For Nurse Practitioners in Nephrology Practice

Certified Nephrology Nurse - Nurse Practitioner™ (CNN-NP™)

Three Easy Steps to Certification

  • The applicant must hold a full and unrestricted license as a registered nurse in the United States, or its territories and be nationally certified as a nurse practitioner.
  • The applicant must have a minimum of BOTH 2,000 hours AND two (2) years as a nurse practitioner practicing in nephrology within two (2) years prior to submitting an application..
  • The applicant must possess a minimum of a master’s degree in nursing.
  • Effective 10/1/2022, the applicant must have completed twenty contact hours of approved continuing education in nephrology within two (2) years prior to submitting this application. Continuing education must be approved by one of the following:
    • Organizations accredited by the American Nurses’ Credentialing Center – Commission on Accreditation (ANCC-COA) the credentialing body of the American Nurses Association.
    • The American Association of Critical-Care Nurses (AACN).
    • The Council of Continuing Education.
    • The American Association of Nurse Practitioners.
    • All State Boards of Nursing.
    • Organizations accredited by the Accreditation Council for Continuing Medical Education (ACCME).
      • For example, the American Society of Nephrology and the Office of Continuing Education, School of Medicine, University of Missouri-Columbia that sponsors the Annual Dialysis Conference.

Please be aware that although programs may meet requirements set forth by other state boards of nursing, they may not meet the Nephrology Nursing Certification Commission criteria.

The CNN-NP exam consists of 175 questions and must be completed in four (4) hours. You must receive a standard score of 95 to pass the examination; this is achieved by answering 70% of the test questions correctly.

Download the Exam Application Forms

Standard Fees

Fee Name Amount
Exam Fee
One-time Retake
CBT 90-day Extension
Exam Application Processing Fee (Non-refundable, included in exam fee)
Expedited Review
Late Fee
Incomplete Application Fee
Returned Check/Cancelled Payment Fee
Duplicate Wallet Card or Certificate
Certification Validation Letter (Except to State Boards of Nursing)

Reduced Fees for Partner* Members

Fee Name Amount
Exam Fee
One-time Retake
Late Fee

*Current partner organizations include the American Nephrology Nurses Association, the American Society of Nephrology, the National Kidney Foundation, and the Nurses Organization of Veterans Affairs.

  • Download our Certification Preparation Guide.
  • Determine the content of the examination from the test blueprint.
  • Read the test specifications to determine which content areas have the most "weight," because those will have the highest number of questions.
  • Review the exam reference list to familiarize yourself with material that will be included on the test.
  • Focus on areas with which you are least familiar.
  • Take the Online Practice Exam (see info below)
  • Learning strategies:
    • complete a certification review course offered by a national nephrology organization such as ANNA, NKF or ASN.
    • check with your local nephrology organizations chapter regarding upcoming certification review opportunities.
    • systematically review a nephrology nursing reference textbook.
    • participate in a study group.
    • spend a day with a colleague working in an area you need to learn about.
    *Course content has not been reviewed by NNCC.
  • Listen to the directions given prior to the examination and follow them exactly.
  • Each month, NNCC poses a question of the month for each credential. Review the questions posed for this credential including the correct answer, rationale and reference information here:
  • Caution: Test preparation websites offering alternative and/or shortcuts to test preparation should be avoided. Exam content is confidential and is not shared with any individuals involved in test preparation activities. "Tricks of testing" and "short cut methods for test preparation" are specifically avoided when creating this exam. We test candidates on content and not on their "test taking skills." If you have any questions about the best methods to prepare please call us at 888.884.6622. Our goal is that each exam candidate best use their time and money to reach the end result of demonstrating their excellence in nephrology nursing care through certification.

The purpose of the CNN-NP Practice Test is to allow candidates for the CNN-NP examination to practice with a test similar in content and format to the actual CNN-NP examination. However, no questions on the CNN-NP Practice Test will be on the actual CNN-NP examination. Taking the CNN-NP Practice Test is not required and does not guarantee a similar result on the CNN-NP examination.

The fee for the test is $50. The CNN-NP Practice Test contains 50 multiple-choice questions available in two modes: Practice Mode provides the correct answer and rationale after each question, while Test Mode holds the results until the end of the test. Both modes at the end of the test provide a Score Report which displays your score and breakdown of percentage correct in each area of the test blueprint. Please note: NNCC will now offer the online practice exam for free to individuals who have been approved for the CNN-NP certification examination.

