Certification Program

DDNA offers professional nursing certification in the specialty of intellectual and developmental disabilities nursing – for Registered Nurses and for Licensed Practical/Vocational Nurses.

Certification in the specialty demonstrates that a nurse possesses specialized knowledge in IDD nursing, indicating advanced experience, competence, and proficiency beyond that required for basic nursing licensure. 

Being certified promotes your choice of specialization, enhancing recognition by colleagues, employers and other professionals as a highly credentialed professional in the specialty of IDD nursing.  Most importantly, as a certified nurse you also benefit the profession of nursing, the specialty of developmental disabilities nursing, and the care of those you serve.

Please review all tabs below to learn more about the certification program, the exam, review study materials, and exam day information.

Attention Examinees: Prometric is following the COVID-19 guidance of the CDC in determining to close their US and Canadian test centers for a period of 30 days, starting today March 17. Learn More

Certification Process

Perspective and rationale for certification

It has been estimated that at least one percent of the U.S. population has been diagnosed with an intellectual/developmental disability (IDD). This estimate is felt to be a conservative figure. To address this, a vast field of professionals — nurses, psychologists, physicians, social workers, counselors, clergy, psychiatrists, recreational specialists, and many others — evolved to form the IDD specialty. Although many disciplines come together to address the needs of individuals with IDD, it is clear that each discipline must have its own standards.

To keep pace with the growing variety of practice modalities, the activities and functions of the IDD nurse have not only multiplied, but have grown more complex. To be effective in the habilitation and treatment of persons with IDD, an IDD nurse should possess a broad range of knowledge, covering a large number of areas, and should be competent in performing all of the many professional functions that IDD nursing requires.

Nursing has a long history of working with people with IDD. In recent years it has become apparent that nursing expertise in IDD is not ensured by traditional nursing education programs or in other nursing practice areas. To create a professional support, networking, and advocacy system and to develop national standards for certification within the IDD nursing specialty, the Developmental Disabilities Nurses Association was formed.

This organization is composed of nurses from various academic and experiential backgrounds who, based on clinical experience and education specific to IDD, have the unique skills that are most effective in providing nursing services to people with IDD. Within the discipline of nursing, they have come together to establish a standard through certification to enhance the education and experience level of nurses providing expert care to individuals with IDD.

Only those who have been certified by the Developmental Disabilities Nurses Association (DDNA) may use the title Certified Developmental Disabilities Nurse, designated by the appellations “RN, CDDN” or the title Licensed Practical Nurse Developmental Disabilities Certified, designated by the appellations “LPN, DDC” and Licensed Vocational Nurse Developmental Disabilities Certified, designated by the appellations “LVN, DDC.”

Goals of certification

Certification has been established nationally by DDNA to achieve these goals:

  1. To increase the effectiveness of nursing services rendered to individuals with IDD.
  2. To provide a method whereby professional standards can be established, maintained, and continually updated through a system of competency-based testing and professional development hours required for certification and certification renewal.
  3. To expand public recognition of the nursing needs of individuals with IDD and of the value of the IDD nurse in meeting those needs as a member of the interdisciplinary team.
  4. To encourage the IDD nurse to grow in knowledge in the specialty area.
  5. To enhance the skills and competence of the IDD nurse.

Purpose of certification

  1. To develop and coordinate a system of evaluation and subsequent certification for IDD nurses. This requires professional standards of competence, knowledge, and skill from those who are certified.
  2. To promote and advance the profession of IDD nursing to lead to the establishment of a professional code of ethics and adoption of standards of competence, to ensure the highest standard of care for persons with IDD, and to promote continuous quality improvement in the care of individuals with IDD.
  3. To promote, support, and evaluate comprehensive training and education programs designed to increase the competence and capabilities of IDD nurses.
  4. To offer professional consultation and education related to the advancement of IDD nurse certification, and to cooperate and collaborate with other interested persons and organizations in pursuit of this purpose.

It has become apparent that expertise in IDD nursing is not ensured by traditional nursing education programs nor is it guaranteed by practice in the field of IDD. The recognized role and function of the IDD nurse has evolved out of self-education, desire, experimentation, trial and error, self-motivation, intuition, and the desire to gain an expertise in understanding and addressing the unique and often complex needs of individuals with IDD. Developmental disabilities nurses come from a variety of backgrounds, some with academic credentials and some with experience in the field. Because of this, certification from DDNA is based upon competency rather than academic or professional background. Competency is demonstrated through completion of the certification testing process.

The “RN, CDDN” credential, the “LPN, DDC” credential, and the “LVN, DDC” credential are advanced standing certificates: each requires previous work experience in developmental disabilities nursing before admission to candidacy.

Certification is voluntary and is not intended as a license to practice, nor as a qualification for a certain position; however, an employer, civil service system, state licensing body, or third party underwriter may accept it as a preferred or alternate credential.

Your role as a certified IDD nurse

In establishing standards for the certification of IDD nurses, it is necessary to define the role of the IDD nurse. This role is distinct from the roles of others who may provide additional professional services to the same person in the same setting.

An IDD nurse is a person, who by the virtue of special knowledge, training, and experience, is uniquely able to inform, motivate, guide, assist, and care for individuals with IDD.

In this process, it is the primary responsibility of the IDD nurse to be able to recognize which problems are beyond the scope of his/her training, skill, or competency and to be willing and able to refer the individual to other appropriate professional services.

The professional activities of the IDD nurse will, out of necessity, cover a broad range of approaches, techniques, and modalities appropriate for the infinite variety of characteristics that include the lifestyle and developmental levels of individuals with IDD.

Tasks of an IDD nurse

The tasks which the IDD nurse performs and the areas in which she or he is expected to be competent will generally fall into the following categories:

  • Staff education/training
  • Direct care
  • Supervision of staff
  • Assessment
  • Individualized Service or Education Plans (ISPs or IEPs)
  • Consumer education/training
  • Service coordination/case management
  • Quality assurance
  • Documentation/record-keeping
  • Medical or other health-related appointments
  • Medication administration and treatments
  • Research
  • Consultation
  • Interdisciplinary team meetings
  • Diagnostics testing
  • Advocacy/consumer rights
  • Networking/professional issues
  • Program development
  • Counseling

There are a number of other activities IDD nurses may be expected to perform. While such activities may be important to a particular agency, they may not be considered an essential part of the function of the IDD nurse for professional certification purposes.

Personal attributes of an IDD nurse

  1. Ability to relate comfortably, confidently, and effectively with individuals with IDD;
  2. Sincere interest in supporting individuals with IDD and in the provision of humanitarian, sophisticated, and quality care;
  3. Ability to pinpoint problems and implement effective action toward their solution;
  4. Ability to motivate change in others;
  5. Ability to work in team situation with other professionals in various disciplines and with individuals with IDD;
  6. A positive attitude toward individuals with IDD and their care;
  7. Adherence to values and ethics commonly associated with professionals having access to confidential and sensitive client/consumer information;
  8. Ability to serve all individuals without discrimination as to race, color, creed, age, gender, sexual orientation, or abilities.

Practice (work experience) requirement

To apply for certification, you must meet the following criteria for the Practice (Work Experience) Requirement: a minimum of four thousand (4,000) hours of active developmental disabilities nursing practice as a Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse within the immediate previous 60 months (five years). Practice experience hours prior to this will not be considered.  Please note:  If you have worked as an LPN/LVN and are now an RN and wish to sit for the RN certification exam, you must have 4,000 hours of active practice as an RN before you are eligible to sit for the CDDN exam.  Hours worked as an LPN/LVN do not meet this requirement of active practice as an RN.

The Practice (Work Experience) Requirement may be met with experience in the following roles:

  1. Practicing nurse in developmental disabilities in an institutional or community setting;
  2. Nurse administrator in a developmental disabilities program;
  3. Nurse educator in a developmental disabilities program;
  4. Nurse consultant in developmental disabilities;
  5. Nurse practicing in the expanded role in an IDD institutional or community setting, including nurse practitioners.

Special circumstances

The diversified role of the nurse in all facets of developmental disabilities practice is recognized by DDNA, and nurses practicing in any role other than those listed above will be evaluated on a case-by-case basis. Consideration will be given to information submitted by the applicant (in job descriptions and program brochures) to verify that the experience meets the DDNA certification practice requirement.

Please note: Caring for a family member with IDD in the home, whether paid or unpaid, does not meet the work experience hours requirement.


  1. Before completing your application packet, review the Guidelines, these Instructions, and all of the required forms (Forms A, B, and C) and documentation listed in the Checklist (below).
  2. Read each form carefully for instructions. Only original signatures will be accepted – do not submit copies of any signed forms. Type or neatly print the requested information on the forms. Documentation that is altered in any way (whiteout used, information crossed out, etc.) or is illegible will not be accepted and must be replaced with correctly completed forms. It is your responsibility to check your application packet for accuracy and completeness before submitting it to the DDNA Certification Committee for review. The certification credential is a reflection of your professional dedication. The application packet should reflect the same professionalism.
  3. Submit all required forms, documentation, and fees as part of the application packet. The Certification Committee and DDNA will not initiate transfer of information from other sources. Omission of any required item in the certification application may result in a significant delay in the processing of your application.
  4. Only one application per envelope. Do not staple, tape, or paper clip forms together. All documents submitted should be on standard 8½” x 11″ paper. Include only the items listed on the Checklist. Do not include printouts of the certification instructions, because the weight of these pages will unnecessarily increase your postage expense.
  5. Mail your completed application packet to: DDNA Certification, 1501 South Loop 288, Suite 104 – 381, Denton, TX 76205. If you are interested in a specific examination date, submit the application at least five weeks before that exam to allow sufficient processing time.
  6. When mailing your application packet, please remember that these packets are considered “oversized,” which requires additional postage. Please have the packet weighed for correct postage before mailing. If your application packet arrives at the DDNA post office box with “postage due,” it will be returned to you by the post office. We appreciate your taking the time to make sure that your postage is correct.
  7. Please allow a minimum of five weeks for application processing once it is received at the DDNA office. You will be notified of the outcome of the review, including approval of or deficiencies in the application.

If you need help or would like further clarification of the above instructions, please call DDNA at (800) 888-6733 during business hours.


Documentation All documentation submitted is subject to verification and becomes the property of DDNA.

Fees All fees are non-refundable. Payment of application fees does not guarantee that approval to take the certification examination will be granted.

Period of Eligibility Once approved, candidate eligibility is valid for a period of two years. Candidates may choose when to take the exam within two years of being approved. After the two-year period, the candidate must submit a new application and fee. The certification approval expiration date will be listed on your letter of confirmation.

Recognition of certification Certification is voluntary. No governmental or other regulatory entity currently requires certification. Any value or credence given to certification by an agency, employer, or third-party insurer is entirely at its discretion. Such value or credence should be based upon knowledge of the certification standards and upon experience with CDDNs and DDCs. Individuals seeking certification choose to do so of their own free will and, in doing so, agree to accept the decisions of DDNA. The authority of DDNA is derived from those persons who are dedicated to service as practicing I/DD nurses and are, as such, those who are most affected by certification.

