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CCHT practice questions

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Question 1Patient Care and Assessment

Which information does the pre-dialysis weight mainly provide for the care team?

  1. Whether the patient needs a blood transfusion
  2. How well the patient has been eating and sleeping
  3. The patient's lean body mass in kilograms
  4. The fluid to remove to reach target weight Correct answer.

Explanation

The pre-dialysis weight is compared with the patient's target (dry) weight to set the ultrafiltration goal for the treatment. It is a fluid measure, not a nutritional or hematologic assessment.

Question 2Patient Care and Assessment

A thrill at a dialysis access is best described as which of the following?

  1. A vibration felt with the fingertips Correct answer.
  2. A blowing sound heard through a stethoscope
  3. A reddish streak along the skin
  4. A sharp pain reported by the patient

Explanation

A thrill is the palpable vibration created by turbulent flow through the access and is assessed by light palpation. The corresponding sound heard with a stethoscope is the bruit.

Question 3Patient Care and Assessment

Which pre-dialysis heart rate should be reported to the nurse before treatment begins?

  1. 88 beats/min
  2. 62 beats/min
  3. 118 beats/min Correct answer.
  4. 78 beats/min

Explanation

The usual resting adult heart rate is about 60 to 100 beats per minute. A rate of 118 beats/min is above that range and warrants evaluation before treatment starts.

Question 4Patient Care and Assessment

Muscle cramps during hemodialysis are most often related to which cause?

  1. Too much sodium removed during treatment
  2. An allergic response to the dialyzer membrane
  3. A sudden drop in blood potassium
  4. Rapid or excessive fluid removal Correct answer.

Explanation

Cramping is most commonly linked to a high ultrafiltration rate or removal of fluid below the patient's target weight. Slowing fluid removal and reassessing the target usually relieves it.

Question 5Patient Care and Assessment

Which symptom cluster is typical of a hypotensive episode during treatment?

  1. Itching, rash, and hives
  2. Yawning, nausea, and cold sweats Correct answer.
  3. Fever, chills, and a productive cough
  4. Numbness and tingling of the fingers

Explanation

Falling blood pressure during dialysis commonly presents with yawning, nausea, diaphoresis, restlessness, and dizziness. Recognizing these early signs allows prompt intervention.

Question 6Patient Care and Assessment

Which finding at the needle site most suggests a local infection?

  1. Warmth, redness, and purulent drainage Correct answer.
  2. A small bruise from the previous treatment
  3. Slight induration from today's cannulation
  4. A faint pulse felt over the site

Explanation

Warmth, erythema, purulent drainage, and tenderness at a cannulation site are classic signs of access-related infection. These findings require prompt reporting.

Question 7Patient Care and Assessment

Which food should a patient on hemodialysis be taught to limit because of its high potassium content?

  1. White bread
  2. Apple slices
  3. Bananas Correct answer.
  4. Cooked rice

Explanation

Bananas are a well-known high-potassium fruit and are commonly restricted in the renal diet. Bread, rice, and apples are comparatively lower in potassium.

Question 8Patient Care and Assessment

Hand hygiene is required at which point in the patient care sequence?

  1. Only at the end of the shift
  2. Only after removing gloves
  3. Before and after every patient contact Correct answer.
  4. Only when the hands look soiled

Explanation

Hand hygiene is performed before and after every patient contact, and also after glove removal. Gloves do not replace hand washing.

Question 9Patient Care and Assessment

A patient becomes diaphoretic and nauseated with a blood pressure of 84/48 mmHg. Which action should the technician take first?

  1. Give the patient a potassium supplement
  2. Stop ultrafiltration and lay the patient flat Correct answer.
  3. Increase the blood flow rate to finish sooner
  4. Send the patient home to rest

Explanation

Symptomatic hypotension during treatment is managed by halting fluid removal and positioning the patient supine or in Trendelenburg to support perfusion. Further measures such as saline per protocol follow.

Question 10Patient Care and Assessment

If the venous needle is pulled out during treatment, which action comes first?

  1. Restart the treatment at a lower blood flow
  2. Document the event after treatment ends
  3. Apply a warm compress to the site
  4. Stop the blood pump and clamp the lines Correct answer.

Explanation

Stopping the pump and clamping the lines halts blood loss and prevents air from entering the circuit. Direct pressure at the site and assessment of the patient follow immediately.

Question 11Patient Care and Assessment

Which finding indicates that a needle has infiltrated?

