Candidate Examination Handbook


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Candidate Examination Handbook

  1. 1. BONENT Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook Certified Hemodialysis Technologist/Technician (CHT) Certified Hemodialysis Nurse (CHN) Certified Peritoneal Dialysis Nurse (CPDN) Paper and Pencil Exam & Computer Based Testing Choose from Over 275 Revised September 15, 2010 Testing Locations
  2. 2. BONENT Board of Nephrology Examiners Nursing and Technology The Premier International Organization for Certification of Nephrology Professionals The Board of Nephrology Examiners Nursing and Technology Despite its impressive growth in recent years, BONENT (BONENT) is a non-profit organization promoting excellence remains largely a “grassroots” organization that depends in the quality of care of nephrology patients in the United on the help of all of its members in order to sustain itself, States and many countries around the world. thrive and grow. BONENT serves as a trusted representative voice to policy Benefits of BONENT Certification makers by urging legislative and regulatory movement toward meaningful training, certification and credentialing • Increases your ability to provide the highest quality of nephrology practitioners. care to patients in the unit; Recognized since 1974 as the leading, independent pro- • Carries the distinction of the title CHT, CHN, or CPDN; fessional certification body, BONENT identifies safe and • Provides personal satisfaction from performance; competent practitioners in nephrology by providing the most highly regarded comprehensive specialty examina- • Enhances your resumé, which may result in tions to achieve the following credentials: preferential consideration for promotion or salary increases; • Certified Hemodialysis Technologist/Technician (CHT) • Presents opportunities for continued professional • Certified Hemodialysis Nurse (CHN) growth through recertification programs; • Certified Peritoneal Dialysis Nurse (CPDN) • Presents opportunities to participate in the creation Nephrology nurses may receive certification in eaither or and development of new BONENT programs; both hemo and peritoneal dialysis. • Includes complimentary subscription to the BONENT membership is comprised of nurses and techni- BONENT newsletter, which contains practical program cians who have received a passing score on a BONENT information for nurses and technicians; and, exam and are thereby certified. Members must recertify • Includes complimentary copies of various nephrology every four years. Today, over 6,000 nurses and technicians publications have met our criteria and are BONENT-certified. 9/15/10 Board of Nephrology Examiners, Inc. Copyright © 2010. The Board of Nephrology Nursing and Technology Examiners, Inc., Nursing and Technology. All rights reserved. No part of this publication may 1901 Pennsylvania Ave., NW, Suite 607 be reproduced or transmitted in any form or by Washington, DC 20006 any means, electronic or mechanical, including Phone: 202-462-1252 photocopy or recording, or any information and Fax: 202-463-1257 retrieval system, without permission from the Board of Nephrology Examiners, Inc., Nursing Website: and Technology. Printed in USA. 2 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  3. 3. Table of Contents Section 1 Examinations Section 5 Guidelines and Rules for Examinations Exam Development 4 Bring to the Exam 7 Exam Application 4 Guidelines for Day of Exam 8 Exam Methods 4 US & International 4 Section 6 Preparing for Exams Exam Schedules 4 Online Practice Examination 8 Host Opportunities 4 Study Guide 8 Certified Hemodialysis Technologist/ Section 2 Eligibility and Fees Technician (CHT) • Examination Content 9 Eligibility 5 • Eligibility 9 • Legislative Mandates for Certification 9 Fees 5 • Detail of Examination Content 9 • Exam Fees 5 • Incomplete Fee 5 Certified Hemodialysis Nurse (CHN) • Insufficient Funds Fee 5 • Examination Content 13 • Annual Certification Fee 5 • Eligibility 13 • Recertification 5 • Detail of Examination Content 13 Certified Peritoneal Dialysis Nurse (CPDN) Section 3 Exam Policies • Examination Content • Eligibility • Detail of Examination Content 15 15 15 Applications & Deadlines 5 Acceptance 5 ADA Requests 6 Section 7 Suggested Reading Materials Refunds and Exam Transfers/Withdrawals 6 Reference Guide 19 Score Reports 6 Manual Re-scoring 6 Re-examination 6 Exam Application 21 Multiple Certifications 7 Duplicate Certificates 7 NOTE: Duplicate Wallet Cards 7 The most detailed and up-to-date policies may be found on the BONENT web site at: Section 4 Recertification and Renewal How Often Must You Renew? 7 How to Recertify 7 Payment 7 Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 3
  4. 4. Section 1 US & International BONENT certification programs reflect its global status as the leading certification group of nephrology nurses and technologists/technicians who have received a passing score on a BONENT examination. Examinations Examinations are conducted throughout the United States and as far away as far away as Australia, New Zealand, Singapore, Turkey and a growing list of other international countries. Deadlines for international candidates differ from those of their American colleagues, such as: • The application must be received 60 days prior to the examination at which they wish to appear Exam Development • Application requirements, such as letters of reference, license Examination committees conduct analyses of tasks, role delieation, and scholastic documentation, must be received 60 days prior skills and knowledge in conjunction with a professional testing to the examination agency. Examination validity is maintained through expert statistical • Host applications must be received a minimum of 120 days prior and scientific analysis. to the examination date Payment for all items must be in United States currency. Questions are then solicited from qualified nephrology nurses and technologists/technicians in different areas of the country. The submitted questions are categorized, edited grammatically and psycho- metrically, reviewed by experts and placed in an item pool. Questions Exam Schedules are drawn from an item pool for placement in an examination. For a detailed list of PPE exam locations and times, please visit the BONENT website ( or All BONENT examinations are designed, constructed and analyzed contact the Executive Office at (202) 462-1252. This list for reliability and validity. Each examination is regularly updated. is updated weekly. The examinations are comprised of multiple-choice questions. The The CBT list of locations is available at examination should be completed and all questions answered, as This list is updated often and is completely different from grades are based on the number of questions answered correctly. the Paper & Pencil Exam (PPE) schedule. Most CBT locations’ business hours are approximately 9am - 5pm daily and some are open on Saturday. The availability of exam times Exam Application depends on each location. Since the exam is only 3 hours, they are To apply for a BONENT exam, you must submit a completed given once or twice daily. When your application is approved, you will Application Form, fees and all required documentation. (see pages be given a unique name and password. Specific registration instruc- 21-22 for application and instructions). tions will be itemized in the Confirmation Letter. Only during the process of scheduling your exam time, will you be able to access the location and time availability. Exam Methods Candidates can chose between two exam methods by which to become BONENT certified: Host Opportunities BONENT Certification Examinations may be offered at various Paper & Pencil Computer Based locations throughout the United States as well as worldwide, upon Exam (PPE) Testing (CBT) request. Examinations can be administered anywhere, any time there are five qualified candidates to take the exam. The following points are the same for both exam methods: The candidates may be a combination of Hemodialysis Technologists/ • Use the same application (candidates must indicate PPE or CBT) Technicians, Hemodialysis Nurses and Peritoneal Dialysis Nurses. • Require the same amount of time • Have the same questions BONENT encourages certification; therefore, proctors are required • Have a proctor on site to be a BONENT-certified nurse or technologist/ technician, a physi- • You choose your own exam site cian, a dietitian, or a renal social worker. These requirements are necessary to prevent any breach of security of the BONENT exami- The differences between the two exam methods are: nation process. • Each exam method has its own separate list of locations To host an examination, the sponsor must submit a Host Form, along • Candidates receive an unofficial printout of their scores as soon with their resumé to the BONENT Executive Office a minimum of 90 as the CBT exam is completed days (120 days international examinations) prior to the examination • There is no application deadline for the CBT date chosen by the Host Facility. • Confirmation letters will be sent after your application has been processed and approved. The approximate timeframe of when Due to security concerns, host forms must be accompanied by a you receive your confirmation letter depends on the exam copy of a curriculum vitae or resumé of the potential proctor and method you choose: assistant proctors. An assistant proctor is required for all exams. • PPE – 2 weeks before the exam After verification of proctor credentials and approval by the Host • CBT – 4 weeks after BONENT receives your application Review Committee, the exam date and site are added to the • Taking the BONENT exam by Computer Based Testing (CBT) Examination Schedule and an acceptance letter will be mailed to the requires basic knowledge of how to use a computer. While taking proctor. the exam, candidates are able to skip questions, go back to a Please visit to download: previous question and change answers. • Host Form • Proctor/Assistant Proctor Agreement 4 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  5. 5. Section 2 Incomplete Fee Applications submitted without signed letters of reference, scholastic documentation, license or any other information left blank on the application will be assessed a $30 incomplete application fee. Eligibility and Fees Insufficient Funds Fee A $50 Insufficient Funds Fee is assessed for any checks returned for Insufficient Funds or credit cards rejected by the financial institution. Annual Certification Fee To maintain a BONENT membership, nurses and technologists/ Eligibility technicians are required to pay an annual Certification fee of $55. In addition to requirements imposed by state licensing authorities, appli- Members are given two payment options – annually (@ $55), or four cants must meet the following minimum criteria: years in advance ($200). • Nurses (CHN, CPDN) – a valid RN, one year of experience in nephrology, and current active participation in an ESRD facility Recertification There is NO extra fee for the Recertification process and wallet card • LPN or LVN – a valid LVN or LPN license, current active participation in an ESRD facility and for the following exams: in the fourth year, but the annual Certification fee is still applicable. If - CHN or CPDN Exam: two years of experience in nephrology; fees are NOT received within 30 days of the due date, a $10/yr. late - CHT Exam: one year of experience in nephrology. fee will apply (in the first three years after certification and $20/yr. • Technicians (CHT) – a copy of your high school diploma or official transcripts on the fourth year). (with principal’s signature and/or school seal), one year of experience (12 months) in nephrology patient care, and current active participation in an ESRD facility. - If you are currently unemployed but have a minimum of 12 months experience as a dialysis patient care technologist, you will be required to have your immediate past supervisor sign your appliction and write a reference letter. All other stated requirements apply. - PCTs with greater than 4 years of work experience in dialysis, who lack evidence Section 3 of a high school diploma, may use that work experience in lieu of the requirement for a high school diploma. Exam Policies - If you have no experience as a patient care technician/technologist, you may apply to take the BONENT exam upon successful completion of a BONENT Approved Program. All experience must be verified by two signed letters of reference: Applications & Deadlines • One from the applicant’s immediate supervisor (the same person Paper & Pencil Exam who signs the application) Your original, signed application (see page 21-22) and • The other from a professional, e.g., a peer or mentor in the field examination fees (paid in full with application) are of nephrology required to be received 45 days (60-day international examinations) before the exam date. Applications postmarked after the deadline will NOT be accepted and will be returned, unprocessed. Fees Computer Based Testing There is no deadline to submit your original, signed Exam Fees application and examination fees, (paid in full with application). Country Faxed or photocopied applications will NOT be accepted. Examination results will not be released to the candidate until receipt First-time Candidates of all application requirements and fees. NO exceptions will be made. USA $200 $225 If your name has changed since High School, you must indicate Locations Outside USA $230 $240 your previous name in the space provided on the application and Repeat Candidates Within One Year provide court documentation (i.e. marriage certificate). USA $160 $185 Locations Outside USA $230 $240 Repeat Candidates After One Year Acceptance USA $200 $225 Approximately two weeks before the scheduled exam, can- Locations Outside USA $230 $240 didates whose applications have been accepted will receive an official Confirmation letter indicating the examination site, Examination results will not be released to the candidate until receipt exact address and time to report for the examination. This of all application requirements and fees. NO exceptions will be made. letter is your admission ticket for the examination. You must bring the letter with you in order to sit for the exam. Additional Fees All applications and examination fees (paid in full) must be Incomplete Application Penalty $30 received by the 45-day deadline (60-day international examina- Exam Withdrawals & Transfers $65 tions). All applications received after the 45-day (60-day international examinations) deadline will be returned. Insufficient Funds Fee $50 Applications postmarked after the deadline will NOT be accepted. Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 5
  6. 6. Once we receive your CBT application, it will take or transfer must be submitted in writing (by mail or fax) with the $65 approimately 4 weeks for the approval process. After your processing fee attached. application is approved, you will receive a Confirmation Letter from BONENT containing pertinent registration information including your: • CBT exam confirmation number Score Reports • unique username and password Candidates can expect to receive their score results app- roximately 3 to 4 weeks following the date of the exam. After you receive the above information, you will need Score results are sent via USPS First Class mail to the to register online for a specific CBT date, location and time. address on your application form. BONENT will not pro- Registration instructions will be itemized in the Confirmation vide candidate scores over the telephone, via e-mail or via fax. Letter. You will have a deadline of 6 months to choose when and where you will take the exam. If you do not take the exam within CBT candidates will receive a printed copy of their score 6 months of receiving your username and password, you will have to and pass/fail status at the conclusion of the examination re-register for the exam at full price. session. This will NOT be your official report. Candidates can expect to receive their official score results approxi- CBT No-Show Reactivation: Candidates are responsible for mately 3 to 4 weeks following the date of the exam. Score results are scheduling their own CBT time, date and location. sent via USPS First Class mail to the address on your application form. Failure to show up at the scheduled time, date and location results in forfeiture of the CBT exam fee. However, you may reactivate your username and password: Manual Re-scoring Any candidate failing to achieve a passing score on the examination • The fee to reactivate your CBT username and password is $125. may request a manual re-scoring of his/her answer sheet after scoring • The CBT No-Show Reactivation Form must be submitted with has been completed. The fee is $100, payable to BONENT. A request payment to the BONENT Executive, postmarked or faxed, no for manual re-scoring must be submitted in writing to the Executive more than 14 days after the missed eam date. Office, accompanied by the $100 fee within 100-days following the examination date. The request must include: the candidate’s name, current mailing address, Social Security number, examination date and location. ADA Requests BONENT accepts requests for special examination accommodations under the Americans with Disabilities Act. Candidates with disabilities covered by the Act are requested to complete the BONENT Re-examination Applicants are given a maximum of three opportunities to successfully Documentation of Disability-Related Needs form and submit it when complete the examination within 12 months (examination date to exam- filing the exam application. Information provided, and any documen- ination date). If passing the examination does not occur after 3 tation regarding disabilities or the need to accommodate them, will attempts, applicants will be required to complete 8 hours of nephrology- be treated with the utmost confidentiality. related continuing education or attend and complete a nephrology The Documentation of Disability-related Needs form may be educational program. A certificate of participation or passing grade accessed on line at: must be submitted before taking a future BONENT examination., In the event a candidate does not achieve a passing score on the by request in writing to the BONENT Executive Office or by examination, he/she may retake the next available examination. The requesting by phone (202) 462-1252 for a copy. candidate must submit a signed application or written request with his/her full address, social security number, previous exam date and location, and requested exam date and location. Refunds, Exam Transfers & Withdrawals Fees Requests to withdraw from a scheduled examination must be The chart below describes the fees (in $US) for re-examination: received in writing, postmarked, 20-days prior to the examination date. A refund of the application fee, minus a $65 processing fee, Fees for Re-examination will be issued. Faxed requests are accepted at the BONENT your Within 1 Year After 1 Year * social security number. E-mail requests are not accepted. Exam Method USA INT’L. USA INT’L. Applicants who wish to transfer to a future examination must do so in writing (indicate original examination date and desired transfer date) $160 $230 $200 $230 with the $65 processing fee, postmarked 20-days prior to the exami- nation date. Faxed requests are accepted at the BONENT Executive Office (202) 463-1257, and must be signed and include your social $185 $240 $225 $240 security number. E-mail requests are not accepted. In the event that a candidate CANNOT sit for a scheduled exam- * After one year has elapsed since the candidate’s initial examination, ination due to the death of an immediate family member (mother, appropriate documentation must be resubmitted (letters of reference, father, siblings), unexpected natural disaster, or the candidate’s high school diploma.) hospitalization, the candidate will be able to sit for the next scheduled examination in his/her area. Documentation of the event must accom- pany the written transfer request. All requests for special circumstances 6 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  7. 