Credibility of certification The credibility of certification results from the standards established by DDNA, by the performance of the DDNA Board of Directors, Officers and Certification Committee, and most importantly, by the professional competence and integrity of the Certified Developmental Disabilities Nurse or the Developmental Disabilities Certified Licensed Practical Nurse or Licensed Vocational Nurse.

The role of DDNA Although DDNA encourages and promotes the work of other professional associations and other organizations involved in the various facets of providing services to individuals with I/DD, it is an independent body and seeks to remain free from any vested interest.


The following forms, documentation, and fees are required for the application:

  1. Form A – Applicant Information
  2. Copy of nursing license
    A photocopy of your current nursing license on standard 8½” x 11″ paper, marked void. Do not cut out the license. You may also print out a copy of your license from your state’s licensing website.
  3. Form B – DDNA Code of Ethics Agreement
  4. Form C – Employment Verification
    A separate form must be submitted for each place of employment specific to I/DD nursing at which you have been employed within the five-year period prior to applying for certification.  Some examples: Sally is employed at one facility for five or more years prior to applying for certification. Sally will submit one form. Brian has been working at his current facility for the last three years. Before that, Brian worked at a different facility for four years. Brian will submit two forms. Diane has worked at the same facility for ten years. During that time, she was promoted twice. Diane will submit one form.
    For independent practitioners: The Certification Committee has developed an alternative process to determine the validity and duration of work experience for independent practitioners, such as business owners, consultants, and direct care contractors. The Employment Verification form (Form C) must be completed and may be signed by a business partner, the representative of an agency to whom the applicant is contracted, or any professional who is in a position to verify the work involvement of the applicant. The applicant may sign his or her own job verification form onlyif the documentation of the hours worked is substantiated by contracts or service invoices, and the party affiliated with the contracts and/or invoices is not available to sign the employment verification form (Form C).
  5. Job description(s)
    To accompany Form C. The job description must be written by the employer. Each position documented must be specific to I/DD nursing. List each position, period of employment, and/or facility documented. If the job description is not I/DD specific, then an addendum written on facility letterhead and signed by a supervisor is required.
    For independent practitioners: For independent practitioners, the Committee will accept a job description, designed and signed by the applicant, if it specifically includes the I/DD aspect of the work responsibility.
  6. Brochure or program outline
    Include a brochure or program outline, if available, for each facility and/or program documented on the employment verification form(s)
  7. Copy of your current curriculum vitae, resume, or biosketch
  8. Application Fee (NON-REFUNDABLE) – Must be paid by check or money order.
    Submit only the application fee (see the certification fees page for details). Do not include payment of exam fees at this time.

Application Forms for CDDN/DDC certification

By clicking the ‘download forms’ link on the sidebar, you are confirming that you have read and understand the Guidelines, Instructions, and Checklist outlined above and want to download the forms now.

Mail to:  DDNA Certification, 1501 South Loop 288, Suite 104 – 381, Denton, TX 76205.

Forms, including instructions (9 pgs):

Forms A, B, and C, including instructions for RN certification application (CDDN).

Forms A, B, and C, including instructions for LPN/LVN certification application (DDC).

Forms only (4 pgs):

Forms A, B, and C for RN certification application (CDDN)

Forms A, B, and C for LPN/LVN certification application (DDC)

Approval process

Within five weeks of receiving your application packet, DDNA will notify you as to whether your application is approved or deficient. Be sure to include your correct email address and phone number on the application forms, as these may be used to contact you.

If your application is deficient:

You will be notified by email and given the opportunity to correct the deficiency. Common occurrences that cause an application to be deficient include: work experience not specific to I/DD nursing, insufficient I/DD-related work experience, illegible forms, forms that are faxed rather than mailed, incorrect fees paid, and inaccurate/missing contact information.

If your application is approved:

Once approved, you will be emailed a letter of approval and an examination registration form. Your eligibility to take the certification exam is valid for two years from the date of the application approval. The expiration date is on the letter of approval.

If you do not understand the Guidelines, Instructions, and Checklist, please email the Certification Committee at: [email protected]

How to register for the exam

You must be approved to take the exam. Once your application is approved, DDNA will send you an approval packet that contains the notice of your approval and the exam registration forms for both the group and local exam options. Follow the detailed instructions within the approval packet. You will choose either the group or local exam options, complete the exam registration form for that option, and mail the form and corresponding exam fees (see certification fees page) to DDNA.

Group exam option

Group exams are held once per year at DDNA’s Annual Education Conference. Seating at the conference exam is limited, available in the order approved. If there is sufficient interest from a group of nurses at one location, DDNA may choose to offer a group exam at another designated time and location. To take the group exam, you must follow these steps:

  1. Apply for certification
    Detailed instructions regarding certification application submissions are on the apply for certification page. Your application must be approved before you will be allowed to register for the exam.
  2. Submit group exam form and fees
    After you have been approved, complete the group exam registration form and mail it with the correct exam fees to: DDNA, 1501 South Loop 288, Suite 104 – PMB 381, Denton, TX 76205. It must be postmarked 30 days before the conference (or other designated group exam). Once you have paid the group exam fee, there are no additional sitting fees. The exam fee does not include attendance at the conference.
  3. Await confirmation
    Upon receipt of your registration form and payment, DDNA will send you a written confirmation of your registration and information about taking the test at the conference (or other designated group exam site). If you do not receive this confirmation within two weeks prior to the exam date, it is your responsibility to contact DDNA to confirm your admission to the exam.
  4. Study for the exam
    See below for study guidelines, recommended materials, and related courses.
  5. Arrive prepared
    On the day of the exam, you must bring the written confirmation of registration letter, your current nursing license (not a photocopy), and photo identification, such as a driver’s license or passport. Additional instructions are below.

Local exam option

Local exams are available, by appointment, throughout the year at select Prometric testing centers. To take a local exam, you must follow these steps:

  1. Apply for certification
    Detailed instructions regarding certification application submissions are on the apply for certification page. Your application must be approved before you will be allowed to register for the exam.
  2. Submit local exam form and fees
    After you have been approved, complete the local exam registration form and mail it with the correct exam fees (see certification fees page) to: DDNA, 1501 South Loop 288, Suite 104 – PMB 381, Denton, TX 76205.
  3. Await confirmation from DDNA
    Upon receipt of your registration form and payment, DDNA will send you written confirmation of your registration and inform Elsevier (the company that distributes the exam) that you are eligible to take the exam.
  4. Await confirmation from Elsevier
    You will receive an email from Elsevier that provides you with your test code and directions for how to schedule your exam. IMPORTANT: DO NOT call any Prometrics Testing Center to schedule an appointment to take the test until after you receive this email from Elsevier.
  5. Schedule an appointment
    You must have a letter of approval from DDNA and a confirmation from Elsevier before you can schedule a testing time at a local Prometrics Testing Center. When you receive both confirmations, you may schedule your exam appointment time. To schedule an appointment, email a message that contains your first name, middle initial, last name, address, city, state, zip, phone number, and email address to [email protected]. You will receive a confirmation notice from Elsevier indicating that you may schedule your exam. The notice contains detailed instructions for using the Prometric Scheduling System. Scheduling must be completed using the Prometric Scheduling System, and cannot be handled directly by any of the local testing centers. Do not contact any local testing center until you receive the confirmation notice and instructions from Elsevier.
  6. Pay sitting fees
    Prometric charges a sitting fee payable by credit card only, to take the exam at their testing centers. See certification fees page. Please note: This is not the application or the registration fee charge by DDNA. It is a separate fee charged by Prometric that covers administration of the exam at your individually scheduled appointment time.
  7. Follow Prometric’s instructions
    Carefully follow all directions provided to you by Prometric regarding your exam administration procedures. If you opt to take the exam at Prometric, you assume all responsibility for meeting their policies and requirements. DDNA cannot refund any monies paid by you to Prometric for your exam administration, and additional fees may be applied by Prometric if you re-schedule your testing appointment times.

Local test sites

Do not call the Prometric test site to register for the exam.

You will be contacted by the testing company after you have received a letter of approval from DDNA.

There are 400 Prometric testing centers available in the U.S. and Canada. Check here for a testing center near you. To take the test locally, you must follow the steps outlined in the local exam option section (above) to register for the exam.

Period of eligibility

Once your application is approved, your eligibility to sit for the exam is valid for a period of two years. After the end of the two-year period, if you wish to take the exam, you must submit a new application packet (including the application fee).

Preparing to study

Please bear in mind that the exam covers the lifespan, so if you work in pediatrics, you may need to focus your studies on adult and aging issues. Likewise, if you have expertise in adult and aging issues, you need to review pediatrics. Be very familiar with common syndromes and conditions. Know about seizure care. Know about appropriate delegation to caregivers and direct support personnel. Know about medications that are commonly administered to people with IDD. Know about health problems that are associated with different syndromes and conditions, including their signs and symptoms and their treatments. Know about common laws that affect the rights of people with IDD. Know the significance of laboratory values for tests that are commonly ordered for persons with IDD.

Basically, this is a nursing exam that evaluates your overall IDD nursing knowledge. There are no trick questions. You are not asked to do drug calculations, although you may be asked about the appropriateness of a particular medication for a particular client with a particular syndrome or condition in a particular situation. The questions on this exam reflect the day-to-day practice of IDD nurses.

Additional Certification Exam Study Resources are listed here.

Example Questions follow in this expanded section.

Certification practice questions

These are practice questions only.  They are not actual questions from the certification exams.  Practice questions will range in difficulty.  Some questions will be appropriate for both RNs and LPNs/LVNs, while other questions will not be.

Question 1

A 26-year-old female with Turner Syndrome lives in her own apartment and receives intermittent services from the health support team. She recently has been diagnosed with hypertension. Treatment with Valsartan/hydrochlorothiazide (Diovan HCT) has been initiated. Which statement from the woman illustrates the need for further health education from the nurse?

a) “I should check my blood pressure at least daily, at different times of the day.”

b) “I still have to watch for being hungry and having to go to the bathroom a lot.”

c) “Now my boyfriend and I can get married and I will be able to get pregnant.”

d) “The doctor said I need lab work drawn before I run out of my medicine.”

e) “I will probably have to take the blood pressure medicine for a long time.”

View Week 1 answer

Correct answer: C

Turner Syndrome is specific to females. Cardiovascular and kidney problems are common, with an increased risk for developing hypertension in adulthood. Persons with Turner Syndrome are at a significantly increased risk of developing Type II diabetes. The lack of ovarian development is also characteristic of the syndrome, typically resulting in infertility/sterility. The Turner Syndrome Society notes that “Fertility without assisted reproduction therapy is rare – (less than 1%).” (See references below)

A – At least daily monitoring of blood pressure is indicated. The woman verbalized an understanding of the need to monitor her blood pressure. This does not demonstrate a need for further health education.

B – Persons with Turner Syndrome have twice the risk of the general population of developing diabetes (nih). Polyphagia and polyuria are both signs of diabetes. The woman’s statement indicates that she understands that she must still monitor for signs of diabetes. This does not demonstrate a need for further health education.