  1. Bright red blood flowing briskly into the arterial line
  2. A continuous bruit over the access
  3. Swelling and pain around the needle with poor flow Correct answer.
  4. A palpable thrill along the whole fistula

Explanation

Infiltration occurs when the needle tip leaves the vessel, so blood leaks into surrounding tissue, producing swelling, pain, and reduced flow. The needle should be stopped and the area assessed.

Question 12Patient Care and Assessment

A patient suddenly develops dyspnea and chest pain after air enters the extracorporeal circuit. How should the patient be positioned?

  1. Right side down with the head elevated
  2. Flat on the back with legs raised
  3. Head down and turned onto the left side Correct answer.
  4. Sitting upright leaning forward

Explanation

Trendelenburg position with the patient on the left side traps air in the right ventricular apex and limits its movement into the pulmonary circulation. The nurse or provider must be summoned at once.

Question 13Patient Care and Assessment

Which symptoms suggest dialysis disequilibrium syndrome?

  1. Tremor and hunger with a low glucose
  2. Hives and wheezing after treatment starts
  3. Fever and chills during the first hour
  4. Headache, nausea, and confusion Correct answer.

Explanation

Disequilibrium results from a rapid osmolar shift, producing headache, nausea, restlessness, confusion, and in severe cases seizures. Slowing the treatment helps prevent it.

Question 14Patient Care and Assessment

Cherry-red blood in the venous line accompanied by back pain and shortness of breath suggests which problem?

  1. An air embolism in the venous line
  2. Hemolysis of the patient's red cells Correct answer.
  3. A mild allergic reaction to heparin
  4. A hypotensive reaction to treatment

Explanation

Dark red plasma and cherry-red blood, together with back pain and dyspnea, are hallmarks of hemolysis. The pump should be stopped and the nurse notified immediately.

Question 15Patient Care and Assessment

To be effective, phosphate binders must be taken at which time?

  1. Only when the phosphorus level is elevated
  2. With meals or snacks Correct answer.
  3. Only at bedtime with a full glass of water
  4. On an empty stomach one hour before meals

Explanation

Binders work by binding phosphorus in the gut lumen, so they must be present when food is eaten. They are taken with meals and snacks consistently, not just when levels are high.

Question 16Patient Care and Assessment

Which statement by a patient shows correct understanding of a fluid restriction?

  1. I can drink all I want if I avoid salt.
  2. Thirst is a sign I should drink more.
  3. Ice chips and gelatin count toward my fluid limit. Correct answer.
  4. Soup and ice count as food, not fluid.

Explanation

All foods that are liquid at room temperature, including ice, gelatin, soup, and popsicles, count toward the daily fluid allowance. Limiting sodium helps reduce thirst but does not remove the fluid limit.

Question 17Patient Care and Assessment

After the needles are removed, the patient's access site keeps oozing. Which action is appropriate?

  1. Apply a tourniquet above the access
  2. Send the patient home with extra gauze
  3. Loosen the dressing to let it drain
  4. Hold firm pressure until bleeding stops Correct answer.

Explanation

Direct, firm pressure over the puncture sites stops bleeding without occluding the access. A tourniquet or an early discharge is unsafe when bleeding persists.

Question 18Patient Care and Assessment

During treatment a patient reports crushing chest pain. What should the technician do?

  1. Stop ultrafiltration and monitor vital signs Correct answer.
  2. Increase the ultrafiltration rate to finish early
  3. Assume it is heartburn and continue treatment
  4. Give the patient a large glass of water

Explanation

Chest pain during dialysis may signal ischemia related to fluid removal or a cardiac event, so ultrafiltration is stopped and vital signs are checked while the nurse is notified. Treatment resumes only on direction of the care team.

Question 19Patient Care and Assessment

A patient begins to seize during treatment. Which action is correct?

  1. Restrain the arms and legs firmly
  2. Disconnect the blood lines immediately
  3. Place a tongue blade between the teeth
  4. Protect the patient from injury and summon help Correct answer.

Explanation

During a seizure the priority is protecting the patient from injury by padding and clearing the area while calling for assistance. Restraints and objects in the mouth risk harm.

Question 20Patient Care and Assessment

A patient's weight is 4 kg above target since the last treatment. What is the most appropriate action?

  1. Report the gain and review fluid limits Correct answer.
  2. Restrict all fluids for the next 24 hours
  3. Skip the treatment and recheck weight next time
  4. Remove the extra fluid as fast as the machine allows

Explanation

A large interdialytic gain is reported to the care team and addressed with fluid-removal planning and reinforcement of the fluid and sodium plan. Rapid removal increases the risk of hypotension and cramping.

Question 21Patient Care and Assessment

A patient must lose 2.8 kg over a 3.5-hour treatment. What average ultrafiltration rate is required?

  1. 600 mL/hr
  2. 1200 mL/hr
  3. 800 mL/hr Correct answer.
  4. 1000 mL/hr

Explanation

Convert the fluid goal to milliliters and divide by treatment hours: 2800 mL divided by 3.5 hours equals 800 mL/hr. This average rate is compared with the patient's tolerance and maximum allowed rate.

Question 22Patient Care and Assessment

At the start of treatment, the technician can neither palpate a thrill nor hear a bruit in the fistula. What should be done?

  1. Do not cannulate and notify the team Correct answer.
  2. Apply warm compresses and try again in one hour
  3. Cannulate the access anyway and watch the flows
  4. Use the access but lower the blood flow rate

Explanation

Absent thrill and bruit suggest loss of flow, such as clotting, and the access must not be cannulated. The nurse or provider is notified so the access can be evaluated and other vascular access arranged.

Question 23Patient Care and Assessment

A firm, pulsating mass has developed over a fistula, with shiny skin overlying it. What does this most likely represent?

  1. A pseudoaneurysm Correct answer.
  2. An infected needle site
  3. A normal mature fistula
  4. A simple hematoma

Explanation

A pulsatile, firm swelling with taut, shiny skin over an access reflects a pseudoaneurysm from repeated needle injury to the vessel wall. It should not be cannulated and must be reported for evaluation.

Question 24Patient Care and Assessment

A patient with a target weight of 70 kg arrives 3.5 kg above target. What is the percent weight gain?

  1. 5 percent Correct answer.
  2. 7 percent
  3. 10 percent
  4. 2 percent

Explanation

Percent gain is the gain divided by target weight times 100: 3.5 divided by 70 equals 0.05, or 5 percent. Gains above the program's threshold are reported and addressed with the patient.

Question 25Patient Care and Assessment

A patient with diabetes becomes tremulous, sweaty, and confused during treatment while blood pressure stays stable. Which cause should be suspected first?

  1. Dialysis disequilibrium
  2. Access infection
  3. Air embolism
  4. Low blood glucose Correct answer.

Explanation

Dialysis removes glucose, so diabetic patients can become hypoglycemic, producing diaphoresis, tremor, and confusion with a stable blood pressure. A glucose check should be done and the nurse notified.

Question 26Patient Care and Assessment

Which measurement best helps determine a hemodialysis patient's target weight?

  1. Weight at home before breakfast
  2. Weight at the end of each treatment
  3. Weight without edema at normal blood pressure Correct answer.
  4. Weight after a saline bolus during treatment

Explanation

Target weight is the weight at which the patient is free of edema and has a normal or near-normal blood pressure without extra fluid removal. It is reassessed over time and is not simply the weight at the end of a treatment.

Question 27Patient Care and Assessment

Where should the technician place the blood pressure cuff for a patient with a left forearm arteriovenous fistula?

  1. On the right arm Correct answer.
  2. Over the fistula site on the left arm
  3. On the left wrist below the fistula
  4. On the left upper arm above the fistula

Explanation

Blood pressure should be measured in the arm without the vascular access to avoid compressing the fistula or graft. The access arm is avoided for cuffs, venipuncture, and intravenous lines.

Question 28Patient Care and Assessment

Which finding in a hemodialysis patient most suggests fluid overload between treatments?

  1. Flat neck veins when sitting
  2. Dry, flaky skin
  3. Shortness of breath when lying flat Correct answer.
  4. Weight lower than target

Explanation

Orthopnea and new shortness of breath are signs of fluid overload, often accompanied by weight gain and edema. A falling weight, flat neck veins, and dry skin do not suggest excess fluid.

Question 29Patient Care and Assessment

Which symptom is most associated with a high serum potassium level in a dialysis patient?

  1. Muscle weakness Correct answer.
  2. Ringing in the ears
  3. Frequent hiccups
  4. Increased thirst

Explanation

Hyperkalemia can cause muscle weakness, fatigue, and cardiac arrhythmias; peaked T waves may be seen on an electrocardiogram. The other symptoms are not typical of high potassium.

Question 30Patient Care and Assessment

A patient develops painful muscle cramps near the end of treatment while fluid is being removed rapidly. What is the most appropriate first action?

  1. Give an oral potassium binder
  2. Raise the ultrafiltration rate
  3. Lower the ultrafiltration rate Correct answer.
  4. Stop the treatment immediately

Explanation

Muscle cramps during treatment often result from rapid fluid removal, so the initial response is to slow the ultrafiltration rate and, per protocol, give saline. Raising the rate would worsen cramping, and stopping treatment is not the first step.

