NNCC CNN-NP Certification Sample Questions

The NNCC Certified Nephrology Nurse - Nurse Practitioner Certification Sample Question Set on this page is designed to familiarize you with the actual NNCC CNN-NP exam format and question types. These sample questions help you understand how questions are structured and what to expect on test day. While they provide a useful starting point, they represent only a limited preview of the real exam experience.

These sample questions are intended for evaluation and familiarization only. To understand exam style, pacing, and reasoning patterns more clearly, we recommend trying our online sample practice environment. If you are preparing for the NNCC Certified Nephrology Nurse - Nurse Practitioner (CNN-NP) and want to assess your readiness more rigorously, structured, timed, scenario-based practice is recommended. This approach aligns with the cognitive demands and professional expectations typically associated with Nephrology nurse practitioners, nurse practitioners in kidney care, advanced practice nurses in nephrology working in settings such as Nephrology practices, dialysis and kidney replacement therapy settings, hospital and outpatient kidney-care settings.

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The demo introduces core concepts, while full-length premium simulations provide deeper, scenario-based coverage that more closely reflects the actual cognitive demands of the NNCC Certified Nephrology Nurse - Nurse Practitioner exam, particularly in areas such as Assessing and diagnosing kidney disease processes and complications, prescribing evidence-based treatments therapies and procedures, patient education interdisciplinary care and holistic care planning. You can use these sample questions as a starting point, then progress to the NNCC CNN-NP Certification Practice Exam for stronger readiness. Our premium simulations are designed to mirror real exam conditions, helping you refine reasoning, pacing, and decision-making before your official exam attempt.

NNCC CNN-NP Sample Questions:

01. A 38-year-old woman with autosomal dominant polycystic kidney disease has an eGFR that has fallen from 71 to 58 mL/min/1.73 m2 over 24 months. Height-adjusted total kidney volume places her in Mayo imaging class 1D. Blood pressure is controlled on lisinopril, transaminases are normal, and she has unrestricted access to water.
Which prescription is most appropriate to slow her rate of decline?
a) Tolvaptan (Jynarque) 45 mg by mouth on waking and 15 mg eight hours later, titrated as tolerated.
b) Octreotide long-acting release (Sandostatin LAR) 40 mg intramuscularly every 28 days, with gallbladder ultrasonography before and during treatment.
c) Empagliflozin (Jardiance) 10 mg by mouth once daily, with the expected early fall in eGFR explained.
d) Allopurinol (Zyloprim) 100 mg by mouth once daily, titrated to the serum urate.

02. A 58-year-old patient with chronic kidney disease stage G3a and a urine albumin-to-creatinine ratio of 46 mg/g has an average home blood pressure of 148/88 mm Hg on lisinopril (Prinivil) 40 mg PO daily. Potassium is 4.1 mEq/L, estimated glomerular filtration rate is 52 mL/min/1.73 m2, and there is trace ankle edema. Sodium intake is estimated at 4.4 g daily.
Which of these should the NP prescribe next?
a) Amlodipine (Norvasc) 5 mg PO daily, alongside counseling to reduce dietary sodium.
b) Spironolactone (Aldactone) 25 mg PO daily, alongside counseling to reduce dietary sodium.
c) Chlorthalidone (Thalitone) 12.5 mg PO daily, alongside counseling to reduce dietary sodium.
d) Losartan (Cozaar) 50 mg PO daily, alongside counseling to reduce dietary sodium.

03. A 68-year-old anuric man on hemodialysis three times weekly has heart failure with an ejection fraction of 30%. He takes furosemide 80 mg orally twice daily and no other cardiac agent. Potassium: 5.0 mEq/L, blood pressure: 138/80 mmHg. His interdialytic gains are modest and he tolerates ultrafiltration without hypotension.
Which change to his regimen is most appropriate?
a) Start digoxin (Lanoxin) 0.25 mg orally once daily for rate and symptom control.
b) Stop the furosemide (Lasix) and start carvedilol (Coreg) 3.125 mg orally twice daily, titrating as tolerated.
c) Continue the furosemide (Lasix) 80 mg orally twice daily and add metolazone (Zaroxolyn) 2.5 mg orally daily for additional fluid removal.
d) Start spironolactone (Aldactone) 50 mg orally daily and continue the furosemide (Lasix) 80 mg orally twice daily.

04. A blood leak alarm during a hemodialysis treatment has been confirmed to reflect a ruptured dialyzer membrane. The NP orders that ___
a) the treatment continue at a reduced blood flow with the breach kept under observation
b) the extracorporeal blood be rinsed back to the patient rather than discarded with the dialyzer
c) the treatment stop and the circuit blood be discarded rather than returned
d) the dialyzer be replaced and the same circuit blood returned through the new dialyzer

05. A patient on hemodialysis is admitted with a gastrointestinal bleed, a hemoglobin of 7.4 g/dL and ongoing melena. Dialysis is required today for a potassium of 6.4 mEq/L. The access is a mature fistula with good flow.
Which prescription should the NP write?
a) Reduced-dose heparin given as a single bolus at the start with no maintenance infusion.
b) Heparin-free dialysis with periodic saline flushes and a higher blood flow to limit clotting.
c) Low molecular weight heparin at a renally adjusted dose given before the treatment starts.
d) Regional citrate anticoagulation of the circuit and a calcium infusion into the venous line.

06. A unit review shows that erythropoiesis-stimulating agent doses have drifted upward across many patients over six months, with hemoglobin values unchanged and iron studies inconsistently ordered. The unit has a protocol nurse, a clinical pharmacist, a dietitian and a medical director.
Which action by the NP best facilitates the interdisciplinary response?
a) Ask the medical director to cap the maximum dose that may be prescribed without a documented indication.
b) Ask the clinical pharmacist to review every patient on a high dose and recommend individual dose reductions to each prescriber.
c) Ask the protocol nurse and the pharmacist to build an iron-status check into the protocol before any dose escalation.
d) Ask the protocol nurse to add a standing monthly iron panel for every patient in the unit.

07. Chronic kidney disease is distinguished from acute kidney injury by the requirement that the abnormality of kidney structure or function be present for ___
a) more than three months, with implications for health.
b) more than twelve months, with implications for health.
c) more than six months, with implications for health.
d) more than six weeks, with implications for health.

08. Mrs. Nakamura is a 67-year-old woman with CKD stage G4 who attends the nephrology clinic for routine review. She reports increasing fatigue over the past four months.
Her anemia panel shows Hemoglobin: 9.4 g/dL (12.0-15.5); Mean corpuscular volume: 76 fL (80-100); Transferrin saturation: 12%; Ferritin: 90 ng/mL; and a fecal occult blood test is positive.
Which conclusion about the anemia do these findings best support?
a) Functional iron deficiency of inflammation, indicated by the ferritin of 90 ng/mL.
b) A false-positive fecal occult blood test.
c) Erythropoietin deficiency of CKD, which is corrected with an erythropoiesis-stimulating agent.
d) Iron deficiency from occult gastrointestinal blood loss, which requires endoscopic investigation alongside iron replacement.

09. The NP is reviewing a primary-care practice's chronic kidney disease registry before an interdisciplinary meeting. The registry holds 412 patients, and the practice has asked the NP to lead the review.
Of the 412 patients, 96 have had no albumin-to-creatinine ratio in the last year, and 54 have a medication refill needing review at their level of kidney function.
Which allocation of the work should the NP make?
a) Ask the clinical pharmacist to present a medication-safety audit of the registry, and hold the testing and the referral decisions until that audit has been discussed.
b) Ask the lead physician to work through the whole registry personally, flagging the refills, the overdue tests and the referrals, with the pharmacist and the nurse briefed at the following meeting.
c) Ask the nurse care manager to schedule all 412 patients for a face-to-face review, with the pharmacist and the lead physician each seeing only those the nurse flags.
d) Ask the clinical pharmacist to work through the 54 medication refills, ask the nurse care manager to schedule albumin-to-creatinine testing for the 96 who are overdue, and set the referral criteria the team will apply to the results.

10. When a patient with progressive chronic kidney disease has chosen hemodialysis, an arteriovenous fistula is best created ___
a) several months before dialysis is expected to be needed, to allow maturation with any revision.
b) at the time a tunneled catheter is placed, so that both accesses are established together.
c) within two weeks of the first dialysis treatment, to limit the time an unused access is at risk.
d) only after a trial of peritoneal dialysis has shown the modality to be unsuitable.

Answers:

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Note: These sample questions are not official exam questions and are intended only for familiarization and study purposes. If you find any typos or data entry errors in these NNCC Certified Nephrology Nurse - Nurse Practitioner (CNN-NP) sample questions, please let us know by emailing us at feedback@medicoexam.com