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

A) Quickly clamp line and air-trap it

B) Increase blood flow to flush air

C) Ignore if bubbles are small

D) Turn off heparin pump

2 / 50

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

A) Slight discoloration only

B) Loud continuous thrill

C) Absence of bruit

D) Warmth, redness, swelling, and drainage

3 / 50

3) 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) Give acetaminophen and continue

C) Increase dialysate temperature

D) Administer extra heparin

4 / 50

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

A) 18 G

B) 14 G

C) 20 G

D) 16 G

5 / 50

5) Which symptom suggests an allergic reaction to dialyzer?

A) Itching and wheezing within first 15 minutes

B) Cool, clammy skin post-dialysis

C) Hypertension near session end

D) Cramps after two hours

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) Started with higher dialysate temperature

D) Cancelled without notification

7 / 50

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

A) Inspecting dialyzer labels

B) Reviewing physician orders

C) Palpating for a thrill

D) Checking last month’s Kt/V

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

A) Both simultaneously

B) Arterial needle first

C) Venous needle first

D) Whichever is bleeding more

10 / 50

10) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Persistent dry cough

B) Sudden severe headache, nausea, restlessness

C) Gradual blurred vision post-dialysis

D) Pruritus on non-dialysis days

11 / 50

11) The recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) Not used for fistulas

C) Below the venous needle site

D) 2–3 cm above needle site

12 / 50

12) 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

13 / 50

13) 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

14 / 50

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

A) Administer heparin

B) Increase ultrafiltration rate

C) Lower the ultrafiltration rate and assess blood pressure

D) Stop the treatment permanently

15 / 50

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

A) Gloves only

B) Apron only

C) Gloves and a mask with eye shield

D) Hair cover only

16 / 50

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

A) 30–45 degrees

B) 15–20 degrees

C) 60–75 degrees

D) 90 degrees

17 / 50

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

A) Chlorhexidine 2 % with alcohol

B) Tap water and soap

C) Normal saline

D) Hydrogen peroxide 3 %

18 / 50

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

A) Check serum potassium level

B) Assess blood pressure and ask about tingling

C) Stop the pump immediately

D) Increase dialysate sodium

19 / 50

19) Heparin is administered primarily to

A) Reduce blood pressure spikes

B) Prevent clotting in the extracorporeal circuit

C) Correct hypocalcemia

D) Increase ultrafiltration

20 / 50

20) The best cannulation technique for a mature fistula is

A) Random needle placement

B) Rope-ladder rotating sites along the vessel

C) Buttonhole for every treatment

D) Area technique in one spot

21 / 50

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

A) Send them home quickly

B) Seat or recline them and check blood pressure

C) Give food immediately

D) Ask them to walk slowly

22 / 50

22) 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

23 / 50

23) Which intervention helps prevent hypotension during dialysis?

A) Profiling ultrafiltration rate

B) Skipping mid-treatment vitals

C) Using cold dialysate for all patients

D) Starting with low dialysate sodium

24 / 50

24) 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) Dialyzer clotting

C) Hypervolemia

D) Air embolism

25 / 50

25) A bruit is assessed by

A) Compression of the access

B) Auscultation with a stethoscope

C) Visual inspection alone

D) Palpation with fingertips

26 / 50

26) The correct order for disconnecting bloodlines is

A) Both simultaneously

B) Either order is fine

C) Arterial line, then venous line

D) Venous line, then arterial line

27 / 50

27) The primary reason for rotating cannulation sites is to

A) Shorten treatment time

B) Allow vessel healing and prevent aneurysms

C) Lower dialyzer reuse cost

D) Reduce staff workload

28 / 50

28) Which finding warrants HOLDING heparin before treatment?

A) Serum sodium 137 mEq/L

B) Heart rate 88 bpm

C) Platelets 50 × 10⁹/L

D) Hemoglobin 11 g/dL

29 / 50

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

A) Critically low; inform nurse promptly

B) Too high; extend dialysis

C) Indicator of infection

D) Normal and expected

30 / 50

30) Proper hand hygiene before gloving involves

A) Sanitizer only when visibly soiled

B) Skipping if gloves are clean

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

D) 5-second rinse with water only

31 / 50

31) Conductivity is checked before treatment mainly to

A) Verify water softening

B) Ensure proper electrolyte concentration

C) Confirm dialysate temperature

D) Test for bacteriologic contamination

32 / 50

32) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Hypertension

C) Polyuria

D) Severe headache

33 / 50

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

A) Heart rate

B) Respiratory rate

C) Temperature

D) Blood pressure

34 / 50

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

A) Serum albumin

B) Fasting glucose

C) LDL cholesterol

D) Predialysis potassium

35 / 50

35) During treatment, a rising arterial pressure usually signals

A) High dialysate temperature

B) Venous needle displacement

C) Machine in bypass

D) Tubing kink or clot before dialyzer

36 / 50

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

A) Re-using dressings if still clean

B) Allowing the catheter caps to hang freely

C) Flushing only once per week

D) Using povidone-iodine ointment at exit site

37 / 50

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

A) Placed on chairside table temporarily

B) Bent before disposal

C) Recapped carefully

D) Discarded in approved sharps container immediately

38 / 50

38) 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

39 / 50

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

A) Prevent clotting in the dialyzer

B) Reduce cramping

C) Increase adequacy

D) Avoid post-dialysis bleeding

40 / 50

40) Adequate dialysis is MOST accurately measured by

A) Color of dialysate

B) Patient feeling well

C) Kt/V or URR values

D) Postweight alone

41 / 50

41) Proper needle bevel orientation on entry should be

A) Orientation doesn’t matter

B) Bevel down to reduce pain

C) Bevel up to ease vessel entry

D) Bevel sideways to reduce infiltration

42 / 50

42) 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?”

43 / 50

43) 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) Skip assessment because symptoms are common

D) Start session right away

44 / 50

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

A) Continue; bruising will resolve

B) Stop blood pump and remove needle

C) Speed the pump to clear clot

D) Tape it tighter

45 / 50

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

A) Stenosis needing further evaluation

B) Good blood flow

C) Hypotension

D) Dialyzer clotting

46 / 50

46) 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

47 / 50

47) When should the technician document vital signs?

A) Once at the end

B) Whenever convenient

C) Only pre- and post-dialysis

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

48 / 50

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

A) Test dialysate pH

B) Lower serum phosphorus

C) Add fluid for weight gain

D) Return as much blood as possible from the circuit

49 / 50

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

A) Dialyzer clotting

B) Normal vascular tone

C) Possible hypoxemia; notify nurse

D) Adequate oxygenation

50 / 50

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

A) Heparin given too early

B) Too small needle gauge

C) Low dialysate flow rate

D) Hypotension

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