CCHT Clinical Practice Test 2026

Last Updated on May 13, 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) The recommended tourniquet placement for fistula cannulation is

A) 2–3 cm above needle site

B) Below the venous needle site

C) Not used for fistulas

D) Directly over the anastomosis

2 / 50

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

A) Started with higher dialysate temperature

B) Continued as normal with more saline

C) Begun after notifying the nurse and following fever protocol

D) Cancelled without notification

3 / 50

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

A) After the dialyzer

B) At the venous drip chamber

C) Inside the dialysate circuit

D) Before the blood pump

4 / 50

4) 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

5 / 50

5) Heparin is administered primarily to

A) Correct hypocalcemia

B) Increase ultrafiltration

C) Reduce blood pressure spikes

D) Prevent clotting in the extracorporeal circuit

6 / 50

6) During treatment, a rising arterial pressure usually signals

A) Machine in bypass

B) Venous needle displacement

C) Tubing kink or clot before dialyzer

D) High dialysate temperature

7 / 50

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

A) Indicator of infection

B) Normal and expected

C) Critically low; inform nurse promptly

D) Too high; extend dialysis

8 / 50

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

A) 16 G

B) 14 G

C) 20 G

D) 18 G

9 / 50

9) 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

10 / 50

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

A) Check the name on their dialysis chair

B) Recognize their face from last week

C) Ask, “Are you Mr. Smith?”

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

11 / 50

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

A) Arterial needle first

B) Whichever is bleeding more

C) Venous needle first

D) Both simultaneously

12 / 50

12) Which intervention helps prevent hypotension during dialysis?

A) Starting with low dialysate sodium

B) Skipping mid-treatment vitals

C) Using cold dialysate for all patients

D) Profiling ultrafiltration rate

13 / 50

13) Conductivity is checked before treatment mainly to

A) Test for bacteriologic contamination

B) Verify water softening

C) Ensure proper electrolyte concentration

D) Confirm dialysate temperature

14 / 50

14) Adequate dialysis is MOST accurately measured by

A) Kt/V or URR values

B) Color of dialysate

C) Patient feeling well

D) Postweight alone

15 / 50

15) Which symptom suggests an allergic reaction to dialyzer?

A) Hypertension near session end

B) Cramps after two hours

C) Itching and wheezing within first 15 minutes

D) Cool, clammy skin post-dialysis

16 / 50

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

A) Turn off heparin pump

B) Ignore if bubbles are small

C) Increase blood flow to flush air

D) Quickly clamp line and air-trap it

17 / 50

17) 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) Explain risks, document refusal, and notify nurse

D) Double next session’s UF

18 / 50

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

A) Recapped carefully

B) Discarded in approved sharps container immediately

C) Placed on chairside table temporarily

D) Bent before disposal

19 / 50

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

A) LDL cholesterol

B) Serum albumin

C) Predialysis potassium

D) Fasting glucose

20 / 50

20) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Sudden severe headache, nausea, restlessness

B) Gradual blurred vision post-dialysis

C) Pruritus on non-dialysis days

D) Persistent dry cough

21 / 50

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

A) Low dialysate flow rate

B) Hypotension

C) Heparin given too early

D) Too small needle gauge

22 / 50

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

A) Weigh patient to assess fluid overload

B) Increase dialysate flow rate

C) Skip assessment because symptoms are common

D) Start session right away

23 / 50

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

A) Stenosis needing further evaluation

B) Good blood flow

C) Hypotension

D) Dialyzer clotting

24 / 50

24) 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

25 / 50

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

A) Test dialysate pH

B) Lower serum phosphorus

C) Add fluid for weight gain

D) Return as much blood as possible from the circuit

26 / 50

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

A) Tap water and soap

B) Normal saline

C) Chlorhexidine 2 % with alcohol

D) Hydrogen peroxide 3 %

27 / 50

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

A) Flushing only once per week

B) Using povidone-iodine ointment at exit site

C) Re-using dressings if still clean

D) Allowing the catheter caps to hang freely

28 / 50

28) Which finding warrants HOLDING heparin before treatment?

A) Heart rate 88 bpm

B) Platelets 50 × 10⁹/L

C) Serum sodium 137 mEq/L

D) Hemoglobin 11 g/dL

29 / 50

29) The correct order for disconnecting bloodlines is

A) Venous line, then arterial line

B) Either order is fine

C) Both simultaneously

D) Arterial line, then venous line

30 / 50

30) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Elevate the arm above the head

C) Massage the site vigorously

D) Apply firm pressure with a clean gauze

31 / 50

31) When should the technician document vital signs?

A) Once at the end

B) Only pre- and post-dialysis

C) Whenever convenient

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

32 / 50

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

A) Air in the arterial line

B) Dialyzer clotting

C) Dislodged needle or line separation

D) Conductivity error

33 / 50

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

A) Possible fluid overload and need for dietary review

B) Hyperkalemia correction

C) Adequate fluid removal

D) Anemia management success

34 / 50

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

A) Respiratory rate

B) Heart rate

C) Blood pressure

D) Temperature

35 / 50

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

A) Reviewing physician orders

B) Inspecting dialyzer labels

C) Palpating for a thrill

D) Checking last month’s Kt/V

36 / 50

36) The best cannulation technique for a mature fistula is

A) Rope-ladder rotating sites along the vessel

B) Area technique in one spot

C) Random needle placement

D) Buttonhole for every treatment

37 / 50

37) 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

38 / 50

38) 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

39 / 50

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

A) Increase ultrafiltration rate

B) Administer heparin

C) Lower the ultrafiltration rate and assess blood pressure

D) Stop the treatment permanently

40 / 50

40) The primary reason for rotating cannulation sites is to

A) Reduce staff workload

B) Lower dialyzer reuse cost

C) Shorten treatment time

D) Allow vessel healing and prevent aneurysms

41 / 50

41) 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) Air embolism

D) Dialyzer clotting

42 / 50

42) 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

43 / 50

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

A) Gloves only

B) Gloves and a mask with eye shield

C) Hair cover only

D) Apron only

44 / 50

44) 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

45 / 50

45) 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

46 / 50

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

A) 15–20 degrees

B) 30–45 degrees

C) 60–75 degrees

D) 90 degrees

47 / 50

47) The FIRST sign of an air embolism may be

A) Hypertension

B) Polyuria

C) Chest pain and coughing

D) Severe headache

48 / 50

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

A) Slight discoloration only

B) Warmth, redness, swelling, and drainage

C) Loud continuous thrill

D) Absence of bruit

49 / 50

49) A bruit is assessed by

A) Compression of the access

B) Palpation with fingertips

C) Auscultation with a stethoscope

D) Visual inspection alone

50 / 50

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

A) Normal vascular tone

B) Adequate oxygenation

C) Dialyzer clotting

D) Possible hypoxemia; notify nurse

Your score is

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