You will have access to the test for 90 days. Several scrambled versions of the same 50 questions are offered for retesting. Your credit card payment will be processed on-line and you will be granted immediate access to the CNN-NP Practice Test.

To purchase the CNN-NP Practice Exam, please read the Terms of Agreement and click the appropriate button below.

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Online Practice Exam

Fee Name Amount
Online Practice Exam

Core References

  • Bodin, S.M. (Ed.) (2022). Contemporary Nephrology Nursing, 4th ed.  Pitman, NJ: ANNA.

    More Info and Purchase Here

  • Counts, C.S. (Ed.) (2020). Core Curriculum for Nephrology Nursing, 7th ed.  Pitman, NJ: ANNA.

    More Info and Purchase Here

  • Danovitch, G.M. (2017). Handbook of Kidney Transplantation, 6th ed., Philadelphia: Walters Kluwer. 
  • Daugirdas, J.T., Blake, P.G., & Ing, T.S. (2015). Handbook of Dialysis. 5th ed. Philadelphia: Wolters Kluwer / Lippincott Williams & Wilkins.
  • Gilbert, et al. (2023). National Kidney Foundation’s Primer on Kidney Diseases, 8th ed.  Philadelphia: Elsevier/Saunders.
  • NNCC & C-Net. Online Practice Test for the CNN-NP.

    Take the Practice Test

  • NNCC. (2016). CNN-NP Certification Preparation Guide. Pitman, NJ: NNCC.

    Download Here

Additional References

  • Alhamad, T., Cheng, S. & Vijayan, A. (Ed.) (2019). Washington Manual: Nephrology Subspecialty Consult. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
  • Daugirdas, J.T. (2019). Handbook of Chronic Kidney Disease Management, 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins.
  • Feehally, J., Floege, J., Tonelli, M. & Johnson, R.J. (2019). Comprehensive Clinical Nephrology. 6th ed. Philadelphia: Saunders/Elsevier.
  • Guest, S. (2014). Handbook of Peritoneal Dialysis. 2nd ed. Middletown, DE: Author.
  • Ikizler, T.A. & Mitch, W.E. (2018). Handbook of Nutrition and the Kidney, 7th ed. Philadelphia: Wolters Kluwer.
  • Lerma, E.V. & Weir, M.P. (2017). Henrich’s Principles and Practices of Dialysis, 5th ed., Philadelphia: Walters Kluwer/Lippincott Williams & Willson.
  • Lexi-Comp (2017). Drug Information Handbook for Advanced Practice Nursing. 17th ed. Hudson, OH: Lexi-Comp, Inc.
  • Nissenson, A.P. & Fine, R.W. (2017). Handbook of Dialysis Therapy, 5th ed. Philadelphia: Elsevier. 
  • Schrier, R.W. (2015). Manual of Nephrology, 8th ed.  Philadelphia: Wolters Kluwer.
  • UpToDate. Philadelphia: Wolters Kluwer.

    View Online

Guideline References

  • CDC (2012). Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease.

    View Online

  • Kam-Tao Li, P., et al. (2016). ISPD Guidelines/Recommendations. Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Peritoneal Dialysis International, 36(5), 481-508.
  • Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO Clinical Practice Guidelines.
  • National Kidney Foundation. KDOQI Clinical Practice Guidelines.

    View Online

Emotional Preparation

  • Moderate anxiety is normal and may be helpful - you may be more alert and open to learning; however too much anxiety is detrimental and will interfere with learning and test-taking.
  • Study and prepare for the examination so that you feel confident.
  • Think positively - you possess a wealth of experience and the examination will allow you to demonstrate that knowledge.
  • Use anxiety-reducing strategies:
    • relaxation response.
    • guided imagery.
    • exercise.
    • prayer.
  • Even though some test takers may finish the exam early, use as much of the allotted time as you need to think through and answer the questions.

Physical Preparation

  • Get a good night's sleep.
  • Eat before the examination - those gray cells will have glucose available when you're answering questions.
  • Gather all the materials you need to take the test the night before the exam:
    • government-issued photo ID.
    • nursing license.
    • examination permit.
    • sweater or jacket in case the room is cool.
  • Allow plenty of time to arrive early.
  • If you are distracted by other candidates during the test or leaving to use the rest room, select a seat at the front of the room where you will be less likely to notice the other candidates.

