CCHT Clinical Practice Test 2025

Last Updated on June 14, 2025

The Nephrology Nursing Certification Commission (NNCC) Certified Clinical Hemodialysis Technician (CCHT) Clinical Practice Test 2025 – Questions and Answers Quiz. In the actual test, this part consists of 71 to 78 multiple-choice questions, which is approximately 48–52%.

Questions in the Clinical area deal with patient care before, during, and after dialysis treatment. 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) 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

2 / 50

2) 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

3 / 50

3) 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

4 / 50

4) Conductivity is checked before treatment mainly to

A) Confirm dialysate temperature

B) Ensure proper electrolyte concentration

C) Verify water softening

D) Test for bacteriologic contamination

5 / 50

5) 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

6 / 50

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

A) Quickly clamp line and air-trap it

B) Ignore if bubbles are small

C) Increase blood flow to flush air

D) Turn off heparin pump

7 / 50

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

A) Dislodged needle or line separation

B) Dialyzer clotting

C) Conductivity error

D) Air in the arterial line

8 / 50

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

A) Begun after notifying the nurse and following fever protocol

B) Continued as normal with more saline

C) Cancelled without notification

D) Started with higher dialysate temperature

9 / 50

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

A) Warmth, redness, swelling, and drainage

B) Loud continuous thrill

C) Slight discoloration only

D) Absence of bruit

10 / 50

10) 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

11 / 50

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

A) Fasting glucose

B) Serum albumin

C) LDL cholesterol

D) Predialysis potassium

12 / 50

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

A) Normal and expected

B) Too high; extend dialysis

C) Critically low; inform nurse promptly

D) Indicator of infection

13 / 50

13) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

B) Skipping if gloves are clean

C) Sanitizer only when visibly soiled

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

14 / 50

14) The recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) Below the venous needle site

C) Not used for fistulas

D) 2–3 cm above needle site

15 / 50

15) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Hypertension

C) Polyuria

D) Severe headache

16 / 50

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

A) Increase dialysate temperature

B) Stop dialysis and obtain blood cultures

C) Administer extra heparin

D) Give acetaminophen and continue

17 / 50

17) 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

18 / 50

18) The primary reason for rotating cannulation sites is to

A) Reduce staff workload

B) Allow vessel healing and prevent aneurysms

C) Lower dialyzer reuse cost

D) Shorten treatment time

19 / 50

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

A) Hypervolemia

B) Air embolism

C) Dialyzer clotting

D) Steal syndrome and alert the nurse immediately

20 / 50

20) The best cannulation technique for a mature fistula is

A) Area technique in one spot

B) Rope-ladder rotating sites along the vessel

C) Random needle placement

D) Buttonhole for every treatment

21 / 50

21) 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

22 / 50

22) 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

23 / 50

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

A) Dialyzer clotting

B) Possible hypoxemia; notify nurse

C) Adequate oxygenation

D) Normal vascular tone

24 / 50

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

A) Placed on chairside table temporarily

B) Bent before disposal

C) Discarded in approved sharps container immediately

D) Recapped carefully

25 / 50

25) 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

26 / 50

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

A) Allowing the catheter caps to hang freely

B) Using povidone-iodine ointment at exit site

C) Flushing only once per week

D) Re-using dressings if still clean

27 / 50

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

A) Palpating for a thrill

B) Reviewing physician orders

C) Checking last month’s Kt/V

D) Inspecting dialyzer labels

28 / 50

28) Heparin is administered primarily to

A) Prevent clotting in the extracorporeal circuit

B) Increase ultrafiltration

C) Reduce blood pressure spikes

D) Correct hypocalcemia

29 / 50

29) 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

30 / 50

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

A) Hypotension

B) Stenosis needing further evaluation

C) Dialyzer clotting

D) Good blood flow

31 / 50

31) Adequate dialysis is MOST accurately measured by

A) Patient feeling well

B) Color of dialysate

C) Kt/V or URR values

D) Postweight alone

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) Give food immediately

C) Send them home quickly

D) Seat or recline them and check blood pressure

33 / 50

33) 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

34 / 50

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

A) Respiratory rate

B) Blood pressure

C) Temperature

D) Heart rate

35 / 50

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

A) Lower serum phosphorus

B) Add fluid for weight gain

C) Test dialysate pH

D) Return as much blood as possible from the circuit

36 / 50

36) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Persistent dry cough

B) Pruritus on non-dialysis days

C) Gradual blurred vision post-dialysis

D) Sudden severe headache, nausea, restlessness

37 / 50

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

A) Force completion under policy

B) Double next session’s UF

C) Ignore refusal and end session

D) Explain risks, document refusal, and notify nurse

38 / 50

38) 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

39 / 50

39) A bruit is assessed by

A) Compression of the access

B) Palpation with fingertips

C) Visual inspection alone

D) Auscultation with a stethoscope

40 / 50

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

A) 60–75 degrees

B) 90 degrees

C) 30–45 degrees

D) 15–20 degrees

41 / 50

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

A) Continue; bruising will resolve

B) Stop blood pump and remove needle

C) Tape it tighter

D) Speed the pump to clear clot

42 / 50

42) Proper needle bevel orientation on entry should be

A) Bevel up to ease vessel entry

B) Orientation doesn’t matter

C) Bevel sideways to reduce infiltration

D) Bevel down to reduce pain

43 / 50

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

A) 16 G

B) 20 G

C) 18 G

D) 14 G

44 / 50

44) Before starting treatment, bloodlines are primed to

A) Calibrate the machine scales

B) Increase dialysate conductivity

C) Warm the dialyzer

D) Remove air and sterilant residue

45 / 50

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

A) Prevent clotting in the dialyzer

B) Avoid post-dialysis bleeding

C) Increase adequacy

D) Reduce cramping

46 / 50

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

A) Both simultaneously

B) Venous needle first

C) Whichever is bleeding more

D) Arterial needle first

47 / 50

47) Which intervention helps prevent hypotension during dialysis?

A) Skipping mid-treatment vitals

B) Profiling ultrafiltration rate

C) Starting with low dialysate sodium

D) Using cold dialysate for all patients

48 / 50

48) Immediately after needle removal, the technician should

A) Elevate the arm above the head

B) Apply firm pressure with a clean gauze

C) Massage the site vigorously

D) Cover with an adhesive bandage only

49 / 50

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

A) Anemia management success

B) Possible fluid overload and need for dietary review

C) Hyperkalemia correction

D) Adequate fluid removal

50 / 50

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

A) Apron only

B) Hair cover only

C) Gloves and a mask with eye shield

D) Gloves only

Your score is

See also: