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) The purpose of post-dialysis saline flush is to

A) Lower serum phosphorus

B) Add fluid for weight gain

C) Test dialysate pH

D) Return as much blood as possible from the circuit

2 / 50

2) 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

3 / 50

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

A) Gloves and a mask with eye shield

B) Apron only

C) Hair cover only

D) Gloves only

4 / 50

4) Conductivity is checked before treatment mainly to

A) Test for bacteriologic contamination

B) Ensure proper electrolyte concentration

C) Confirm dialysate temperature

D) Verify water softening

5 / 50

5) 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

6 / 50

6) The FIRST sign of an air embolism may be

A) Severe headache

B) Chest pain and coughing

C) Hypertension

D) Polyuria

7 / 50

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

A) Heparin given too early

B) Low dialysate flow rate

C) Hypotension

D) Too small needle gauge

8 / 50

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

A) Continue; bruising will resolve

B) Tape it tighter

C) Speed the pump to clear clot

D) Stop blood pump and remove needle

9 / 50

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

A) Begun after notifying the nurse and following fever protocol

B) Continued as normal with more saline

C) Cancelled without notification

D) Started with higher dialysate temperature

10 / 50

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

A) Ask, “Are you Mr. Smith?”

B) Check the name on their dialysis chair

C) Recognize their face from last week

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

11 / 50

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

A) Increase ultrafiltration rate

B) Administer heparin

C) Stop the treatment permanently

D) Lower the ultrafiltration rate and assess blood pressure

12 / 50

12) 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

13 / 50

13) When should the technician document vital signs?

A) Only pre- and post-dialysis

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

C) Once at the end

D) Whenever convenient

14 / 50

14) 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) Dialyzer clotting

D) Air embolism

15 / 50

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

A) Inside the dialysate circuit

B) After the dialyzer

C) Before the blood pump

D) At the venous drip chamber

16 / 50

16) 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

17 / 50

17) 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

18 / 50

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

A) Double next session’s UF

B) Force completion under policy

C) Ignore refusal and end session

D) Explain risks, document refusal, and notify nurse

19 / 50

19) 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

20 / 50

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

A) Reviewing physician orders

B) Checking last month’s Kt/V

C) Palpating for a thrill

D) Inspecting dialyzer labels

21 / 50

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

A) Ask them to walk slowly

B) Seat or recline them and check blood pressure

C) Give food immediately

D) Send them home quickly

22 / 50

22) Heparin is administered primarily to

A) Correct hypocalcemia

B) Increase ultrafiltration

C) Prevent clotting in the extracorporeal circuit

D) Reduce blood pressure spikes

23 / 50

23) 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

24 / 50

24) The best cannulation technique for a mature fistula is

A) Rope-ladder rotating sites along the vessel

B) Random needle placement

C) Area technique in one spot

D) Buttonhole for every treatment

25 / 50

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

A) Venous needle first

B) Arterial needle first

C) Whichever is bleeding more

D) Both simultaneously

26 / 50

26) A bruit is assessed by

A) Auscultation with a stethoscope

B) Palpation with fingertips

C) Compression of the access

D) Visual inspection alone

27 / 50

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

A) Respiratory rate

B) Heart rate

C) Temperature

D) Blood pressure

28 / 50

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

A) Skip assessment because symptoms are common

B) Start session right away

C) Increase dialysate flow rate

D) Weigh patient to assess fluid overload

29 / 50

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

A) Stop the pump immediately

B) Assess blood pressure and ask about tingling

C) Increase dialysate sodium

D) Check serum potassium level

30 / 50

30) Adequate dialysis is MOST accurately measured by

A) Kt/V or URR values

B) Patient feeling well

C) Postweight alone

D) Color of dialysate

31 / 50

31) The primary reason for rotating cannulation sites is to

A) Shorten treatment time

B) Lower dialyzer reuse cost

C) Allow vessel healing and prevent aneurysms

D) Reduce staff workload

32 / 50

32) 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

33 / 50

33) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Hypertension near session end

C) Cool, clammy skin post-dialysis

D) Cramps after two hours

34 / 50

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

A) Dislodged needle or line separation

B) Dialyzer clotting

C) Air in the arterial line

D) Conductivity error

35 / 50

35) The correct order for disconnecting bloodlines is

A) Venous line, then arterial line

B) Either order is fine

C) Arterial line, then venous line

D) Both simultaneously

36 / 50

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

A) Normal saline

B) Chlorhexidine 2 % with alcohol

C) Tap water and soap

D) Hydrogen peroxide 3 %

37 / 50

37) Proper needle bevel orientation on entry should be

A) Orientation doesn’t matter

B) Bevel sideways to reduce infiltration

C) Bevel up to ease vessel entry

D) Bevel down to reduce pain

38 / 50

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

A) Stenosis needing further evaluation

B) Hypotension

C) Dialyzer clotting

D) Good blood flow

39 / 50

39) 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

40 / 50

40) Proper hand hygiene before gloving involves

A) Sanitizer only when visibly soiled

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

C) Skipping if gloves are clean

D) 5-second rinse with water only

41 / 50

41) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Pruritus on non-dialysis days

B) Sudden severe headache, nausea, restlessness

C) Gradual blurred vision post-dialysis

D) Persistent dry cough

42 / 50

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

A) Serum albumin

B) Predialysis potassium

C) Fasting glucose

D) LDL cholesterol

43 / 50

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

A) 15–20 degrees

B) 90 degrees

C) 60–75 degrees

D) 30–45 degrees

44 / 50

44) 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

45 / 50

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

A) Slight discoloration only

B) Absence of bruit

C) Warmth, redness, swelling, and drainage

D) Loud continuous thrill

46 / 50

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

A) Adequate oxygenation

B) Normal vascular tone

C) Possible hypoxemia; notify nurse

D) Dialyzer clotting

47 / 50

47) 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) Administer extra heparin

D) Increase dialysate temperature

48 / 50

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

A) 16 G

B) 14 G

C) 20 G

D) 18 G

49 / 50

49) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Elevate the arm above the head

C) Massage the site vigorously

D) Apply firm pressure with a clean gauze

50 / 50

50) 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

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