CCHT Clinical Practice Test 2026

Last Updated on June 30, 2026

The Nephrology Nursing Certification Commission (NNCC) Certified Clinical Hemodialysis Technician (CCHT) Clinical Practice Test 2025 – Questions and Answers Quiz. In the actual test, this section consists of 71-78 multiple-choice questions, which is approximately 48–52%.

Questions in the Clinical area address patient care before, during, and after dialysis. 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 of these is a KEY sign of infection at an access site?

A) Warmth, redness, swelling, and drainage

B) Absence of bruit

C) Loud continuous thrill

D) Slight discoloration only

2 / 50

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

A) Dialyzer clotting

B) Air in the arterial line

C) Dislodged needle or line separation

D) Conductivity error

3 / 50

3) 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

4 / 50

4) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Confirm dialysate temperature

C) Verify water softening

D) Test for bacteriologic contamination

5 / 50

5) 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) Weigh patient to assess fluid overload

D) Increase dialysate flow rate

6 / 50

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

A) Normal and expected

B) Critically low; inform nurse promptly

C) Too high; extend dialysis

D) Indicator of infection

7 / 50

7) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Cool, clammy skin post-dialysis

C) Hypertension near session end

D) Cramps after two hours

8 / 50

8) Before starting treatment, bloodlines are primed to

A) Increase dialysate conductivity

B) Remove air and sterilant residue

C) Warm the dialyzer

D) Calibrate the machine scales

9 / 50

9) Which finding warrants HOLDING heparin before treatment?

A) Hemoglobin 11 g/dL

B) Platelets 50 × 10⁹/L

C) Heart rate 88 bpm

D) Serum sodium 137 mEq/L

10 / 50

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

A) Air embolism

B) Dialyzer clotting

C) Steal syndrome and alert the nurse immediately

D) Hypervolemia

11 / 50

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

A) Low dialysate flow rate

B) Heparin given too early

C) Hypotension

D) Too small needle gauge

12 / 50

12) 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

13 / 50

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

A) 30–45 degrees

B) 90 degrees

C) 60–75 degrees

D) 15–20 degrees

14 / 50

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

A) Fasting glucose

B) Serum albumin

C) LDL cholesterol

D) Predialysis potassium

15 / 50

15) Proper needle bevel orientation on entry should be

A) Orientation doesn’t matter

B) Bevel up to ease vessel entry

C) Bevel down to reduce pain

D) Bevel sideways to reduce infiltration

16 / 50

16) Immediately after needle removal, the technician should

A) Massage the site vigorously

B) Elevate the arm above the head

C) Cover with an adhesive bandage only

D) Apply firm pressure with a clean gauze

17 / 50

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

A) Hypotension

B) Dialyzer clotting

C) Stenosis needing further evaluation

D) Good blood flow

18 / 50

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

A) Turn off heparin pump

B) Increase blood flow to flush air

C) Ignore if bubbles are small

D) Quickly clamp line and air-trap it

19 / 50

19) 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

20 / 50

20) 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

21 / 50

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

A) Administer extra heparin

B) Give acetaminophen and continue

C) Increase dialysate temperature

D) Stop dialysis and obtain blood cultures

22 / 50

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

A) Using povidone-iodine ointment at exit site

B) Allowing the catheter caps to hang freely

C) Re-using dressings if still clean

D) Flushing only once per week

23 / 50

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

A) Continue; bruising will resolve

B) Speed the pump to clear clot

C) Tape it tighter

D) Stop blood pump and remove needle

24 / 50

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

A) Normal saline

B) Chlorhexidine 2 % with alcohol

C) Hydrogen peroxide 3 %

D) Tap water and soap

25 / 50

25) Which intervention helps prevent hypotension during dialysis?

A) Profiling ultrafiltration rate

B) Starting with low dialysate sodium

C) Skipping mid-treatment vitals

D) Using cold dialysate for all patients

26 / 50

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

A) Reviewing physician orders

B) Palpating for a thrill

C) Checking last month’s Kt/V

D) Inspecting dialyzer labels

27 / 50

27) 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

28 / 50

28) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Increase ultrafiltration

C) Prevent clotting in the extracorporeal circuit

D) Correct hypocalcemia

29 / 50

29) The FIRST sign of an air embolism may be

A) Polyuria

B) Severe headache

C) Hypertension

D) Chest pain and coughing

30 / 50

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

A) Inside the dialysate circuit

B) At the venous drip chamber

C) After the dialyzer

D) Before the blood pump

31 / 50

31) 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

32 / 50

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

A) 18 G

B) 14 G

C) 16 G

D) 20 G

33 / 50

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

A) Venous needle first

B) Whichever is bleeding more

C) Both simultaneously

D) Arterial needle first

34 / 50

34) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Gradual blurred vision post-dialysis

B) Persistent dry cough

C) Sudden severe headache, nausea, restlessness

D) Pruritus on non-dialysis days

35 / 50

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

A) Hair cover only

B) Gloves only

C) Gloves and a mask with eye shield

D) Apron only

36 / 50

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

A) Give food immediately

B) Send them home quickly

C) Seat or recline them and check blood pressure

D) Ask them to walk slowly

37 / 50

37) The best cannulation technique for a mature fistula is

A) Buttonhole for every treatment

B) Area technique in one spot

C) Random needle placement

D) Rope-ladder rotating sites along the vessel

38 / 50

38) The recommended tourniquet placement for fistula cannulation is

A) Below the venous needle site

B) Directly over the anastomosis

C) Not used for fistulas

D) 2–3 cm above needle site

39 / 50

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

A) Explain risks, document refusal, and notify nurse

B) Double next session’s UF

C) Ignore refusal and end session

D) Force completion under policy

40 / 50

40) The correct order for disconnecting bloodlines is

A) Venous line, then arterial line

B) Both simultaneously

C) Arterial line, then venous line

D) Either order is fine

41 / 50

41) Proper hand hygiene before gloving involves

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

B) Skipping if gloves are clean

C) Sanitizer only when visibly soiled

D) 5-second rinse with water only

42 / 50

42) A bruit is assessed by

A) Palpation with fingertips

B) Auscultation with a stethoscope

C) Visual inspection alone

D) Compression of the access

43 / 50

43) 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

44 / 50

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

A) Reduce cramping

B) Prevent clotting in the dialyzer

C) Increase adequacy

D) Avoid post-dialysis bleeding

45 / 50

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

A) Respiratory rate

B) Temperature

C) Blood pressure

D) Heart rate

46 / 50

46) During treatment, a rising arterial pressure usually signals

A) Tubing kink or clot before dialyzer

B) High dialysate temperature

C) Venous needle displacement

D) Machine in bypass

47 / 50

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

A) Recognize their face from last week

B) Check the name on their dialysis chair

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

D) Ask, “Are you Mr. Smith?”

48 / 50

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

A) Normal vascular tone

B) Dialyzer clotting

C) Adequate oxygenation

D) Possible hypoxemia; notify nurse

49 / 50

49) Adequate dialysis is MOST accurately measured by

A) Postweight alone

B) Color of dialysate

C) Patient feeling well

D) Kt/V or URR values

50 / 50

50) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Reduce staff workload

C) Allow vessel healing and prevent aneurysms

D) Shorten treatment time

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