Candidate Examination Handbook

CandidateExaminationHandbook

Certified Hemodialysis Technologist/Technician (CHT)

Certified Hemodialysis Nurse (CHN)

Certified Peritoneal Dialysis Nurse (CPDN)

BONENT Board of Nephrology Examiners Nursing and Technology

&Paper andPencil Exam

ComputerBased Testing

Choose from Over 275

Testing LocationsRevised September 15, 2010

2 Candidate Examination Handbook Board of Nephrology Examiners Nursing and Technology

The Board of Nephrology Examiners Nursing and Technology (BONENT) is a non-profit organization promoting excellence in the quality of care of nephrology patients in the UnitedStates and many countries around the world.

BONENT serves as a trusted representative voice to policy makers by urging legislative and regulatory movementtoward meaningful training, certification and credentialingof nephrology practitioners.

Recognized since 1974 as the leading, independent pro-fessional certification body, BONENT identifies safe andcompetent practitioners in nephrology by providing themost highly regarded comprehensive specialty examina-tions to achieve the following credentials:

• Certified Hemodialysis Technologist/Technician (CHT)

• Certified Hemodialysis Nurse (CHN)

• Certified Peritoneal Dialysis Nurse (CPDN)

Nephrology nurses may receive certification in eaither orboth hemo and peritoneal dialysis.

BONENT membership is comprised of nurses and techni-cians who have received a passing score on a BONENTexam and are thereby certified. Members must recertifyevery four years. Today, over 6,000 nurses and technicianshave met our criteria and are BONENT-certified.

Despite its impressive growth in recent years, BONENTremains largely a “grassroots” organization that dependson the help of all of its members in order to sustain itself,thrive and grow.

Benefits of BONENT Certification

• Increases your ability to provide the highest quality care to patients in the unit;

• Carries the distinction of the title CHT, CHN, or CPDN;

• Provides personal satisfaction from performance;

• Enhances your resumé, which may result in preferential consideration for promotion or salary increases;

• Presents opportunities for continued professional growth through recertification programs;

• Presents opportunities to participate in the creation and development of new BONENT programs;

• Includes complimentary subscription to the BONENT newsletter, which contains practical program information for nurses and technicians; and,

• Includes complimentary copies of various nephrology publications

BONENT Board of Nephrology Examiners Nursing and Technology

The Premier International Organization for Certification of Nephrology Professionals

Board of Nephrology Examiners, Inc.Nursing and Technology1901 Pennsylvania Ave., NW, Suite 607Washington, DC 20006Phone: 202-462-1252Fax: 202-463-1257Website: www.BONENT.org

Copyright © 2010. The Board of NephrologyExaminers, Inc., Nursing and Technology. Allrights reserved. No part of this publication maybe reproduced or transmitted in any form or byany means, electronic or mechanical, includingphotocopy or recording, or any information andretrieval system, without permission from theBoard of Nephrology Examiners, Inc., Nursingand Technology. Printed in USA.

9/15/10

Candidate Examination Handbook 3Board of Nephrology Examiners Nursing and Technology

Section1 Examinations

Exam Development 4

Exam Application 4

Exam Methods 4

US & International 4

Exam Schedules 4

Host Opportunities 4

Section 2 Eligibility and Fees

Eligibility 5

Fees 5• Exam Fees 5• Incomplete Fee 5• Insufficient Funds Fee 5• Annual Certification Fee 5• Recertification 5

Section 3 Exam Policies

Applications & Deadlines 5

Acceptance 5

ADA Requests 6

Refunds and Exam Transfers/Withdrawals 6

Score Reports 6

Manual Re-scoring 6

Re-examination 6

Multiple Certifications 7

Duplicate Certificates 7

Duplicate Wallet Cards 7

Section 4 Recertification and RenewalHow Often Must You Renew? 7

How to Recertify 7

Payment 7

Section 5 Guidelines and Rules for Examinations

Bring to the Exam 7

Guidelines for Day of Exam 8

Section 6 Preparing for Exams

Online Practice Examination 8

Study Guide 8


• Examination Content 9• Eligibility 9• Legislative Mandates for Certification 9• Detail of Examination Content 9

Certified Hemodialysis Nurse (CHN) • Examination Content 13• Eligibility 13• Detail of Examination Content 13

Certified Peritoneal Dialysis Nurse (CPDN)• Examination Content 15• Eligibility 15• Detail of Examination Content 15

Section 7 Suggested Reading MaterialsReference Guide 19

Exam Application 21

Table of Contents

NOTE:The most detailed and up-to-date policies

may be found on the BONENT web site at:www.BONENT.org


Section1Examinations

Exam DevelopmentExamination committees conduct analyses of tasks, role delieation,skills and knowledge in conjunction with a professional testingagency. Examination validity is maintained through expert statisticaland scientific analysis.

Questions are then solicited from qualified nephrology nurses andtechnologists/technicians in different areas of the country. Thesubmitted questions are categorized, edited grammatically and psycho-metrically, reviewed by experts and placed in an item pool. Questions are drawn from an item pool for placement in an examination.

All BONENT examinations are designed, constructed and analyzedfor reliability and validity. Each examination is regularly updated.The examinations are comprised of multiple-choice questions. Theexamination should be completed and all questions answered, asgrades are based on the number of questions answered correctly.

Exam ApplicationTo apply for a BONENT exam, you must submit a completedApplication Form, fees and all required documentation. (see pages21-22 for application and instructions).

Exam MethodsCandidates can chose between two exam methods by which tobecome BONENT certified:

The following points are the same for both exam methods:• Use the same application (candidates must indicate PPE or CBT)• Require the same amount of time• Have the same questions• Have a proctor on site• You choose your own exam site

The differences between the two exam methods are:• Each exam method has its own separate list of locations• Candidates receive an unofficial printout of their scores as soon

as the CBT exam is completed• There is no application deadline for the CBT• Confirmation letters will be sent after your application has been

processed and approved. The approximate timeframe of when you receive your confirmation letter depends on the exammethod you choose:

• PPE – 2 weeks before the exam• CBT – 4 weeks after BONENT receives your application

• Taking the BONENT exam by Computer Based Testing (CBT)requires basic knowledge of how to use a computer. While taking the exam, candidates are able to skip questions, go back to a previous question and change answers.

US & InternationalBONENT 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 are conducted throughout the United States and as faraway as far away as Australia, New Zealand, Singapore, Turkey and agrowing 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

• Application requirements, such as letters of reference, license and scholastic documentation, must be received 60 days prior to the examination

• Host applications must be received a minimum of 120 days prior to the examination date

Payment for all items must be in United States currency.

Exam SchedulesFor a detailed list of PPE exam locations and times,please visit the BONENT website (www.bonent.org) orcontact the Executive Office at (202) 462-1252. This listis updated weekly.

The CBT list of locations is available at www.bonent.org.This list is updated often and is completely different from the Paper & Pencil Exam (PPE) schedule. Most CBTlocations’ business hours are approximately 9am - 5pm

daily and some are open on Saturday. The availability of exam timesdepends on each location. Since the exam is only 3 hours, they aregiven once or twice daily. When your application is approved, you will be given a unique name and password. Specific registration instruc-tions will be itemized in the Confirmation Letter. Only during theprocess of scheduling your exam time, will you be able to accessthe location and time availability.

Host OpportunitiesBONENT Certification Examinations may be offered at variouslocations throughout the United States as well as worldwide, uponrequest. Examinations can be administered anywhere, any timethere are five qualified candidates to take the exam.

The candidates may be a combination of Hemodialysis Technologists/Technicians, Hemodialysis Nurses and Peritoneal Dialysis Nurses.

BONENT encourages certification; therefore, proctors are requiredto be a BONENT-certified nurse or technologist/ technician, a physi-cian, a dietitian, or a renal social worker. These requirements arenecessary to prevent any breach of security of the BONENT exami-nation process.

To host an examination, the sponsor must submit a Host Form, alongwith their resumé to the BONENT Executive Office a minimum of 90 days (120 days international examinations) prior to the examinationdate chosen by the Host Facility.

Due to security concerns, host forms must be accompanied by acopy of a curriculum vitae or resumé of the potential proctor andassistant proctors. An assistant proctor is required for all exams.After verification of proctor credentials and approval by the HostReview Committee, the exam date and site are added to theExamination Schedule and an acceptance letter will be mailed to theproctor.

Please visit www.BONENT.org to download:• Host Form• Proctor/Assistant Proctor Agreement

Paper & PencilExam (PPE)

Computer BasedTesting (CBT)


Exam Policies

Applications & DeadlinesPaper & Pencil ExamYour original, signed application (see page 21-22) andexamination fees (paid in full with application) arerequired 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.

Computer Based TestingThere is no deadline to submit your original, signedapplication and examination fees, (paid in full withapplication).

Faxed or photocopied applications will NOT be accepted.

Examination results will not be released to the candidate until receiptof all application requirements and fees. NO exceptions will be made.

If your name has changed since High School, you must indicateyour previous name in the space provided on the application andprovide court documentation (i.e. marriage certificate).

AcceptanceApproximately two weeks before the scheduled exam, can-didates whose applications have been accepted will receive an official Confirmation letter indicating the examination site,exact address and time to report for the examination.This letter is your admission ticket for the examination. You

must bring the letter with you in order to sit for the exam.

All applications and examination fees (paid in full) must bereceived by the 45-day deadline (60-day international examina-tions). All applications received after the 45-day (60-day international examinations) deadline will be returned.

Applications postmarked after the deadline will NOT be accepted.

Section3

Section2Eligibility and Fees

EligibilityIn addition to requirements imposed by state licensing authorities, appli-cants must meet the following minimum criteria:

• Nurses (CHN, CPDN) – a valid RN, one year of experience in nephrology, and current active participation in an ESRD facility

• LPN or LVN – a valid LVN or LPN license, current active participation in an ESRD facility and for the following exams:- CHN or CPDN Exam: two years of experience in nephrology;- CHT Exam: one year of experience in nephrology.

• Technicians (CHT) – a copy of your high school diploma or official transcripts(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 asa dialysis patient care technologist, you will be required to have your immediatepast supervisor sign your appliction and write a reference letter. All other statedrequirements apply.

- PCTs with greater than 4 years of work experience in dialysis, who lack evidenceof a high school diploma, may use that work experience in lieu of the requirementfor a high school diploma.

- If you have no experience as a patient care technician/technologist, you mayapply to take the BONENT exam upon successful completion of a BONENT Approved Program.

All experience must be verified by two signed letters of reference:• One from the applicant’s immediate supervisor (the same person

who signs the application)• The other from a professional, e.g., a peer or mentor in the field

of nephrology

Fees

Examination results will not be released to the candidate until receiptof all application requirements and fees. NO exceptions will be made.

Exam Fees

Country

First-time Candidates

USA $200 $225

Locations Outside USA $230 $240

Repeat Candidates Within One Year

USA $160 $185


Repeat Candidates After One Year

USA $200 $225


Incomplete FeeApplications 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.

Insufficient Funds FeeA $50 Insufficient Funds Fee is assessed for any checks returned for Insufficient Funds or credit cards rejected by the financial institution.

Annual Certification FeeTo maintain a BONENT membership, nurses and technologists/technicians are required to pay an annual Certification fee of $55.Members are given two payment options – annually (@ $55), or four years in advance ($200).

RecertificationThere is NO extra fee for the Recertification process and wallet card in the fourth year, but the annual Certification fee is still applicable. If fees are NOT received within 30 days of the due date, a $10/yr. latefee will apply (in the first three years after certification and $20/yr.on the fourth year).

Additional FeesIncomplete Application Penalty $30

Exam Withdrawals & Transfers $65

Insufficient Funds Fee $50


Once we receive your CBT application, it will takeapproimately 4 weeks for the approval process. After your application is approved, you will receive a ConfirmationLetter from BONENT containing pertinent registration

information including your:• CBT exam confirmation number• unique username and password

After you receive the above information, you will need to register online for a specific CBT date, location and time.Registration instructions will be itemized in the ConfirmationLetter. You will have a deadline of 6 months to choose whenand where you will take the exam. If you do not take the exam within6 months of receiving your username and password, you will have tore-register for the exam at full price.

CBT No-Show Reactivation: Candidates are responsible forscheduling their own CBT time, date and location.

Failure to show up at the scheduled time, date and location resultsin forfeiture of the CBT exam fee.

However, you may reactivate your username and password:

• The fee to reactivate your CBT username and password is $125.

• The CBT No-Show Reactivation Form must be submitted with payment to the BONENT Executive, postmarked or faxed, no more than 14 days after the missed eam date.

ADA RequestsBONENT accepts requests for special examination accommodationsunder the Americans with Disabilities Act. Candidates with disabilities covered by the Act are requested to complete the BONENTDocumentation of Disability-Related Needs form and submit it whenfiling the exam application. Information provided, and any documen-tation regarding disabilities or the need to accommodate them, willbe treated with the utmost confidentiality.

The Documentation of Disability-related Needs form may beaccessed on line at:http://www.bonent.org/exam_policies/ada_requests.html,

by request in writing to the BONENT Executive Office or byrequesting by phone (202) 462-1252 for a copy.

Refunds, Exam Transfers & WithdrawalsRequests to withdraw from a scheduled examination must bereceived in writing, postmarked, 20-days prior to the examinationdate. A refund of the application fee, minus a $65 processing fee,will be issued. Faxed requests are accepted at the BONENT yoursocial security number. E-mail requests are not accepted.

Applicants who wish to transfer to a future examination must do soin writing (indicate original examination date and desired transfer date) with the $65 processing fee, postmarked 20-days prior to the exami-nation date. Faxed requests are accepted at the BONENT ExecutiveOffice (202) 463-1257, and must be signed and include your socialsecurity number. E-mail requests are not accepted.

In the event that a candidate CANNOT sit for a scheduled exam-ination due to the death of an immediate family member (mother, father, siblings), unexpected natural disaster, or the candidate’shospitalization, the candidate will be able to sit for the next scheduledexamination in his/her area. Documentation of the event must accom-pany the written transfer request. All requests for special circumstances

or transfer must be submitted in writing (by mail or fax) with the $65processing fee attached.

Score ReportsCandidates can expect to receive their score results app-roximately 3 to 4 weeks following the date of the exam.Score results are sent via USPS First Class mail to theaddress on your application form. BONENT will not pro-

vide candidate scores over the telephone, via e-mail or via fax.

CBT candidates will receive a printed copy of their scoreand pass/fail status at the conclusion of the examinationsession. This will NOT be your official report. Candidatescan expect to receive their official score results approxi-

mately 3 to 4 weeks following the date of the exam. Score results are sent via USPS First Class mail to the address on your application form.

Manual Re-scoringAny candidate failing to achieve a passing score on the examination may request a manual re-scoring of his/her answer sheet after scoringhas been completed. The fee is $100, payable to BONENT. A request for manual re-scoring must be submitted in writing to the ExecutiveOffice, accompanied by the $100 fee within 100-days following theexamination date. The request must include: the candidate’s name,current mailing address, Social Security number, examination dateand location.

Re-examinationApplicants are given a maximum of three opportunities to successfully complete the examination within 12 months (examination date to exam-ination date). If passing the examination does not occur after 3attempts, applicants will be required to complete 8 hours of nephrology-related continuing education or attend and complete a nephrologyeducational program. A certificate of participation or passing grademust be submitted before taking a future BONENT examination.

In the event a candidate does not achieve a passing score on theexamination, he/she may retake the next available examination. Thecandidate must submit a signed application or written request withhis/her full address, social security number, previous exam date andlocation, and requested exam date and location.

FeesThe chart below describes the fees (in $US) for re-examination:

* After one year has elapsed since the candidate’s initial examination, appropriate documentation must be resubmitted (letters of reference,high school diploma.)

Fees for Re-examination

Exam MethodWithin 1 Year After 1 Year *

USA INT’L. USA INT’L.

$160 $230 $200 $230

$185 $240 $225 $240


Section4Recertification and Renewal

BONENT adheres to the premise that certification not only promotesexcellence in the quality of care of the nephrology patient, it ensuressafe, competent practitioners in nephrology nursing and technology.Initial certification is the result of having successfully passed theBONENT certification examination.

How Often Must You Renew?Recertification is required every four years. Certification is valid from the date the candidate originally passed the examination. Documentationis due within 30-days of the recertification date to avoid revocation of the credential. Faxed Recertification Application Forms andbooklets will not be accepted.

A 30-day grace period will be allowed after the certification renewaldate expires before the candidate’s certification is considered lapsed.Lapsed candidates have two options:

• Retake the examination, or• Submit a letter to the BONENT Board, providing a detailed

explanation of their situation. A $100 penalty fee will be assessed to lapsed candidates in this category.

Multiple CertificationsIf a nurse wishes to apply for certification in both hemodialysis andperitoneal dialysis, the candidate must pay the application fee for eachtype of examination for which he/she wishes to sit. Payment of the appli-cation fee must accompany the completed application a minimum of45-days prior to the examination date.The $55 annual certification feemust be paid for each certification.

Duplicate CertificatesRequests for duplicate certificates must be submitted in writing tothe Executive Office. A $30 fee must accompany each request.

Duplicate Wallet CardsRequests for duplicate wallet cards must be submitted in writing tothe Executive Office. A $20 fee must accompany each request.

How to RecertifyIn order to continue certification beyond the initial four-year period,one of the following two options must be chosen:

• Earn 40 Contact Hours through workshops, seminars, home study activities, academic courses, presentations or publications

- A minimum of 25 hours must be from Group A- 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 required to complete a new one-page application and subit it to the BONENT Eecutive office.The application will be theonly 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.

Once we receive your recertification application or booklet, it will take approximately 4-6 weeks for the approval process.After approval, you will receive a new BONENT wallet card in the mail.

OR• Retake the exam at the end of your certification period.

OR• Use the One-Time Waiver which allows you to automatically

recertify without having to accumulate 40 contact hours.Check the waiver option on the Recertification Application.

For more details, go to www.BONENT.org

PaymentTo maintain a BONENT membership, nurses and technologists/technicians are required to pay an annual Certification fee of $55. Mem-bers are given two payment options – annually (@ $55), or four years in advance ($200). There is NO extra fee for the Recertification pro-cess and wallet card in the fourth year, but the annual Certification fee is still applicable. If dues are NOT received by the due date, a $10 late fee will apply (in the first three years after certification and $20on the fourth year).

Insufficient Funds FeeA $50 Insufficient Funds Fee is assessed for any checks returned forInsufficient Funds or credit cards rejected by the financial institution.

Incomplete FeeIncomplete Recertification Applications will be assessed a $30incomplete application fee.

Section

Guidelines and Rules forExaminations

Bring to the ExamThe applicant’s Confirmation Letter lists his/her test center address.To gain admission to the test center an applicant must show theConfirmation Letter to the supervising proctor.

5


Section6Preparing for Exams

BONENT has assembled a list of various textbooks and publications that are currently available to assist candidatesin preparing for the examination. Please see page 18 to viewa list of suggested references for use in preparing for each ofthe respective examinations.

Online Practice ExaminationThe Online Practice Examination for HemodialysisTechnologists/Technicians was developed by BONENT andconforms to the specifications of the CHT examination in termsof its content and average degree of difficulty. The onlinepractice exam is only available online and has a length of 50questions, whereas the CHT exam is 150 questions. Theonline exam is intended to reflect the knowledge required ofa hemodialysis technologist/technician to be successful onthe CHT examination. The Online Practice Exam is availablefor a fee of $50.

Do NOT send payment for the practice exam to theExecutive Office.The Executive Office does not havecopies of the practice exam.

Go to www.BONENT.org to take the online practice exam.

Study GuideThe following section contains detailed content outlinesfor each of the three BONENT examinations, as well assample questions similar to what will appear on theactual examination.These examination tools and theSuggested Reading Materials on page 19 can be useful study aids when preparing for an examination.

He/she must provide two forms of identification.

• A valid driver’s license

• A valid government-issued ID card with photo, a valid passport

• A notarized photo with the Candidate’s name printed on the back

These are the ONLY acceptable forms of ID.

Employment and student I.D. cards are NOT acceptable formsof primary identification.

You must have proper identification to gain admission to thetest center.

Applicants must report to the test center at the time listed on theConfirmation Letter. Seating of candidates, distribution of test mate-rials and testing instructions begin shortly thereafter. The actualstarting time of the test may vary at different test centers due to theamount of time necessary for pre-administration procedures.

ANYONE WHO ARRIVES AFTER TESTING BEGINS WILL NOTBE ADMITTED.

Guidelines for Day of ExamBONENT provides these guidelines as part of its criteria for candi-dates who are scheduled to sit for an exam:

• Do not bring pencils. Pencils will be provided.

• You may wish to take your watch to the examination to help pace yourself during the examination. The test center super-visor will keep the official time and ensure that you are given the correct amount of time for the examination.

• No books, calculators, writing instruments, slide rules, papers, dictionaries or other reference materials may be taken into the examination room.

• No electronic devices are permitted in the examination room or center, including cell phones or signaling devices such as pagers, alarms, and PDAs (personal digital assistants).

• No examination materials, documents or memoranda of any kind are to be taken from the examination room.

• No questions concerning the content of the examination may be asked during the examination. Listen carefully to the 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 observer will not answer questions regarding the examinationor become involved with exam administration. The observerwill file a report with BONENT after the examination concerning test center facilities and administration procedures.

• You must have the supervising Proctor’s permission to leave the room during the examination.You will not be allowed 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;

4. if a candidate attempts to remove examination materialsor notes from the testing room; and/or5. if a candidate attempts to take the examination for someone else.

• Proctors will not accept application materials of any kind.Candidates are required to submit all application materials tothe BONENT Executive Office only.


Ohio certification requires that all appli-cants have completed one year ofpatient care prior to the administrationof the examination. Other states mayhave similar requirements.

Detail of ExaminationContent

I. PATIENT CARE (65%)A. Assessment

1. Assess fluid management:a. replacement therapyb. sequential ultrafiltrationc. TMP calculationd. ultrafiltration concepts

2. Collect and evaluate patient data:a. access patencyb. apical pulsec. blood pressured. breath sounde. heart soundsf. jugular vein distensiong. peripheral edemah. pulsei. respirationj. signs of infectionk. temperaturel. weight

3. Observe changes in appearance of dialyzer

4. Recognize symptoms and/or complications occurring during dialysis:

a. chillsb. crampsc. feverd. shock

5. Recognize symptoms and/or complications due to operator or equipment error:

a. air embolismb. bleach or formaldehyde

reactionc. chemical pyrogen reactiond. hemolysis and water quality

6. Recognize symptoms and/or com-plications associated with the administration of medications and dialysis treatments (e.g., antihyper-tensives, erythropoietin, iron dex-tran)

7. Recognize problems regarding heparinization in hemodialysis (e.g.,coagulation, hemorrhage, hemostasis)

8. Recognize access complications inpatient (e.g., clotting, infection, recirculation)

9. Recognize blood leaks during dialysis

B. Management of Treatment

1. Adjust blood pump settings and pressure monitors to maintain safeand efficient dialysis per order of physician

2. Adjust fluid removal (TMP) according to established protocols

3. Administer local anesthetics according to established protocols

4. Administer anticoagulants to patient

5. Administer medication for initiation of treatment:

a. Heparinb. local anesthetic

6. Alter dialyzing fluid

7. Apply pressure to cannulation sitesafter removal of cannulation needle

8. Apply dressings to cannulation sites

9. Cannulate:a. AV graftsb. AV fistulas

10. Clean and dress access site using appropriate techniques

11. Collect blood samples for:a. aluminum levelsb. blood chemistryc. clotting time studiesd. culturese. hematocritsf. hepatitis studiesg. iron studiesh. Kt/Vi. recirculation time studies

12. Communicate orally or in writing with other health care professionals regarding patient treatment plan (pre and post dialysis)

Examination ContentThe BONENT Certified HemodialysisTechnologist/Technician examinationmeasures technical proficiency in certainskills, and general areas of knowledge.The examination tests the following fivemajor domains of practice and tasksperformed in the scope of hemodialysistechnology:

• Patient Care 65%

• Machine Technology 10%

• Water Treatment 5%

• Dialyzer Reprocessing 5%

• Education/Personal Development 15%

The examination has a three-hour timelimit and consists of 150 multiple-choice questions.

Eligibility• A copy of your high school diploma

or official transcripts with school seal/stamp.

• One year of experience (12 months)in nephrology patient care, and currentactive participation in an ESRD facility orsuccessful completion of an accrediteddialysis course approved by the BONENTBoard. All programs are subject to theapproval of the BONENT Board.

• Applicants are required to submittwo signed letters of reference withtheir applications. A signed letter will berequired from their immediate supervi-sor. The other will be required from aprofessional, e.g., a peer or mentor inthe field of nephrology. Applicants mustbe employed at the time of applicationsubmission.

