100+ Free CNN-NP Practice Questions

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Question 1

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

Greater than 1 month

Greater than 3 months

Greater than 6 months

Greater than 12 months

to track

2026 Statistics

Key Facts: CNN-NP Exam

175

Exam Questions

NNCC

4 hrs

Exam Duration

NNCC

70%

Passing Score

NNCC

$375

Exam Fee

NNCC

<120

KDIGO BP Target SBP

KDIGO 2021

10-11

Hgb Target g/dL

KDIGO Anemia

The CNN-NP exam has 175 multiple-choice questions in 4 hours with a 70% passing score and a $375 exam fee. It assesses comprehensive nephrology nurse practitioner practice including CKD staging by KDIGO 2024 (G1-G5/A1-A3 with the CKD-EPI 2021 race-free equation), SGLT2 inhibitors for diabetic and non-diabetic CKD (DAPA-CKD eGFR ≥25, EMPA-KIDNEY ≥20), nonsteroidal MRA finerenone (FIDELIO-DKD, FIGARO-DKD), KDIGO 2021 BP target <120 SBP, anemia management (Hgb 10-11 with ESA + iron, TSAT >20%, ferritin >100/200 in HD), CKD-MBD (phosphate binders, vitamin D, calcimimetics), KDIGO AKI staging, ISPD peritonitis criteria (cloudy effluent, WBC >100/μL with PMN >50%) treated with intraperitoneal antibiotics, KDOQI vascular access (fistula first), and transplant immunosuppression (tacrolimus + MMF + prednisone with basiliximab/thymoglobulin induction).

Sample CNN-NP Practice Questions

Try these sample questions to test your CNN-NP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Per KDIGO 2024, chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function present for what minimum duration?

A.Greater than 1 month

B.Greater than 3 months

C.Greater than 6 months

D.Greater than 12 months

Explanation: KDIGO defines CKD as abnormalities of kidney structure or function present for greater than 3 months with implications for health. Markers include eGFR <60 mL/min/1.73 m² or markers of kidney damage such as albuminuria (ACR ≥30 mg/g), urine sediment abnormalities, electrolyte/tubular disorders, structural abnormalities on imaging, history of transplant, or biopsy abnormalities.

2A 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?

A.G2 A2

B.G3a A2

C.G3b A3

D.G4 A3

Explanation: KDIGO GFR stages: G3a is eGFR 45-59 mL/min/1.73 m² and G3b is eGFR 30-44. An eGFR of 50 falls in G3a. KDIGO albuminuria stages: A1 is ACR <30 mg/g, A2 is 30-300 mg/g, and A3 is >300 mg/g. ACR 250 is A2. Therefore, this patient is G3a A2.

3Which feature of the CKD-EPI 2021 creatinine equation differentiates it from the prior CKD-EPI 2009 equation?

A.It includes a race coefficient for Black patients

B.It removes the race coefficient and uses sex and creatinine only

C.It requires cystatin C in all calculations

D.It uses 24-hour urine creatinine clearance instead of serum creatinine

Explanation: The CKD-EPI 2021 creatinine equation, recommended by the NKF-ASN Task Force, removes the race coefficient that was used in older equations. It estimates GFR using age, sex, and serum creatinine only. This change addresses health equity concerns and was adopted in clinical labs and KDIGO guidelines.

4A 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?

A.Start calcium-based phosphate binder with each meal

B.Counsel on dietary phosphate restriction and start a non-calcium phosphate binder if phosphate remains elevated

C.Begin cinacalcet immediately to lower PTH

D.Start IV calcitriol to suppress PTH

Explanation: KDIGO CKD-MBD guidelines suggest lowering elevated phosphate toward the normal range, with initial focus on dietary counseling and reduction of phosphate intake. When phosphate-lowering therapy is needed in CKD G4, non-calcium-based phosphate binders (sevelamer, lanthanum, ferric citrate, sucroferric oxyhydroxide) are preferred to limit calcium load and vascular calcification risk.

5Per 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

Explanation: KDIGO 2021 recommends a target SBP <120 mmHg for most adults with CKD not receiving dialysis, when measured using standardized office BP measurement. This recommendation is based largely on the SPRINT trial evidence. Standardized BP measurement (correct cuff, rest period, multiple readings) is essential because automated office BP runs lower than routine clinic BP.

6A 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?

A.Empagliflozin 10 mg daily

B.Dapagliflozin 10 mg daily

C.Pioglitazone 30 mg daily

D.Glipizide 10 mg daily

Explanation: Dapagliflozin 10 mg daily was studied in DAPA-CKD and demonstrated reduction in CKD progression and cardiovascular events in patients with eGFR 25-75 and ACR 200-5000, with or without diabetes. EMPA-KIDNEY studied empagliflozin and supports its use down to eGFR 20. Either SGLT2 inhibitor would be reasonable, but dapagliflozin is the choice tied directly to DAPA-CKD.

