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) The FIRST sign of an air embolism may be

A) Chest pain and coughing

B) Severe headache

C) Polyuria

D) Hypertension

2 / 50

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

A) Weigh patient to assess fluid overload

B) Start session right away

C) Increase dialysate flow rate

D) Skip assessment because symptoms are common

3 / 50

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

A) 16 G

B) 20 G

C) 14 G

D) 18 G

4 / 50

4) 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) Administer extra heparin

D) Increase dialysate temperature

5 / 50

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

A) Temperature

B) Heart rate

C) Respiratory rate

D) Blood pressure

6 / 50

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

A) Ask, “Are you Mr. Smith?”

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

C) Check the name on their dialysis chair

D) Recognize their face from last week

7 / 50

7) A bruit is assessed by

A) Visual inspection alone

B) Palpation with fingertips

C) Auscultation with a stethoscope

D) Compression of the access

8 / 50

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

A) Re-using dressings if still clean

B) Using povidone-iodine ointment at exit site

C) Flushing only once per week

D) Allowing the catheter caps to hang freely

9 / 50

9) Before starting treatment, bloodlines are primed to

A) Remove air and sterilant residue

B) Increase dialysate conductivity

C) Calibrate the machine scales

D) Warm the dialyzer

10 / 50

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

A) Good blood flow

B) Stenosis needing further evaluation

C) Hypotension

D) Dialyzer clotting

11 / 50

11) The recommended tourniquet placement for fistula cannulation is

A) Directly over the anastomosis

B) 2–3 cm above needle site

C) Not used for fistulas

D) Below the venous needle site

12 / 50

12) The best cannulation technique for a mature fistula is

A) Random needle placement

B) Buttonhole for every treatment

C) Rope-ladder rotating sites along the vessel

D) Area technique in one spot

13 / 50

13) Proper hand hygiene before gloving involves

A) 5-second rinse with water only

B) Skipping if gloves are clean

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

D) Sanitizer only when visibly soiled

14 / 50

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

A) Continue; bruising will resolve

B) Speed the pump to clear clot

C) Tape it tighter

D) Stop blood pump and remove needle

15 / 50

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

A) Before the blood pump

B) After the dialyzer

C) At the venous drip chamber

D) Inside the dialysate circuit

16 / 50

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

A) Warmth, redness, swelling, and drainage

B) Absence of bruit

C) Slight discoloration only

D) Loud continuous thrill

17 / 50

17) Adequate dialysis is MOST accurately measured by

A) Color of dialysate

B) Kt/V or URR values

C) Postweight alone

D) Patient feeling well

18 / 50

18) The primary reason for rotating cannulation sites is to

A) Reduce staff workload

B) Lower dialyzer reuse cost

C) Allow vessel healing and prevent aneurysms

D) Shorten treatment time

19 / 50

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

A) Anemia management success

B) Adequate fluid removal

C) Possible fluid overload and need for dietary review

D) Hyperkalemia correction

20 / 50

20) 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

21 / 50

21) 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

22 / 50

22) Which of these symptoms suggests dialysis disequilibrium syndrome?

A) Gradual blurred vision post-dialysis

B) Pruritus on non-dialysis days

C) Sudden severe headache, nausea, restlessness

D) Persistent dry cough

23 / 50

23) Immediately after needle removal, the technician should

A) Elevate the arm above the head

B) Cover with an adhesive bandage only

C) Apply firm pressure with a clean gauze

D) Massage the site vigorously

24 / 50

24) The correct order for disconnecting bloodlines is

A) Either order is fine

B) Venous line, then arterial line

C) Both simultaneously

D) Arterial line, then venous line

25 / 50

25) Proper needle bevel orientation on entry should be

A) Bevel down to reduce pain

B) Orientation doesn’t matter

C) Bevel sideways to reduce infiltration

D) Bevel up to ease vessel entry

26 / 50

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

A) Dialyzer clotting

B) Dislodged needle or line separation

C) Conductivity error

D) Air in the arterial line

27 / 50

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

A) Heparin given too early

B) Too small needle gauge

C) Hypotension

D) Low dialysate flow rate

28 / 50

28) Which intervention helps prevent hypotension during dialysis?

A) Using cold dialysate for all patients

B) Starting with low dialysate sodium

C) Profiling ultrafiltration rate

D) Skipping mid-treatment vitals

29 / 50

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

A) Both simultaneously

B) Whichever is bleeding more

C) Arterial needle first

D) Venous needle first

30 / 50

30) 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) Lower the ultrafiltration rate and assess blood pressure

D) Administer heparin

31 / 50

31) Conductivity is checked before treatment mainly to

A) Ensure proper electrolyte concentration

B) Verify water softening

C) Test for bacteriologic contamination

D) Confirm dialysate temperature

32 / 50

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

A) Hypervolemia

B) Steal syndrome and alert the nurse immediately

C) Air embolism

D) Dialyzer clotting

33 / 50

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

A) Normal vascular tone

B) Possible hypoxemia; notify nurse

C) Dialyzer clotting

D) Adequate oxygenation

34 / 50

34) 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

35 / 50

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

A) Apron only

B) Gloves only

C) Hair cover only

D) Gloves and a mask with eye shield

36 / 50

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

A) Too high; extend dialysis

B) Normal and expected

C) Critically low; inform nurse promptly

D) Indicator of infection

37 / 50

37) During treatment, a rising arterial pressure usually signals

A) Venous needle displacement

B) Machine in bypass

C) Tubing kink or clot before dialyzer

D) High dialysate temperature

38 / 50

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

A) Cancelled without notification

B) Begun after notifying the nurse and following fever protocol

C) Continued as normal with more saline

D) Started with higher dialysate temperature

39 / 50

39) 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

40 / 50

40) 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

41 / 50

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

A) Avoid post-dialysis bleeding

B) Increase adequacy

C) Reduce cramping

D) Prevent clotting in the dialyzer

42 / 50

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

A) Assess blood pressure and ask about tingling

B) Check serum potassium level

C) Stop the pump immediately

D) Increase dialysate sodium

43 / 50

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

A) Ignore if bubbles are small

B) Quickly clamp line and air-trap it

C) Increase blood flow to flush air

D) Turn off heparin pump

44 / 50

44) Which symptom suggests an allergic reaction to dialyzer?

A) Cool, clammy skin post-dialysis

B) Hypertension near session end

C) Itching and wheezing within first 15 minutes

D) Cramps after two hours

45 / 50

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

A) Recapped carefully

B) Placed on chairside table temporarily

C) Bent before disposal

D) Discarded in approved sharps container immediately

46 / 50

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

A) Tap water and soap

B) Chlorhexidine 2 % with alcohol

C) Normal saline

D) Hydrogen peroxide 3 %

47 / 50

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

A) Predialysis potassium

B) Serum albumin

C) LDL cholesterol

D) Fasting glucose

48 / 50

48) Which finding warrants HOLDING heparin before treatment?

A) Heart rate 88 bpm

B) Platelets 50 × 10⁹/L

C) Serum sodium 137 mEq/L

D) Hemoglobin 11 g/dL

49 / 50

49) Heparin is administered primarily to

A) Prevent clotting in the extracorporeal circuit

B) Reduce blood pressure spikes

C) Increase ultrafiltration

D) Correct hypocalcemia

50 / 50

50) When should the technician document vital signs?

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

B) Once at the end

C) Only pre- and post-dialysis

D) Whenever convenient

Your score is

See also: