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) Proper needle bevel orientation on entry should be

A) Bevel sideways to reduce infiltration

B) Orientation doesn’t matter

C) Bevel down to reduce pain

D) Bevel up to ease vessel entry

2 / 50

2) 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

3 / 50

3) 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) Force completion under policy

D) Double next session’s UF

4 / 50

4) Heparin is administered primarily to

A) Increase ultrafiltration

B) Correct hypocalcemia

C) Prevent clotting in the extracorporeal circuit

D) Reduce blood pressure spikes

5 / 50

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

A) Give acetaminophen and continue

B) Increase dialysate temperature

C) Administer extra heparin

D) Stop dialysis and obtain blood cultures

6 / 50

6) 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

7 / 50

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

A) Before the blood pump

B) Inside the dialysate circuit

C) At the venous drip chamber

D) After the dialyzer

8 / 50

8) The recommended tourniquet placement for fistula cannulation is

A) Not used for fistulas

B) Directly over the anastomosis

C) Below the venous needle site

D) 2–3 cm above needle site

9 / 50

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

A) Recognize their face from last week

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

C) Check the name on their dialysis chair

D) Ask, “Are you Mr. Smith?”

10 / 50

10) 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

11 / 50

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

A) Absence of bruit

B) Warmth, redness, swelling, and drainage

C) Loud continuous thrill

D) Slight discoloration only

12 / 50

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

A) Heart rate

B) Blood pressure

C) Temperature

D) Respiratory rate

13 / 50

13) The correct order for disconnecting bloodlines is

A) Venous line, then arterial line

B) Arterial line, then venous line

C) Either order is fine

D) Both simultaneously

14 / 50

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

A) Weigh patient to assess fluid overload

B) Start session right away

C) Skip assessment because symptoms are common

D) Increase dialysate flow rate

15 / 50

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

A) Serum albumin

B) Fasting glucose

C) Predialysis potassium

D) LDL cholesterol

16 / 50

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

A) Too small needle gauge

B) Heparin given too early

C) Hypotension

D) Low dialysate flow rate

17 / 50

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

A) Placed on chairside table temporarily

B) Discarded in approved sharps container immediately

C) Recapped carefully

D) Bent before disposal

18 / 50

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

A) Normal vascular tone

B) Dialyzer clotting

C) Adequate oxygenation

D) Possible hypoxemia; notify nurse

19 / 50

19) 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

20 / 50

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

A) Hypervolemia

B) Steal syndrome and alert the nurse immediately

C) Dialyzer clotting

D) Air embolism

21 / 50

21) The FIRST sign of an air embolism may be

A) Severe headache

B) Polyuria

C) Hypertension

D) Chest pain and coughing

22 / 50

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

A) Allowing the catheter caps to hang freely

B) Re-using dressings if still clean

C) Using povidone-iodine ointment at exit site

D) Flushing only once per week

23 / 50

23) Immediately after needle removal, the technician should

A) Apply firm pressure with a clean gauze

B) Cover with an adhesive bandage only

C) Elevate the arm above the head

D) Massage the site vigorously

24 / 50

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

A) Ask them to walk slowly

B) Send them home quickly

C) Seat or recline them and check blood pressure

D) Give food immediately

25 / 50

25) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Pruritus on non-dialysis days

B) Persistent dry cough

C) Gradual blurred vision post-dialysis

D) Sudden severe headache, nausea, restlessness

26 / 50

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

A) Speed the pump to clear clot

B) Tape it tighter

C) Continue; bruising will resolve

D) Stop blood pump and remove needle

27 / 50

27) A bruit is assessed by

A) Palpation with fingertips

B) Auscultation with a stethoscope

C) Compression of the access

D) Visual inspection alone

28 / 50

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

A) Hyperkalemia correction

B) Anemia management success

C) Possible fluid overload and need for dietary review

D) Adequate fluid removal

29 / 50

29) Conductivity is checked before treatment mainly to

A) Verify water softening

B) Ensure proper electrolyte concentration

C) Confirm dialysate temperature

D) Test for bacteriologic contamination

30 / 50

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

A) 20 G

B) 14 G

C) 16 G

D) 18 G

31 / 50

31) When should the technician document vital signs?

A) Once at the end

B) Whenever convenient

C) Only pre- and post-dialysis

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

32 / 50

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

A) Stop the treatment permanently

B) Administer heparin

C) Lower the ultrafiltration rate and assess blood pressure

D) Increase ultrafiltration rate

33 / 50

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

A) Ignore if bubbles are small

B) Turn off heparin pump

C) Increase blood flow to flush air

D) Quickly clamp line and air-trap it

34 / 50

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

A) Critically low; inform nurse promptly

B) Normal and expected

C) Too high; extend dialysis

D) Indicator of infection

35 / 50

35) 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

36 / 50

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

A) Hypotension

B) Stenosis needing further evaluation

C) Good blood flow

D) Dialyzer clotting

37 / 50

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

A) Dislodged needle or line separation

B) Conductivity error

C) Air in the arterial line

D) Dialyzer clotting

38 / 50

38) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Hypertension near session end

C) Cramps after two hours

D) Cool, clammy skin post-dialysis

39 / 50

39) Which finding warrants HOLDING heparin before treatment?

A) Platelets 50 × 10⁹/L

B) Serum sodium 137 mEq/L

C) Hemoglobin 11 g/dL

D) Heart rate 88 bpm

40 / 50

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

A) Return as much blood as possible from the circuit

B) Test dialysate pH

C) Add fluid for weight gain

D) Lower serum phosphorus

41 / 50

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

A) Stop the pump immediately

B) Check serum potassium level

C) Increase dialysate sodium

D) Assess blood pressure and ask about tingling

42 / 50

42) The best cannulation technique for a mature fistula is

A) Buttonhole for every treatment

B) Random needle placement

C) Area technique in one spot

D) Rope-ladder rotating sites along the vessel

43 / 50

43) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Shorten treatment time

C) Reduce staff workload

D) Allow vessel healing and prevent aneurysms

44 / 50

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

A) Tap water and soap

B) Hydrogen peroxide 3 %

C) Normal saline

D) Chlorhexidine 2 % with alcohol

45 / 50

45) Adequate dialysis is MOST accurately measured by

A) Color of dialysate

B) Patient feeling well

C) Kt/V or URR values

D) Postweight alone

46 / 50

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

A) Palpating for a thrill

B) Reviewing physician orders

C) Checking last month’s Kt/V

D) Inspecting dialyzer labels

47 / 50

47) During treatment, a rising arterial pressure usually signals

A) Tubing kink or clot before dialyzer

B) Venous needle displacement

C) Machine in bypass

D) High dialysate temperature

48 / 50

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

A) Apron only

B) Gloves only

C) Hair cover only

D) Gloves and a mask with eye shield

49 / 50

49) 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

50 / 50

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

A) 90 degrees

B) 30–45 degrees

C) 15–20 degrees

D) 60–75 degrees

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