7. Multiple Certifications How to Recertify If a nurse wishes to apply for certification in both hemodialysis and In order to continue certification beyond the initial four-year period, peritoneal dialysis, the candidate must pay the application fee for each one of the following two options must be chosen: type of examination for which he/she wishes to sit. Payment of the appli- • Earn 40 Contact Hours through workshops, seminars, home cation fee must accompany the completed application a minimum of study activities, academic courses, presentations or publications 45-days prior to the examination date. The $55 annual certification fee - A minimum of 25 hours must be from Group A must be paid for each certification. - The balance of 15 hours may include a combination of contact hours from Groups B, C, D, E, or F. - BONENT members eligible for recertification will only be Duplicate Certificates required to complete a new one-page application and subit Requests for duplicate certificates must be submitted in writing to it to the BONENT Eecutive office. The application will be the the Executive Office. A $30 fee must accompany each request. only paperwork requirered to complete recertification. It is recommended that all members continue to complete the “Contact Hours for Recertification” booklet and keep their certificates to help track your courses and number of hours. Duplicate Wallet Cards Requests for duplicate wallet cards must be submitted in writing to Once we receive your recertification application or booklet, it the Executive Office. A $20 fee must accompany each request. will take approximately 4-6 weeks for the approval process. After approval, you will receive a new BONENT wallet card in the mail. Section 4 OR OR • Retake the exam at the end of your certification period. • Use the One-Time Waiver which allows you to automatically Recertification and Renewal recertify without having to accumulate 40 contact hours. Check the waiver option on the Recertification Application. For more details, go to BONENT adheres to the premise that certification not only promotes excellence in the quality of care of the nephrology patient, it ensures Payment safe, competent practitioners in nephrology nursing and technology. To maintain a BONENT membership, nurses and technologists/ Initial certification is the result of having successfully passed the technicians are required to pay an annual Certification fee of $55. Mem- BONENT certification examination. bers are given two payment options – annually (@ $55), or four years in advance ($200). There is NO extra fee for the Recertification pro- How Often Must You Renew? cess and wallet card in the fourth year, but the annual Certification fee Recertification is required every four years. Certification is valid from the is still applicable. If dues are NOT received by the due date, a $10 date the candidate originally passed the examination. Documentation late fee will apply (in the first three years after certification and $20 is due within 30-days of the recertification date to avoid revocation on the fourth year). of the credential. Faxed Recertification Application Forms and Insufficient Funds Fee booklets will not be accepted. A $50 Insufficient Funds Fee is assessed for any checks returned for A 30-day grace period will be allowed after the certification renewal Insufficient Funds or credit cards rejected by the financial institution. date expires before the candidate’s certification is considered lapsed. Incomplete Fee Lapsed candidates have two options: Incomplete Recertification Applications will be assessed a $30 • Retake the examination, or incomplete application fee. • Submit a letter to the BONENT Board, providing a detailed explanation of their situation. A $100 penalty fee will be 5 assessed to lapsed candidates in this category. Section Guidelines and Rules for Examinations Bring to the Exam The applicant’s Confirmation Letter lists his/her test center address. To gain admission to the test center an applicant must show the Confirmation Letter to the supervising proctor. Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 7
  8. 8. He/she must provide two forms of identification. 4. if a candidate attempts to remove examination materials or notes from the testing room; and/or • A valid driver’s license 5. if a candidate attempts to take the examination for • A valid government-issued ID card with photo, a valid someone else. passport • Proctors will not accept application materials of any kind. • A notarized photo with the Candidate’s name printed on Candidates are required to submit all application materials to the back the BONENT Executive Office only. These are the ONLY acceptable forms of ID. 6 Employment and student I.D. cards are NOT acceptable forms of primary identification. You must have proper identification to gain admission to the Section test center. Applicants must report to the test center at the time listed on the Confirmation Letter. Seating of candidates, distribution of test mate- Preparing for Exams rials and testing instructions begin shortly thereafter. The actual starting time of the test may vary at different test centers due to the amount of time necessary for pre-administration procedures. BONENT has assembled a list of various textbooks and ANYONE WHO ARRIVES AFTER TESTING BEGINS WILL NOT publications that are currently available to assist candidates BE ADMITTED. in preparing for the examination. Please see page 18 to view a list of suggested references for use in preparing for each of the respective examinations. Guidelines for Day of Exam BONENT provides these guidelines as part of its criteria for candi- Online Practice Examination dates who are scheduled to sit for an exam: • Do not bring pencils. Pencils will be provided. The Online Practice Examination for Hemodialysis Technologists/Technicians was developed by BONENT and • You may wish to take your watch to the examination to help conforms to the specifications of the CHT examination in terms pace yourself during the examination. The test center super- visor will keep the official time and ensure that you are given of its content and average degree of difficulty. The online the correct amount of time for the examination. practice exam is only available online and has a length of 50 questions, whereas the CHT exam is 150 questions. The • No books, calculators, writing instruments, slide rules, papers, online exam is intended to reflect the knowledge required of dictionaries or other reference materials may be taken into a hemodialysis technologist/technician to be successful on the examination room. the CHT examination. The Online Practice Exam is available • No electronic devices are permitted in the examination room for a fee of $50. or center, including cell phones or signaling devices such as pagers, alarms, and PDAs (personal digital assistants). Do NOT send payment for the practice exam to the • No examination materials, documents or memoranda of any Executive Office. The Executive Office does not have kind are to be taken from the examination room. copies of the practice