Tips on Answering Examination Questions

  • Read the questions carefully and focus on key words in the question such as "first", "most likely", "most important", "best". These words are usually printed in boldface type to attract your attention.
  • As you read the question, anticipate the correct answer.
  • Read each of the four choices carefully. Even if the first option sounds correct, read all options before choosing the answer.
  • Do not "read into" the question. Answer the question based only on the information presented, even if you think the answer is too obvious or too easy.
  • Do not be afraid to change an answer. Research has shown that more often than not, test takers change answers to the correct one.
  • Do not spend too much time on any one question. Make a note of the questions of which you are uncertain and return to them later if you have time.
  • If you are unsure about one of the content areas, you may find it helpful to complete the other areas first and leave the problem area for last.

Are there any math problems on the test?

None of the test questions require any mathematical ability beyond basic arithmetic that would be used daily by any NP. The computers used for the exam have calculators available for use. 

If I do not pass the test how soon can I take it again? How many times can I take it if I fail?

If you are unsuccessful on the exam, you have one opportunity within one year to retake the examination at a reduced rate. C-NET will mail a re-examination application to those applicants who do not pass.

Does authoring an article in a peer review journal count toward recertification?

Yes! Anyone who has published will assure you that there is a significant amount of learning involved in writing and polishing content. In recognition, 15 contact hours will be awarded toward recertification for a book chapter, manuscript, article or paper that is relevant to nephrology nursing and published by a recognized publishing house or professional journal.

Which of the following over-the-counter medications can result in loss of residual kidney function?

Ranitidine (Zantac) Naproxen (Aleve) Loratadine (Claritin) Guaifenesin (Mucinex) Answer: Naproxen Reference: Contemporary Nephrology Nursing (3rd Edition), 2017, American Nephrology Nurses Association, pp. 296-297.

What impact will becoming a Certified Nephrology Nurse-Nurse Practitioner have on my being an NP?

The number one reason to become certified is to help ensure patient safety. For the NP who is driven to be certified it is often to fulfill a personal need to be professionally recognized as having obtained a higher level of excellence in their practice.  Putting "CNN-NP" next to your name shows your colleagues that you have the advanced knowledge and competence as a nephrology NP and you provide an excellence of care that is the desired by our standards of practice.  Some other benefits of becoming certified can depend in part on the support the NP gets from the practice they are employed by.  Many practices pay for the certification exam, provide extra benefits or financial incentives and acknowledge the clinical excellence you can bring to their practice. 

Is this certification accepted by any State Boards of Nursing or other nursing organizations for continuing education (CEU) credit? Is it accepted to as being the only certification I will need for my state to be licensed as an NP?

To the best of our knowledge the CNN-NP exam is not accepted as a source of CEU credit by any State Board of Nursing or other nursing organizations.  It is not accepted by any states as being the only certification required to practice.

Is this considered a board accredited exam program?

Not now, although the Nephrology Nursing Certification Commission (NNCC) board and the CNN-NP board are actively pursuing having this test being recognized and approved for national board certification by the Accreditation Board for Specialty Nursing Certification (ABSNC). 

What is the best way for me to study for the test, especially if I work most of my time in a community dialysis center?

First, review the test blueprint to understand the breakdown of the test as to what areas are emphasized. The blueprint lists the ideal distribution of questions and the number of questions that are included for each client problem and activity associated to it. Questions on the kidney replacement therapies are much of the questions on the test (56-59% currently) but examining a broad overview of nephrology nursing is important. Only you know your strengths and weakness and concentrating on the areas that you feel you are weak helps prepare you to feel more confident.  Taking the practice questions at the end of the Certification Preparation Guide or the online CNN-NP Practice Test can be helpful. You can also consult the list of references, list in the CNN-NP exam information in Certify as well as in the Resources section. This includes ANNA’s Core Curriculum for Nephrology Nursing, Daugirdas’ Handbook of Dialysis, and other prominent nephrology journals and textbooks. 

How are the questions on the test created?

