These CNN practice questions target assessment — including MHD, ISRNM, International Society, Renal Nutrition. The complete CNN deck holds 1020 flashcards, 20 of them dedicated to this topic. Study the free samples below, then unlock the whole collection for a one-time $7.
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A maintenance hemodialysis (MHD) patient has a serum albumin of 3.4 g/dL. According to KDOQI guidelines and CNN exam standards, why is serum albumin considered a powerful but non-specific marker of nutritional status?
Show answer →Albumin is the strongest predictor of morbidity and mortality in ESRD. However, it is non-specific because it is a negative acute-phase reactant; levels decrease significantly during inflammation, infection, or fluid overload, regardless of actual protein intake. For the CNN exam, remember that while the target is >4.0 g/dL (BCP method), a low level requires the nurse to investigate both nutrition and systemic inflammation (Protein-Energy Wasting/PEW). Strategy: If albumin is low, look for signs of infection or volume expansion before assuming the patient is simply non-compliant with protein intake.
A patient presents with a 10% unintentional weight loss over 6 months, an albumin of 3.5 g/dL, and a decreased muscle mass. Which clinical syndrome should the nurse suspect based on the International Society of Renal Nutrition and Metabolism (ISRNM) criteria?
Show answer →The nurse should suspect Protein-Energy Wasting (PEW). PEW is a state of decreased body stores of protein and energy fuels. Diagnosis requires at least one parameter in three of the four categories: 1) Low serum chemistry (Albumin/Prealbumin/Cholesterol), 2) Reduced body mass (BMI/Weight loss), 3) Reduced muscle mass, and 4) Reduced dietary intake (nPCR <0.8). CNN candidates must recognize that PEW is distinct from simple malnutrition because it is often driven by the pro-inflammatory state of uremia.
Why might a patient with Stage 4 CKD (not yet on dialysis) have a paradoxically high Prealbumin level despite signs of poor dietary intake?
Show answer →Prealbumin (Transthyretin) is partially excreted and metabolized by the kidneys. As GFR declines in advanced CKD (Stages 4 and 5), the renal clearance of prealbumin decreases, leading to an accumulation in the blood. This can mask underlying malnutrition. While Prealbumin is a sensitive marker in HD patients (where levels are usually stable despite lack of renal clearance), it must be interpreted with extreme caution in pre-dialysis patients. Strategy: In non-dialysis CKD, rely more on physical assessment and diet logs than prealbumin.
A patient with a 4-week-old AVF presents for evaluation. The fistula feels soft and flat, with a weak thrill only at the anastomosis. What is the most likely cause of this failure to mature?
Show answer →This presentation suggests inflow stenosis, often occurring at the juxta-anastomotic site (the area just past the surgical connection). Rationale: If the inflow is restricted, the fistula cannot dilate or develop the necessary flow (600 mL/min). This differs from accessory veins (side branches), which would allow a strong thrill at the anastomosis but steal flow away from the main trunk, preventing the mid-section from maturing. CNN exams often test the ability to distinguish between flat fistulas (inflow) and collateralized fistulas (accessory veins).
A 6-week-old AVF meets diameter and flow criteria but is located 9mm below the skin surface. Which surgical or procedural intervention is indicated?
Show answer →The patient requires a superficialization or transposition procedure. Rationale: The Rule of 6s requires the vessel to be within 0.6 cm (6 mm) of the skin for safe and successful cannulation. If the vessel is too deep, the risk of infiltration, hematoma, and blind cannulation increases significantly. In 2026, Point-of-Care Ultrasound (POCUS) is the preferred method to map the exact depth before deciding on surgical intervention.
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Try 30 free CNN cards firstThe full CNN deck contains 1020 flashcards, and 20 of them focus on assessment. This page shows 5 free samples.
Our CNN deck dedicates 20 of 1020 cards (2%) to assessment — always cross-check the official NNCC exam outline for the current blueprint weighting.
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