CCHT Clinical Practice Test 2025

Last Updated on June 14, 2025

The Nephrology Nursing Certification Commission (NNCC) Certified Clinical Hemodialysis Technician (CCHT) Clinical Practice Test 2025 – Questions and Answers Quiz. In the actual test, this part consists of 71 to 78 multiple-choice questions, which is approximately 48–52%.

Questions in the Clinical area deal with patient care before, during, and after dialysis treatment. Sometimes, a patient case is described, and several questions follow, as seen in the case of Ivan Jackson in the Prep Test at the end of this booklet. Other questions are individual items that stand alone. The Clinical area is the most significant part of the test, making up 50% of the test content. Examples of the kinds of technician activities tested in the Clinical area include:

1. Using aseptic technique for dialysis procedures.
2. Evaluating the patient’s access before dialysis.
3. Cannulating the patient’s access.
4. Monitoring patient during dialysis treatment, e.g., vital signs.
5. Discontinuing the patient’s dialysis treatment with an arteriovenous fistula or graft.

CCHT Clinical Practice Test

1 / 50

1) Proper needle bevel orientation on entry should be

A) Bevel up to ease vessel entry

B) Orientation doesn’t matter

C) Bevel down to reduce pain

D) Bevel sideways to reduce infiltration

2 / 50

2) Excessive bleeding from a needle site post-dialysis can be caused by

A) Heparin given too early

B) Hypotension

C) Too small needle gauge

D) Low dialysate flow rate

3 / 50

3) During treatment, a rising arterial pressure usually signals

A) Machine in bypass

B) Venous needle displacement

C) High dialysate temperature

D) Tubing kink or clot before dialyzer

4 / 50

4) Before starting treatment, bloodlines are primed to

A) Calibrate the machine scales

B) Warm the dialyzer

C) Remove air and sterilant residue

D) Increase dialysate conductivity

5 / 50

5) A bruit is assessed by

A) Palpation with fingertips

B) Compression of the access

C) Visual inspection alone

D) Auscultation with a stethoscope

6 / 50

6) A pulse oximeter reading of 88 % during treatment indicates

A) Adequate oxygenation

B) Dialyzer clotting

C) Possible hypoxemia; notify nurse

D) Normal vascular tone

7 / 50

7) A patient develops chills and a temperature rise to 39 °C during dialysis. The FIRST step is to

A) Stop dialysis and obtain blood cultures

B) Give acetaminophen and continue

C) Increase dialysate temperature

D) Administer extra heparin

8 / 50

8) Which cannulation angle is generally recommended for a new AV fistula?

A) 90 degrees

B) 60–75 degrees

C) 15–20 degrees

D) 30–45 degrees

9 / 50

9) Which lab value is MOST important to review right before dialysis?

A) LDL cholesterol

B) Serum albumin

C) Fasting glucose

D) Predialysis potassium

10 / 50

10) The technician checks for residual heparin at treatment end primarily to

A) Increase adequacy

B) Prevent clotting in the dialyzer

C) Reduce cramping

D) Avoid post-dialysis bleeding

11 / 50

11) Which finding warrants HOLDING heparin before treatment?

A) Hemoglobin 11 g/dL

B) Platelets 50 × 10⁹/L

C) Serum sodium 137 mEq/L

D) Heart rate 88 bpm

12 / 50

12) A patient with an AVG reports coolness and pallor in the hand. The technician should suspect

A) Hypervolemia

B) Dialyzer clotting

C) Air embolism

D) Steal syndrome and alert the nurse immediately

13 / 50

13) A sudden drop in venous pressure during treatment often indicates

A) Air in the arterial line

B) Dislodged needle or line separation

C) Conductivity error

D) Dialyzer clotting

14 / 50

14) Before cannulating a fistula, which step best verifies access patency?

A) Reviewing physician orders

B) Inspecting dialyzer labels

C) Checking last month’s Kt/V

D) Palpating for a thrill

15 / 50

15) The most accurate way to confirm patient identity is to

A) Recognize their face from last week

B) Verify two identifiers such as name and date of birth

C) Ask, “Are you Mr. Smith?”

D) Check the name on their dialysis chair

16 / 50

16) Which action best minimizes catheter-related infection risk?

A) Allowing the catheter caps to hang freely

B) Re-using dressings if still clean

C) Flushing only once per week

D) Using povidone-iodine ointment at exit site

17 / 50

17) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Correct hypocalcemia

C) Prevent clotting in the extracorporeal circuit

D) Increase ultrafiltration

18 / 50

18) The MOST appropriate antiseptic for prepping intact skin before needle insertion is

A) Tap water and soap

B) Chlorhexidine 2 % with alcohol

C) Hydrogen peroxide 3 %

D) Normal saline

19 / 50

19) The MOST appropriate action when a patient feels faint while standing post-dialysis is to

A) Give food immediately

B) Seat or recline them and check blood pressure

C) Send them home quickly

D) Ask them to walk slowly

20 / 50

20) A post-dialysis weight 4 kg above target indicates

A) Adequate fluid removal

B) Anemia management success

C) Possible fluid overload and need for dietary review

D) Hyperkalemia correction

21 / 50

21) If arterial needle infiltrates, the BEST immediate action is to

A) Tape it tighter

B) Speed the pump to clear clot

C) Continue; bruising will resolve

D) Stop blood pump and remove needle

22 / 50

22) When should the technician document vital signs?

