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 numb lips during dialysis. The technician should first

A) Increase dialysate sodium

B) Stop the pump immediately

C) Check serum potassium level

D) Assess blood pressure and ask about tingling

2 / 50

2) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Kt/V or URR values

C) Postweight alone

D) Color of dialysate

3 / 50

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

A) Explain risks, document refusal, and notify nurse

B) Force completion under policy

C) Ignore refusal and end session

D) Double next session’s UF

4 / 50

4) The correct order for disconnecting bloodlines is

A) Either order is fine

B) Both simultaneously

C) Venous line, then arterial line

D) Arterial line, then venous line

5 / 50

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

A) Loud continuous thrill

B) Slight discoloration only

C) Warmth, redness, swelling, and drainage

D) Absence of bruit

6 / 50

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

A) Started with higher dialysate temperature

B) Continued as normal with more saline

C) Begun after notifying the nurse and following fever protocol

D) Cancelled without notification

7 / 50

7) The recommended tourniquet placement for fistula cannulation is

A) Below the venous needle site

B) Not used for fistulas

C) 2–3 cm above needle site

D) Directly over the anastomosis

8 / 50

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

A) Prevent clotting in the dialyzer

B) Avoid post-dialysis bleeding

C) Reduce cramping

D) Increase adequacy

9 / 50

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

A) Increase blood flow to flush air

B) Ignore if bubbles are small

C) Quickly clamp line and air-trap it

D) Turn off heparin pump

10 / 50

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

A) Heart rate

B) Respiratory rate

C) Blood pressure

D) Temperature

11 / 50

11) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) Tubing kink or clot before dialyzer

C) High dialysate temperature

D) Machine in bypass

12 / 50

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

A) Arterial needle first

B) Venous needle first

C) Both simultaneously

D) Whichever is bleeding more

13 / 50

13) The best cannulation technique for a mature fistula is

A) Random needle placement

B) Buttonhole for every treatment

C) Rope-ladder rotating sites along the vessel

D) Area technique in one spot

14 / 50

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

A) Hypotension

B) Good blood flow

C) Stenosis needing further evaluation

D) Dialyzer clotting

15 / 50

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

A) Adequate fluid removal

B) Possible fluid overload and need for dietary review

C) Hyperkalemia correction

D) Anemia management success

16 / 50

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

A) Stop the treatment permanently

B) Increase ultrafiltration rate

C) Administer heparin

D) Lower the ultrafiltration rate and assess blood pressure

17 / 50

17) Proper hand hygiene before gloving involves

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

B) 5-second rinse with water only

C) Skipping if gloves are clean

D) Sanitizer only when visibly soiled

18 / 50

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

A) Increase dialysate flow rate

B) Weigh patient to assess fluid overload

C) Skip assessment because symptoms are common

D) Start session right away

19 / 50

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

A) Re-using dressings if still clean

B) Using povidone-iodine ointment at exit site

C) Flushing only once per week

D) Allowing the catheter caps to hang freely

20 / 50

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

A) Dialyzer clotting

B) Dislodged needle or line separation

C) Air in the arterial line

D) Conductivity error

21 / 50

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

A) 60–75 degrees

B) 15–20 degrees

C) 90 degrees

D) 30–45 degrees

22 / 50

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

A) Low dialysate flow rate

B) Hypotension

C) Too small needle gauge

D) Heparin given too early

23 / 50

23) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Prevent clotting in the extracorporeal circuit

C) Correct hypocalcemia

D) Increase ultrafiltration

24 / 50

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

A) Before the blood pump

B) At the venous drip chamber

C) Inside the dialysate circuit

D) After the dialyzer

25 / 50

25) Conductivity is checked before treatment mainly to

A) Confirm dialysate temperature

B) Ensure proper electrolyte concentration

C) Verify water softening

D) Test for bacteriologic contamination

26 / 50

26) Which symptom suggests an allergic reaction to dialyzer?

A) Cramps after two hours

B) Cool, clammy skin post-dialysis

C) Hypertension near session end

D) Itching and wheezing within first 15 minutes

27 / 50

27) 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) Increase dialysate temperature

C) Administer extra heparin

D) Give acetaminophen and continue

28 / 50

28) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Hypertension

C) Polyuria

D) Severe headache

29 / 50

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

A) Serum albumin

B) Fasting glucose

C) Predialysis potassium

D) LDL cholesterol

30 / 50

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

A) 18 G

B) 16 G

C) 14 G

D) 20 G

31 / 50

31) Before starting treatment, bloodlines are primed to

A) Increase dialysate conductivity

B) Warm the dialyzer

C) Remove air and sterilant residue

D) Calibrate the machine scales

32 / 50

32) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Gradual blurred vision post-dialysis

B) Persistent dry cough

C) Pruritus on non-dialysis days

D) Sudden severe headache, nausea, restlessness

33 / 50

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

A) Air embolism

B) Hypervolemia

C) Dialyzer clotting

D) Steal syndrome and alert the nurse immediately

34 / 50

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

A) Inspecting dialyzer labels

B) Palpating for a thrill

C) Reviewing physician orders

D) Checking last month’s Kt/V

35 / 50

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

A) Send them home quickly

B) Seat or recline them and check blood pressure

C) Ask them to walk slowly

D) Give food immediately

36 / 50

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

A) Normal vascular tone

B) Adequate oxygenation

C) Possible hypoxemia; notify nurse

D) Dialyzer clotting

37 / 50

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

A) Recapped carefully

B) Discarded in approved sharps container immediately

C) Bent before disposal

D) Placed on chairside table temporarily

38 / 50

38) Which intervention helps prevent hypotension during dialysis?

A) Using cold dialysate for all patients

B) Skipping mid-treatment vitals

C) Profiling ultrafiltration rate

D) Starting with low dialysate sodium

39 / 50

39) Which finding warrants HOLDING heparin before treatment?

A) Hemoglobin 11 g/dL

B) Platelets 50 × 10⁹/L

C) Heart rate 88 bpm

D) Serum sodium 137 mEq/L

40 / 50

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

A) Critically low; inform nurse promptly

B) Too high; extend dialysis

C) Normal and expected

D) Indicator of infection

41 / 50

41) A bruit is assessed by

A) Compression of the access

B) Visual inspection alone

C) Auscultation with a stethoscope

D) Palpation with fingertips

42 / 50

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

A) Check the name on their dialysis chair

B) Ask, “Are you Mr. Smith?”

C) Recognize their face from last week

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

43 / 50

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

A) Stop blood pump and remove needle

B) Speed the pump to clear clot

C) Tape it tighter

D) Continue; bruising will resolve

44 / 50

44) Proper needle bevel orientation on entry should be

A) Bevel sideways to reduce infiltration

B) Bevel down to reduce pain

C) Orientation doesn’t matter

D) Bevel up to ease vessel entry

45 / 50

45) 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

46 / 50

46) 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

47 / 50

47) The primary reason for rotating cannulation sites is to

A) Allow vessel healing and prevent aneurysms

B) Shorten treatment time

C) Reduce staff workload

D) Lower dialyzer reuse cost

48 / 50

48) 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

49 / 50

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

A) Test dialysate pH

B) Lower serum phosphorus

C) Return as much blood as possible from the circuit

D) Add fluid for weight gain

50 / 50

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

A) Chlorhexidine 2 % with alcohol

B) Hydrogen peroxide 3 %

C) Tap water and soap

D) Normal saline

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