CCHT Clinical Practice Test 2026

Last Updated on October 1, 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) 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

2 / 50

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

A) Ask, “Are you Mr. Smith?”

B) Recognize their face from last week

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

D) Check the name on their dialysis chair

3 / 50

3) 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

4 / 50

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

A) Recapped carefully

B) Discarded in approved sharps container immediately

C) Bent before disposal

D) Placed on chairside table temporarily

5 / 50

5) 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

6 / 50

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

A) Weigh patient to assess fluid overload

B) Skip assessment because symptoms are common

C) Start session right away

D) Increase dialysate flow rate

7 / 50

7) Which finding warrants HOLDING heparin before treatment?

A) Serum sodium 137 mEq/L

B) Platelets 50 × 10⁹/L

C) Hemoglobin 11 g/dL

D) Heart rate 88 bpm

8 / 50

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

A) Inside the dialysate circuit

B) Before the blood pump

C) After the dialyzer

D) At the venous drip chamber

9 / 50

9) A bruit is assessed by

A) Auscultation with a stethoscope

B) Compression of the access

C) Visual inspection alone

D) Palpation with fingertips

10 / 50

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

A) Reviewing physician orders

B) Palpating for a thrill

C) Checking last month’s Kt/V

D) Inspecting dialyzer labels

11 / 50

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

A) Increase blood flow to flush air

B) Ignore if bubbles are small

C) Quickly clamp line and air-trap it

D) Turn off heparin pump

12 / 50

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

A) Temperature

B) Heart rate

C) Blood pressure

D) Respiratory rate

13 / 50

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

A) Loud continuous thrill

B) Absence of bruit

C) Warmth, redness, swelling, and drainage

D) Slight discoloration only

14 / 50

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

A) Hypotension

B) Heparin given too early

C) Too small needle gauge

D) Low dialysate flow rate

15 / 50

15) Conductivity is checked before treatment mainly to

A) Verify water softening

B) Test for bacteriologic contamination

C) Confirm dialysate temperature

D) Ensure proper electrolyte concentration

16 / 50

16) Which intervention helps prevent hypotension during dialysis?

A) Starting with low dialysate sodium

B) Using cold dialysate for all patients

C) Profiling ultrafiltration rate

D) Skipping mid-treatment vitals

17 / 50

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

A) Normal and expected

B) Indicator of infection

C) Too high; extend dialysis

D) Critically low; inform nurse promptly

18 / 50

18) Immediately after needle removal, the technician should

A) Apply firm pressure with a clean gauze

B) Massage the site vigorously

C) Cover with an adhesive bandage only

D) Elevate the arm above the head

19 / 50

19) Before starting treatment, bloodlines are primed to

A) Increase dialysate conductivity

B) Calibrate the machine scales

C) Remove air and sterilant residue

D) Warm the dialyzer

20 / 50

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

A) Steal syndrome and alert the nurse immediately

B) Hypervolemia

C) Air embolism

D) Dialyzer clotting

21 / 50

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

A) Whichever is bleeding more

B) Arterial needle first

C) Both simultaneously

D) Venous needle first

22 / 50

22) 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

23 / 50

23) The recommended tourniquet placement for fistula cannulation is

A) Below the venous needle site

B) Directly over the anastomosis

C) Not used for fistulas

D) 2–3 cm above needle site

24 / 50

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

A) Explain risks, document refusal, and notify nurse

B) Double next session’s UF

C) Ignore refusal and end session

D) Force completion under policy

25 / 50

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

A) Dialyzer clotting

B) Stenosis needing further evaluation

C) Good blood flow

D) Hypotension

26 / 50

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

A) Started with higher dialysate temperature

B) Continued as normal with more saline

C) Cancelled without notification

D) Begun after notifying the nurse and following fever protocol

27 / 50

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

A) Give acetaminophen and continue

B) Administer extra heparin

C) Increase dialysate temperature

D) Stop dialysis and obtain blood cultures

28 / 50

28) The FIRST sign of an air embolism may be

A) Severe headache

B) Polyuria

C) Chest pain and coughing

D) Hypertension

29 / 50

29) Which symptom suggests an allergic reaction to dialyzer?

A) Cramps after two hours

B) Itching and wheezing within first 15 minutes

C) Cool, clammy skin post-dialysis

D) Hypertension near session end

30 / 50

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

A) Dialyzer clotting

B) Normal vascular tone

C) Possible hypoxemia; notify nurse

D) Adequate oxygenation

31 / 50

31) 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

32 / 50

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

A) Ask them to walk slowly

B) Seat or recline them and check blood pressure

C) Give food immediately

D) Send them home quickly

33 / 50

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

A) 20 G

B) 18 G

C) 16 G

D) 14 G

34 / 50

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

A) Serum albumin

B) Predialysis potassium

C) LDL cholesterol

D) Fasting glucose

35 / 50

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

A) Hair cover only

B) Gloves and a mask with eye shield

C) Gloves only

D) Apron only

36 / 50

36) 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

37 / 50

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

A) Stop blood pump and remove needle

B) Tape it tighter

C) Speed the pump to clear clot

D) Continue; bruising will resolve

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) A sudden drop in venous pressure during treatment often indicates

A) Conductivity error

B) Air in the arterial line

C) Dialyzer clotting

D) Dislodged needle or line separation

40 / 50

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

A) 30–45 degrees

B) 60–75 degrees

C) 15–20 degrees

D) 90 degrees

41 / 50

41) 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

42 / 50

42) 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) Stop the pump immediately

D) Check serum potassium level

43 / 50

43) The primary reason for rotating cannulation sites is to

A) Reduce staff workload

B) Allow vessel healing and prevent aneurysms

C) Shorten treatment time

D) Lower dialyzer reuse cost

44 / 50

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

A) Administer heparin

B) Stop the treatment permanently

C) Lower the ultrafiltration rate and assess blood pressure

D) Increase ultrafiltration rate

45 / 50

45) 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) Flushing only once per week

D) Re-using dressings if still clean

46 / 50

46) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Postweight alone

C) Kt/V or URR values

D) Color of dialysate

47 / 50

47) When should the technician document vital signs?

A) Whenever convenient

B) Once at the end

C) Only pre- and post-dialysis

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

48 / 50

48) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Prevent clotting in the extracorporeal circuit

C) Correct hypocalcemia

D) Increase ultrafiltration

49 / 50

49) 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) Skipping if gloves are clean

D) 5-second rinse with water only

50 / 50

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

A) Hydrogen peroxide 3 %

B) Chlorhexidine 2 % with alcohol

C) Tap water and soap

D) Normal saline

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