Legislative Mandates forCertification

In several states, BONENT certificationor state certification is required fortechnologists/technicians who performcertain patient care procedures. It isincumbent upon all applicants to famil-iarize themselves with any state licen-sure requirements for the state in whichthey intend to be certified. For instance,



13. Initiate dialysis treatment using established access routes

14. Maintain appropriate documentation (data) regarding incident reporting

15. Monitor and record treatment data:a. apical pulseb. arterial and venous pressuresc. blood flowsd. blood pressuree. clotting timesf. dialysate flow ratesg. fluid removal parametersh. hemoglobin/hematocrit levelsi. Kt/Vj. pulsek. temperature of dialysatel. TMPm. recirculation bloodsn. respirationo. UFRp. weight

16. Monitor fluid management:a. replacement therapyb. sequential ultrafiltrationc. TMP calculationd. ultrafiltration concepts

17. Monitor the dialyzer delivery system continuously during treatment

18. Obtain (spin) serum specimens

19. Perform coagulation studies to determine heparinization

20. Perform procedure(s) to terminate dialysis treatment

21. Perform hematocrit test and quality assurance

22. Prepare medication for initiation of treatment:

a. Heparinb. local anestheticc. normal saline

23. Prepare specimens for transportation to laboratory for analysis

24. Recommend patient care needs to nurse

25. Remove needles after terminationof treatment

26. Verify patient identification at initiation of dialysis

C. Intervention

1. Administer oxygen to patient by cannula or mask

2. Initiate CPR to ensure patient survival

3. Initiate appropriate action regardingsymptoms and/or complications occurring during dialysis:


4. Initiate appropriate action regardingsymptoms and/or complications dueto operator or equipment error:


reactionc. chemical pyrogen reactiond. hemolysis

5. Initiate appropriate action regardingsymptoms and/or complications occurring with the administration ofmedications and dialysis treatments(e.g., antihypertensives, erythropoi-etin, iron dextran)

6. Initiate appropriate action regardingproblems of heparinization in hemo-dialysis (e.g., coagulation, hemor-rhage, hemostasis)

7. Initiate appropriate action regardingaccess complications in patient (e.g., clotting, infection, recirculation)

8. Initiate appropriate action regardingblood leaks during dialysis

9. Perform hemastix safety test

10. Provide emotional support to:a. patientb. family

11. Respond to patient needs (e.g., comfort items)

12. Respond to alarms and make dialysis adjustments

D. Evaluation1. Evaluate symptoms and/or

complications occurring during dialysis:


2. Evaluate symptoms and/or complications due to operator or equipment error:


reactionc. chemical pyrogen reactiond. hemolysis

3. Evaluate symptoms and/or complications associated with the administration of medications and dialysis treatments (e.g., antihypertensives, erythropoietin, iron dextran)

4. Evaluate problems regarding heparinization in hemodialysis (e.g., coagulation, hemorrhage, hemostasis)

5. Evaluate access complications in patient (e.g., clotting, infection, recirculation)

6. Evaluate blood leaks during dialysis

7. Review patient laboratory data for abnormal values

8. Review dialysis orders

II. MACHINE TECHNOLOGY (10%)A. Maintenance of Systems

1. Clean and disinfect dialysis equipment per unit policy (protocol)

2. Develop preventative maintenance schedules for all dialysis equipment

3. Document all dialysis equipment repair work performed

4. Maintain record of all machine maintenance performed

5. Maintain emergency equipment in proper working order for immediate use

6. Maintain/verify the calibration of ancillary equipment used to maintain medical devices

7. Maintain/calibrate dialysis machine

8. Order supplies and equipment for dialysis unit

9. Perform troubleshooting and repairof unit or home equipment accordingto manufacturer’s recommendations,and OSHA, HCFA, requirements

10. Perform preventative maintenanceto dialysis and ancillary equipmentfollowing manufacturer’s recom-mendations, and OSHA, HCFA and AMMI requirements


11. Perform repairs to dialysis and ancillary equipment following manufacturer’s recommendationsand OSHA, HCFA, and AMMI requirements

12. Perform electrical leakage tests on all dialysis equipment

13. Verify blood and dialysate flow rates

B. Machine Set-up

1. Assemble dialysis equipment for operation

2. Assemble auxiliary equipment (e.g., oxygen therapy)

3. Install dialysis equipment in dialysis unit

4. Perform residual chemical checks

5. Perform required safety checks on dialysis equipment:

a. conductivityb. pHc. pressure holding testd. temperature

6. Perform safety checks:a. air bubble detector/alarmb. arterial pressure gaugec. blood leak detector/alarmd. blood pumpe. dialysis fluidf. heparin pumpg. venous pressure gauge

7. Prepare bicarbonate solution

8. Prepare dialysis machine for operation:

a. rinseb. primec. calibrate alarm(s)d. set monitor(s)e. fluid delivery systemf. connections

9. Prime dialysis machines

10. Rinse dialyzer of disinfectant/germicide

C. Machine Operation/Evaluation1. Evaluate quality control of dialysis

equipment per AAMI standards

2. Monitor usage of equipment and supplies

3. Perform rinse procedures for dialysis delivery systems

4. Perform disinfect procedures for dialysis delivery systems

5. Maintain equipment maintenance records for compliance with regulatory and standard setting organizations (e.g., OSHA, HCFA, JCAHO, CDC, AMMI, FDA)

6. Participate in the development of equipment maintenance procedures and schedules

III. WATER TREATMENT (5%)A. Components/Design of Systems

1. Recognize the action of:a. micron filtrationb. multimedia filtration

(e.g., sand filter)c. submicron filtrationd. ultrafiltration

2. Recognize the action of carbon absorption

3. Recognize the action of water softening

4. Recognize the action of reverse osmosis (RO)

5. Recognize the action of deionization

6. Recognize the process of ultraviolet light exposure

B. Maintenance of Systems

1. Clean and disinfect water treatment equipment

2. Maintain in proper working order, all treatment components

3. Perform water treatment system checks:

a. bacterial culturingb. conductivityc. residual disinfectantsd. resistivitye. soft testf. total dissolved solids (TDS)

C. Monitoring/Evaluating Systems1. Analyze/examine water for use in

dialysis to determine:a. water contaminationb. water purityc. water treatment

component efficiency

2. Collect water and dialysate specimens for cultures and chemicalanalysis per AMMI standards

3. Evaluate quality control of reprocessing equipment per AAMI standards

4. Monitor safety tests:a. chloramineb. chloridesc. hardnessd. LALe. percent rejection

5. Maintain water treatment systems records for compliance with regulatory and standard setting organizations (e.g., OSHA, HCFA, JCAHO, CDC, AMMI, FDA)

6. Review (annually) AAMI recommended practices for water treatment

IV. DIALYZER REPROCESSING (5%)A. Procedures

1. Document dialyzer reprocessing inaccordance with regulatory agencies, AAMI standards and manufacturer’s recommendations

2. Ensure proper labeling according to facility protocol

3. Maintain reprocessing records

4. Prepare dialyzer for reprocessing

5. Reprocess dialyzer per facility protocol

B. Testing/Validation/Evaluation

1. Perform dialyzer reuse tests:a. bacterial culturingb. presence of

disinfectant/germicidec. pressure testingd. residual disinfectante. visual inspection

V. EDUCATION/PERSONAL DEVELOPMENT (15%)

A. Patient Education1. Advise patient of discharge

instructions (e.g., care of infiltrationsite)

2. Advise patient and family membersbased on physician’s orders regarding:

a. personal hygieneb. self-carec. various treatment modalities

3. Explain dialysis concepts to patients:a. access careb. artificial kidney functionc. dialyzer reprocessingd. diffusion, osmosis,

ultrafiltration


e. fluid, electrolyte, acid-base balance/composition

f. physiology of kidneyg. physiology of urinary system

B. Personal/Professional Development

1. Attend staff meetings for procedural updates

2. Attend continuing education programs to maintain current knowledge of dialysis

3. Demonstrate an understanding of the purpose of multi-disciplinary care plans

4. Explain the uses of medications and treatments to patient:

a. antihypertensivesb. Calcijexc. EPOd. Heparine. Hypertonic salinef. IDPNg. Infedh. Salinei. Xylocaine

