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 MOST appropriate antiseptic for prepping intact skin before needle insertion is

A) Chlorhexidine 2 % with alcohol

B) Tap water and soap

C) Hydrogen peroxide 3 %

D) Normal saline

2 / 50

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

A) 14 G

B) 20 G

C) 18 G

D) 16 G

3 / 50

3) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) Machine in bypass

C) High dialysate temperature

D) Tubing kink or clot before dialyzer

4 / 50

4) 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

5 / 50

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

A) Apron only

B) Gloves and a mask with eye shield

C) Hair cover only

D) Gloves only

6 / 50

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

A) Tape it tighter

B) Speed the pump to clear clot

C) Continue; bruising will resolve

D) Stop blood pump and remove needle

7 / 50

7) The recommended tourniquet placement for fistula cannulation is

A) Not used for fistulas

B) 2–3 cm above needle site

C) Directly over the anastomosis

D) Below the venous needle site

8 / 50

8) Proper needle bevel orientation on entry should be

A) Bevel up to ease vessel entry

B) Bevel down to reduce pain

C) Orientation doesn’t matter

D) Bevel sideways to reduce infiltration

9 / 50

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

A) Hypotension

B) Too small needle gauge

C) Heparin given too early

D) Low dialysate flow rate

10 / 50

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

A) Stenosis needing further evaluation

B) Hypotension

C) Good blood flow

D) Dialyzer clotting

11 / 50

11) Immediately after needle removal, the technician should

A) Apply firm pressure with a clean gauze

B) Massage the site vigorously

C) Elevate the arm above the head

D) Cover with an adhesive bandage only

12 / 50

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

A) Dialyzer clotting

B) Normal vascular tone

C) Possible hypoxemia; notify nurse

D) Adequate oxygenation

13 / 50

13) 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

14 / 50

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

A) Temperature

B) Blood pressure

C) Heart rate

D) Respiratory rate

15 / 50

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

A) Lower serum phosphorus

B) Add fluid for weight gain

C) Return as much blood as possible from the circuit

D) Test dialysate pH

16 / 50

16) 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

17 / 50

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

A) Give food immediately

B) Seat or recline them and check blood pressure

C) Ask them to walk slowly

D) Send them home quickly

18 / 50

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

A) At the venous drip chamber

B) After the dialyzer

C) Before the blood pump

D) Inside the dialysate circuit

19 / 50

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

A) Conductivity error

B) Air in the arterial line

C) Dislodged needle or line separation

D) Dialyzer clotting

20 / 50

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

A) Serum albumin

B) Predialysis potassium

C) Fasting glucose

D) LDL cholesterol

21 / 50

21) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Pruritus on non-dialysis days

B) Persistent dry cough

C) Sudden severe headache, nausea, restlessness

D) Gradual blurred vision post-dialysis

22 / 50

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

A) Quickly clamp line and air-trap it

B) Turn off heparin pump

C) Increase blood flow to flush air

D) Ignore if bubbles are small

23 / 50

23) 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

24 / 50

24) 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

25 / 50

25) The correct order for disconnecting bloodlines is

A) Either order is fine

B) Venous line, then arterial line

C) Both simultaneously

D) Arterial line, then venous line

26 / 50

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

A) 60–75 degrees

B) 90 degrees

C) 15–20 degrees

D) 30–45 degrees

27 / 50

27) A bruit is assessed by

A) Compression of the access

B) Visual inspection alone

C) Auscultation with a stethoscope

D) Palpation with fingertips

28 / 50

28) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Severe headache

C) Hypertension

D) Polyuria

29 / 50

29) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Shorten treatment time

C) Allow vessel healing and prevent aneurysms

D) Reduce staff workload

30 / 50

30) 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) Started with higher dialysate temperature

D) Cancelled without notification

31 / 50

31) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Correct hypocalcemia

C) Prevent clotting in the extracorporeal circuit

D) Increase ultrafiltration

32 / 50

32) Which intervention helps prevent hypotension during dialysis?

A) Skipping mid-treatment vitals

B) Starting with low dialysate sodium

C) Profiling ultrafiltration rate

D) Using cold dialysate for all patients

33 / 50

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

A) Recapped carefully

B) Placed on chairside table temporarily

C) Discarded in approved sharps container immediately

D) Bent before disposal

34 / 50

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

A) Double next session’s UF

B) Ignore refusal and end session

C) Explain risks, document refusal, and notify nurse

D) Force completion under policy

35 / 50

35) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Postweight alone

C) Kt/V or URR values

D) Color of dialysate

36 / 50

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

A) Arterial needle first

B) Both simultaneously

C) Whichever is bleeding more

D) Venous needle first

37 / 50

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

A) Prevent clotting in the dialyzer

B) Avoid post-dialysis bleeding

C) Reduce cramping

D) Increase adequacy

38 / 50

38) Proper hand hygiene before gloving involves

A) Skipping if gloves are clean

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

C) 5-second rinse with water only

D) Sanitizer only when visibly soiled

39 / 50

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

A) Hyperkalemia correction

B) Adequate fluid removal

C) Possible fluid overload and need for dietary review

D) Anemia management success

40 / 50

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

A) Stop the pump immediately

B) Increase dialysate sodium

C) Check serum potassium level

D) Assess blood pressure and ask about tingling

41 / 50

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

A) Administer extra heparin

B) Increase dialysate temperature

C) Give acetaminophen and continue

D) Stop dialysis and obtain blood cultures

42 / 50

42) Conductivity is checked before treatment mainly to

A) Confirm dialysate temperature

B) Test for bacteriologic contamination

C) Verify water softening

D) Ensure proper electrolyte concentration

43 / 50

43) 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

44 / 50

44) Which finding warrants HOLDING heparin before treatment?

A) Serum sodium 137 mEq/L

B) Platelets 50 × 10⁹/L

C) Heart rate 88 bpm

D) Hemoglobin 11 g/dL

45 / 50

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

A) Inspecting dialyzer labels

B) Reviewing physician orders

C) Palpating for a thrill

D) Checking last month’s Kt/V

46 / 50

46) 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

47 / 50

47) When should the technician document vital signs?

A) Whenever convenient

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

C) Only pre- and post-dialysis

D) Once at the end

48 / 50

48) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Hypertension near session end

C) Itching and wheezing within first 15 minutes

D) Cramps after two hours

49 / 50

49) 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

50 / 50

50) 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

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