7EMPA-KIDNEY enrolled patients with CKD down to which minimum eGFR threshold?

A.eGFR ≥45

B.eGFR ≥30

C.eGFR ≥25

D.eGFR ≥20

Explanation: EMPA-KIDNEY enrolled patients with eGFR 20-45 with or without albuminuria, or eGFR 45-90 with ACR ≥200, with or without diabetes. The trial demonstrated that empagliflozin reduced CKD progression and cardiovascular death across this broad CKD population, expanding SGLT2i evidence below the eGFR 25 threshold of DAPA-CKD.

8Which monitoring threshold defines a serum potassium level at which finerenone should NOT be initiated per FIDELIO-DKD/FIGARO-DKD protocols and FDA labeling?

A.K+ >4.5 mEq/L

B.K+ >4.8 mEq/L

C.K+ >5.0 mEq/L

D.K+ >5.5 mEq/L

Explanation: Finerenone (Kerendia) labeling and the FIDELIO-DKD/FIGARO-DKD trials specify that finerenone should not be initiated if serum potassium is >5.0 mEq/L. K+ should be checked 4 weeks after initiation and after dose changes. If K+ rises >5.5, hold finerenone and resume at lower dose once K+ ≤5.0.

9FIDELIO-DKD and FIGARO-DKD studied which class of agents added to ACEi or ARB in patients with type 2 diabetes and CKD?

A.Steroidal mineralocorticoid receptor antagonists

B.Nonsteroidal mineralocorticoid receptor antagonists

C.SGLT2 inhibitors

D.GLP-1 receptor agonists

Explanation: FIDELIO-DKD and FIGARO-DKD studied finerenone, a nonsteroidal mineralocorticoid receptor antagonist (nsMRA), added to maximally tolerated ACEi or ARB in patients with T2DM and CKD with albuminuria. The trials demonstrated reductions in CKD progression and cardiovascular outcomes. Compared with steroidal MRAs (spironolactone, eplerenone), finerenone has a more selective receptor binding and a different tissue distribution.

10For a non-dialysis CKD patient with iron deficiency, which iron studies thresholds typically warrant iron repletion before initiating an erythropoiesis-stimulating agent (ESA)?

A.TSAT <20% and ferritin <100 ng/mL

B.TSAT <30% and ferritin <500 ng/mL

C.TSAT <40% and ferritin <800 ng/mL

D.TSAT <50% and ferritin <1000 ng/mL

Explanation: Per KDIGO anemia guidance, in non-dialysis CKD adults, a trial of iron is appropriate when TSAT is ≤20% (some sources say <30%) and ferritin is ≤100 ng/mL (or <500 in some adjuncts). The 'classical' deficiency thresholds — TSAT <20% and ferritin <100 — clearly mandate repletion before ESA initiation. In hemodialysis patients, ferritin targets are higher (often >200 ng/mL with TSAT >20%).

About the CNN-NP Exam

The CNN-NP (Certified Nephrology Nurse — Nurse Practitioner) exam validates advanced practice expertise in nephrology for APRNs. The 175-question, 4-hour exam covers CKD/ESRD pathophysiology and management, dialysis modalities and prescribing, vascular access planning (KDOQI), AKI by KDIGO criteria, glomerular and tubular disorders, electrolyte and acid-base disorders, drug dosing in CKD, and kidney transplantation. The CNN-NP scope includes prescribing, ordering and interpreting diagnostics, and managing dialysis prescriptions in collaboration with nephrologists.

Questions

175 scored questions

Time Limit

4 hours

Passing Score

70% (scaled passing score per NNCC)

Exam Fee

$375 (Nephrology Nursing Certification Commission (NNCC))

CNN-NP Exam Content Outline

20%

Diagnosis and Management of CKD

Etiology workup, proteinuria evaluation, KDIGO 2021 BP target <120 SBP, SGLT2 inhibitors (DAPA-CKD, EMPA-KIDNEY), nonsteroidal MRA finerenone (FIDELIO-DKD, FIGARO-DKD), GLP-1 agonists, RAAS inhibitors, statin therapy, anemia management (Hgb 10-11, TSAT >20%, ferritin >100/200 in HD), CKD-MBD with phosphate binders, vitamin D analogs, and calcimimetics.

15%

CKD and ESRD Pathophysiology

CKD definition (GFR <60 or kidney damage >3 months), KDIGO 2024 staging G1-G5/A1-A3, CKD-EPI 2021 race-free equation, CKD-MBD, anemia of CKD, metabolic acidosis, uremia.