5. Maintain proper body mechanics for patient and self

6. Maintain current CPR certification from the American Heart Association

7. Maintain a clean and safe patient environment (e.g., infection control)

8. Maintain patient confidentiality on medical and personal matters

9. Maintain (handle) patient’s

personal property (e.g., prosthetic devices, dentures)

10. Maintain universal precautions forinfection 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-

serviceb. technical instrumentation in-

service

15. Recognize complications in dialysis treatments regarding infectious diseases (e.g., AIDS, hepatitis-B, influenza)

16. Recognize clinical manifestations of electrolyte imbalances

17. Recognize problems with decreased efficiency of dialyzer

18. Review relevant current professional literature

19. Train (precept) new technologists

C. Quality Related Issues

1. Document incidents appropriately:a. emergency-related issuesb. equipment/devices related

issuesc. patient care issues

2. Maintain appropriate documentation (data) regarding:

a. quality monitoringb. treatment

3. Maintain an inventory of all chemical and equipment supplies

4. Maintain proper storage of medications to ensure quality

5. Maintain proper storage of equipment and materials

6. Participate in continuous quality improvement (CQI) activities

7. Participate in the development of Quality Assurance programs for dialysis unit

8. Participate in the development of dialysis unit objectives


11. Nutritional considerationsa. restrictions (i.e., fluid, protein, potassium, sodium)b. dietary noncompliance

12. Complications occurring during dialysis

13. Psychosocial aspects of renal failure

14. Types of vascular accessa. creationb. care and precautionsc. complications of each type

15. Heparinizationa. the coagulation systemb. heparin and its affects on the coagulation system

16. Types of adjunctive therapya. sequential ultrafiltrationb. hemoperfusionc. hemofiltrationd. bicarbonate dialysise. high sodium dialysate

17. Determining the adequacy of dialysis

a. kinetic modeling

18. Quality control and quality assurance

19. Other treatment modalitiesa. peritoneal dialysisb. transplantation

B. Machine Set UpSet up equipment prior to the start of

the dialysis procedure to ensure that allparameters are intact and functional.

1. Dialysis fluid delivery systemsa. typesb. functions

i. abnormal functionsii. corrective actions

c. monitors and alarmsi. function

d. disinfectantsi. rinsing and testing

e. AAMI Standards for Dialysate Supply Systems

2. Dialyzersa. various typesb. priming and testing

procedures

Examination ContentThe BONENT Certified HemodialysisNurse examination measures nursingproficiency in certain skills, tasks andgeneral areas of knowledge. The exam-ination tests skills and general areas ofknowledge. The examination tests thefollowing four major domains of prac-tice and tasks performed in the scopeof hemodialysis nursing.

• Supervision/Administration 10%

• Dialysis and Related Issues 74.5%

• Professional Development 5.5%

• Environmental Control 10.0%

The examination has a three hour timelimit and consists of 150 multiple-choice questions.

Eligibility• RN with valid license and one year

of experience in an ESRD facility (copyof valid license)

• LPN or LVN with valid license andtwo years experience in ESRD in anursing capacity as verified by immedi-ate supervisor or medical director

• Applicants are required to submittwo signed letters of reference withtheir applications. A signed letter will berequired from their immediate supervi-sor. The other will be required from aprofessional, e.g., a peer or mentor inthe field of nephrology. Applicants mustbe employed at the time of applicationsubmission.

• Applicants must complete theapplication in its entirety and sign.

Detail of ExaminationContent

I. SUPERVISION/MANAGEMENT (10%)

A. Personnel Management Develop and implement policies and

procedures relating to personnel man-agement of patient care staff.

1. Patient needs and staffing patterns

2. Staff abilities and limitations

3. Standards of dialysis care

4. Unit policies and procedures relating to personnel management

5. Medical ethical issues involved with patient care

B. Equipment and Supplies Develop and implement policies and

procedures for evaluation of equipmentand supplies for potential unit use.

1. Current status of dialysis technology

2. Critical elements for evaluation of dialysis equipment and supplies

3. AAMI Standards for Hemodialysis Systems

II. DIALYSIS AND RELATED ISSUES (74.5%)

A. Patient CareCollect, document and analyze

patient information before, during andafter dialysis in order to maintain and/orimprove the quality of patient carethrough continuous evaluation andongoing revision of interventions.

1. Steps in the nursing process

2. Normal renal anatomy and physiology

3. Fluid and electrolytes

4. Causes of renal failure

5. Clinical manifestations of renal failure

6. Dialysis principles and procedures

7. Physical assessmenta. normal and abnormal

patient signs and symptoms

8. Nursing interventionsa. teachingb. counselingc. referral

9. Charting

10. Medications a. use of medications b. desired effects of

medications c. interactions with dialysis



3. Dialysis Batha. chemical compositionb. types of dialysis bathsc. techniques for altering the composition of the dialysis bathd. verification of dialysate

composition

4. Ancillary equipmenta. procedures for use of

ancillary equipment

C. Initiation of DialysisConnect patient to dialysis machine

to initiate procedure by obtaining accessto circulation, taking blood samples,beginning blood flow, administering theanticoagulant, monitoring machineparameters and patient response.

1. Aseptic technique

2. Access to the patient’s blood circulation (i.e., types)

3. Machine parameters a. QB b. QD c. TMP/UFR d. conductivity e. temperature

4. Blood drawing a. sampling techniques b. blood analyses

5. Anticoagulation a. parameters b. dosage adjustment c. methods for performing

blood clotting time analysis

6. Patient responses, potential problems and emergencies (i.e., hemolysis, blood leak, venipuncture)

a. resolutions

7. Acute dialysis a. acute renal failure care b. specific and/or special

care and precautions to be taken

D. Monitoring During DialysisMonitor patient response during dial-

ysis, recognizing and responding toproblems and emergencies, by collect-ing and analyzing patient and machinedata in order to maintain safe andeffective dialysis.

1. Patient response

2. Machine parameters and adjustments

a. QB/QD b. TMP/UFR c. conductivity d. temperature

3. Complications during dialysisa. resolution

E. Termination of Dialysis Procedure

Terminate dialysis procedure by stop-ping further blood flow, returning theextracorporeal blood to the patient, dis-connecting the patient, stabilizing anddressing the access and cleaning themachines.

1. Methods of returning extracorporeal blood

2. Achieving hemostasis of various internal blood accesses

a. dressing procedures for all types of dialysis access

b. maintaining patency of catheters

3. Cleaning and disinfection of machine

a. types of solutions b. solution concentration c. dwell time

4. Disposal of software

5. Potential problems and emergencies associated with the termination of dialysis

a. resolutions

F. Home DialysisTeach the patient and dialysis part-

ner how to set up the machine, initiate,monitor and terminate the dialysis pro-cedure and recognize and respond toproblems, or emergencies in order tomaintain safe and effective dialysis inthe patient’s home.

1. Principles of adult learning

G. Dialyzer ReuseProcedures used for cleaning, disin-

fecting and rinsing dialyzers so thatthey will approximate their original per-formance characteristics with use ofappropriate recycling equipment.

1. Methods of dialyzer recyclinga. cleaning and disinfectant

solutions

2. Testing procedures

3. Record keeping

H. Water TreatmentEquipment and methods used for

treating water to make it suitable foruse in dialysis procedures in order toremove contaminants and trace ele-ments by use of deionization, reverseosmosis, filtration and/or softening.

1. Source watera. analysis of source waterb. normal versus abnormal

wateri. effect on patient and

machinery2. Methods of treating water

a. AAMI Standardsb. disinfection and rinsing

procedures

I. TransplantationCurrent practice relating to renal

transplantation in order to inform andsupport potential and previous trans-plant candidates and their families.

1. Advantages/disadvantages of kidney transplantation

2. Indications/contraindications for transplantation

3. Work-up procedures required for transplantation

4. Drugs commonly used as immunosuppressive agents in transplantation

5. Special care needs of patients returning to hemodialysis after a failed transplant

6. Laboratory and other parameters expected in a new transplant patient

III. PROFESSIONAL DEVELOPMENT(5.5%)

A. Information SharingShare information with colleagues to

stimulate professional growth by partici-pating in and/or organizing formal in-service programs, disseminating pro-fessional literature and attending pro-fessional meetings.

1. Professional literature

2. Professional organizationsa. purpose of professional

organizations


Examination ContentThe BONENT Certified PeritonealDialysis Nurse examination measuresnursing proficiency in certain skills,tasks and general areas of knowledge.The examination tests the following fourmajor domains of practice and tasksperformed in the scope of peritonealdialysis nursing.

