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

A) Temperature

B) Blood pressure

C) Heart rate

D) Respiratory rate

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

A) Seat or recline them and check blood pressure

B) Give food immediately

C) Send them home quickly

D) Ask them to walk slowly

4 / 50

4) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) High dialysate temperature

C) Tubing kink or clot before dialyzer

D) Machine in bypass

5 / 50

5) The FIRST sign of an air embolism may be

A) Hypertension

B) Severe headache

C) Polyuria

D) Chest pain and coughing

6 / 50

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

A) Inspecting dialyzer labels

B) Palpating for a thrill

C) Reviewing physician orders

D) Checking last month’s Kt/V

7 / 50

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

A) LDL cholesterol

B) Fasting glucose

C) Predialysis potassium

D) Serum albumin

8 / 50

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

A) Hydrogen peroxide 3 %

B) Normal saline

C) Tap water and soap

D) Chlorhexidine 2 % with alcohol

9 / 50

9) When should the technician document vital signs?

A) Only pre- and post-dialysis

B) Once at the end

C) Whenever convenient

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

10 / 50

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

A) Increase dialysate flow rate

B) Start session right away

C) Skip assessment because symptoms are common

D) Weigh patient to assess fluid overload

11 / 50

11) 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

12 / 50

12) 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

13 / 50

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

A) Hypervolemia

B) Dialyzer clotting

C) Steal syndrome and alert the nurse immediately

D) Air embolism

14 / 50

14) The correct order for disconnecting bloodlines is

A) Either order is fine

B) Both simultaneously

C) Arterial line, then venous line

D) Venous line, then arterial line

15 / 50

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

A) Administer extra heparin

B) Stop dialysis and obtain blood cultures

C) Give acetaminophen and continue

D) Increase dialysate temperature

16 / 50

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

A) Inside the dialysate circuit

B) At the venous drip chamber

C) Before the blood pump

D) After the dialyzer

17 / 50

17) Which finding warrants HOLDING heparin before treatment?

A) Platelets 50 × 10⁹/L

B) Heart rate 88 bpm

C) Serum sodium 137 mEq/L

D) Hemoglobin 11 g/dL

18 / 50

18) 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

19 / 50

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

A) Discarded in approved sharps container immediately

B) Recapped carefully

C) Placed on chairside table temporarily

D) Bent before disposal

20 / 50

20) Heparin is administered primarily to

A) Correct hypocalcemia

B) Reduce blood pressure spikes

C) Increase ultrafiltration

D) Prevent clotting in the extracorporeal circuit

21 / 50

21) Conductivity is checked before treatment mainly to

A) Confirm dialysate temperature

B) Ensure proper electrolyte concentration

C) Test for bacteriologic contamination

D) Verify water softening

22 / 50

22) A bruit is assessed by

A) Visual inspection alone

B) Compression of the access

C) Palpation with fingertips

D) Auscultation with a stethoscope

23 / 50

23) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Kt/V or URR values

C) Postweight alone

D) Color of dialysate

24 / 50

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

A) Continued as normal with more saline

B) Cancelled without notification

C) Started with higher dialysate temperature

D) Begun after notifying the nurse and following fever protocol

25 / 50

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

A) Loud continuous thrill

B) Warmth, redness, swelling, and drainage

C) Absence of bruit

D) Slight discoloration only

26 / 50

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

A) Heparin given too early

B) Hypotension

C) Too small needle gauge

D) Low dialysate flow rate

27 / 50

27) 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

28 / 50

28) Proper needle bevel orientation on entry should be

A) Bevel down to reduce pain

B) Orientation doesn’t matter

C) Bevel sideways to reduce infiltration

D) Bevel up to ease vessel entry

29 / 50

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

A) 18 G

B) 14 G

C) 16 G

D) 20 G

30 / 50

30) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Gradual blurred vision post-dialysis

B) Persistent dry cough

C) Pruritus on non-dialysis days

D) Sudden severe headache, nausea, restlessness

31 / 50

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

A) Adequate oxygenation

B) Dialyzer clotting

C) Normal vascular tone

D) Possible hypoxemia; notify nurse

32 / 50

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

A) Stenosis needing further evaluation

B) Hypotension

C) Good blood flow

D) Dialyzer clotting

33 / 50

33) 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) Stop the treatment permanently

D) Administer heparin

34 / 50

34) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

B) Sanitizer only when visibly soiled

C) Skipping if gloves are clean

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

35 / 50

35) Immediately after needle removal, the technician should

A) Massage the site vigorously

B) Apply firm pressure with a clean gauze

C) Elevate the arm above the head

D) Cover with an adhesive bandage only

36 / 50

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

A) Adequate fluid removal

B) Possible fluid overload and need for dietary review

C) Hyperkalemia correction

D) Anemia management success

37 / 50

37) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Cramps after two hours

C) Cool, clammy skin post-dialysis

D) Hypertension near session end

38 / 50

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

A) Whichever is bleeding more

B) Venous needle first

C) Arterial needle first

D) Both simultaneously

39 / 50

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

A) Allowing the catheter caps to hang freely

B) Flushing only once per week

C) Re-using dressings if still clean

D) Using povidone-iodine ointment at exit site

40 / 50

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

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

B) Check the name on their dialysis chair

C) Recognize their face from last week

D) Ask, “Are you Mr. Smith?”

41 / 50

41) The best cannulation technique for a mature fistula is

A) Buttonhole for every treatment

B) Area technique in one spot

C) Rope-ladder rotating sites along the vessel

D) Random needle placement

42 / 50

42) 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

43 / 50

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

A) Prevent clotting in the dialyzer

B) Increase adequacy

C) Reduce cramping

D) Avoid post-dialysis bleeding

44 / 50

44) 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

45 / 50

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

A) Tape it tighter

B) Stop blood pump and remove needle

C) Speed the pump to clear clot

D) Continue; bruising will resolve

46 / 50

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

A) Return as much blood as possible from the circuit

B) Add fluid for weight gain

C) Lower serum phosphorus

D) Test dialysate pH

47 / 50

47) 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

48 / 50

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

A) Stop the pump immediately

B) Check serum potassium level

C) Assess blood pressure and ask about tingling

D) Increase dialysate sodium

49 / 50

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

A) 60–75 degrees

B) 30–45 degrees

C) 15–20 degrees

D) 90 degrees

50 / 50

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

A) Apron only

B) Hair cover only

C) Gloves and a mask with eye shield

D) Gloves only

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