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 recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) Below the venous needle site

C) 2–3 cm above needle site

D) Not used for fistulas

2 / 50

2) Adequate dialysis is MOST accurately measured by

A) Kt/V or URR values

B) Color of dialysate

C) Postweight alone

D) Patient feeling well

3 / 50

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

A) Flushing only once per week

B) Allowing the catheter caps to hang freely

C) Re-using dressings if still clean

D) Using povidone-iodine ointment at exit site

4 / 50

4) Conductivity is checked before treatment mainly to

A) Verify water softening

B) Test for bacteriologic contamination

C) Confirm dialysate temperature

D) Ensure proper electrolyte concentration

5 / 50

5) 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

6 / 50

6) 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

7 / 50

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

A) Quickly clamp line and air-trap it

B) Increase blood flow to flush air

C) Turn off heparin pump

D) Ignore if bubbles are small

8 / 50

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

A) 90 degrees

B) 60–75 degrees

C) 30–45 degrees

D) 15–20 degrees

9 / 50

9) Which intervention helps prevent hypotension during dialysis?

A) Profiling ultrafiltration rate

B) Skipping mid-treatment vitals

C) Using cold dialysate for all patients

D) Starting with low dialysate sodium

10 / 50

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

A) Increase adequacy

B) Reduce cramping

C) Prevent clotting in the dialyzer

D) Avoid post-dialysis bleeding

11 / 50

11) 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

12 / 50

12) The FIRST sign of an air embolism may be

A) Severe headache

B) Hypertension

C) Chest pain and coughing

D) Polyuria

13 / 50

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

A) Stenosis needing further evaluation

B) Dialyzer clotting

C) Hypotension

D) Good blood flow

14 / 50

14) A patient develops chills and a temperature rise to 39 °C during dialysis. The FIRST step is to

A) Give acetaminophen and continue

B) Stop dialysis and obtain blood cultures

C) Administer extra heparin

D) Increase dialysate temperature

15 / 50

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

A) Anemia management success

B) Possible fluid overload and need for dietary review

C) Hyperkalemia correction

D) Adequate fluid removal

16 / 50

16) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Persistent dry cough

B) Gradual blurred vision post-dialysis

C) Pruritus on non-dialysis days

D) Sudden severe headache, nausea, restlessness

17 / 50

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

A) Increase ultrafiltration rate

B) Stop the treatment permanently

C) Administer heparin

D) Lower the ultrafiltration rate and assess blood pressure

18 / 50

18) 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

19 / 50

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

A) Predialysis potassium

B) Fasting glucose

C) LDL cholesterol

D) Serum albumin

20 / 50

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

A) 14 G

B) 18 G

C) 16 G

D) 20 G

21 / 50

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

A) Send them home quickly

B) Ask them to walk slowly

C) Give food immediately

D) Seat or recline them and check blood pressure

22 / 50

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

A) Continue; bruising will resolve

B) Speed the pump to clear clot

C) Stop blood pump and remove needle

D) Tape it tighter

23 / 50

23) The best cannulation technique for a mature fistula is

A) Area technique in one spot

B) Random needle placement

C) Buttonhole for every treatment

D) Rope-ladder rotating sites along the vessel

24 / 50

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

A) Slight discoloration only

B) Absence of bruit

C) Loud continuous thrill

D) Warmth, redness, swelling, and drainage

25 / 50

25) Which finding warrants HOLDING heparin before treatment?

A) Platelets 50 × 10⁹/L

B) Hemoglobin 11 g/dL

C) Serum sodium 137 mEq/L

D) Heart rate 88 bpm

26 / 50

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

A) Hair cover only

B) Apron only

C) Gloves and a mask with eye shield

D) Gloves only

27 / 50

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

A) Placed on chairside table temporarily

B) Bent before disposal

C) Discarded in approved sharps container immediately

D) Recapped carefully

28 / 50

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

A) Conductivity error

B) Dialyzer clotting

C) Air in the arterial line

D) Dislodged needle or line separation

29 / 50

29) 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

30 / 50

30) A bruit is assessed by

A) Auscultation with a stethoscope

B) Compression of the access

C) Palpation with fingertips

D) Visual inspection alone

31 / 50

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

A) Both simultaneously

B) Arterial needle first

C) Whichever is bleeding more

D) Venous needle first

32 / 50

32) 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

33 / 50

33) The correct order for disconnecting bloodlines is

A) Arterial line, then venous line

B) Venous line, then arterial line

C) Either order is fine

D) Both simultaneously

34 / 50

34) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Cramps after two hours

C) Hypertension near session end

D) Cool, clammy skin post-dialysis

35 / 50

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

A) Tap water and soap

B) Normal saline

C) Hydrogen peroxide 3 %

D) Chlorhexidine 2 % with alcohol

36 / 50

36) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Allow vessel healing and prevent aneurysms

C) Shorten treatment time

D) Reduce staff workload

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

A) Increase dialysate sodium

B) Check serum potassium level

C) Assess blood pressure and ask about tingling

D) Stop the pump immediately

39 / 50

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

A) Ignore refusal and end session

B) Force completion under policy

C) Double next session’s UF

D) Explain risks, document refusal, and notify nurse

40 / 50

40) Immediately after needle removal, the technician should

A) Massage the site vigorously

B) Elevate the arm above the head

C) Apply firm pressure with a clean gauze

D) Cover with an adhesive bandage only

41 / 50

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

A) Continued as normal with more saline

B) Started with higher dialysate temperature

C) Cancelled without notification

D) Begun after notifying the nurse and following fever protocol

42 / 50

42) During treatment, a rising arterial pressure usually signals

A) Tubing kink or clot before dialyzer

B) Machine in bypass

C) Venous needle displacement

D) High dialysate temperature

43 / 50

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

A) Normal vascular tone

B) Dialyzer clotting

C) Adequate oxygenation

D) Possible hypoxemia; notify nurse

44 / 50

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

A) Test dialysate pH

B) Lower serum phosphorus

C) Add fluid for weight gain

D) Return as much blood as possible from the circuit

45 / 50

45) Proper hand hygiene before gloving involves

A) Skipping if gloves are clean

B) 5-second rinse with water only

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

D) Sanitizer only when visibly soiled

46 / 50

46) Before starting treatment, bloodlines are primed to

A) Warm the dialyzer

B) Calibrate the machine scales

C) Remove air and sterilant residue

D) Increase dialysate conductivity

47 / 50

47) Heparin is administered primarily to

A) Prevent clotting in the extracorporeal circuit

B) Increase ultrafiltration

C) Correct hypocalcemia

D) Reduce blood pressure spikes

48 / 50

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

A) Weigh patient to assess fluid overload

B) Increase dialysate flow rate

C) Start session right away

D) Skip assessment because symptoms are common

49 / 50

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

A) Critically low; inform nurse promptly

B) Too high; extend dialysis

C) Indicator of infection

D) Normal and expected

50 / 50

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

A) Temperature

B) Heart rate

C) Respiratory rate

D) Blood pressure

Your score is

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