• Nursing Process 60%• Administration 10%• Education 20%• Professional Development 10%

The examination has a three-hour timelimit and consists of 150 multiple-choice questions.

Nephrology nurses may receive certifi-cation in either or both hemo and peri-toneal dialysis.

Eligibility• RN with valid license and one year

of experience in nephrology nursing(copy of valid license)

• LPN or LVN with valid license andtwo signed years experience in ESRDin a nursing capacity as verified byimmediate supervisor or medicaldirector

• All experience must be verified bytwo signed letters of reference: onefrom the immediate supervisor, theother from a professional, e.g., a peeror mentor in the field of nephrology.Applicants must be employed at thetime of application submission

• Applicants must complete theapplication in its entirety and sign

Detail of Examination ContentI. NURSING PROCESS (60%)

Collect, document and analyzepatient information before, during, andafter dialysis in order to maintain and/orimprove the quality of patient carethrough continuous evaluation andongoing revision of interventions.

A. Interviewing Techniques

B. Physical Assessment1. Normal and abnormal patient

signs and symptoms

C. Nursing Assessment1. Patient, family, and significant

others’ knowledge, skills, and self-care abilities

2. Gross and fine motor coordination

3. Hand strength

4. Vision

D. Human Anatomy and Physiology

1. Anatomy and physiology of the kidney and urinary system

2. Anatomy and physiology of the peritoneum

3. Fluid balance

4. Acid base balance


B. ResearchInvestigate clinical nephrology issues

to resolve a problem in order to contribute to the body of nephrologyknowledge and improve patient care byusing the scientific method.

1. Scientific method and its application

2. Research design and implementation

C. Staff TrainingOrient and instruct staff to unit policies

and dialysis procedures to maintain the

5. Electrolyte balance

6. Erythropoiesis

E. Pathophysiology of the Kidney and Urinary System

F. Etiologies of End Stage Renal Disease

G. Laboratory Testing

1. Patient preparation

2. Nursing responsibilities

3. Interpretation of results

H. Diagnostic Testing

1. Patient preparation

2. Nursing responsibilities

3. Interpretation of results

I. Pharmacology

1. General

2. Alterations in drug excretion and metabolism in end stage renal disease

3. Drugs used frequently in ESRD patients

4. Alterations in drug metabolism andexcretion in peritoneal dialysis

5. Kinetics of intraperitoneally administered medications

6. Antibiotics used in peritonitis

7. Methods of administration

standards of performance by providinglearning situations and observing andevaluating performance.

IV. ENVIRONMENTAL CONTROL (10%)

Maintain a safe environment forpatients and staff to prevent injury andthe spread of disease by developing,promoting and implementing policies forthe use and handling of chemical andbiological agents and the prevention ofcontamination.

1. Chemical Agentsa. use of chemical agentsb. effects of chemical agentsc. potential hazards of

chemical agents

2. Biological Agentsa. potential hazardsb. effects of biological agentsc. routes of transmission

3. Infection Control

4. Occupational Injuries

5. Hazards Prevention and Control (i.e., fire, bomb threats, power failure,

water loss and/or contamination, etc.)


J. Medical and Surgical Asepsis

K. Clinical Manifestations of End Stage Renal Disease

L. Dietary Prescriptions for End Stage Renal Disease Patients

1. Predialysis

2. Peritoneal dialysis

3. Hemodialysis

4. Transplantation

M. General Principles of Dialysis

1. Osmosis

2. Diffusion

3. Ultrafiltration

4. Blood flow

5. Membrane area

6. Dialysis solution

N. Kinetics of Peritoneal Dialysis

1. Dialysate to plasma equilibration

2. Ultrafiltration patterns

3. Absorption of calcium, dextrose

4. Obligatory losses of protein, water soluble vitamins, hormones

5. Factors that influence ultrafiltration

6. Factors that influence solute transport

7. Drug transport

8. Kt/V measurement

O. Peritoneal Membrane Characteristics

1. Measurement of peritoneal mem-brane characteristics (PET)

P. Types of Peritoneal Dialysis

1. CAPD

2. CCPD

3. IPD or NPD

Q. Peritoneal Dialysis Systems

1. (i.e., Cyclers; CAPD systems – bag-spike, bag-spike with assist device; disconnect systems; sterile connections device)

R.Dialysis Solutions

1. Composition

2. Dextrose concentrations

3. Volumes

4. Containers

S. Access

1. Typesa. acute b. chronic

2. Preoperative nursing management

3. Insertion techniques

4. Postoperative management

T. Peritoneal Dialysis Prescription

1. Type of dialysis (i.e., IPD, CAPD, CCPD)

2. Frequency of dialysis

3. Exchange volume

4. Number exchanges

5. Type(s) solution

6. System of equipment to be used

7. Time (total exchange, fill time, dwell time, drain time, etc.)

8. Additives

U. Acute Peritoneal Dialysis (hospitalized, ill patients)

1. Indications

2. Predialysis patient assessment and education

3. Initiating and terminating dialysis

4. Monitoring

5. Patient education, psychosocial support during treatment

V. Procedures

1. Chronic automated dialysis (IPD, CCPD)

a. predialysis patient assessment

b. machine setup c. initiation of dialysis d. technical problem solving,

troubleshooting e. diagnosis and management

of patient problems/complications

f. discontinuing dialysis

g. post dialysis assessment h. documentation

2. Chronic manual dialysis (CAPD) a. procedure for initiation of

dialysis b. exchange procedure c. daily patient assessment,

documentation d. diagnosis and management

of patient problems/complications

e. technical problems f. procedure to discontinue or

interrupt dialysis

3. Other procedures a. warming dialysis solutions b. adding medications for IP

administration c. catheter fluoroscopy d. CT scan for diagnosis of

internal leaks e. splicing damaged catheter f. changing catheter adapter g. transfer set change

W. Complications

1. Infectious Etiology, signs and symptoms, diag-

nostic evaluation, nursing, medical andsurgical intervention, sequelae of:

a. peritonitis b. exit site infection c. subcutaneous tunnel infection d. intraperitoneal abscess e. systemic infection

(septicemia) f. recurrent infections

2. NoninfectiousEtiology, signs and symptoms, diag-

nostic evaluation, nursing, medical andsurgical intervention, sequelae of:

a. catheter related problemsi. malfunction (i.e.,

malposition, obstruction, air lock, other)

ii painiii. cuff erosioniv. cuff extrusionv. damage to catheter

b. surgical complicationsi. bladder perforationii. bowel perforationiii. incisional painiv. external leakv. subcutaneous leakvi. hemorrhagevii. ileus


c. complications resulting from increased intraabdominal pressurei. herniaii. hemorrhagesiii. dialysate leaks

d. problems related to peritoneal dialysis (inherent and due to less than optimalmanagement)

e. paini. abdominal pain

a) low pH b) solution infusion c)empty abdomen

ii. low back pain iii. shoulder pain

f. pneumoperitoneum g. fibrin production h. blood in dialysate i. pleural leak j. changes in pulmonary

function k. changes in cardiovascular

function l. inherent glucose load m. changes in glucose

metabolism n. fluid overload o. hyperkalemia p. hypokalemia q. hypernatremia r. hyponatremia s. hyperphosphatemia t. hypertension u. hypotension v. hyperglycemia w.protein losses x. other lossesy. peritoneal eosinophilia z. significant changes in

membrane permeability

X. Contraindications to Peritoneal Dialysis

1. Hypercatabolism

2. Pleural-peritoneal communication

3. Inadequate membrane permeability

4. Relative contraindications

Y. Outpatient Nursing Managementof the Chronic Peritoneal Dialysis Patient

1. Ongoing assessment, nursing diagnosis and intervention

2. Anemia

a. etiology b. management c. erythropoietin d. administration

3. Diabetes mellitus a. pathophysiology b. glucose control c. insulin pharmacokinetics d. blood glucose monitoring e. urine testing f. systemic complications g. intraperitoneal and

subcutaneous insulin administration

4. Gerontology a. physiologic changes

associated with aging b. interventions to

facilitate vision c. interventions to facilitate

hearing

Z. Other Treatment Modalities

1. Principles of transplantation a. candidate selection criteria b. pre-transplant evaluation c. surgical procedure d. immunosuppressive therapy e. complications f. success/failure rates

2. Principles of hemodialysis a. indications b. access c. components of the

extracorporeal system d. solute and fluid removal e. treatment parameters f. complications

II. ADMINISTRATION (10%)A. Management

Establish and implement policies/pro-cedures/standards relating to person-nel management of patient care staff in order to deliver optimal patient care.