C – Lack of ovarian development, typically resulting in infertility/sterility, is characteristic of Turner Syndrome. Her fertility (or lack of) is unrelated to her hypertension or antihypertensive treatment. The woman’s idea that she can marry and will now be able to “get pregnant” indicates that she does not understand the typical characteristics of her syndrome. This lack of understanding indicates a need for further health education about Turner Syndrome.

D – Intermittent monitoring of lab work is indicated, specifically to monitor potassium levels and other electrolytes (because hydrochlorothiazide is a ‘non-potassium sparing’ diuretic). The woman verbalized an understanding of the need to return for lab work. This does not demonstrate a need for further health education.

E – Cardiovascular defects/disease are common in persons with Turner Syndrome, and the woman’s hypertension is probably secondary to her Turner Syndrome. It is likely that her hypertension will continue throughout her lifetime, as will the need for antihypertensive medication. The woman verbalized an understanding of the “long-term” nature of her hypertension. This does not demonstrate a need for further health education.


  • Ruben, I. Leslie and Allen C. Crocker (2006): Medical Care for Children & Adults with Developmental Disabilities; pp 390 – 391; 419.
  • Brown, Ivan and Maire Percy (2007): A Comprehensive Guide to Intellectual & Developmental Disabilities; pp 257 – 259.
  • Jones, Kenneth Lyons (1997): Smith’s Recognizable Patterns of Human Malformation – 5th Edition; pp 81 – 87.
  • Website Reference: The Turner Syndrome Society:  www.turnersyndrome.org : Turner Syndrome – The Basics; referenced 12/5/08.
  • Website Reference: The National Institutes of Health – Eunice Kennedy-Shriver National Institute of Child Health and Human Development: NIH website – Clinical Features of Turner Syndrome; http//:turners.nichd.nih.gov/ : referenced 12/5/08.

Practice Test Question submitted by Diane Moore.

Question 2

A 12-year-old female with IDD fell after having a seizure and is diagnosed with a fractured left tibia. Last month she fractured her right index finger when she lost her balance while having a seizure. Past medical history includes long-standing cerebral palsy and epilepsy, for which she currently takes carbamazepine (Tegretol). Valproic acid (Epival) was added to her medication regime ten weeks ago and was increased last week. The most recent blood work for CBC, electrolytes, liver function tests and antiepileptic drug levels were within normal limits (WNL) 2 weeks ago.

Which blood work is a priority at this time?

a) Calcium and vitamin D levels

b) Liver function tests

c) Antiepileptic drug levels

d) CBC and electrolytes

View Week 2 answer

Correct answer: C

Long-term use of antiepileptic drugs can increase osteoporosis risk. A long bone fracture in the upper extremity is clinically significant, even though finger and toe fractures are not clinically significant indicators of osteoporosis in children. However, this girl is ambulatory and has no other risk factors. These blood tests could be helpful, but are not the priority at this time.

Liver function needs to be monitored monthly for the first 2 months of treatment in persons taking valproic acid, so liver function tests are not the priority at this time.

Falls caused by seizures are a major safety issue. Antiepileptic drug (AED) levels must be monitored closely, especially with the recent addition of VPA, which can interact with carbamazebine and lower valprioc acid levels. Measure AED levels 5 days after any change in dose.

Monitoring the CBC while on carbamazepine and valproic acid is necessary, and monitoring for hyponatremia is important while on carbamazepine. However, CBC and electrolyte testing is not a priority at this time because results were normal 2 weeks ago.

Question 3

An individual with IDD receives the following medications: phenytoin (Dilantin) and phenobarbital for seizures, loratidine (Claritin) for seasonal allergies, and multivitamin tablets. The loratidine is given in the morning and the phenytoin and phenobarbital are given at bedtime. The physician wants to add ranitidine (Zantac) and sulcrafate (Carafate) for a recent diagnosis of gastroesophageal reflux disorder (GERD). Which is the most correct action nursing action?

  1. Question the physician about the use of both ranitidine and sulcrafate.
  2. Suggest that the individual be tested for H. pylori.
  3. Change the medication schedule so that all doses are given at bedtime.
  4. Schedule ranitidine and sulcrafate to be given in the morning and afternoon.

View Week 3 answer

Correct answer: B

It would be correct to suggest that the individual be tested for H. pylori, because this is a common infection in persons with GERD. Appropriate diagnosis and treatment may avert the need to begin or continue treatment. Some treatments commonly used to treat GI symptoms, such as esophageal reflux, can increase risks for other health problems, e.g., osteoporosis. The GI tract, once rid of the H. pylori, can then heal.

A is Incorrect
Both an H2 blocker (ranitidine), as well as an agent to coat the GI tract (sulcrafate), are sometimes used together to treat GERD.

C is Incorrect
Scheduling all medications to be given separately is unnecessary precautions, because some of these medications can be scheduled to be administered simultaneously.

D is Incorrect
Although this would be an appropriate schedule for these medications, it is more important to definitively diagnose and treat the underlying cause of the reflux.

Question 4

A 30-year-old man with fetal alcohol syndrome has recently transferred from a large facility to a small community-based home. He has a long history of psychotic disorder that is currently being treated with olanzapine (Zyprexa) 30 mg daily at bedtime. Which blood test(s) should be done?

  1. Baseline olanzapine level at 1 month and every 6 months.
  2. Baseline blood glucose and lipid panel and every 3 months.
  3. Baseline serum potassium and every 3 to 6 months.
  4. Baseline thyroid function test and every 6 months.

View Week 4 answer

Correct answer: B
Olazapine can cause hyperglycemia and hyperlipidemia, so routine monitoring of blood glucose and lipid levels is indicated.

A is incorrect.
Blood levels are rarely used to determine the effectiveness of an antipsychotic. Effectiveness is based on clinical judgment and relief of symptoms.