Question 31Patient Care and Assessment

Which laboratory result is most useful for assessing a patient's protein nutrition over several weeks?

  1. Pre-dialysis blood urea nitrogen
  2. Serum albumin Correct answer.
  3. Hematocrit
  4. Serum potassium

Explanation

Serum albumin reflects protein stores and nutrition over weeks and is a standard nutrition marker in dialysis patients. BUN, potassium, and hematocrit are affected by other factors and do not assess protein nutrition over time.

Question 32Patient Care and Assessment

Which set of findings best indicates that a new arteriovenous fistula is mature enough for cannulation?

  1. Flow 900 mL/min, diameter 4 mm, depth 9 mm
  2. Flow 300 mL/min, diameter 3 mm, depth 8 mm
  3. Flow 650 mL/min, diameter 7 mm, depth 5 mm Correct answer.
  4. Flow 500 mL/min, diameter 5 mm, depth 7 mm

Explanation

The rule of 6s is commonly used: flow greater than 600 mL/min, diameter at least 6 mm, depth no more than 6 mm, and at least 6 weeks after creation. Only the set with flow 650 mL/min, diameter 7 mm, and depth 5 mm meets these criteria.

Question 33Patient Care and Assessment

During treatment, the venous pressure alarm sounds repeatedly and the reading is rising. Which action should the technician take first?

  1. Ignore the alarm if the patient feels well
  2. Flush the arterial line with saline
  3. Increase the blood flow rate
  4. Check the venous needle and tubing Correct answer.

Explanation

A rising venous pressure alarm suggests resistance after the venous needle, such as a kink, clot, or needle malposition. The technician should inspect the venous needle and tubing first.

Question 34Patient Care and Assessment

Which statement by a patient shows correct understanding of sodium restriction?

  1. I will check labels and limit canned soup Correct answer.
  2. I should add salt to food for taste
  3. I can use salt substitutes freely
  4. Sodium only matters on dialysis days

Explanation

Canned soups and processed foods are high in sodium, so label reading and limiting them helps control thirst and fluid gain. Salt substitutes are often high in potassium, sodium restriction applies daily, and adding salt worsens thirst.

Question 35Patient Care and Assessment

A patient with an arteriovenous fistula reports numbness, tingling, and weakness in the hand on the access side. What does this most likely indicate?

  1. Access infection
  2. Venous stenosis
  3. Steal syndrome Correct answer.
  4. Pseudoaneurysm

Explanation

Steal syndrome occurs when the fistula diverts blood away from the hand, causing numbness, tingling, weakness, or coolness. Infection, stenosis, and pseudoaneurysm cause different findings.

Question 36Patient Care and Assessment

A patient with a central venous catheter develops fever and chills at the start of treatment. What should the technician do?

  1. Apply a warm compress to the exit site
  2. Flush the catheter with a larger syringe
  3. Begin dialysis as ordered and recheck temperature later
  4. Stop and notify the nurse or physician Correct answer.

Explanation

Fever and chills with a central catheter suggest a catheter-related bloodstream infection, so treatment should be stopped and the nurse or physician notified. Starting dialysis or manipulating the catheter can worsen the situation.

Question 37Patient Care and Assessment

During treatment, the arterial pressure reading becomes more negative than usual. Which cause is most likely?

  1. Low dialysate sodium
  2. Excess fluid removal
  3. Clotting at the arterial needle or line Correct answer.
  4. Infiltration at the venous needle

Explanation

More negative arterial pressure indicates increased resistance before the pump, commonly from clotting or kinking at the arterial needle or line. Venous infiltration, fluid removal, and dialysate sodium affect other pressures or symptoms.

Question 38Patient Care and Assessment

A patient's pre-dialysis BUN is 80 mg/dL and post-dialysis BUN is 24 mg/dL. What is the urea reduction ratio?

  1. 70% Correct answer.
  2. 60%
  3. 75%
  4. 66%

Explanation

URR is calculated as (pre-dialysis BUN minus post-dialysis BUN) divided by pre-dialysis BUN, multiplied by 100. Here (80 minus 24) divided by 80 times 100 equals 70%.

Question 39Patient Care and Assessment

Which patient is at greatest risk for dialysis disequilibrium syndrome?