1. Patient needs and staffing patterns

2. Staff abilities and limitations

3. Standards of dialysis care

4. Unit policies and procedures relating to personnel management

5. Medical-ethical issues involved with patient care

B. Staff Training and Development Orient and instruct staff to unit poli-

cies and dialysis procedures to main-

tain the standards of performance by providing learning situations andobserving and evaluating performance.

C. Environmental Control Maintain a safe environment for

patients and staff to prevent injury andthe spread of disease.

1. Biological agents a. potential hazards b. effects of biological agents c. routes of transmission

2. Infection control a. CDC recommendations b. OSHA Standards

3. Hazards Prevention and Control a. i.e., fire, bomb threats,

power failures, etc.b. EPA requirements

D. Equipment and Supplies Develop and implement policies and

procedures for evaluation, use andmaintenance of equipment and sup-plies in order to deliver safe, effective,and economical care.

1. Current status of dialysis technology

2. Critical elements for evaluation of dialysis equipment and supplies

E. Budgeting/Financial Planning Determine short and long term

operational and financial goals andstrategies in order to achieve efficientmanagement of the peritoneal dialysisprogram.

1. Budget/financial/operational planning

2. Reimbursement structure3. Regulations/options4. Institution’s financial strategies

and billing system

F. Quality Assurance Establish and implement a quality

assurance program that ensures com-pliance with established standards inorder to provide optimal patient care.

1. Continuous quality improvement

III. EDUCATION (20%)Instruction and guidance for the

patient and/or family and significantothers in peritoneal dialysis theory andprocedures based on the principles of


adult learning, to achieve optimalhealth status.

A. Principles of Learning

1. Learning styles

2. Teaching methods

3. Learning domainsa. i.e., cognitive, psychomotor,

affective

B. Activities and Teaching

1. Comparison to nursing process

2. Assessment/diagnosis phasea. assessment of learning needsb. assessment of readiness

and ability to learn

3. Planning phasea. teaching activitiesb. purposec. developing the teaching plan

i. behavioral objectivesii. content and outlineiii. learning activitiesiv. alternative teaching

strategiesv. evaluation

4. Implementation phase

5. Evaluation phase

IV. PROFESSIONAL DEVELOPMENT(10%)

A. Information SharingShare information with colleagues to

stimulate professional growth by partici-pating in and/or organizing formal in-service programs, disseminating pro-fessional literature and attending pro-fessional meetings.

1. Professional literature

2. Professional organizations

B. Research Participate in and/or conduct research

designed to analyze and validate currentpractice and procedures and generatenew knowledge. Communicate theinformation obtained to clarify, revise,and strengthen nursing practice.

1. Scientific method and its application

2. Research design and implementation

C. Ethics Adhere to the professional code of

ethics (e.g., patient confidentiality,patient’s rights, informed consent, allo-cation of resources) and intervene, ifnecessary, when violations of practicestandards, institutional policies, codesof ethics, or legal standards have beenidentified in order to protect the peri-toneal dialysis patient and the public.

1. Nursing Code of Ethics

2. State Nurse Practice Act

3. Patient’s Bill of Rights

4. Nursing Practice Standards

5. Patient Care Standards

6. Legislative process a. legal standards b. legal ramifications


Reference CPD CHT CHN N

American Heart Association. CPR Standards. Dallas, Texas: 1997-98.

Association for the Advancement of Medical Instrumentation. AAMI Standards and

Recommended Practices. Volume 3: Dialysis. Arlington, VA: Association for the

Advancement of Medical Instrumentation, 1990.

Association for the Advancement of Medical Instrumentation

3330 Washington Boulevard, Suite 400, Arlington, VA 22201

(800) 332-2264, (703) 525-4890

Brennan, D.T., Burrows-Hudson, S., Day, C., and Libonate, J. Standards of Clinical Practice

for Nephrology. Nursing Pitman, NJ: American Nephrology Nurses’ Association, 1995.

Brennan, D.T., Burrows-Hudson, S., and Stevens, V.B. ANNA Quality Assurance for Nephrology

Nursing Pitman, NJ: American Nephrology Nurses’ Association, 1989.

Comprehensive Nephrology Nursing. pp. 267-289. Richard, C.J. (ed),

Boston: Little, Brown and Company, 1986.

Core Curriculum for the Dialysis Technician. (2001). Amgen, Inc. (800) 772-6436.

Core Curriculum for Nephrology Nursing. Lancaster, L.E. (ed), Pitman, NJ:

American Nephrology Nurses Association, Third Edition, 1995.

Handbook of Dialysis. Boston: Daugirdas, J.T. and Ing, T.S. (eds). Little, Brown and Co., 1988.

Food and Drug Administration Videotapes; Water Treatment

Gutch, C.F., and Stoner, M.H. Review of Hemodialysis for Nurses and Personnel. 6th Ed,

St. Louis: C.V. Mosby Co., 1999.

Joint Commission on Accreditation of Healthcare Organizations. Accreditation Manual for

Hospitals. Chicago: Joint Commission on Accreditation of Healthcare Organizations, 1989.

Joint Commission on Accreditation of Healthcare Organizations: Joint Commission Guide to

Quality Assurance. Chicago: Joint Commission on Accreditation of Health Care

Organizations, 1990.

Keane, W.F., Everett, P.D., Fine, R.N., Golper, T.A., Vas, S.I., and Peterson, P.K. “CAPD Related

Peritonitis Management and Antibiotic Therapy Recommendations.” Peritoneal Dialysis

Bulletin. 7 (2) (April-June 1987): 55-73.

Keshaviah, P., Luehmann, D., Shapiro, F. and Comty, C. Investigation of Risks and Hazards

Associated with Hemodialysis Systems. (Technical Report. Contract #223-78-5046).

U.S. Department of Health and Human Services, Public Health Service, Food and Drug

Administration, Bureau of Medical Devices. Silver Springs, MD, 1990.

Khanna, R. and Oreopolus, D.G. “Complications of Peritoneal Dialysis other than Peritonitis.”

Peritoneal Dialysis, 2nd Ed, pp. 441-524. Nolph, K.D. (ed), Boston: Martinus-Nijhoff, 1985.

Section7Suggested Reading Materials

Reference GuideA variety of textbooks and publications are currently availableto assist candidates in preparing for the examinations. Thefollowing is a list of suggested references for use in prepar-ing for each of the respective examinations.


Levine, D.Z. Care of the Renal Patient, 2nd ed. W.B. Saunders, 1991.

Luehmann, D., Keshaviah, P.R., Ward, R.A., Klein, E. and Thomas, A. A Manual for Water

Treatment for Hemodialysis. (FDA Contract #233-87-6027). U.S. Department of Health

and Human Services, Public Health Service, Food and Drug Administration, Centers for

Devices and Radiological Health. Rockville, MD, 1989.

Maher, J. (ed). Replacement of Renal Function by Dialysis. 3rd Ed, Hingham, MA: Kluwer

Academic, 1989.

Mayer, L.A., Alter, M.J. and Pavero, M.S. “Hemodialysis – Associated Hepatitis B: Revised

Recommendations for Serologic Screening.” Seminars in Dialysis. Vol. 3, #4.

(October & December 1990) pp. 201-204.

Newberry, Mark. Textbook of Hemodialysis for Patient Care Personnel. Springfield, IL:

Charles C. Thomas, 1989.

Nissenson, A.R. and Fine, R.N. Dialysis Therapy. St. Louis: C.V. Mosby Co., 1993.

Nissenson, A.R., Fine, R.N., and Gentile, D. (eds). Clinical Dialysis. 2nd Ed, E. Norwalk,

CT: Appleton & Lange, 1989.

Nolph, K.D. (ed). Peritoneal Dialysis. 3rd Ed, The Netherlands: Kluwer Academic Publishers, 1989.

Parker, J. (Ed). Contemporary Nephrology Nursing. Tuberculosis: An old disease with a new face

(pg. 367-380), 1998.

Schrier, R.W. Manual of Nephrology, 3rd ed. Little, Brown and Co., 1990.

UNOS. United Network for Organ Sharing Policies on Aids and Transplantation.