exam. • No questions concerning the content of the examination may be asked during the examination. Listen carefully to the Go to to take the online practice exam. instructions given by the supervising Proctor and read all directions in the examination booklet thoroughly. • A BONENT observer may be present at the test center. The Study Guide observer will not answer questions regarding the examination The following section contains detailed content outlines or become involved with exam administration. The observer for each of the three BONENT examinations, as well as will file a report with BONENT after the examination concerning sample questions similar to what will appear on the test center facilities and administration procedures. actual examination. These examination tools and the • You must have the supervising Proctor’s permission to leave Suggested Reading Materials on page 19 can be the room during the examination. You will not be allowed useful study aids when preparing for an examination. additional time to make up for time lost. • The supervising Proctor may dismiss a candidate from the examination for any of the following reasons: 1. if the candidate’s admission to the examination is unauthorized; 2. if a candidate creates a disturbance, is abusive or other- wise uncooperative; 3. if a candidate gives or receives help or is suspected of doing so; 8 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  9. 9. Certified Hemodialysis Technologist/Technician (CHT) Examination Content Ohio certification requires that all appli- 7. Recognize problems regarding The BONENT Certified Hemodialysis cants have completed one year of heparinization in hemodialysis (e.g., Technologist/Technician examination patient care prior to the administration coagulation, hemorrhage, hemostasis) measures technical proficiency in certain of the examination. Other states may 8. Recognize access complications in skills, and general areas of knowledge. have similar requirements. patient (e.g., clotting, infection, The examination tests the following five recirculation) major domains of practice and tasks Detail of Examination performed in the scope of hemodialysis 9. Recognize blood leaks during technology: Content dialysis • Patient Care 65% I. PATIENT CARE (65%) A. Assessment B. Management of Treatment • Machine Technology 10% 1. Assess fluid management: 1. Adjust blood pump settings and • Water Treatment 5% a. replacement therapy pressure monitors to maintain safe b. sequential ultrafiltration and efficient dialysis per order of • Dialyzer Reprocessing 5% c. TMP calculation physician • Education/Personal d. ultrafiltration concepts Development 15% 2. Adjust fluid removal (TMP) 2. Collect and evaluate patient data: according to established a. access patency protocols The examination has a three-hour time b. apical pulse limit and consists of 150 multiple- 3. Administer local anesthetics c. blood pressure choice questions. according to established protocols d. breath sound e. heart sounds 4. Administer anticoagulants to Eligibility f. jugular vein distension patient • A copy of your high school diploma g. peripheral edema 5. Administer medication for initiation or official transcripts with school h. pulse of treatment: seal/stamp. i. respiration a. Heparin j. signs of infection • One year of experience (12 months) b. local anesthetic k. temperature in nephrology patient care, and current 6. Alter dialyzing fluid l. weight active participation in an ESRD facility or successful completion of an accredited 3. Observe changes in appearance 7. Apply pressure to cannulation sites dialysis course approved by the BONENT of dialyzer after removal of cannulation needle Board. All programs are subject to the 4. Recognize symptoms and/or 8. Apply dressings to cannulation sites approval of the BONENT Board. complications occurring during 9. Cannulate: • Applicants are required to submit dialysis: a. AV grafts two signed letters of reference with a. chills b. AV fistulas their applications. A signed letter will be b. cramps c. fever 10. Clean and dress access site required from their immediate supervi- d. shock using appropriate techniques sor. The other will be required from a professional, e.g., a peer or mentor in 5. Recognize symptoms and/or com 11. Collect blood samples for: the field of nephrology. Applicants must plications due to operator or a. aluminum levels be employed at the time of application equipment error: b. blood chemistry submission. a. air embolism c. clotting time studies b. bleach or formaldehyde d. cultures reaction e. hematocrits Legislative Mandates for f. hepatitis studies c. chemical pyrogen reaction Certification d. hemolysis and water quality g. iron studies In several states, BONENT certification h. Kt/V or state certification is required for 6. Recognize symptoms and/or com- i. recirculation time studies technologists/technicians who perform plications associated with the 12. Communicate orally or in writing certain patient care procedures. It is administration of medications and with other health care incumbent upon all applicants to famil- dialysis treatments (e.g., antihyper- professionals regarding patient iarize themselves with any state licen- tensives, erythropoietin, iron dex- treatment plan (pre and post sure requirements for the state in which tran) dialysis) they intend to be certified. For instance, Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 9
  10. 10. 13. Initiate dialysis treatment using C. Intervention a. air embolism established access routes b. bleach or formaldehyde 1. Administer oxygen to patient by reaction 14. Maintain appropriate cannula or mask c. chemical pyrogen reaction documentation (data) regarding 2. Initiate CPR to ensure patient d. hemolysis incident reporting survival 3. Evaluate symptoms and/or 15. Monitor and record treatment data: 3. Initiate appropriate action regarding complications associated with the a. apical pulse administration of medications and symptoms and/or complications b. arterial and venous pressures dialysis treatments (e.g., occurring during dialysis: c. blood flows antihypertensives, erythropoietin, a. chills d. blood pressure iron dextran) b. cramps e. clotting times c. fever 4. Evaluate problems regarding f. dialysate flow rates d. shock heparinization in hemodialysis g. fluid removal parameters h. hemoglobin/hematocrit levels 4. Initiate appropriate action regarding (e.g., coagulation, hemorrhage, i. Kt/V symptoms and/or complications due hemostasis) j. pulse to operator or equipment error: 5. Evaluate access complications in k. temperature of dialysate a. air embolism patient (e.g., clotting, infection, l. TMP b. bleach or formaldehyde recirculation) m. recirculation bloods reaction 6. Evaluate blood leaks during n. respiration c. chemical pyrogen reaction dialysis o. UFR d. hemolysis p. weight 