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

A) Administer heparin

B) Lower the ultrafiltration rate and assess blood pressure

C) Stop the treatment permanently

D) Increase ultrafiltration rate

2 / 50

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

A) Using povidone-iodine ointment at exit site

B) Re-using dressings if still clean

C) Flushing only once per week

D) Allowing the catheter caps to hang freely

3 / 50

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

A) Weigh patient to assess fluid overload

B) Increase dialysate flow rate

C) Skip assessment because symptoms are common

D) Start session right away

4 / 50

4) Heparin is administered primarily to

A) Correct hypocalcemia

B) Prevent clotting in the extracorporeal circuit

C) Reduce blood pressure spikes

D) Increase ultrafiltration

5 / 50

5) 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

6 / 50

6) Which intervention helps prevent hypotension during dialysis?

A) Profiling ultrafiltration rate

B) Starting with low dialysate sodium

C) Skipping mid-treatment vitals

D) Using cold dialysate for all patients

7 / 50

7) Conductivity is checked before treatment mainly to

A) Confirm dialysate temperature

B) Verify water softening

C) Test for bacteriologic contamination

D) Ensure proper electrolyte concentration

8 / 50

8) The correct order for disconnecting bloodlines is

A) Both simultaneously

B) Venous line, then arterial line

C) Either order is fine

D) Arterial line, then venous line

9 / 50

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

A) Good blood flow

B) Hypotension

C) Dialyzer clotting

D) Stenosis needing further evaluation

10 / 50

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

A) Cancelled without notification

B) Begun after notifying the nurse and following fever protocol

C) Continued as normal with more saline

D) Started with higher dialysate temperature

11 / 50

11) Proper needle bevel orientation on entry should be

A) Bevel up to ease vessel entry

B) Bevel sideways to reduce infiltration

C) Orientation doesn’t matter

D) Bevel down to reduce pain

12 / 50

12) During treatment, a rising arterial pressure usually signals

A) Machine in bypass

B) High dialysate temperature

C) Tubing kink or clot before dialyzer

D) Venous needle displacement

13 / 50

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

A) Discarded in approved sharps container immediately

B) Placed on chairside table temporarily

C) Bent before disposal

D) Recapped carefully

14 / 50

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

A) Venous needle first

B) Whichever is bleeding more

C) Arterial needle first

D) Both simultaneously

15 / 50

15) The FIRST sign of an air embolism may be

A) Severe headache

B) Polyuria

C) Hypertension

D) Chest pain and coughing

16 / 50

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

A) Hair cover only

B) Apron only

C) Gloves only

D) Gloves and a mask with eye shield

17 / 50

17) The recommended tourniquet placement for fistula cannulation is

A) Not used for fistulas

B) 2–3 cm above needle site

C) Directly over the anastomosis

D) Below the venous needle site

18 / 50

18) Before starting treatment, bloodlines are primed to

A) Remove air and sterilant residue

B) Warm the dialyzer

C) Increase dialysate conductivity

D) Calibrate the machine scales

19 / 50

19) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Apply firm pressure with a clean gauze

C) Elevate the arm above the head

D) Massage the site vigorously

20 / 50

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

A) Increase dialysate temperature

B) Stop dialysis and obtain blood cultures

C) Administer extra heparin

D) Give acetaminophen and continue

21 / 50

21) Which finding warrants HOLDING heparin before treatment?

A) Serum sodium 137 mEq/L

B) Platelets 50 × 10⁹/L

C) Heart rate 88 bpm

D) Hemoglobin 11 g/dL

22 / 50

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

A) Seat or recline them and check blood pressure

B) Send them home quickly

C) Ask them to walk slowly

D) Give food immediately

23 / 50

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

A) Stop blood pump and remove needle

B) Tape it tighter

C) Speed the pump to clear clot

D) Continue; bruising will resolve

24 / 50

24) A bruit is assessed by

A) Palpation with fingertips

B) Visual inspection alone

C) Compression of the access

D) Auscultation with a stethoscope

25 / 50

25) Adequate dialysis is MOST accurately measured by

A) Postweight alone

B) Kt/V or URR values

C) Color of dialysate

D) Patient feeling well

26 / 50

26) When should the technician document vital signs?