Valid and reliable tests do not arise spontaneously from item writers. They are carefully planned to ensure that they are legally defensible and psychometrically sound. The blueprint, or test plan, identifies what content is included on the test and what majority of the questions are need to address for each type of nephrology patient clients and the activities performed by the NP. The blueprint is a result of a practice analysis survey of NPs in nephrology that identifies the clients we serve and activities performed by NPs. This practice analysis is performed every five years to be sure the test reflects current practice.  A national task force of CNN-NPs is brought together to plan the survey content. Following data collection, the survey results are reviewed and adjustments are made to the blueprint to ensure that the questions are properly distributed along the continuum of care based on current practice. Each question on the test can be linked directly to the tasks/activities in the practice analysis survey and all answers are supported, using the most recent edition of the ANNA Core Curriculum for Nephrology Nursing and other current references. The group that oversees CNN-NP test development is the Advanced Practice Board of NNCC, which is made up of CNN-NPs with expertise in different areas of nephrology. There is also a CNN-NP Test Committee that writes the actual test questions. Item writers are CNN-NPs from a variety of geographic and practice settings. Members of both the Advanced Practice Board and the Item Writers are considered “content experts” concerning the knowledge and skills needed by NPs in nephrology. The Test Committee meets in person twice a year to review, evaluate, and write test questions to be certain that the test content is accurate.

Is there a review course for the test?

Although there is not an actual review course several options exist. Look under Practice/Prepare tab to download the free Certification Preparation Guide which offers sample test questions with answers and the option to pay to take the Online Practice Exam. A "Nurse Practitioner Exam Review" was offered as an NKF Preconference option April 10, 2018. It included test construction, item review and audience response with exam question review and rationale. A similar presentation was given at ANNA's 2014 Fall Meeting (available via ANNA ProLibraries). These options have been prepared by CNN-NPs and approved by NNCC's Advanced Practice Exam Board.  Online one can find "review courses" for nephrology NP’s preparing to take the CNN-NP. They are; however, put out by generic test review companies that have no connection with NNCC and we cannot recommend any of them as a preparation for this test.

Am I able to find out the results of an individual question, whether I got it right or wrong?

No, the results of individual questions from the CNN-NP test are not reported. This is to maintain the integrity of the exam so that the content and questions are not compromised for future test takers.  Your "Score Report" will be available to you at the end of your examination. If you pass the exam, the report will reflect your score as well as notify you of when to expect your certificate in the mail and when your name will appear in the NNCC Certified Directory. If you were unsuccessful on the exam, the report will reflect your score and a breakdown of the test subareas (the Content Areas on the CNN-NP Test Blueprint) with the percent of questions you answered correct in each. This breakdown of subarea scores will help you determine the blueprint areas in which you need further study. 

What can I do if I don’t agree with the options provided for the answers?

The CNN-NP exam is formatted as a multiple-choice test so that there is only one correct answer out of four choices. If you disagree with any specific question or part of the exam you are free to contact NNCC directly after the exam and someone from the CNN-NP board will help answer your concern. 

What are the range of scores typically seen? How many people pass/fail?

The passing score of the test is determined by a panel of CNN-NPs who serve as subject matter experts (SMEs). Both experienced and newly certified NPs serve on this panel. This group performs a standard setting procedure (Angoff) in which each test question is reviewed to determine its level of difficulty.  The passing score is based on the level of difficulty of the questions and what number of questions need to be answered correctly to identify individuals who have an acceptable level of knowledge and skill. Therefore, each candidate’s test score is measured against a predetermined standard, not against the performance of other test takers. Currently a score of 70% correct is required to pass the CNN-NP examination, with about 75% of people taking the test passing the first time.

We all know that reality is such that what you learn in books isn’t what you see in actual practice settings. Is the test based on "book-smart" or "street-smart" information?

The preparation of the test is purposefully designed to be legally defensible and psychometrically sound. The test is kept up-to-date by the CNN-NP item writers to make sure every question is pertinent and current to today’s clinical practice. 

  • "I am really glad that I did it... so much new knowledge that I've learned in addition to all the experiences... and my colleagues are very supportive."

    Analiza CRNP, CNN-NP
  • "Being a CNN-NP means that I am committed to being the best Nephrology Nurse Practitioner by going the extra mile to better serve my patients."

    Joanne, ACNP, CNN-NP