7. Review patient laboratory data for 5. Initiate appropriate action regarding abnormal values 16. Monitor fluid management: symptoms and/or complications a. replacement therapy occurring with the administration of 8. Review dialysis orders b. sequential ultrafiltration medications and dialysis treatments c. TMP calculation (e.g., antihypertensives, erythropoi- II. MACHINE TECHNOLOGY (10%) d. ultrafiltration concepts etin, iron dextran) A. Maintenance of Systems 6. Initiate appropriate action regarding 1. Clean and disinfect dialysis 17. Monitor the dialyzer delivery problems of heparinization in hemo- equipment per unit policy (protocol) system continuously during treatment dialysis (e.g., coagulation, hemor- 2. Develop preventative maintenance rhage, hemostasis) schedules for all dialysis equipment 18. Obtain (spin) serum specimens 7. Initiate appropriate action regarding 3. Document all dialysis equipment 19. Perform coagulation studies to access complications in patient repair work performed determine heparinization (e.g., clotting, infection, recirculation) 4. Maintain record of all machine 20. Perform procedure(s) to 8. Initiate appropriate action regarding maintenance performed terminate dialysis treatment blood leaks during dialysis 5. Maintain emergency equipment in 21. Perform hematocrit test and 9. Perform hemastix safety test proper working order for quality assurance 10. Provide emotional support to: immediate use 22. Prepare medication for initiation a. patient 6. Maintain/verify the calibration of of treatment: b. family ancillary equipment used to a. Heparin 11. Respond to patient needs (e.g., maintain medical devices b. local anesthetic c. normal saline comfort items) 7. Maintain/calibrate dialysis machine 23. Prepare specimens for 12. Respond to alarms and make 8. Order supplies and equipment for transportation to laboratory for dialysis adjustments dialysis unit analysis D. Evaluation 9. Perform troubleshooting and repair 24. Recommend patient care needs 1. Evaluate symptoms and/or of unit or home equipment according to nurse complications occurring during to manufacturer’s recommendations, dialysis: and OSHA, HCFA, requirements 25. Remove needles after termination a. chills of treatment b. cramps 10. Perform preventative maintenance c. fever to dialysis and ancillary equipment 26. Verify patient identification at d. shock following manufacturer’s recom- initiation of dialysis mendations, and OSHA, HCFA 2. Evaluate symptoms and/or and AMMI requirements complications due to operator or equipment error: 10 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  11. 11. 11. Perform repairs to dialysis and 5. Maintain equipment maintenance 4. Monitor safety tests: ancillary equipment following records for compliance with a. chloramine manufacturer’s recommendations regulatory and standard setting b. chlorides and OSHA, HCFA, and AMMI organizations (e.g., OSHA, HCFA, c. hardness requirements JCAHO, CDC, AMMI, FDA) d. LAL e. percent rejection 12. Perform electrical leakage tests 6. Participate in the development of on all dialysis equipment equipment maintenance 5. Maintain water treatment systems procedures and schedules records for compliance with 13. Verify blood and dialysate flow rates regulatory and standard setting organizations (e.g., OSHA, HCFA, III. WATER TREATMENT (5%) B. Machine Set-up JCAHO, CDC, AMMI, FDA) A. Components/Design of Systems 1. Assemble dialysis equipment for 1. Recognize the action of: 6. Review (annually) AAMI operation a. micron filtration recommended practices for water 2. Assemble auxiliary equipment b. multimedia filtration treatment (e.g., oxygen therapy) (e.g., sand filter) c. submicron filtration 3. Install dialysis equipment in IV. DIALYZER REPROCESSING (5%) d. ultrafiltration dialysis unit A. Procedures 2. Recognize the action of carbon 1. Document dialyzer reprocessing in 4. Perform residual chemical checks absorption accordance with regulatory 5. Perform required safety checks on agencies, AAMI standards and 3. Recognize the action of water dialysis equipment: manufacturer’s recommendations softening a. conductivity 2. Ensure proper labeling according b. pH 4. Recognize the action of reverse to facility protocol c. pressure holding test osmosis (RO) d. temperature 3. Maintain reprocessing records 5. Recognize the action of deionization 6. Perform safety checks: 4. Prepare dialyzer for reprocessing 6. Recognize the process of a. air bubble detector/alarm ultraviolet light exposure 5. Reprocess dialyzer per facility b. arterial pressure gauge protocol c. blood leak detector/alarm B. Maintenance of Systems d. blood pump B. Testing/Validation/Evaluation e. dialysis fluid 1. Clean and disinfect water f. heparin pump treatment equipment 1. Perform dialyzer reuse tests: g. venous pressure gauge 2. Maintain in proper working order, a. bacterial culturing b. presence of 7. Prepare bicarbonate solution all treatment components disinfectant/germicide 8. Prepare dialysis machine for 3. Perform water treatment system c. pressure testing operation: checks: d. residual disinfectant a. rinse a. bacterial culturing e. visual inspection b. prime b. conductivity V. EDUCATION/PERSONAL c. calibrate alarm(s) c. residual disinfectants DEVELOPMENT (15%) d. set monitor(s) d. resistivity A. Patient Education e. fluid delivery system e. soft test 1. Advise patient of discharge f. connections f. total dissolved solids (TDS) instructions (e.g., care of infiltration 9. Prime dialysis machines site) C. Monitoring/Evaluating Systems 10. Rinse dialyzer of 1. Analyze/examine water for use in 2. Advise patient and family members disinfectant/germicide dialysis to determine: based on physician’s orders C. Machine Operation/Evaluation a. water contamination regarding: 1. Evaluate quality control of dialysis b. water purity a. personal hygiene equipment per AAMI standards c. water treatment b. self-care component efficiency c. various treatment modalities 2. Monitor usage of equipment and supplies 2. Collect water and dialysate 3. Explain dialysis concepts to patients: specimens for cultures and chemical a. access care 3. Perform rinse procedures for analysis per AMMI standards b. artificial kidney function dialysis delivery systems c. dialyzer reprocessing 3. Evaluate quality control of 4. Perform disinfect procedures for reprocessing equipment per AAMI d. diffusion, osmosis, dialysis delivery systems standards ultrafiltration Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 11