Richmond, VA: 1987.

Varughese, P. Orsini-Negron and Andrysiak, P. A Study Guide for Dialysis Technologists.

1st Ed. 1996. (Available through the NANT National Office, Phone:(937) 586-3705)

Vlchek, D.L. and Burrows-Hudson, S. Quality Assurance Guidelines for Hemodialysis

Devices. (HHS Publication FDA 91-4167) (FDA Contract #223-89-6021). U.S.

Department of Health and Human Services, Public Health Service, Food and Drug

Administration, Centers for Devices and Radiological Health. Rockville, MD, 1991.

NANT Manuals and Study Guides Dialysis Technology: A Manual for Dialysis Technicians, Third Edition (NT-S201)

A Study Guide for Dialysis Technologists, Fourth Edition (NT-S102)

Water Treatment for Hemodialysis (NT-P102)

Go to www.NANT.biz to purchase these publications.

Take the Online BONENTCHT Practice Exam

Visit www.BONENT.org

CPD CHT CHN

Application for Certification

Application to be filled out by Applicant ONLY! (Please Print Clearly)

Name Mr. Ms.________________________________________________________________________________________________________Current Legal Last Name Maiden or Previous Legal Last Name Legal First Name Middle Name

Home Address ____________________________________________________________________________________________________________Street Apt. # City State Zip

Facility Name _____________________________________________________________________________________________________________

Work Address _____________________________________________________________________________________________________________City State Zip

Work Phone ( )____________________ Home Phone ( )______________________ Fax ( ) ___________________________________

E-mail __________________________________________________Social Security #________________________ Date of Birth _____/_____/_____

Board of Nephrology Examiners Nursing and Technology

DO NOT FAX This Application!

Payment Information: Check/Money Order: Make payable to BONENT

Credit Card: MasterCard Visa AMEX

__________________________________________________________________Credit Card Number Exp. Date

__________________________________________________________________Cardholder’s Name as it apears on card (PRINT)

__________________________________________________________________Cardholder’s Signature


Instructions1. Complete ALL sections of the application. Please type or print

legibly in ink.

2. Request your supervisor’s signature as verification of your employment.

3. Include two signed letters of reference that verify experience,one from your immediate supervisor (the same person who signs this application), the second from a professional innephrology.

4. Sign and date the application form.

5. Certified Hemodialysis or Peritoneal Dialysis Nurse examinations: include a photocopy of your current, validnurse’s license with the expiration date clearly visible.

6. Certified Hemodialysis Technologist/Technician: include aphotocopy of your high school diploma or official high school transcript (with principal’s signature and/or school seal) and/or documentation of completion of post-high school education if applicable. If your name has changed since high school, you must indicate your previous name in the space provided on theapplication and provide court documentation (i.e. marriagecertificate or name change application).

7. LVN/LPN applicants must provide written verification of two years experience in ESRD in a nursing capacity.

8. Mail the completed original, signed application form, othermaterials as required and the examination fee listed belowto the BONENT Executive Office.

9. If you choose to pay by MasterCard or VISA, please completethe credit card payment information.

Examination Fees

Country

First-time Candidates

USA $200 $225

International* $230 $240

Repeat Candidates Within One Year

USA $160 $185


Repeat Candidates After One Year

USA $200 $225


Additional FeesIncomplete Application Penalty $30

Exam Withdrawals & Transfers $65

Insufficient Funds Fee $50

• Indicate the date and site of the examination that you wish to take.

• Application must be postmarked no later than the published deadline date. Late applications will bereturned unprocessed.

10.

Contact the BONENT Executive Office at (202) 462-1252if you have questions about the application process orthe application deadline.

9-15-10

Examination Fees (check one)

Examination Method

First Exam $200 $225Within 1 year of first BONENT exam $160 $1851+ years after first BONENT exam $200 $225Locations Outside US* $230 $240

Paper &PencilExam

ComputerBasedTesting

PM______ #_________________________ Amt.________ I______

BONENT Office Use Only:

* US dollars only (credit card or money order)

For which BONENT certification examination are you applying?




Exam Method & Location (check one)

Professional Category (A copy of your current nurses license must be attached for the nursing examinations.)

RN LPN/LVN Patient Care TechnicianEquipment/Machine Technician Other ________________________

Number of years in nephrology:One year 2 to 3 years 4 or more

Highest Level of Education Completed (Attach a copy of your diploma/certificate of completion.)

High School Diploma or Equivalent Bachelor’s Degree – Other_______Technical/Vocational School Master’s Degree – NursingAssociate Degree – Nursing Master’s Degree – Other ________Associate Degree – Other_______ DoctorateBachelor’s Degree – Nursing

Employment Verification As the medical director and/or supervisor of the dialysis unit, the following signature certifies that the above employment information is correct.Current Supervisor* Must Complete this section only and Sign.

______________________________________________________Current Supervisor (please print or type) Title

___________________________________________________________________________________________________________Facility Name Facility Address City State Zip

___________________________________________________________________________________________________________Phone Signature Date

I understand that the Board of Nephrology Examiners Inc., Nursing and Technology Certification Board reserves the right to verify any or all information on this application.I understand that the information accrued in the certification process may be used for statistical purposes and for evaluation of the certification program and that the informa-tion from my certification records shall be held in confidence and shall not be used for any other purpose without my permission. I hereby authorize the Board to requestinformation concerning me from any of the persons or organizations referred to in this application. I further understand that BONENT Certification depends upon meetingthe eligibility requirements stated herein as well as achieving a passing score on the appropriate BONENT examination. If I achieve certification, I agree to pay such feesand meet such standards as are prescribed by the Board of Nephrology Examiners Inc., Nursing and Technology to maintain my certification status. I understand thatBONENT maintains a registry of all BONENT-certified practitioners and that, should I become BONENT certified, my name and professionalcategory will appear in this reg-istry as long as my certification remains current.Upon successful completion, I authorize BONENT to verify my current status regarding my certification. I hereby state thatto the best of my knowledge, I meet the eligibility requirements for this examination and that the information contained in this application is true, complete, correct and ismade in good faith. I understand that any falsification in this application will be grounds for rejection of my application for certification or revocation of any certification issued.

__________________________________________ ______________Applicant’s Signature Date

Mail to: BONENT Executive Office: 1901 Pennsylvania Ave, NW, Suite 607, Washington, DC 20006

Current Employment (Document nephrology-related employment beginning with present employment.)

From (mo/yr) ______________ to __________________

Company ______________________________________________________

Position________________________________________ Hrs/Wk_________

Describe major duties and responsibilities.

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Past Nephrology Employment

From (mo/yr) _______________ to _________________

Company ______________________________________________________

Position_________________________________________Hrs/Wk_________

Describe major duties and responsibilities.

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Date you previouslyattempted the examination

_____________________

Application Checklist - Please check the boxes below to ensure that you have:Included check, money order or credit card informationIndicated test date and location for PPE onlyIndicated examination typeIncluded photocopy of high school diploma, nurse’s license or equivalent, marriage certificate or court documents proving name change (if applicable)Included two signed letters of reference that verify experience [see #3 in “Instructions”]Indicated number of years of experienceSignature of applicant and supervisor

Incomplete by Deadline: If you submit an incomplete applicationand fail to provide documents requested by the BONENT Executive Office by the given deadline, you will not be allowed totake the exam for which you are applying.

ConfidentialityOfficial Board policy states that the BONENT Executive Office:• Can only speak to exam applicants regarding application details.• May not discuss any application with managers, supervisors educators,

co-workers or family members.

INCOMPLETE FEE $30Assessed on

incomplete applications.

Transfers & Withdrawals$65

Insufficient Funds Fee$50

Send Original, Signed Application Only(NO Photocopies • NO Faxes)

(You schedule your exam and location online only after receipt ofa BONENT Confirmation Letter)

Site_______________________________________City State Date

*If you are currently unemployed but have a minimum of 12 months experienceas a dialysis patient care technologist, you are required to have your immediatepast supervisor sign your application and write a reference letter. All other statedrequirements apply.

For More Information Visit Our Web Site:

www.BONENT.org

Board of Nephrology Examiners, Inc.Nursing and Technology

1901 Pennsylvania Ave., NW, Suite 607Washington, DC 20006Phone: (202) 462-1252

Fax: (202) 463-1257Website: www.BONENT.org

Documents

Candidate Examination Handbook