CCHT Clinical Practice Test 2026

Last Updated on May 13, 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) The technician checks for residual heparin at treatment end primarily to

A) Increase adequacy

B) Reduce cramping

C) Prevent clotting in the dialyzer

D) Avoid post-dialysis bleeding

2 / 50

2) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Gradual blurred vision post-dialysis

B) Persistent dry cough

C) Sudden severe headache, nausea, restlessness

D) Pruritus on non-dialysis days

3 / 50

3) 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

4 / 50

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

A) Temperature

B) Blood pressure

C) Respiratory rate

D) Heart rate

5 / 50

5) 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

6 / 50

6) Which finding warrants HOLDING heparin before treatment?

A) Hemoglobin 11 g/dL

B) Serum sodium 137 mEq/L

C) Platelets 50 × 10⁹/L

D) Heart rate 88 bpm

7 / 50

7) A bruit is assessed by

A) Compression of the access

B) Auscultation with a stethoscope

C) Visual inspection alone

D) Palpation with fingertips

8 / 50

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

A) Using povidone-iodine ointment at exit site

B) Re-using dressings if still clean

C) Flushing only once per week

D) Allowing the catheter caps to hang freely

9 / 50

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

D) Ask, “Are you Mr. Smith?”

10 / 50

10) Adequate dialysis is MOST accurately measured by

A) Color of dialysate

B) Kt/V or URR values

C) Patient feeling well

D) Postweight alone

11 / 50

11) 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) Explain risks, document refusal, and notify nurse

D) Double next session’s UF

12 / 50

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

A) Gloves and a mask with eye shield

B) Gloves only

C) Apron only

D) Hair cover only

13 / 50

13) 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

14 / 50

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

A) Good blood flow

B) Stenosis needing further evaluation

C) Hypotension

D) Dialyzer clotting

15 / 50

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

A) After the dialyzer

B) Inside the dialysate circuit

C) Before the blood pump

D) At the venous drip chamber

16 / 50

16) 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) Seat or recline them and check blood pressure

D) Ask them to walk slowly

17 / 50

17) During treatment, a rising arterial pressure usually signals

A) Machine in bypass

B) Tubing kink or clot before dialyzer

C) Venous needle displacement

D) High dialysate temperature

18 / 50

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

A) Both simultaneously

B) Whichever is bleeding more

C) Venous needle first

D) Arterial needle first

19 / 50

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

A) 90 degrees

B) 30–45 degrees

C) 60–75 degrees

D) 15–20 degrees

20 / 50

20) 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

21 / 50

21) Heparin is administered primarily to

A) Correct hypocalcemia

B) Increase ultrafiltration

C) Prevent clotting in the extracorporeal circuit

D) Reduce blood pressure spikes

22 / 50

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

A) LDL cholesterol

B) Serum albumin

C) Fasting glucose

D) Predialysis potassium

23 / 50

23) 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

24 / 50

24) Immediately after needle removal, the technician should

A) Cover with an adhesive bandage only

B) Apply firm pressure with a clean gauze

C) Elevate the arm above the head

D) Massage the site vigorously

25 / 50

25) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Cool, clammy skin post-dialysis

C) Cramps after two hours

D) Hypertension near session end

26 / 50

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

A) Placed on chairside table temporarily

B) Discarded in approved sharps container immediately

C) Recapped carefully

D) Bent before disposal

27 / 50

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

A) 14 G

B) 20 G

C) 16 G

D) 18 G

28 / 50

28) 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

29 / 50

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

A) Lower serum phosphorus

B) Return as much blood as possible from the circuit

C) Test dialysate pH

D) Add fluid for weight gain

30 / 50

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

A) Air embolism

B) Hypervolemia

C) Dialyzer clotting

D) Steal syndrome and alert the nurse immediately

31 / 50

31) 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

32 / 50

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

A) Normal and expected

B) Critically low; inform nurse promptly

C) Indicator of infection

D) Too high; extend dialysis

33 / 50

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

A) Inspecting dialyzer labels

B) Checking last month’s Kt/V

C) Palpating for a thrill

D) Reviewing physician orders

34 / 50

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

A) Begun after notifying the nurse and following fever protocol

B) Started with higher dialysate temperature

C) Cancelled without notification

D) Continued as normal with more saline

35 / 50

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

A) Adequate oxygenation

B) Dialyzer clotting

C) Possible hypoxemia; notify nurse

D) Normal vascular tone

36 / 50

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

A) Absence of bruit

B) Loud continuous thrill

C) Warmth, redness, swelling, and drainage

D) Slight discoloration only

37 / 50

37) 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

38 / 50

38) The recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) Not used for fistulas

C) 2–3 cm above needle site

D) Below the venous needle site

39 / 50

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

A) Start session right away

B) Skip assessment because symptoms are common

C) Weigh patient to assess fluid overload

D) Increase dialysate flow rate

40 / 50

40) 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) Increase dialysate temperature

C) Administer extra heparin

D) Give acetaminophen and continue

41 / 50

41) Which intervention helps prevent hypotension during dialysis?

A) Profiling ultrafiltration rate

B) Skipping mid-treatment vitals

C) Starting with low dialysate sodium

D) Using cold dialysate for all patients

42 / 50

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

A) Stop blood pump and remove needle

B) Tape it tighter

C) Continue; bruising will resolve

D) Speed the pump to clear clot

43 / 50

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

A) Normal saline

B) Chlorhexidine 2 % with alcohol

C) Hydrogen peroxide 3 %

D) Tap water and soap

44 / 50

44) The primary reason for rotating cannulation sites is to

A) Lower dialyzer reuse cost

B) Reduce staff workload

C) Shorten treatment time

D) Allow vessel healing and prevent aneurysms

45 / 50

45) Proper needle bevel orientation on entry should be

A) Bevel down to reduce pain

B) Orientation doesn’t matter

C) Bevel up to ease vessel entry

D) Bevel sideways to reduce infiltration

46 / 50

46) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Confirm dialysate temperature

C) Verify water softening

D) Test for bacteriologic contamination

47 / 50

47) The FIRST sign of an air embolism may be

A) Hypertension

B) Severe headache

C) Chest pain and coughing

D) Polyuria

48 / 50

48) The correct order for disconnecting bloodlines is

A) Arterial line, then venous line

B) Venous line, then arterial line

C) Either order is fine

D) Both simultaneously

49 / 50

49) 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

50 / 50

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

A) Adequate fluid removal

B) Possible fluid overload and need for dietary review

C) Anemia management success

D) Hyperkalemia correction

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