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) Orientation doesn’t matter

B) Bevel up to ease vessel entry

C) Bevel sideways to reduce infiltration

D) Bevel down to reduce pain

2 / 50

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

A) Respiratory rate

B) Blood pressure

C) Heart rate

D) Temperature

3 / 50

3) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Prevent clotting in the extracorporeal circuit

C) Correct hypocalcemia

D) Increase ultrafiltration

4 / 50

4) The FIRST sign of an air embolism may be

A) Hypertension

B) Severe headache

C) Polyuria

D) Chest pain and coughing

5 / 50

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

A) After the dialyzer

B) Before the blood pump

C) At the venous drip chamber

D) Inside the dialysate circuit

6 / 50

6) Proper hand hygiene before gloving involves

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

B) Sanitizer only when visibly soiled

C) Skipping if gloves are clean

D) 5-second rinse with water only

7 / 50

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

A) Discarded in approved sharps container immediately

B) Bent before disposal

C) Placed on chairside table temporarily

D) Recapped carefully

8 / 50

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

A) Check serum potassium level

B) Stop the pump immediately

C) Increase dialysate sodium

D) Assess blood pressure and ask about tingling

9 / 50

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

A) Venous needle first

B) Arterial needle first

C) Both simultaneously

D) Whichever is bleeding more

10 / 50

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

A) Increase ultrafiltration rate

B) Lower the ultrafiltration rate and assess blood pressure

C) Administer heparin

D) Stop the treatment permanently

11 / 50

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

A) Adequate oxygenation

B) Possible hypoxemia; notify nurse

C) Normal vascular tone

D) Dialyzer clotting

12 / 50

12) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Itching and wheezing within first 15 minutes

C) Hypertension near session end

D) Cramps after two hours

13 / 50

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

A) 90 degrees

B) 15–20 degrees

C) 30–45 degrees

D) 60–75 degrees

14 / 50

14) 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

15 / 50

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

A) Inspecting dialyzer labels

B) Reviewing physician orders

C) Checking last month’s Kt/V

D) Palpating for a thrill

16 / 50

16) Which intervention helps prevent hypotension during dialysis?

A) Starting with low dialysate sodium

B) Skipping mid-treatment vitals

C) Profiling ultrafiltration rate

D) Using cold dialysate for all patients

17 / 50

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

A) Adequate fluid removal

B) Hyperkalemia correction

C) Possible fluid overload and need for dietary review

D) Anemia management success

18 / 50

18) The primary reason for rotating cannulation sites is to

A) Shorten treatment time

B) Allow vessel healing and prevent aneurysms

C) Lower dialyzer reuse cost

D) Reduce staff workload

19 / 50

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

A) Gloves only

B) Gloves and a mask with eye shield

C) Apron only

D) Hair cover only

20 / 50

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

A) Reduce cramping

B) Avoid post-dialysis bleeding

C) Increase adequacy

D) Prevent clotting in the dialyzer

21 / 50

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

A) Skip assessment because symptoms are common

B) Weigh patient to assess fluid overload

C) Start session right away

D) Increase dialysate flow rate

22 / 50

22) When should the technician document vital signs?

A) Whenever convenient

B) Only pre- and post-dialysis

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

D) Once at the end

23 / 50

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

A) Increase dialysate temperature

B) Give acetaminophen and continue

C) Stop dialysis and obtain blood cultures

D) Administer extra heparin

24 / 50

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

A) 18 G

B) 16 G

C) 14 G

D) 20 G

25 / 50

25) Adequate dialysis is MOST accurately measured by

A) Kt/V or URR values

B) Color of dialysate

C) Patient feeling well

D) Postweight alone

26 / 50

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

A) Hypotension

B) Stenosis needing further evaluation

C) Dialyzer clotting

D) Good blood flow

27 / 50

27) Before starting treatment, bloodlines are primed to

A) Warm the dialyzer

B) Increase dialysate conductivity

C) Remove air and sterilant residue

D) Calibrate the machine scales

28 / 50

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

A) Explain risks, document refusal, and notify nurse

B) Ignore refusal and end session

C) Force completion under policy

D) Double next session’s UF

29 / 50

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

A) Dialyzer clotting

B) Steal syndrome and alert the nurse immediately

C) Hypervolemia

D) Air embolism

30 / 50

30) 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

31 / 50

31) Which finding warrants HOLDING heparin before treatment?

A) Heart rate 88 bpm

B) Hemoglobin 11 g/dL

C) Platelets 50 × 10⁹/L

D) Serum sodium 137 mEq/L

32 / 50

32) 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

33 / 50

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

A) Slight discoloration only

B) Warmth, redness, swelling, and drainage

C) Absence of bruit

D) Loud continuous thrill

34 / 50

34) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Apply firm pressure with a clean gauze

C) Massage the site vigorously

D) Elevate the arm above the head

35 / 50

35) A bruit is assessed by

A) Visual inspection alone

B) Compression of the access

C) Palpation with fingertips

D) Auscultation with a stethoscope

36 / 50

36) The best cannulation technique for a mature fistula is

A) Buttonhole for every treatment

B) Rope-ladder rotating sites along the vessel

C) Area technique in one spot

D) Random needle placement

37 / 50

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

A) Check the name on their dialysis chair

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

C) Recognize their face from last week

D) Ask, “Are you Mr. Smith?”

38 / 50

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

A) Conductivity error

B) Dislodged needle or line separation

C) Dialyzer clotting

D) Air in the arterial line

39 / 50

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

A) Too small needle gauge

B) Hypotension

C) Heparin given too early

D) Low dialysate flow rate

40 / 50

40) The recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) 2–3 cm above needle site

C) Not used for fistulas

D) Below the venous needle site

41 / 50

41) 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) Ignore if bubbles are small

D) Increase blood flow to flush air

42 / 50

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

A) Add fluid for weight gain

B) Test dialysate pH

C) Lower serum phosphorus

D) Return as much blood as possible from the circuit

43 / 50

43) 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

44 / 50

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

A) Predialysis potassium

B) Fasting glucose

C) LDL cholesterol

D) Serum albumin

45 / 50

45) The correct order for disconnecting bloodlines is

A) Both simultaneously

B) Venous line, then arterial line

C) Either order is fine

D) Arterial line, then venous line

46 / 50

46) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Verify water softening

C) Confirm dialysate temperature

D) Test for bacteriologic contamination

47 / 50

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

A) Allowing the catheter caps to hang freely

B) Flushing only once per week

C) Using povidone-iodine ointment at exit site

D) Re-using dressings if still clean

48 / 50

48) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Sudden severe headache, nausea, restlessness

B) Pruritus on non-dialysis days

C) Persistent dry cough

D) Gradual blurred vision post-dialysis

49 / 50

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

A) Started with higher dialysate temperature

B) Begun after notifying the nurse and following fever protocol

C) Cancelled without notification

D) Continued as normal with more saline

50 / 50

50) During treatment, a rising arterial pressure usually signals

A) High dialysate temperature

B) Venous needle displacement

C) Tubing kink or clot before dialyzer

D) Machine in bypass

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