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) 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

2 / 50

2) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Polyuria

C) Hypertension

D) Severe headache

3 / 50

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

A) Ask, “Are you Mr. Smith?”

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

C) Check the name on their dialysis chair

D) Recognize their face from last week

4 / 50

4) The best cannulation technique for a mature fistula is

A) Area technique in one spot

B) Buttonhole for every treatment

C) Rope-ladder rotating sites along the vessel

D) Random needle placement

5 / 50

5) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) High dialysate temperature

C) Machine in bypass

D) Tubing kink or clot before dialyzer

6 / 50

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

A) Fasting glucose

B) LDL cholesterol

C) Predialysis potassium

D) Serum albumin

7 / 50

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

A) Checking last month’s Kt/V

B) Palpating for a thrill

C) Inspecting dialyzer labels

D) Reviewing physician orders

8 / 50

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

A) Reduce cramping

B) Avoid post-dialysis bleeding

C) Prevent clotting in the dialyzer

D) Increase adequacy

9 / 50

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

A) Explain risks, document refusal, and notify nurse

B) Force completion under policy

C) Double next session’s UF

D) Ignore refusal and end session

10 / 50

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

A) Dialyzer clotting

B) Hypervolemia

C) Steal syndrome and alert the nurse immediately

D) Air embolism

11 / 50

11) The correct order for disconnecting bloodlines is

A) Either order is fine

B) Arterial line, then venous line

C) Both simultaneously

D) Venous line, then arterial line

12 / 50

12) Which symptom suggests an allergic reaction to dialyzer?

A) Cramps after two hours

B) Hypertension near session end

C) Itching and wheezing within first 15 minutes

D) Cool, clammy skin post-dialysis

13 / 50

13) When should the technician document vital signs?

A) Once at the end

B) Whenever convenient

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

D) Only pre- and post-dialysis

14 / 50

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

A) Re-using dressings if still clean

B) Using povidone-iodine ointment at exit site

C) Flushing only once per week

D) Allowing the catheter caps to hang freely

15 / 50

15) 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

16 / 50

16) Adequate dialysis is MOST accurately measured by

A) Postweight alone

B) Patient feeling well

C) Color of dialysate

D) Kt/V or URR values

17 / 50

17) Before starting treatment, bloodlines are primed to

A) Calibrate the machine scales

B) Increase dialysate conductivity

C) Remove air and sterilant residue

D) Warm the dialyzer

18 / 50

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

A) Temperature

B) Heart rate

C) Blood pressure

D) Respiratory rate

19 / 50

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

A) At the venous drip chamber

B) After the dialyzer

C) Inside the dialysate circuit

D) Before the blood pump

20 / 50

20) A bruit is assessed by

A) Compression of the access

B) Visual inspection alone

C) Palpation with fingertips

D) Auscultation with a stethoscope

21 / 50

21) 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

22 / 50

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

A) Possible hypoxemia; notify nurse

B) Adequate oxygenation

C) Normal vascular tone

D) Dialyzer clotting

23 / 50

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

A) Loud continuous thrill

B) Warmth, redness, swelling, and drainage

C) Slight discoloration only

D) Absence of bruit

24 / 50

24) Proper needle bevel orientation on entry should be

A) Bevel up to ease vessel entry

B) Orientation doesn’t matter

C) Bevel down to reduce pain

D) Bevel sideways to reduce infiltration

25 / 50

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

A) Critically low; inform nurse promptly

B) Normal and expected

C) Indicator of infection

D) Too high; extend dialysis

26 / 50

26) 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

27 / 50

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

A) Chlorhexidine 2 % with alcohol

B) Hydrogen peroxide 3 %

C) Tap water and soap

D) Normal saline

28 / 50

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

A) Increase dialysate sodium

B) Assess blood pressure and ask about tingling

C) Check serum potassium level

D) Stop the pump immediately

29 / 50

29) Immediately after needle removal, the technician should

A) Apply firm pressure with a clean gauze

B) Cover with an adhesive bandage only

C) Massage the site vigorously

D) Elevate the arm above the head

30 / 50

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

A) Possible fluid overload and need for dietary review

B) Anemia management success

C) Hyperkalemia correction

D) Adequate fluid removal

31 / 50

31) 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

32 / 50

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

A) Stop dialysis and obtain blood cultures

B) Increase dialysate temperature

C) Give acetaminophen and continue

D) Administer extra heparin

33 / 50

33) The primary reason for rotating cannulation sites is to

A) Shorten treatment time

B) Allow vessel healing and prevent aneurysms

C) Reduce staff workload

D) Lower dialyzer reuse cost

34 / 50

34) 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) Increase ultrafiltration rate

D) Administer heparin

35 / 50

35) Which intervention helps prevent hypotension during dialysis?

A) Using cold dialysate for all patients

B) Profiling ultrafiltration rate

C) Starting with low dialysate sodium

D) Skipping mid-treatment vitals

36 / 50

36) 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

37 / 50

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

A) 60–75 degrees

B) 15–20 degrees

C) 90 degrees

D) 30–45 degrees

38 / 50

38) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Test for bacteriologic contamination

C) Verify water softening

D) Confirm dialysate temperature

39 / 50

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

A) Good blood flow

B) Dialyzer clotting

C) Hypotension

D) Stenosis needing further evaluation

40 / 50

40) The recommended tourniquet placement for fistula cannulation is

A) Not used for fistulas

B) Below the venous needle site

C) Directly over the anastomosis

D) 2–3 cm above needle site

41 / 50

41) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Prevent clotting in the extracorporeal circuit

C) Correct hypocalcemia

D) Increase ultrafiltration

42 / 50

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

A) 20 G

B) 16 G

C) 18 G

D) 14 G

43 / 50

43) 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

44 / 50

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

A) Tape it tighter

B) Continue; bruising will resolve

C) Speed the pump to clear clot

D) Stop blood pump and remove needle

45 / 50

45) 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

46 / 50

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

A) Recapped carefully

B) Placed on chairside table temporarily

C) Bent before disposal

D) Discarded in approved sharps container immediately

47 / 50

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

A) Gloves and a mask with eye shield

B) Gloves only

C) Apron only

D) Hair cover only

48 / 50

48) 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) 5-second rinse with water only

D) Skipping if gloves are clean

49 / 50

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

A) Test dialysate pH

B) Return as much blood as possible from the circuit

C) Lower serum phosphorus

D) Add fluid for weight gain

50 / 50

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

A) Send them home quickly

B) Ask them to walk slowly

C) Seat or recline them and check blood pressure

D) Give food immediately

Your score is

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