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) 18 G

B) 16 G

C) 20 G

D) 14 G

2 / 50

2) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Hypertension

C) Polyuria

D) Severe headache

3 / 50

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

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

B) Recognize their face from last week

C) Check the name on their dialysis chair

D) Ask, “Are you Mr. Smith?”

4 / 50

4) 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) Administer extra heparin

C) Increase dialysate temperature

D) Give acetaminophen and continue

5 / 50

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

A) Predialysis potassium

B) Serum albumin

C) Fasting glucose

D) LDL cholesterol

6 / 50

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

A) 30–45 degrees

B) 60–75 degrees

C) 90 degrees

D) 15–20 degrees

7 / 50

7) Which finding warrants HOLDING heparin before treatment?

A) Heart rate 88 bpm

B) Serum sodium 137 mEq/L

C) Platelets 50 × 10⁹/L

D) Hemoglobin 11 g/dL

8 / 50

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

A) Blood pressure

B) Respiratory rate

C) Temperature

D) Heart rate

9 / 50

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

A) Adequate fluid removal

B) Possible fluid overload and need for dietary review

C) Anemia management success

D) Hyperkalemia correction

10 / 50

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

A) Begun after notifying the nurse and following fever protocol

B) Cancelled without notification

C) Continued as normal with more saline

D) Started with higher dialysate temperature

11 / 50

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

A) Warmth, redness, swelling, and drainage

B) Loud continuous thrill

C) Slight discoloration only

D) Absence of bruit

12 / 50

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

A) Test dialysate pH

B) Add fluid for weight gain

C) Return as much blood as possible from the circuit

D) Lower serum phosphorus

13 / 50

13) The correct order for disconnecting bloodlines is

A) Venous line, then arterial line

B) Both simultaneously

C) Either order is fine

D) Arterial line, then venous line

14 / 50

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

A) Dislodged needle or line separation

B) Air in the arterial line

C) Conductivity error

D) Dialyzer clotting

15 / 50

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

A) Turn off heparin pump

B) Ignore if bubbles are small

C) Quickly clamp line and air-trap it

D) Increase blood flow to flush air

16 / 50

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

A) Normal vascular tone

B) Possible hypoxemia; notify nurse

C) Dialyzer clotting

D) Adequate oxygenation

17 / 50

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

A) Good blood flow

B) Stenosis needing further evaluation

C) Hypotension

D) Dialyzer clotting

18 / 50

18) 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

19 / 50

19) 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

20 / 50

20) 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

21 / 50

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

A) Placed on chairside table temporarily

B) Recapped carefully

C) Bent before disposal

D) Discarded in approved sharps container immediately

22 / 50

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

A) Both simultaneously

B) Arterial needle first

C) Venous needle first

D) Whichever is bleeding more

23 / 50

23) A bruit is assessed by

A) Visual inspection alone

B) Palpation with fingertips

C) Auscultation with a stethoscope

D) Compression of the access

24 / 50

24) 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

25 / 50

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

A) Heparin given too early

B) Too small needle gauge

C) Hypotension

D) Low dialysate flow rate

26 / 50

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

A) Normal saline

B) Hydrogen peroxide 3 %

C) Chlorhexidine 2 % with alcohol

D) Tap water and soap

27 / 50

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

A) Stop blood pump and remove needle

B) Tape it tighter

C) Continue; bruising will resolve

D) Speed the pump to clear clot

28 / 50

28) Heparin is administered primarily to

A) Prevent clotting in the extracorporeal circuit

B) Correct hypocalcemia

C) Reduce blood pressure spikes

D) Increase ultrafiltration

29 / 50

29) 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

30 / 50

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

A) Before the blood pump

B) After the dialyzer

C) At the venous drip chamber

D) Inside the dialysate circuit

31 / 50

31) 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) Double next session’s UF

D) Ignore refusal and end session

32 / 50

32) Before starting treatment, bloodlines are primed to

A) Warm the dialyzer

B) Calibrate the machine scales

C) Increase dialysate conductivity

D) Remove air and sterilant residue

33 / 50

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

A) Checking last month’s Kt/V

B) Palpating for a thrill

C) Reviewing physician orders

D) Inspecting dialyzer labels

34 / 50

34) 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) Give food immediately

D) Ask them to walk slowly

35 / 50

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

A) Apron only

B) Gloves and a mask with eye shield

C) Hair cover only

D) Gloves only

36 / 50

36) 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

37 / 50

37) Conductivity is checked before treatment mainly to

A) Confirm dialysate temperature

B) Verify water softening

C) Ensure proper electrolyte concentration

D) Test for bacteriologic contamination

38 / 50

38) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Cramps after two hours

C) Hypertension near session end

D) Itching and wheezing within first 15 minutes

39 / 50

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

A) Using povidone-iodine ointment at exit site

B) Flushing only once per week

C) Allowing the catheter caps to hang freely

D) Re-using dressings if still clean

40 / 50

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

A) Air embolism

B) Dialyzer clotting

C) Hypervolemia

D) Steal syndrome and alert the nurse immediately

41 / 50

41) The primary reason for rotating cannulation sites is to

A) Allow vessel healing and prevent aneurysms

B) Reduce staff workload

C) Shorten treatment time

D) Lower dialyzer reuse cost

42 / 50

42) 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

43 / 50

43) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Pruritus on non-dialysis days

B) Gradual blurred vision post-dialysis

C) Persistent dry cough

D) Sudden severe headache, nausea, restlessness

44 / 50

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

A) Too high; extend dialysis

B) Indicator of infection

C) Normal and expected

D) Critically low; inform nurse promptly

45 / 50

45) Proper needle bevel orientation on entry should be

A) Bevel up to ease vessel entry

B) Bevel down to reduce pain

C) Orientation doesn’t matter

D) Bevel sideways to reduce infiltration

46 / 50

46) 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

47 / 50

47) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) Machine in bypass

C) High dialysate temperature

D) Tubing kink or clot before dialyzer

48 / 50

48) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

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

C) Skipping if gloves are clean

D) Sanitizer only when visibly soiled

49 / 50

49) Adequate dialysis is MOST accurately measured by

A) Kt/V or URR values

B) Postweight alone

C) Color of dialysate

D) Patient feeling well

50 / 50

50) 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

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