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

A) 16 G

B) 14 G

C) 18 G

D) 20 G

2 / 50

2) Before starting treatment, bloodlines are primed to

A) Increase dialysate conductivity

B) Calibrate the machine scales

C) Warm the dialyzer

D) Remove air and sterilant residue

3 / 50

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

A) Start session right away

B) Skip assessment because symptoms are common

C) Weigh patient to assess fluid overload

D) Increase dialysate flow rate

4 / 50

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

A) Hypotension

B) Dialyzer clotting

C) Stenosis needing further evaluation

D) Good blood flow

5 / 50

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

A) Critically low; inform nurse promptly

B) Indicator of infection

C) Too high; extend dialysis

D) Normal and expected

6 / 50

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

A) Allowing the catheter caps to hang freely

B) Using povidone-iodine ointment at exit site

C) Flushing only once per week

D) Re-using dressings if still clean

7 / 50

7) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Sudden severe headache, nausea, restlessness

B) Gradual blurred vision post-dialysis

C) Pruritus on non-dialysis days

D) Persistent dry cough

8 / 50

8) 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

9 / 50

9) Which finding warrants HOLDING heparin before treatment?

A) Serum sodium 137 mEq/L

B) Hemoglobin 11 g/dL

C) Platelets 50 × 10⁹/L

D) Heart rate 88 bpm

10 / 50

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

A) Avoid post-dialysis bleeding

B) Prevent clotting in the dialyzer

C) Reduce cramping

D) Increase adequacy

11 / 50

11) Proper needle bevel orientation on entry should be

A) Bevel sideways to reduce infiltration

B) Orientation doesn’t matter

C) Bevel down to reduce pain

D) Bevel up to ease vessel entry

12 / 50

12) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Hypertension near session end

C) Cramps after two hours

D) Itching and wheezing within first 15 minutes

13 / 50

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

A) Adequate oxygenation

B) Dialyzer clotting

C) Normal vascular tone

D) Possible hypoxemia; notify nurse

14 / 50

14) 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

15 / 50

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

A) Tape it tighter

B) Stop blood pump and remove needle

C) Continue; bruising will resolve

D) Speed the pump to clear clot

16 / 50

16) The correct order for disconnecting bloodlines is

A) Both simultaneously

B) Either order is fine

C) Venous line, then arterial line

D) Arterial line, then venous line

17 / 50

17) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Massage the site vigorously

C) Elevate the arm above the head

D) Apply firm pressure with a clean gauze

18 / 50

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

A) Bent before disposal

B) Discarded in approved sharps container immediately

C) Recapped carefully

D) Placed on chairside table temporarily

19 / 50

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

A) Quickly clamp line and air-trap it

B) Turn off heparin pump

C) Ignore if bubbles are small

D) Increase blood flow to flush air

20 / 50

20) During treatment, a rising arterial pressure usually signals

A) Tubing kink or clot before dialyzer

B) Machine in bypass

C) High dialysate temperature

D) Venous needle displacement

21 / 50

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

A) Stop the treatment permanently

B) Lower the ultrafiltration rate and assess blood pressure

C) Administer heparin

D) Increase ultrafiltration rate

22 / 50

22) The recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) 2–3 cm above needle site

C) Not used for fistulas

D) Below the venous needle site

23 / 50

23) Which intervention helps prevent hypotension during dialysis?

A) Skipping mid-treatment vitals

B) Using cold dialysate for all patients

C) Profiling ultrafiltration rate

D) Starting with low dialysate sodium

24 / 50

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

A) Tap water and soap

B) Hydrogen peroxide 3 %

C) Chlorhexidine 2 % with alcohol

D) Normal saline

25 / 50

25) The FIRST sign of an air embolism may be

A) Hypertension

B) Chest pain and coughing

C) Polyuria

D) Severe headache

26 / 50

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

D) Ask, “Are you Mr. Smith?”

27 / 50

27) Conductivity is checked before treatment mainly to

A) Verify water softening

B) Confirm dialysate temperature

C) Test for bacteriologic contamination

D) Ensure proper electrolyte concentration

28 / 50

28) When should the technician document vital signs?

A) Only pre- and post-dialysis

B) Whenever convenient

C) Once at the end

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

29 / 50

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

A) Test dialysate pH

B) Add fluid for weight gain

C) Lower serum phosphorus

D) Return as much blood as possible from the circuit

30 / 50

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

A) Predialysis potassium

B) Serum albumin

C) LDL cholesterol

D) Fasting glucose

31 / 50

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

A) Checking last month’s Kt/V

B) Inspecting dialyzer labels

C) Palpating for a thrill

D) Reviewing physician orders

32 / 50

32) The primary reason for rotating cannulation sites is to

A) Allow vessel healing and prevent aneurysms

B) Lower dialyzer reuse cost

C) Shorten treatment time

D) Reduce staff workload

33 / 50

33) 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) Double next session’s UF

D) Ignore refusal and end session

34 / 50

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

A) Conductivity error

B) Air in the arterial line

C) Dislodged needle or line separation

D) Dialyzer clotting

35 / 50

35) A bruit is assessed by

A) Palpation with fingertips

B) Compression of the access

C) Visual inspection alone

D) Auscultation with a stethoscope

36 / 50

36) Heparin is administered primarily to

A) Correct hypocalcemia

B) Prevent clotting in the extracorporeal circuit

C) Increase ultrafiltration

D) Reduce blood pressure spikes

37 / 50

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

A) Venous needle first

B) Both simultaneously

C) Arterial needle first

D) Whichever is bleeding more

38 / 50

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

A) Continued as normal with more saline

B) Begun after notifying the nurse and following fever protocol

C) Started with higher dialysate temperature

D) Cancelled without notification

39 / 50

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

A) Warmth, redness, swelling, and drainage

B) Loud continuous thrill

C) Absence of bruit

D) Slight discoloration only

40 / 50

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

A) Dialyzer clotting

B) Hypervolemia

C) Air embolism

D) Steal syndrome and alert the nurse immediately

41 / 50

41) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Color of dialysate

C) Postweight alone

D) Kt/V or URR values

42 / 50

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

A) Ask them to walk slowly

B) Give food immediately

C) Send them home quickly

D) Seat or recline them and check blood pressure

43 / 50

43) 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

44 / 50

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

A) Heart rate

B) Blood pressure

C) Temperature

D) Respiratory rate

45 / 50

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

A) Hypotension

B) Too small needle gauge

C) Low dialysate flow rate

D) Heparin given too early

46 / 50

46) Proper hand hygiene before gloving involves

A) Sanitizer only when visibly soiled

B) Skipping if gloves are clean

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

D) 5-second rinse with water only

47 / 50

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

A) 15–20 degrees

B) 90 degrees

C) 30–45 degrees

D) 60–75 degrees

48 / 50

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

A) Gloves only

B) Gloves and a mask with eye shield

C) Hair cover only

D) Apron only

49 / 50

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

A) Stop the pump immediately

B) Check serum potassium level

C) Increase dialysate sodium

D) Assess blood pressure and ask about tingling

50 / 50

50) 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

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