  12. 12. e. fluid, electrolyte, acid-base 15. Recognize complications in balance/composition dialysis treatments regarding f. physiology of kidney infectious diseases (e.g., AIDS, g. physiology of urinary system hepatitis-B, influenza) 16. Recognize clinical manifestations B. Personal/Professional of electrolyte imbalances Development 17. Recognize problems with 1. Attend staff meetings for decreased efficiency of dialyzer procedural updates 18. Review relevant current 2. Attend continuing education professional literature programs to maintain current knowledge of dialysis 19. Train (precept) new technologists 3. Demonstrate an understanding of the purpose of multi-disciplinary C. Quality Related Issues care plans 1. Document incidents appropriately: 4. Explain the uses of medications a. emergency-related issues and treatments to patient: b. equipment/devices related a. antihypertensives issues b. Calcijex c. patient care issues c. EPO 2. Maintain appropriate d. Heparin documentation (data) regarding: e. Hypertonic saline a. quality monitoring f. IDPN b. treatment g. Infed h. Saline 3. Maintain an inventory of all i. Xylocaine chemical and equipment supplies 5. Maintain proper body mechanics 4. Maintain proper storage of for patient and self medications to ensure quality 6. Maintain current CPR certification 5. Maintain proper storage of from the American Heart equipment and materials Association 6. Participate in continuous quality 7. Maintain a clean and safe patient improvement (CQI) activities environment (e.g., infection control) 7. Participate in the development of 8. Maintain patient confidentiality on Quality Assurance programs for medical and personal matters dialysis unit 9. Maintain (handle) patient’s 8. Participate in the development of dialysis unit objectives personal property (e.g., prosthetic devices, dentures) 10. Maintain universal precautions for infection control and blood borne pathogens 11. Maintain current knowledge of AAMI Standards for Dialysate Supply Systems 12. Participate in case presentations at patient care conferences 13. Participate in dialysis unit safety procedures (e.g., fire drills) 14. Perform on-site: a. clinical instrumentation in- service b. technical instrumentation in- service 12 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  13. 13. Certified Hemodialysis Nurse (CHN) Examination Content 1. Patient needs and staffing patterns 11. Nutritional considerations The BONENT Certified Hemodialysis a. restrictions (i.e., fluid, 2. Staff abilities and limitations Nurse examination measures nursing protein, potassium, sodium) 3. Standards of dialysis care b. dietary noncompliance proficiency in certain skills, tasks and general areas of knowledge. The exam- 4. Unit policies and procedures 12. Complications occurring during ination tests skills and general areas of relating to personnel management dialysis knowledge. The examination tests the 5. Medical ethical issues involved 13. Psychosocial aspects of renal following four major domains of prac- with patient care failure tice and tasks performed in the scope of hemodialysis nursing. 14. Types of vascular access B. Equipment and Supplies a. creation Develop and implement policies and b. care and precautions • Supervision/Administration 10% procedures for evaluation of equipment c. complications of each type • Dialysis and Related Issues 74.5% and supplies for potential unit use. 15. Heparinization • Professional Development 5.5% 1. Current status of dialysis technology a. the coagulation system • Environmental Control 10.0% 2. Critical elements for evaluation of b. heparin and its affects on dialysis equipment and supplies the coagulation system The examination has a three hour time 3. AAMI Standards for Hemodialysis 16. Types of adjunctive therapy limit and consists of 150 multiple- Systems a. sequential ultrafiltration choice questions. b. hemoperfusion c. hemofiltration II. DIALYSIS AND RELATED d. bicarbonate dialysis Eligibility ISSUES (74.5%) e. high sodium dialysate • RN with valid license and one year A. Patient Care Collect, document and analyze 17. Determining the adequacy of of experience in an ESRD facility (copy dialysis of valid license) patient information before, during and after dialysis in order to maintain and/or a. kinetic modeling • LPN or LVN with valid license and improve the quality of patient care 18. Quality control and quality two years experience in ESRD in a through continuous evaluation and assurance nursing capacity as verified by immedi- ongoing revision of interventions. ate supervisor or medical director 19. Other treatment modalities 1. Steps in the nursing process a. peritoneal dialysis • Applicants are required to submit b. transplantation two signed letters of reference with 2. Normal renal anatomy and their applications. A signed letter will be physiology required from their immediate supervi- 3. Fluid and electrolytes B. Machine Set Up sor. The other will be required from a Set up equipment prior to the start of 4. Causes of renal failure the dialysis procedure to ensure that all professional, e.g., a peer or mentor in the field of nephrology. Applicants must 5. Clinical manifestations of renal parameters are intact and functional. be employed at the time of application failure 1. Dialysis fluid delivery systems submission. 6. Dialysis principles and procedures a. types • Applicants must complete the b. functions 7. Physical assessment application in its entirety and sign. i. abnormal functions a. normal and abnormal ii. corrective actions patient signs and symptoms c. monitors and alarms Detail of Examination 8. Nursing interventions i. function Content a. teaching d. disinfectants b. counseling i. rinsing and testing I. SUPERVISION/MANAGEMENT c. referral e. AAMI Standards for (10%) 9. Charting Dialysate Supply Systems A. Personnel Management 2. Dialyzers 10. Medications Develop and implement policies and a. various types a. use of medications procedures relating to personnel man- b. priming and testing b. desired effects of agement of patient care staff. procedures medications c. interactions with dialysis Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 13
  14. 14. 3. Dialysis Bath a. QB/QD 3. Record keeping a. chemical composition b. TMP/UFR b. types of dialysis baths c. conductivity H. Water Treatment c. techniques for altering the d. temperature Equipment and methods used for composition of the dialysis bath 3. Complications during dialysis treating water to make it suitable for d. verification of dialysate a. resolution use in dialysis procedures in order to composition remove contaminants and trace ele- 4. Ancillary equipment ments by use of deionization, reverse E. Termination of Dialysis a. procedures for use of osmosis, filtration and/or softening. Procedure ancillary equipment Terminate dialysis procedure by stop- 1. Source water ping further blood flow, returning the a. analysis of source water C. Initiation of Dialysis extracorporeal blood to the patient, dis- b. normal versus abnormal Connect patient to dialysis machine connecting the patient, stabilizing and water to initiate procedure by obtaining access dressing the access and cleaning the i. effect on patient and to