C is incorrect.
Olanzapine does not interfere in any way with blood potassium, neither increasing it nor decreasing it.

D is incorrect.
Olanzapine does not affect thyroid function.

Question 5

A 64-year-old individual with cerebral palsy has been newly diagnosed with osteoporosis. The healthcare provider (HCP) has prescribed alondronate (Fosamax) once daily. Other medications include a multivitamin daily, atorvastin (Lipitor) daily and escitalopram (Lexapro). Which nursing action is of highest priority?

  1. Instruct the individual to continue Fosamax unless HCP instructs otherwise.
  2. Schedule DEXA bone density scan for next annual provider appointment.
  3. Consult with the HCP about the need for calcium and vitamin D supplements.
  4. Encourage the individual to begin a weight-bearing exercise program daily.

View Week 5 answer

Correct answer: C
To be effective Fosamax requires supplementation with calcium and vitamin D.

A is incorrect.
Once prescribed, Fosamax should be continued indefinitely. This instruction is not of highest priority.

B is incorrect.
While it is important that this individual have follow-up DEXA bone scans, it is not of highest priority to make the appointment at this time.

D is incorrect.
Weight-bearing exercise is important to maintain bone density; however, it is not of highest priority.

Question 6

A 20-year-old individual with autism picks at his skin repeatedly, changes his clothes multiple times daily, eats only white foods, and washes his hands four to five times per hour. These behaviors have recently increased. The healthcare provider has prescribed a starting dose of citalopram (Celexa) 40 mg daily. You have contacted the healthcare provider and confirmed the dosage. Which instruction is most important to communicate to support staff?

  1. Observe and report signs of increased anxiety, hyperactivity, irritability, difficulty sleeping, and mood changes.
  2. Ensure that a follow-up medication evaluation appointment is scheduled within three to four weeks.
  3. Work with the client on a self-medication program that includes the need to take medications that are not white in color.
  4. Recognize that medications in this class often require four to six weeks to reach full therapeutic effectiveness.

View Week 6 answer

Correct answer: A
This starting dose of Celexa is high and may cause signs of mania, which need to be reported to the nurse immediately should they occur so that a dose adjustment can be made by the healthcare provider.

B is incorrect.
While it is important to schedule medication review follow-ups, it is more important to communicate instructions to observe the individual’s response to this new medication.

C is incorrect.
Implementing a self-administration of medication program to decrease an individual’s sensitivity to medication and food colors is important; however, it is not a priority at this time.

D is incorrect.
Therapeutic effects of this medication may take four to six weeks to be apparent; however, this instruction is not of highest importance.

Question 7

During the quarterly nursing assessment on a 23-year-old woman with a seizure disorder, pinpoint bruising is noted on her legs, abdomen, and breasts. She also seems lethargic. Her medications are divalproex 250 qid (Depakote), benazepril (Lotensin) 5 mg/day, multivitamin daily, and vitamin D 1000 IU daily. After completing the assessment, which action should the nurse take first?

  1. Ask the woman “Did someone hurt you or did you fall down?”
  2. Complete an incident report and notify the family of the bruises.
  3. Instruct staff to observe for falls and notify the nurse if injury occurs.
  4. Call the healthcare provider to request CBC and Depakote level.

View Week 7 answer

Correct answer: D
Divalproex can cause thrombocytopenia, so the pinpoint bruising and lethargy may indicate divalproex toxicity. This requires immediate healthcare provider notification.

A is incorrect.
Asking the women whether someone has hurt her or if she fell is a leading question and may cause the woman to respond inaccurately. When bruising is present, it is appropriate to interview the person to determine its cause. However, pinpoint (petechial) bruising is unlikely to be caused by abuse or a fall.

B is incorrect.
While those might be appropriate actions for the nurse to take, they would not be the action that the nurse should take first.

C is incorrect.
While those might be appropriate actions for the nurse to take, they would not be the action that the nurse should take first.

Question 8

The mother of a three-year-old child recently diagnosed with autism contacts the nurse and asks, “What do I do with my child? Every time I touch him he cries and arches away.” How should the nurse respond to this mother?

  1. “This behavior is expected in young children with autism. Research shows that nothing can be done.”
  2. “Using a light touch will help to desensitize your son. You may want to brush his skin with just the tips of your fingers.”
  3. “This behavior is not uncommon in children with autism. Using a firm, sustained touch can be helpful.”
  4. “You can call your healthcare provider to see whether there is a medication that can help calm your son.”

View Week 8 answer

Correct answer: C
Although touch aversion is common in persons with autism, research shows that deep touch pressure may be calming.

A is incorrect.
Although touch aversion is common in persons with autism, this response is neither helpful nor therapeutic.

B is incorrect.
Touch aversion is common in persons with autism. Light touch may uncomfortably stimulate the nervous system.

D is incorrect.
Medications may or may not be required in the future. Less intrusive interventions should always be implemented first and their effectiveness evaluated.

Question 9

A 27-year-old man who resides in a group home is deaf and mute due to cytomegalovirus (CMV) infection in utero. He also has a seizure disorder and anxiety, both of which are being effectively treated with medication. He has a long-standing pattern of behavior that involves shaking hands with others in his home. He approaches them, shakes their hands, walks away for 20-30 minutes, and then returns to shake their hands again. A newly hired direct support person (DSP) asks the nurse, “What should I do with this guy who wants to shake hands all the time?” What would be the correct response to the DSP?

  1. “This behavior is a common sign of mental illness and must be documented.”
  2. “Gently push his hands away and shake your head to indicate ‘No.’”
  3. “Shake his hand. This is how he communicates and connects with you.”
  4. “Do not offer your hand and ignore this behavior until he walks away.”

