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) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) Tubing kink or clot before dialyzer

C) Machine in bypass

D) High dialysate temperature

2 / 50

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

A) Continue; bruising will resolve

B) Tape it tighter

C) Speed the pump to clear clot

D) Stop blood pump and remove needle

3 / 50

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

A) Cancelled without notification

B) Started with higher dialysate temperature

C) Begun after notifying the nurse and following fever protocol

D) Continued as normal with more saline

4 / 50

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

A) Test dialysate pH

B) Lower serum phosphorus

C) Return as much blood as possible from the circuit

D) Add fluid for weight gain

5 / 50

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

A) Increase blood flow to flush air

B) Quickly clamp line and air-trap it

C) Turn off heparin pump

D) Ignore if bubbles are small

6 / 50

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

A) Too small needle gauge

B) Low dialysate flow rate

C) Hypotension

D) Heparin given too early

7 / 50

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

A) Predialysis potassium

B) Serum albumin

C) Fasting glucose

D) LDL cholesterol

8 / 50

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

A) Double next session’s UF

B) Ignore refusal and end session

C) Explain risks, document refusal, and notify nurse

D) Force completion under policy

9 / 50

9) 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

10 / 50

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

A) Placed on chairside table temporarily

B) Discarded in approved sharps container immediately

C) Bent before disposal

D) Recapped carefully

11 / 50

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

A) Critically low; inform nurse promptly

B) Too high; extend dialysis

C) Normal and expected

D) Indicator of infection

12 / 50

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

A) Loud continuous thrill

B) Absence of bruit

C) Slight discoloration only

D) Warmth, redness, swelling, and drainage

13 / 50

13) The best cannulation technique for a mature fistula is

A) Random needle placement

B) Rope-ladder rotating sites along the vessel

C) Area technique in one spot

D) Buttonhole for every treatment

14 / 50

14) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Allow vessel healing and prevent aneurysms

C) Reduce staff workload

D) Shorten treatment time

15 / 50

15) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

B) Sanitizer only when visibly soiled

C) Skipping if gloves are clean

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

16 / 50

16) 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

17 / 50

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

A) Dialyzer clotting

B) Good blood flow

C) Hypotension

D) Stenosis needing further evaluation

18 / 50

18) The FIRST sign of an air embolism may be

A) Polyuria

B) Severe headache

C) Chest pain and coughing

D) Hypertension

19 / 50

19) Before starting treatment, bloodlines are primed to

A) Calibrate the machine scales

B) Warm the dialyzer

C) Increase dialysate conductivity

D) Remove air and sterilant residue

20 / 50

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

A) Increase ultrafiltration rate

B) Stop the treatment permanently

C) Administer heparin

D) Lower the ultrafiltration rate and assess blood pressure

21 / 50

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

A) Administer extra heparin

B) Give acetaminophen and continue

C) Stop dialysis and obtain blood cultures

D) Increase dialysate temperature

22 / 50

22) Which intervention helps prevent hypotension during dialysis?

A) Starting with low dialysate sodium

B) Profiling ultrafiltration rate

C) Using cold dialysate for all patients

D) Skipping mid-treatment vitals

23 / 50

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

A) Ask them to walk slowly

B) Send them home quickly

C) Seat or recline them and check blood pressure

D) Give food immediately

24 / 50

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

A) Re-using dressings if still clean

B) Using povidone-iodine ointment at exit site

C) Allowing the catheter caps to hang freely

D) Flushing only once per week

25 / 50

25) Heparin is administered primarily to

A) Prevent clotting in the extracorporeal circuit

B) Correct hypocalcemia

C) Reduce blood pressure spikes

D) Increase ultrafiltration

26 / 50

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

A) 60–75 degrees

B) 90 degrees

C) 15–20 degrees

D) 30–45 degrees

27 / 50

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

A) Checking last month’s Kt/V

B) Inspecting dialyzer labels

C) Palpating for a thrill

D) Reviewing physician orders

28 / 50

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

A) Normal saline

B) Hydrogen peroxide 3 %

C) Tap water and soap

D) Chlorhexidine 2 % with alcohol

29 / 50

29) 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

30 / 50

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

A) Recognize their face from last week

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

C) Check the name on their dialysis chair

D) Ask, “Are you Mr. Smith?”

31 / 50

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

A) Stop the pump immediately

B) Increase dialysate sodium

C) Check serum potassium level

D) Assess blood pressure and ask about tingling

32 / 50

32) 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

33 / 50

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

A) Adequate fluid removal

B) Hyperkalemia correction

C) Anemia management success

D) Possible fluid overload and need for dietary review

34 / 50

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

A) Before the blood pump

B) After the dialyzer

C) Inside the dialysate circuit

D) At the venous drip chamber

35 / 50

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

A) Heart rate

B) Temperature

C) Respiratory rate

D) Blood pressure

36 / 50

36) Proper needle bevel orientation on entry should be

A) Orientation doesn’t matter

B) Bevel up to ease vessel entry

C) Bevel sideways to reduce infiltration

D) Bevel down to reduce pain

37 / 50

37) Adequate dialysis is MOST accurately measured by

A) Color of dialysate

B) Patient feeling well

C) Postweight alone

D) Kt/V or URR values

38 / 50

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

A) Dialyzer clotting

B) Air in the arterial line

C) Dislodged needle or line separation

D) Conductivity error

39 / 50

39) 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

40 / 50

40) Immediately after needle removal, the technician should

A) Elevate the arm above the head

B) Massage the site vigorously

C) Apply firm pressure with a clean gauze

D) Cover with an adhesive bandage only

41 / 50

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

A) 20 G

B) 14 G

C) 18 G

D) 16 G

42 / 50

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

A) Skip assessment because symptoms are common

B) Start session right away

C) Increase dialysate flow rate

D) Weigh patient to assess fluid overload

43 / 50

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

A) Possible hypoxemia; notify nurse

B) Dialyzer clotting

C) Normal vascular tone

D) Adequate oxygenation

44 / 50

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

A) Gloves only

B) Hair cover only

C) Apron only

D) Gloves and a mask with eye shield

45 / 50

45) 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

46 / 50

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

A) Air embolism

B) Steal syndrome and alert the nurse immediately

C) Dialyzer clotting

D) Hypervolemia

47 / 50

47) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Cramps after two hours

C) Hypertension near session end

D) Itching and wheezing within first 15 minutes

48 / 50

48) A bruit is assessed by

A) Compression of the access

B) Visual inspection alone

C) Auscultation with a stethoscope

D) Palpation with fingertips

49 / 50

49) 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

50 / 50

50) Which finding warrants HOLDING heparin before treatment?

A) Heart rate 88 bpm

B) Hemoglobin 11 g/dL

C) Platelets 50 × 10⁹/L

D) Serum sodium 137 mEq/L

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