A) Once at the end

B) Only pre- and post-dialysis

C) Whenever convenient

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

27 / 50

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

A) Before the blood pump

B) After the dialyzer

C) Inside the dialysate circuit

D) At the venous drip chamber

28 / 50

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

A) Adequate oxygenation

B) Possible hypoxemia; notify nurse

C) Dialyzer clotting

D) Normal vascular tone

29 / 50

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

A) Hyperkalemia correction

B) Possible fluid overload and need for dietary review

C) Adequate fluid removal

D) Anemia management success

30 / 50

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

A) Return as much blood as possible from the circuit

B) Test dialysate pH

C) Lower serum phosphorus

D) Add fluid for weight gain

31 / 50

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

A) Reviewing physician orders

B) Palpating for a thrill

C) Checking last month’s Kt/V

D) Inspecting dialyzer labels

32 / 50

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

A) Too small needle gauge

B) Hypotension

C) Heparin given too early

D) Low dialysate flow rate

33 / 50

33) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Sudden severe headache, nausea, restlessness

B) Persistent dry cough

C) Pruritus on non-dialysis days

D) Gradual blurred vision post-dialysis

34 / 50

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

A) Slight discoloration only

B) Loud continuous thrill

C) Warmth, redness, swelling, and drainage

D) Absence of bruit

35 / 50

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

A) Double next session’s UF

B) Ignore refusal and end session

C) Force completion under policy

D) Explain risks, document refusal, and notify nurse

36 / 50

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

A) Increase dialysate sodium

B) Check serum potassium level

C) Stop the pump immediately

D) Assess blood pressure and ask about tingling

37 / 50

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

A) Air in the arterial line

B) Dislodged needle or line separation

C) Dialyzer clotting

D) Conductivity error

38 / 50

38) Which symptom suggests an allergic reaction to dialyzer?

A) Hypertension near session end

B) Cool, clammy skin post-dialysis

C) Itching and wheezing within first 15 minutes

D) Cramps after two hours

39 / 50

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

A) Check the name on their dialysis chair

B) Recognize their face from last week

C) Ask, “Are you Mr. Smith?”

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

40 / 50

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

A) 16 G

B) 20 G

C) 18 G

D) 14 G

41 / 50

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

A) Indicator of infection

B) Normal and expected

C) Too high; extend dialysis

D) Critically low; inform nurse promptly

42 / 50

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

A) Respiratory rate

B) Temperature

C) Blood pressure

D) Heart rate

43 / 50

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

A) Air embolism

B) Dialyzer clotting

C) Steal syndrome and alert the nurse immediately

D) Hypervolemia

44 / 50

44) The primary reason for rotating cannulation sites is to

A) Allow vessel healing and prevent aneurysms

B) Shorten treatment time

C) Lower dialyzer reuse cost

D) Reduce staff workload

45 / 50

45) The best cannulation technique for a mature fistula is

A) Area technique in one spot

B) Rope-ladder rotating sites along the vessel

C) Random needle placement

D) Buttonhole for every treatment

46 / 50

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

A) Quickly clamp line and air-trap it

B) Ignore if bubbles are small

C) Increase blood flow to flush air

D) Turn off heparin pump

47 / 50

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

A) Serum albumin

B) LDL cholesterol

C) Predialysis potassium

D) Fasting glucose

48 / 50

48) Proper hand hygiene before gloving involves

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

B) Skipping if gloves are clean

C) 5-second rinse with water only

D) Sanitizer only when visibly soiled

49 / 50

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

A) Chlorhexidine 2 % with alcohol

B) Tap water and soap

C) Hydrogen peroxide 3 %

D) Normal saline

50 / 50

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

A) Reduce cramping

B) Increase adequacy

C) Prevent clotting in the dialyzer

D) Avoid post-dialysis bleeding

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