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 with an AVG reports coolness and pallor in the hand. The technician should suspect

A) Steal syndrome and alert the nurse immediately

B) Hypervolemia

C) Air embolism

D) Dialyzer clotting

2 / 50

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

A) Hypotension

B) Stenosis needing further evaluation

C) Dialyzer clotting

D) Good blood flow

3 / 50

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

A) Continue; bruising will resolve

B) Speed the pump to clear clot

C) Tape it tighter

D) Stop blood pump and remove needle

4 / 50

4) 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

5 / 50

5) 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

6 / 50

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

A) Gloves only

B) Hair cover only

C) Gloves and a mask with eye shield

D) Apron only

7 / 50

7) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Massage the site vigorously

C) Apply firm pressure with a clean gauze

D) Elevate the arm above the head

8 / 50

8) Adequate dialysis is MOST accurately measured by

A) Kt/V or URR values

B) Postweight alone

C) Patient feeling well

D) Color of dialysate

9 / 50

9) 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

10 / 50

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

A) Ask, “Are you Mr. Smith?”

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

C) Recognize their face from last week

D) Check the name on their dialysis chair

11 / 50

11) The FIRST sign of an air embolism may be

A) Polyuria

B) Chest pain and coughing

C) Hypertension

D) Severe headache

12 / 50

12) 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

13 / 50

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

A) Ignore refusal and end session

B) Explain risks, document refusal, and notify nurse

C) Double next session’s UF

D) Force completion under policy

14 / 50

14) 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

15 / 50

15) The primary reason for rotating cannulation sites is to

A) Reduce staff workload

B) Shorten treatment time

C) Allow vessel healing and prevent aneurysms

D) Lower dialyzer reuse cost

16 / 50

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

A) After the dialyzer

B) Inside the dialysate circuit

C) At the venous drip chamber

D) Before the blood pump

17 / 50

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

A) Turn off heparin pump

B) Quickly clamp line and air-trap it

C) Increase blood flow to flush air

D) Ignore if bubbles are small

18 / 50

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

A) Reduce cramping

B) Prevent clotting in the dialyzer

C) Avoid post-dialysis bleeding

D) Increase adequacy

19 / 50

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

A) Heart rate

B) Blood pressure

C) Temperature

D) Respiratory rate

20 / 50

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

A) Loud continuous thrill

B) Absence of bruit

C) Warmth, redness, swelling, and drainage

D) Slight discoloration only

21 / 50

21) The recommended tourniquet placement for fistula cannulation is

A) 2–3 cm above needle site

B) Directly over the anastomosis

C) Below the venous needle site

D) Not used for fistulas

22 / 50

22) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Increase ultrafiltration

C) Correct hypocalcemia

D) Prevent clotting in the extracorporeal circuit

23 / 50

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

A) 14 G

B) 18 G

C) 20 G

D) 16 G

24 / 50

24) 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

25 / 50

25) 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) Lower the ultrafiltration rate and assess blood pressure

D) Administer heparin

26 / 50

26) Which intervention helps prevent hypotension during dialysis?

A) Skipping mid-treatment vitals

B) Using cold dialysate for all patients

C) Starting with low dialysate sodium

D) Profiling ultrafiltration rate

27 / 50

27) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Persistent dry cough

B) Sudden severe headache, nausea, restlessness

C) Pruritus on non-dialysis days

D) Gradual blurred vision post-dialysis

28 / 50

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

A) Assess blood pressure and ask about tingling

B) Check serum potassium level

C) Increase dialysate sodium

D) Stop the pump immediately

29 / 50

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

A) Air in the arterial line

B) Dialyzer clotting

C) Dislodged needle or line separation

D) Conductivity error

30 / 50

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

A) Reviewing physician orders

B) Checking last month’s Kt/V

C) Inspecting dialyzer labels

D) Palpating for a thrill

31 / 50

31) A bruit is assessed by

A) Visual inspection alone

B) Auscultation with a stethoscope

C) Compression of the access

D) Palpation with fingertips

32 / 50

32) The best cannulation technique for a mature fistula is

A) Rope-ladder rotating sites along the vessel

B) Area technique in one spot

C) Buttonhole for every treatment

D) Random needle placement

33 / 50

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

A) Recapped carefully

B) Bent before disposal

C) Discarded in approved sharps container immediately

D) Placed on chairside table temporarily

34 / 50

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

A) Arterial needle first

B) Whichever is bleeding more

C) Both simultaneously

D) Venous needle first

35 / 50

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

A) Fasting glucose

B) LDL cholesterol

C) Predialysis potassium

D) Serum albumin

36 / 50

36) 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

37 / 50

37) Which finding warrants HOLDING heparin before treatment?

A) Heart rate 88 bpm

B) Platelets 50 × 10⁹/L

C) Hemoglobin 11 g/dL

D) Serum sodium 137 mEq/L

38 / 50

38) 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

39 / 50

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

A) Cancelled without notification

B) Started with higher dialysate temperature

C) Continued as normal with more saline

D) Begun after notifying the nurse and following fever protocol

40 / 50

40) 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

41 / 50

41) The correct order for disconnecting bloodlines is

A) Either order is fine

B) Arterial line, then venous line

C) Both simultaneously

D) Venous line, then arterial line

42 / 50

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

A) Dialyzer clotting

B) Possible hypoxemia; notify nurse

C) Adequate oxygenation

D) Normal vascular tone

43 / 50

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

A) 30–45 degrees

B) 90 degrees

C) 15–20 degrees

D) 60–75 degrees

44 / 50

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

A) Normal saline

B) Tap water and soap

C) Chlorhexidine 2 % with alcohol

D) Hydrogen peroxide 3 %

45 / 50

45) Before starting treatment, bloodlines are primed to

A) Remove air and sterilant residue

B) Warm the dialyzer

C) Calibrate the machine scales

D) Increase dialysate conductivity

46 / 50

46) 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

47 / 50

47) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

B) Skipping if gloves are clean

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

D) Sanitizer only when visibly soiled

48 / 50

48) When should the technician document vital signs?

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

B) Once at the end

C) Whenever convenient

D) Only pre- and post-dialysis

49 / 50

49) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Confirm dialysate temperature

C) Verify water softening

D) Test for bacteriologic contamination

50 / 50

50) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Cool, clammy skin post-dialysis

C) Hypertension near session end

D) Cramps after two hours

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