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

A) Predialysis potassium

B) LDL cholesterol

C) Fasting glucose

D) Serum albumin

2 / 50

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

A) Good blood flow

B) Stenosis needing further evaluation

C) Dialyzer clotting

D) Hypotension

3 / 50

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

A) Turn off heparin pump

B) Quickly clamp line and air-trap it

C) Increase blood flow to flush air

D) Ignore if bubbles are small

4 / 50

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

A) Lower the ultrafiltration rate and assess blood pressure

B) Stop the treatment permanently

C) Administer heparin

D) Increase ultrafiltration rate

5 / 50

5) 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

6 / 50

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

A) Continued as normal with more saline

B) Begun after notifying the nurse and following fever protocol

C) Cancelled without notification

D) Started with higher dialysate temperature

7 / 50

7) When should the technician document vital signs?

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

B) Once at the end

C) Whenever convenient

D) Only pre- and post-dialysis

8 / 50

8) 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

9 / 50

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

A) Too high; extend dialysis

B) Indicator of infection

C) Critically low; inform nurse promptly

D) Normal and expected

10 / 50

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

A) Re-using dressings if still clean

B) Flushing only once per week

C) Using povidone-iodine ointment at exit site

D) Allowing the catheter caps to hang freely

11 / 50

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

A) Arterial needle first

B) Both simultaneously

C) Venous needle first

D) Whichever is bleeding more

12 / 50

12) Which intervention helps prevent hypotension during dialysis?

A) Skipping mid-treatment vitals

B) Profiling ultrafiltration rate

C) Using cold dialysate for all patients

D) Starting with low dialysate sodium

13 / 50

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

A) Dialyzer clotting

B) Hypervolemia

C) Air embolism

D) Steal syndrome and alert the nurse immediately

14 / 50

14) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Itching and wheezing within first 15 minutes

C) Hypertension near session end

D) Cramps after two hours

15 / 50

15) The recommended tourniquet placement for fistula cannulation is

A) 2–3 cm above needle site

B) Directly over the anastomosis

C) Below the venous needle site

D) Not used for fistulas

16 / 50

16) 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

17 / 50

17) 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

18 / 50

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

A) Check serum potassium level

B) Stop the pump immediately

C) Increase dialysate sodium

D) Assess blood pressure and ask about tingling

19 / 50

19) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Increase ultrafiltration

C) Prevent clotting in the extracorporeal circuit

D) Correct hypocalcemia

20 / 50

20) 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

21 / 50

21) 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) Start session right away

D) Skip assessment because symptoms are common

22 / 50

22) Immediately after needle removal, the technician should

A) Apply firm pressure with a clean gauze

B) Cover with an adhesive bandage only

C) Elevate the arm above the head

D) Massage the site vigorously

23 / 50

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

A) Normal vascular tone

B) Adequate oxygenation

C) Dialyzer clotting

D) Possible hypoxemia; notify nurse

24 / 50

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

A) Too small needle gauge

B) Low dialysate flow rate

C) Heparin given too early

D) Hypotension

25 / 50

25) Which finding warrants HOLDING heparin before treatment?

A) Hemoglobin 11 g/dL

B) Heart rate 88 bpm

C) Platelets 50 × 10⁹/L

D) Serum sodium 137 mEq/L

26 / 50

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

A) Give food immediately

B) Send them home quickly

C) Ask them to walk slowly

D) Seat or recline them and check blood pressure

27 / 50

27) 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

28 / 50

28) The correct order for disconnecting bloodlines is

A) Both simultaneously

B) Arterial line, then venous line

C) Either order is fine

D) Venous line, then arterial line

29 / 50

29) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Postweight alone

C) Kt/V or URR values

D) Color of dialysate

30 / 50

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

A) Recognize their face from last week

B) Ask, “Are you Mr. Smith?”

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

D) Check the name on their dialysis chair

31 / 50

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

A) Recapped carefully

B) Bent before disposal

C) Placed on chairside table temporarily

D) Discarded in approved sharps container immediately

32 / 50

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

A) Heart rate

B) Blood pressure

C) Respiratory rate

D) Temperature

33 / 50

33) 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

34 / 50

34) Before starting treatment, bloodlines are primed to

A) Remove air and sterilant residue

B) Warm the dialyzer

C) Calibrate the machine scales

D) Increase dialysate conductivity

35 / 50

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

A) Checking last month’s Kt/V

B) Reviewing physician orders

C) Palpating for a thrill

D) Inspecting dialyzer labels

36 / 50

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

A) Speed the pump to clear clot

B) Tape it tighter

C) Continue; bruising will resolve

D) Stop blood pump and remove needle

37 / 50

37) Conductivity is checked before treatment mainly to

A) Test for bacteriologic contamination

B) Ensure proper electrolyte concentration

C) Confirm dialysate temperature

D) Verify water softening

38 / 50

38) A bruit is assessed by

A) Auscultation with a stethoscope

B) Palpation with fingertips

C) Compression of the access

D) Visual inspection alone

39 / 50

39) 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

40 / 50

40) 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

41 / 50

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

A) After the dialyzer

B) Before the blood pump

C) At the venous drip chamber

D) Inside the dialysate circuit

42 / 50

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

A) Adequate fluid removal

B) Hyperkalemia correction

C) Possible fluid overload and need for dietary review

D) Anemia management success

43 / 50

43) The FIRST sign of an air embolism may be

A) Polyuria

B) Chest pain and coughing

C) Hypertension

D) Severe headache

44 / 50

44) During treatment, a rising arterial pressure usually signals

A) Tubing kink or clot before dialyzer

B) Machine in bypass

C) Venous needle displacement

D) High dialysate temperature

45 / 50

45) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

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

C) Sanitizer only when visibly soiled

D) Skipping if gloves are clean

46 / 50

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

A) 16 G

B) 20 G

C) 18 G

D) 14 G

47 / 50

47) The best cannulation technique for a mature fistula is

A) Buttonhole for every treatment

B) Random needle placement

C) Area technique in one spot

D) Rope-ladder rotating sites along the vessel

48 / 50

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

A) Gloves and a mask with eye shield

B) Apron only

C) Hair cover only

D) Gloves only

49 / 50

49) The primary reason for rotating cannulation sites is to

A) Allow vessel healing and prevent aneurysms

B) Reduce staff workload

C) Lower dialyzer reuse cost

D) Shorten treatment time

50 / 50

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

A) Avoid post-dialysis bleeding

B) Increase adequacy

C) Prevent clotting in the dialyzer

D) Reduce cramping

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