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) Post-treatment potassium of 2.8 mEq/L is

A) Indicator of infection

B) Critically low; inform nurse promptly

C) Too high; extend dialysis

D) Normal and expected

2 / 50

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

A) Normal vascular tone

B) Adequate oxygenation

C) Possible hypoxemia; notify nurse

D) Dialyzer clotting

3 / 50

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

A) Anemia management success

B) Possible fluid overload and need for dietary review

C) Adequate fluid removal

D) Hyperkalemia correction

4 / 50

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

A) Ignore if bubbles are small

B) Increase blood flow to flush air

C) Turn off heparin pump

D) Quickly clamp line and air-trap it

5 / 50

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

A) Venous needle first

B) Whichever is bleeding more

C) Arterial needle first

D) Both simultaneously

6 / 50

6) 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

7 / 50

7) Heparin is administered primarily to

A) Increase ultrafiltration

B) Reduce blood pressure spikes

C) Prevent clotting in the extracorporeal circuit

D) Correct hypocalcemia

8 / 50

8) 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

9 / 50

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

A) Hair cover only

B) Gloves only

C) Apron only

D) Gloves and a mask with eye shield

10 / 50

10) 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) Administer extra heparin

C) Give acetaminophen and continue

D) Increase dialysate temperature

11 / 50

11) The FIRST sign of an air embolism may be

A) Hypertension

B) Chest pain and coughing

C) Severe headache

D) Polyuria

12 / 50

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

A) Good blood flow

B) Hypotension

C) Dialyzer clotting

D) Stenosis needing further evaluation

13 / 50

13) 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

14 / 50

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

A) 30–45 degrees

B) 15–20 degrees

C) 60–75 degrees

D) 90 degrees

15 / 50

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

A) Return as much blood as possible from the circuit

B) Lower serum phosphorus

C) Test dialysate pH

D) Add fluid for weight gain

16 / 50

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

A) Low dialysate flow rate

B) Heparin given too early

C) Too small needle gauge

D) Hypotension

17 / 50

17) 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

18 / 50

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

A) Absence of bruit

B) Warmth, redness, swelling, and drainage

C) Loud continuous thrill

D) Slight discoloration only

19 / 50

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

A) Increase adequacy

B) Reduce cramping

C) Avoid post-dialysis bleeding

D) Prevent clotting in the dialyzer

20 / 50

20) 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

21 / 50

21) 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

22 / 50

22) 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

23 / 50

23) The best cannulation technique for a mature fistula is

A) Rope-ladder rotating sites along the vessel

B) Random needle placement

C) Area technique in one spot

D) Buttonhole for every treatment

24 / 50

24) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Test for bacteriologic contamination

C) Confirm dialysate temperature

D) Verify water softening

25 / 50

25) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Pruritus on non-dialysis days

B) Gradual blurred vision post-dialysis

C) Sudden severe headache, nausea, restlessness

D) Persistent dry cough

26 / 50

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

A) Inspecting dialyzer labels

B) Reviewing physician orders

C) Checking last month’s Kt/V

D) Palpating for a thrill

27 / 50

27) Immediately after needle removal, the technician should

A) Massage the site vigorously

B) Cover with an adhesive bandage only

C) Elevate the arm above the head

D) Apply firm pressure with a clean gauze

28 / 50

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

A) Skip assessment because symptoms are common

B) Increase dialysate flow rate

C) Start session right away

D) Weigh patient to assess fluid overload

29 / 50

29) Adequate dialysis is MOST accurately measured by

A) Postweight alone

B) Color of dialysate

C) Kt/V or URR values

D) Patient feeling well

30 / 50

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

A) Stop the treatment permanently

B) Increase ultrafiltration rate

C) Administer heparin

D) Lower the ultrafiltration rate and assess blood pressure

31 / 50

31) A bruit is assessed by

A) Compression of the access

B) Auscultation with a stethoscope

C) Visual inspection alone

D) Palpation with fingertips

32 / 50

32) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Cramps after two hours

C) Itching and wheezing within first 15 minutes

D) Hypertension near session end

33 / 50

33) The recommended tourniquet placement for fistula cannulation is

A) 2–3 cm above needle site

B) Directly over the anastomosis

C) Not used for fistulas

D) Below the venous needle site

34 / 50

34) 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

35 / 50

35) 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

36 / 50

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

A) Increase dialysate sodium

B) Stop the pump immediately

C) Assess blood pressure and ask about tingling

D) Check serum potassium level

37 / 50

37) Before starting treatment, bloodlines are primed to

A) Warm the dialyzer

B) Remove air and sterilant residue

C) Calibrate the machine scales

D) Increase dialysate conductivity

38 / 50

38) 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

39 / 50

39) Which finding warrants HOLDING heparin before treatment?

A) Hemoglobin 11 g/dL

B) Platelets 50 × 10⁹/L

C) Serum sodium 137 mEq/L

D) Heart rate 88 bpm

40 / 50

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

A) After the dialyzer

B) Inside the dialysate circuit

C) At the venous drip chamber

D) Before the blood pump

41 / 50

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

A) Air in the arterial line

B) Dislodged needle or line separation

C) Conductivity error

D) Dialyzer clotting

42 / 50

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

A) LDL cholesterol

B) Serum albumin

C) Fasting glucose

D) Predialysis potassium

43 / 50

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

A) Check the name on their dialysis chair

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

C) Ask, “Are you Mr. Smith?”

D) Recognize their face from last week

44 / 50

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

A) Tap water and soap

B) Chlorhexidine 2 % with alcohol

C) Hydrogen peroxide 3 %

D) Normal saline

45 / 50

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

A) Heart rate

B) Blood pressure

C) Respiratory rate

D) Temperature

46 / 50

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

A) 14 G

B) 16 G

C) 18 G

D) 20 G

47 / 50

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

A) Speed the pump to clear clot

B) Tape it tighter

C) Stop blood pump and remove needle

D) Continue; bruising will resolve

48 / 50

48) 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) Ignore refusal and end session

D) Double next session’s UF

49 / 50

49) 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

50 / 50

50) 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

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