15%

Renal Replacement Therapies

Modality selection (HD, PD, transplant, conservative care), home HD, CAPD vs APD, peritonitis (cloudy effluent, WBC >100/μL with PMN >50%) and ISPD-guided intraperitoneal antibiotic treatment.

10%

Vascular Access Management

KDOQI vascular access (fistula first, plan B/C), pre-emptive access referral when GFR <20-30, AVF/AVG vs tunneled catheter selection, complications and surveillance.

10%

Acute Kidney Injury

KDIGO AKI criteria (creatinine and urine output), pre-renal/intrinsic/post-renal, contrast-induced nephropathy prevention, RRT initiation criteria (AEIOU).

10%

Glomerular and Tubular Disorders

IgA nephropathy, FSGS, membranous nephropathy, diabetic nephropathy, lupus nephritis, ANCA vasculitis, Alport syndrome, polycystic kidney disease.

10%

Electrolytes and Acid-Base

Hyperkalemia (potassium binders patiromer/SZC; insulin/glucose, calcium gluconate, sodium bicarbonate), hyponatremia/hypernatremia, hypercalcemia, hypomagnesemia, anion gap, RTA types I/II/IV.

Pharmacology in CKD

Drug dosing in CKD (eGFR-based), nephrotoxic medications (NSAIDs, contrast, aminoglycosides, vancomycin trough monitoring).

Pediatric/Transition Care, Transplant, Professional Role

Kidney transplant immunosuppression (tacrolimus, mycophenolate, prednisone; induction with thymoglobulin/basiliximab), rejection types, infection prophylaxis, NP scope and collaborative practice.

How to Pass the CNN-NP Exam

What You Need to Know

Passing score: 70% (scaled passing score per NNCC)
Exam length: 175 questions
Time limit: 4 hours
Exam fee: $375

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CNN-NP Study Tips from Top Performers

1Master KDIGO 2024 CKD staging — G1-G5 GFR categories crossed with A1-A3 albuminuria categories. Use the CKD-EPI 2021 race-free equation for eGFR.

2Memorize SGLT2i indications: dapagliflozin (DAPA-CKD, eGFR ≥25) and empagliflozin (EMPA-KIDNEY, eGFR ≥20) reduce CKD progression regardless of diabetes status.

3Know finerenone (FIDELIO-DKD/FIGARO-DKD) is added to maximally tolerated ACEi/ARB in T2DM CKD with albuminuria when K+ ≤4.8 mEq/L.

4Anemia of CKD: target Hgb 10-11 g/dL, replete iron first (TSAT >20%, ferritin >100 non-HD or >200 in HD) before ESA initiation.

5ISPD peritonitis: cloudy effluent + WBC >100/μL with >50% PMNs = empiric intraperitoneal antibiotics covering Gram+ and Gram- organisms.

6Hyperkalemia ladder: stabilize membrane (calcium gluconate), shift (insulin+D50, albuterol, bicarbonate), remove (patiromer, SZC, dialysis).

Frequently Asked Questions

What is the CNN-NP certification?

CNN-NP (Certified Nephrology Nurse — Nurse Practitioner) is an NNCC certification for APRNs practicing in nephrology. It validates advanced practice expertise in comprehensive CKD/ESRD care, prescribing, dialysis prescription management in collaboration with nephrologists, vascular access planning, transplant follow-up, and management of AKI, glomerular disease, and electrolyte/acid-base disorders.

How many questions are on the CNN-NP exam?

The CNN-NP exam has 175 multiple-choice questions and a 4-hour time limit. The passing score is 70%. Content emphasizes CKD/ESRD management, dialysis, vascular access, AKI, glomerular disease, electrolytes/acid-base, transplant, and pharmacology in CKD.

How much does the CNN-NP exam cost?

The CNN-NP exam fee is $375 per NNCC. Confirm current fees and any partner-member rates on the NNCC website (nncc-exam.org) before applying, as fees and policies can change.

What is the CNN-NP scope of practice?

CNN-NPs deliver comprehensive CKD and ESRD management — they prescribe, order and interpret diagnostics, and manage dialysis prescriptions in collaboration with a nephrologist. They guide CKD progression-modifying therapy (SGLT2 inhibitors, finerenone, RAAS blockade), anemia and CKD-MBD management, vascular access planning, and post-transplant follow-up.

Which guidelines should I prioritize when studying for CNN-NP?

Focus on KDIGO 2024 CKD staging, KDIGO 2021 BP guideline (<120 SBP target), KDIGO AKI, KDIGO CKD-MBD, ISPD peritonitis guidelines, KDOQI vascular access, and the CKD-EPI 2021 race-free eGFR equation. Know the SGLT2i trials (DAPA-CKD, EMPA-KIDNEY) and finerenone trials (FIDELIO-DKD, FIGARO-DKD).