A) Pre-, every 30 minutes during, and post-dialysis

B) Once at the end

C) Only pre- and post-dialysis

D) Whenever convenient

23 / 50

23) A patient complains of numb lips during dialysis. The technician should first

A) Assess blood pressure and ask about tingling

B) Stop the pump immediately

C) Increase dialysate sodium

D) Check serum potassium level

24 / 50

24) The correct order for disconnecting bloodlines is

A) Both simultaneously

B) Venous line, then arterial line

C) Arterial line, then venous line

D) Either order is fine

25 / 50

25) Which intervention helps prevent hypotension during dialysis?

A) Profiling ultrafiltration rate

B) Using cold dialysate for all patients

C) Skipping mid-treatment vitals

D) Starting with low dialysate sodium

26 / 50

26) Which of these is a KEY sign of infection at an access site?

A) Loud continuous thrill

B) Slight discoloration only

C) Absence of bruit

D) Warmth, redness, swelling, and drainage

27 / 50

27) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Reduce staff workload

C) Allow vessel healing and prevent aneurysms

D) Shorten treatment time

28 / 50

28) Post-treatment potassium of 2.8 mEq/L is

A) Too high; extend dialysis

B) Indicator of infection

C) Critically low; inform nurse promptly

D) Normal and expected

29 / 50

29) A febrile patient (38.5 °C) should have treatment

A) Begun after notifying the nurse and following fever protocol

B) Continued as normal with more saline

C) Started with higher dialysate temperature

D) Cancelled without notification

30 / 50

30) A patient arrives with a dry cough and shortness of breath. Technician should first

A) Start session right away

B) Weigh patient to assess fluid overload

C) Skip assessment because symptoms are common

D) Increase dialysate flow rate

31 / 50

31) The best cannulation technique for a mature fistula is

A) Area technique in one spot

B) Random needle placement

C) Rope-ladder rotating sites along the vessel

D) Buttonhole for every treatment

32 / 50

32) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Itching and wheezing within first 15 minutes

C) Cramps after two hours

D) Hypertension near session end

33 / 50

33) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

B) Sanitizer only when visibly soiled

C) Skipping if gloves are clean

D) At least 20 seconds of soap and water or approved sanitizer

34 / 50

34) To reduce needle stick injury risk, sharps should be

A) Discarded in approved sharps container immediately

B) Placed on chairside table temporarily

C) Recapped carefully

D) Bent before disposal

35 / 50

35) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Test for bacteriologic contamination

C) Verify water softening

D) Confirm dialysate temperature

36 / 50

36) In case of mild air detected in venous line, the technician should

A) Ignore if bubbles are small

B) Turn off heparin pump

C) Quickly clamp line and air-trap it

D) Increase blood flow to flush air

37 / 50

37) Which personal protective equipment (PPE) must be worn during cannulation?

A) Hair cover only

B) Gloves only

C) Apron only

D) Gloves and a mask with eye shield

38 / 50

38) Which gauge needle is MOST commonly used for routine adult fistula cannulation?

A) 18 G

B) 20 G

C) 14 G

D) 16 G

39 / 50

39) A noisy, high-pitch whistling at the access site suggests

A) Dialyzer clotting

B) Stenosis needing further evaluation

C) Hypotension

D) Good blood flow

40 / 50

40) Which parameter is MOST sensitive to fluid removal during dialysis?

A) Temperature

B) Respiratory rate

C) Heart rate

D) Blood pressure

41 / 50

41) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Pruritus on non-dialysis days

B) Sudden severe headache, nausea, restlessness

C) Gradual blurred vision post-dialysis

D) Persistent dry cough

42 / 50

42) The purpose of post-dialysis saline flush is to

A) Lower serum phosphorus

B) Return as much blood as possible from the circuit

C) Add fluid for weight gain

D) Test dialysate pH

43 / 50

43) When discontinuing treatment on a patient with a graft, the technician should remove

A) Arterial needle first

B) Both simultaneously

C) Whichever is bleeding more

D) Venous needle first

44 / 50

44) Immediately after needle removal, the technician should

A) Apply firm pressure with a clean gauze

B) Elevate the arm above the head

C) Massage the site vigorously

D) Cover with an adhesive bandage only

45 / 50

45) The FIRST sign of an air embolism may be

A) Hypertension

B) Severe headache

C) Polyuria

D) Chest pain and coughing

46 / 50

46) A patient complains of painful cramping in legs during UF. The INITIAL technician response is to

A) Lower the ultrafiltration rate and assess blood pressure

B) Stop the treatment permanently

C) Administer heparin

D) Increase ultrafiltration rate

47 / 50

47) The recommended tourniquet placement for fistula cannulation is

A) 2–3 cm above needle site

B) Not used for fistulas

C) Directly over the anastomosis

D) Below the venous needle site

48 / 50

48) In double-pump dialysis machines, arterial pressure monitors are located

A) At the venous drip chamber

B) Before the blood pump

C) After the dialyzer

D) Inside the dialysate circuit

49 / 50

49) Adequate dialysis is MOST accurately measured by

A) Color of dialysate

B) Kt/V or URR values

C) Patient feeling well

D) Postweight alone

50 / 50

50) A patient refuses to extend treatment needed for target weight. The technician must

A) Force completion under policy

B) Explain risks, document refusal, and notify nurse

C) Ignore refusal and end session

D) Double next session’s UF

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