View Week 9 answer

Correct answer: C
Because he is unable to communicate verbally, touch and visual contact provide a way for him to connect with others. This connection is important to him and the constant reassurance that others are present and aware of him decreases his anxiety.

A is incorrect.
This has been a long-standing, socially acceptable behavior and not a common sign of mental illness. His anxiety symptoms have been effectively controlled by medication, and he has no other signs or symptoms of mental illness.

B is incorrect.
Shaking hands is this man’s way of connecting with others, and pushing his hands away may cause him to feel disrespected.

D is incorrect.
Shaking hands is this man’s way of connecting with others, and pushing his hands away may cause him to feel disrespected.

Question 10

A 75-year-old woman with IDD who resides in a group home is approximately 30 pounds overweight. The only medication she takes is a daily multivitamin. The dietician on the woman’s team wants to decrease her food intake to 1000 calories/day. The woman is very upset that she will not be able to eat at McDonald’s on Sunday with her family, and runs out of the interdisciplinary team (IDT) meeting. The nurse finds the woman sitting on her bed crying. Which would be the nurse’s most therapeutic response to the woman?

  1. “You will see. It will be okay. We are just trying to help you live longer.”
  2. “Come with me so you can discuss how you feel with the rest of the team.”
  3. “Sorry. That is the dietician’s decision because you need to lose weight.”
  4. “You are only allowed to be 5% over ideal body weight by state regulation. “

View Week 10 answer

Correct answer: B
This response appropriately advocates for the woman’s rights in this situation.

A is incorrect.
This response is both false reassurance and patronizing. Additionally, the woman is already 75 years old and has no significant health issues. It would be reasonable to question the appropriateness of this health goal.

C is incorrect.
This response does not reflect a person-centered planning approach, nor does accurately describe the proper function of an IDT meeting.

D is incorrect.
Regardless of state regulations, every individual has the right to make personal health decisions, especially in the absence of significant health issues.

Question 11

A direct support person (DSP) reports finding several pairs of urine-soaked pants in the hamper of a 60-year-old man with IDD. This man’s privacy is important to him and he takes pride in his ability to care for himself. There is no history of urinary incontinence and he has verbalized no physical complaints. What instruction should the nurse give to the DSP?

  1. “Thanks for calling me about this. Please let me know if the problem continues.”
  2. “Encourage him to stay well hydrated and remind him to go to the bathroom hourly.”
  3. “It may be a prostate problem. I’ll make an appointment with his healthcare provider.”
  4. “His annual physical is scheduled next month. I’ll be sure to tell the healthcare provider.”

View Week 11 answer

Correct answer: C
It is common for the prostate gland to become enlarged as a man ages. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH. This man needs to be seen by his primary care provider for evaluation.

A is incorrect.
A more aggressive nursing assessment and intervention is indicated.

B is incorrect.
Increasing fluid intake is unlikely to decrease his incontinence.

D is incorrect.
A more aggressive nursing assessment and intervention is indicated.

Question 12

A 72-year-old man had a traumatic brain injury during childhood that resulted in hemiparesis and mild IDD. Until six months ago when his sister passed away, he was living in his own apartment with support from his sister. Since moving into the group home, he seems to have lost interest in activities and his overall self-care skills have significantly declined. Over the past couple of months, he has been complaining that the house is too noisy, and he has been spending more time in his room. When staff tries to engage him, he answers in monosyllables and avoids eye contact. A nursing assessment fails to identify any obvious reasons for the changes in his behavior. What action should the nurse take next?

  1. Refer to his primary healthcare provider to rule out a medical issue.
  2. Encourage staff to be patient during his adjustment to his new home.
  3. Schedule an appointment with an audiologist for a hearing evaluation.
  4. Refer him to a psychiatrist for treatment of his depressive symptoms.

View Week 12 answer

Correct answer: A
All significant changes in behavior, marked decline in function abilities, cognitive decline, or physical complaints first requires a comprehensive medical examination to rule out underlying health issues.

B is incorrect.
While patience is important when individuals are making transitions, medical evaluation is indicated when deterioration in health or decline in function is identified.

C is incorrect.
In this situation, a hearing evaluation is not of primary importance.

D is incorrect.
Referral to a psychiatrist in advance of a thorough medical evaluation by the individual’s primary healthcare provider is premature.

Recommended study material

The DDNA Board of Directors recommends completion of the free online IDD nursing courseware on this website as a useful study tool for the exam. They also recommend the books listed below. You may be able to obtain these books by contacting your local public library to see whether it has the books or whether it can obtain the books for you through an interlibrary loan program. Some recommended books include:

  • Core Curriculum For Specializing In Intellectual and Developmental Disabilities: A Resource for Nurses and Other Health Care Professionals. Edited by Wendy Nehring. ISBN 0-7637-4765-3 Paperback
  • Medical Care for Children and Adults with Developmental Disabilities, Second Edition. Edited by I. Leslie Rubin, M.D., and Allen C. Crocker, M.D. ISBN 1-55766-766-7 Hardcover
  • When Your Child Has a Disability: The Complete Sourcebook of Daily and Medical Care, Revised Edition. Edited by Mark L. Batshaw, M.D. ISBN 1-55766-472-2 Paperback
  • Genetics and Mental Retardation Syndromes: A New Look at Behavior and Interventions. By Elisabeth M. Dykens, Ph.D., Robert M. Hodapp, Ph.D., and Brenda M. Finucane, M.S ISBN 1-55766-471-4 Paperback

Also, the resources section of this site contains numerous links to IDD related materials.

Exam Locations

  • Group exams are held once annually at the DDNA Annual Education Conference. The conference location varies year by year.  
  • You may also take the exam at a local contracted testing center (Prometrics).  Prometrics Testing Centers are located across the United States and Canada.

Arrive prepared

On the day of the exam, you will need to bring:

  • The written confirmation of registration
  • Your current nursing license (not a photocopy)
  • Your current DDNA membership card
  • A government issued photo identification document, such as a driver’s license or passport.

Taking the exam

  • The exam is administered on a computer in a Prometric testing center.
  • In general, the exam takes between 45 – 90 minutes to complete, but you have up to 2 hours.

Important Note:  While taking the computerized exam, do not skip questions and expect to be able to go back and answer them later. Once you skip a question, you will not be able to return to that question to answer it. The skipped question will be counted as an incorrect answer.

You passed – what happens next

  • DDNA will email you a results letter and PDF document that contains your certification card and certificate.
  • You will have earned the right to use the credential of certification (CDDN or DDC). This credential will remain valid for two years, renewable by the last day of the month in which you sat for the exam.  
  • Please be aware that part of being certified in the specialty of IDD nursing is maintaining an active membership in your professional organization throughout your period of certification.

You didn’t pass – what to do next

If you did not pass the exam, you have the option of retaking the exam. The policy on reexamination for the CDDN/DDC credential is as follows:

  1. Exam candidate eligibility remains valid for two years from the date your application was approved. The expiration date is listed on your letter of confirmation.
  2. If you fail to pass the test on the first try, you may take the test one more time without further documentation or Certification Committee approval.
  3. If you do not pass the examination on your second try and wish to pursue certification, you must submit documentation of 30 hours of continuing education specific to IDD nursing. These education hours must have been acquired after the date of your second examination attempt. The education hours will be reviewed by the Certification Committee and, if the additional requirement is satisfied, you will receive a letter of approval for re-examination.
  4. As a re-examination candidate, you may repeat Step Three as often as desired within the two-year eligibility period, provided the continuing education requirement is satisfied for each repetition.
  5. Each examination attempt will require that you select the examination site, complete the registration form again, and forward payment of the applicable examination fee(s). See certification fees page.

After you take the GROUP exam at the conference: DDNA will email you your test results within 6-8 weeks after the conference. Please do not call DDNA or Prometrics for your score.

After you take the LOCAL exam: Notify DDNA that you have taken the exam by sending an e-mail to the following address: [email protected].  DDNA will email you your test results as soon as they are available (typically 4-6 weeks). Please do not call DDNA or Prometrics for your score.
Note: You may see a number on the computer screen immediately after taking the exam at the local testing center; however, this number does not necessarily indicate whether you have passed.

Certification Application Fees

The application fee is due when a certification application is submitted. The application fee pays for the processing of an application only. It does not include the exam fee.

Please note: Certification fees are non-refundable.

Current DDNA Member  $100

Application Processing Fee (due with application)
This fee is for active members. It does not include membership dues. Please check your membership status before submitting fees.

New Member Option  $200  Please note: membership dues have increased (as of 7/1/2017). 

Application Processing Fee (due with application)
Join the association and apply for certification at the same time. This fee includes one year’s membership dues.


Certification Exam Fees

Please note: Certification fees are non-refundable.

The exam fee is due after your certification application has been approved. The exam fee pays for the costs of the exam only. It does not include sitting fees charged separately by the local test site.

Group Exam  $250

Exam Fee (to be paid after approval)
This fee is for active members. It does not include membership dues. Please check your membership status before submitting fees. The Group Examination Fee is to be paid after you receive your application approval letter. Certification fees are non-refundable. Group examination fees are transferable. You must be a member of DDNA to take the certification exam.

Local Exam  $150*

Exam Fee (to be paid after approval)
This fee is for active members. It does not include membership dues. Please check your membership status before submitting fees. The Local Examination Fee is to be paid after you receive your application approval letter. Certification fees are non-refundable. Local examination fees are not transferable. You must be a member of DDNA to take the certification exam.*An additional sitting fee of $199.95 will be charged by the local testing company (Prometrics). Do not send the $199.95 fee to DDNA.

Certification Renewal Fees
(Certification Renewal Fees are NON-REFUNDABLE)
Please note: membership dues have increased (as of 7/1/2017). 

DDNA Member in Good Standing  $100

Renewal Application Processing Fee (due with application)
This fee is for active members. It does not include membership dues. Please check your membership status before submitting fees.
If your certification renewal is postmarked AFTER your expiration date, please add the $50 late fee to your renewal.  This will be assessed upon receipt of your application and must be paid before your renewal can be processed.

DDNA Member with expired membership  $250

Renewal Application Processing Fee (due with application)
This amount includes reinstatement of your membership for one year ($100), a reactivation fee ($50), and the certification renewal application processing fee ($100).

Chapter & Network Education Programs for IDD Nurses

Want to offer a program that provides education credits that can be used for CDDN or DDC recertification?

Is your Chapter or Network, agency, or work place planning an educational program specifically related to developmental disabilities nursing? Would you like to offer a certificate that nurse attendees can use toward documenting their required education hours for CDDN or DDC certification? You can submit an application to have your offering recognized as being acceptable for CDDN or DDC renewal purposes. Must submit application at least 45 days in advance of program.

Upon receipt, DDNA will review the application and then send the applicant an email of approval or request additional information, if needed for approval.

Please note: All hours for which approval is requested must be offered on the same day and/or on consecutive days during the same conference. Educational offerings for more than 3 hours will be approved and/or advertised ONLY for offering dates at least 60 days before or 60 days after the date of DDNA’s Annual Education Conference. Please do not ask DDNA for an exception to this policy. DDNA’s conferences dates are available on the Conference page.

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