorporeal circuit troubleshooting, intradialytic complications, medications, and patient teaching

32%

Concepts of Kidney Disease in Adults

Infection prevention and control, safety, multisystem effects of kidney disease, care planning, and psychosocial adaptation

8%

Chronic HD Unit (AKI & DGF)

Hemodialysis for acute kidney injury and post-transplant delayed graft function: access care, complications, precautions, and infection risk

8%

Water for Dialysis

Water treatment components, bacteria and pyrogens, required testing and documentation, and patient reactions to contaminated water

Preparing for the CDN Exam

What You Need to Know

  • Passing score: Standard score 95 (70% correct)
  • Exam length: 150 questions
  • Time limit: 3 hours
  • Exam / certification fees: $350 ($300 with ANNA membership) Official sources

Using Our Practice Resources

  • Work through all 200 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CDN: Suggested Study Strategy

1Master hemodialysis (52%) — dialysis principles, vascular access types, and complications management
2Study renal pathophysiology — AKI, CKD stages, ESRD progression, and disease processes
3Know electrolyte imbalances — hyperkalemia, hyperphosphatemia, and management strategies
4Understand vascular access — AV fistula (preferred), AV graft, central venous catheters
5Review water for dialysis (8%): carbon tanks and chlorine/chloramine testing, bacteria and endotoxin limits, and patient reactions to contaminated water
6Learn AKI and delayed graft function care (8%): differences from ESRD, catheter care, nephrotoxic drugs, and infection risk

Frequently Asked Questions

What is the CDN certification?

CDN (Certified Dialysis Nurse) is a certification from the NNCC for registered nurses who care for patients receiving in-center hemodialysis. It validates expertise in hemodialysis care for patients with ESRD, AKI or post-transplant delayed graft function, kidney disease concepts, and water treatment for dialysis.

How many questions are on the CDN exam?

The CDN exam has 150 multiple-choice questions with a 3-hour time limit; about 25 are unscored pilot questions. You pass with a standard score of 95, which NNCC says is achieved by answering 70% of questions correctly. Chronic HD Unit (ESRD) is the largest content area at 52% of the exam.

What are the prerequisites for the CDN exam?

You need a full and unrestricted RN license, at least 2,500 hours of RN experience caring for in-center hemodialysis patients (or educating or supervising their staff), and 30 contact hours of nephrology nursing continuing education. Both the hours and the contact hours must fall within the 2 years before you apply.

What is the most heavily tested topic on the CDN exam?

Chronic HD Unit (ESRD) accounts for 52% of the exam, more than half of all questions. Focus on hemodialysis principles, vascular access (AVF, AVG, catheters), extracorporeal circuit monitoring, and complications such as hypotension and cramping. Water for Dialysis is a separate 8% section.

How should I prepare for the CDN exam?

Plan for 150-200 hours of study. Master the chronic hemodialysis unit content (52% of exam). Study kidney disease concepts, infection control, electrolyte management, and acid-base disorders. Learn hemodialysis care for patients with AKI or delayed graft function, and how the dialysis water treatment system works. Complete 200+ practice questions with detailed explanations.