circulation, taking blood samples, machines. machinery beginning blood flow, administering the 2. Methods of treating water 1. Methods of returning anticoagulant, monitoring machine a. AAMI Standards extracorporeal blood parameters and patient response. b. disinfection and rinsing 2. Achieving hemostasis of various procedures 1. Aseptic technique internal blood accesses 2. Access to the patient’s blood a. dressing procedures for I. Transplantation circulation (i.e., types) all types of dialysis access Current practice relating to renal b. maintaining patency of 3. Machine parameters transplantation in order to inform and catheters a. QB support potential and previous trans- b. QD 3. Cleaning and disinfection of plant candidates and their families. c. TMP/UFR machine 1. Advantages/disadvantages of d. conductivity a. types of solutions kidney transplantation e. temperature b. solution concentration 4. Blood drawing c. dwell time 2. Indications/contraindications for a. sampling techniques transplantation 4. Disposal of software b. blood analyses 3. Work-up procedures required for 5. Potential problems and 5. Anticoagulation transplantation emergencies associated with the a. parameters termination of dialysis 4. Drugs commonly used as b. dosage adjustment a. resolutions immunosuppressive agents in c. methods for performing transplantation blood clotting time analysis F. Home Dialysis 5. Special care needs of patients 6. Patient responses, potential Teach the patient and dialysis part- returning to hemodialysis after a problems and emergencies (i.e., ner how to set up the machine, initiate, failed transplant hemolysis, blood leak, venipuncture) monitor and terminate the dialysis pro- a. resolutions 6. Laboratory and other parameters cedure and recognize and respond to expected in a new transplant 7. Acute dialysis problems, or emergencies in order to patient a. acute renal failure care maintain safe and effective dialysis in b. specific and/or special the patient’s home. care and precautions III. PROFESSIONAL DEVELOPMENT 1. Principles of adult learning (5.5%) to be taken A. Information Sharing G. Dialyzer Reuse Share information with colleagues to D. Monitoring During Dialysis Procedures used for cleaning, disin- stimulate professional growth by partici- Monitor patient response during dial- fecting and rinsing dialyzers so that pating in and/or organizing formal in- ysis, recognizing and responding to they will approximate their original per- service programs, disseminating pro- problems and emergencies, by collect- formance characteristics with use of fessional literature and attending pro- ing and analyzing patient and machine appropriate recycling equipment. fessional meetings. data in order to maintain safe and effective dialysis. 1. Methods of dialyzer recycling 1. Professional literature a. cleaning and disinfectant 1. Patient response 2. Professional organizations solutions a. purpose of professional 2. Machine parameters and 2. Testing procedures organizations adjustments 14 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology
  15. 15. B. Research standards of performance by providing 1. Chemical Agents Investigate clinical nephrology issues learning situations and observing and a. use of chemical agents to resolve a problem in order to evaluating performance. b. effects of chemical agents contribute to the body of nephrology c. potential hazards of knowledge and improve patient care by chemical agents IV. ENVIRONMENTAL CONTROL using the scientific method. (10%) 2. Biological Agents 1. Scientific method and its Maintain a safe environment for a. potential hazards application patients and staff to prevent injury and b. effects of biological agents the spread of disease by developing, c. routes of transmission 2. Research design and promoting and implementing policies for implementation 3. Infection Control the use and handling of chemical and biological agents and the prevention of 4. Occupational Injuries C. Staff Training contamination. 5. Hazards Prevention and Control Orient and instruct staff to unit policies (i.e., fire, bomb threats, power failure, and dialysis procedures to maintain the water loss and/or contamination, etc.) Certified Peritoneal Dialysis Nurse (CPDN) Examination Content • Applicants must complete the 5. Electrolyte balance The BONENT Certified Peritoneal application in its entirety and sign 6. Erythropoiesis Dialysis Nurse examination measures nursing proficiency in certain skills, Detail of Examination Content E. Pathophysiology of the Kidney tasks and general areas of knowledge. I. NURSING PROCESS (60%) and Urinary System The examination tests the following four Collect, document and analyze major domains of practice and tasks patient information before, during, and performed in the scope of peritoneal F. Etiologies of End Stage Renal after dialysis in order to maintain and/or dialysis nursing. Disease improve the quality of patient care • Nursing Process 60% through continuous evaluation and • Administration 10% ongoing revision of interventions. G. Laboratory Testing • Education 20% • Professional Development 10% 1. Patient preparation A. Interviewing Techniques 2. Nursing responsibilities The examination has a three-hour time limit and consists of 150 multiple- 3. Interpretation of results B. Physical Assessment choice questions. 1. Normal and abnormal patient signs and symptoms H. Diagnostic Testing Nephrology nurses may receive certifi- 1. Patient preparation cation in either or both hemo and peri- toneal dialysis. C. Nursing Assessment 2. Nursing responsibilities 1. Patient, family, and significant others’ knowledge, skills, and 3. Interpretation of results Eligibility self-care abilities • RN with valid license and one year 2. Gross and fine motor coordination I. Pharmacology of experience in nephrology nursing 1. General (copy of valid license) 3. Hand strength • LPN or LVN with valid license and 4. Vision 2. Alterations in drug excretion and two signed years experience in ESRD metabolism in end stage renal in a nursing capacity as verified by disease immediate supervisor or medical D. Human Anatomy and Physiology 3. Drugs used frequently in ESRD director patients • All experience must be verified by 1. Anatomy and physiology of the two signed letters of reference: one kidney and urinary system 4. Alterations in drug metabolism and from the immediate supervisor, the excretion in peritoneal dialysis 2. Anatomy and physiology of the other from a professional, e.g., a peer 5. Kinetics of intraperitoneally peritoneum or mentor in the field of nephrology. administered medications Applicants must be employed at the 3. Fluid balance 6. Antibiotics used in peritonitis time of application submission 4. Acid base balance 7. Methods of administration Board of Nephrology Examiners Nursing and Technology Candidate Examination Handbook 15