  1. A patient with a BUN of 60 mg/dL after missing one treatment
  2. A patient starting dialysis with a BUN of 180 mg/dL Correct answer.
  3. A patient with a BUN of 30 mg/dL on peritoneal dialysis
  4. A patient on chronic dialysis with a BUN of 40 mg/dL

Explanation

Disequilibrium is most likely when dialysis is started in a patient with a very high BUN because urea is removed faster from blood than from brain. A first treatment with BUN 180 mg/dL is the highest-risk scenario listed.

Question 40Patient Care and Assessment

A patient's target weight is 68 kg. After treatment the patient weighs 66.5 kg and reports dizziness when standing. What is the best interpretation?

  1. The patient's target weight should be increased by 1.5 kg
  2. The patient has gained fluid and needs more ultrafiltration
  3. The patient is at target and needs no further action
  4. The patient is below target and should be assessed for hypovolemia Correct answer.

Explanation

A post-treatment weight below target with dizziness on standing suggests excessive fluid removal or hypovolemia. The technician should notify the nurse and reassess rather than assume the patient is at target.

Question 41Dialysis Procedures and Equipment

Which component of the extracorporeal circuit detects air before blood is returned to the patient?

  1. The dialysate conductivity meter
  2. The arterial pressure monitor
  3. The blood leak detector
  4. The air detector on the venous line Correct answer.

Explanation

The air detector uses an ultrasonic sensor on the venous blood line to identify air bubbles before blood reaches the patient. When air is detected, the blood pump stops and the venous clamp closes to prevent air embolism.

Question 42Dialysis Procedures and Equipment

What is the purpose of the blood leak detector on a hemodialysis machine?

  1. It detects blood in the dialysate Correct answer.
  2. It monitors the conductivity of the dialysate
  3. It measures the delivered dialysate flow rate
  4. It detects air in the arterial blood line

Explanation

The blood leak detector is an optical sensor on the dialysate outlet that senses blood that has crossed a ruptured membrane. A positive alarm stops the blood pump and places dialysate in bypass to prevent further blood loss.

Question 43Dialysis Procedures and Equipment

Transmembrane pressure (TMP) is best described as which of the following?

  1. The pressure gradient across the dialyzer membrane Correct answer.
  2. The pressure difference between the arterial and venous lines
  3. The pressure inside the venous drip chamber
  4. The pressure of the dialysate entering the dialyzer

Explanation

TMP is the difference between the average blood compartment pressure and the dialysate compartment pressure across the membrane. It is the driving force for ultrafiltration, so higher TMP removes more fluid when the membrane coefficient is constant.

Question 44Dialysis Procedures and Equipment

Which water treatment component removes chlorine and chloramine from the water used for dialysis?

  1. The water softener
  2. The reverse osmosis membrane
  3. The ultraviolet lamp
  4. The carbon filtration tanks Correct answer.

Explanation

Granular activated carbon adsorbs chlorine and chloramine, which must be removed because they cause hemolysis and are not reliably removed by reverse osmosis. Chlorine testing is required before each shift and after carbon tank changes.

Question 45Dialysis Procedures and Equipment

A hardness test on the water treatment system is performed to evaluate which component?

  1. The ultrafilter
  2. The carbon tanks
  3. The ultraviolet lamp
  4. The water softener Correct answer.

Explanation

Hardness testing measures calcium and magnesium, which the softener exchanges for sodium. A rising hardness result indicates the softener is exhausted or failing and needs regeneration or service.

Question 46Dialysis Procedures and Equipment

During a treatment the conductivity alarm sounds and the display reads 11.5 mS/cm. What is the most appropriate first action?

  1. Place the machine in bypass and check the concentrate supply Correct answer.
  2. Increase the blood flow rate to dilute the dialysate
  3. Decrease the dialysate flow to 300 mL/min
  4. Continue the treatment and recheck the conductivity in 30 minutes

Explanation

Conductivity reflects the total ion concentration of dialysate, so an out-of-range reading means the prescribed dialysate composition is not being delivered. The machine must be placed in bypass so the patient is not exposed to incorrectly proportioned dialysate while the concentrate containers, connections, and proportioning system are checked.

Question 47Dialysis Procedures and Equipment

Which statement describes sodium modeling during hemodialysis?

  1. Dialysate sodium is adjusted according to the ultrafiltration goal only
  2. Dialysate sodium is held at 140 mEq/L throughout
  3. Dialysate sodium starts higher and is gradually lowered during treatment Correct answer.
  4. Dialysate sodium starts low and is increased toward the end

Explanation

Sodium modeling uses a higher dialysate sodium early in treatment and a lower value later to support plasma refilling and reduce cramps and hypotension. The total sodium load must still be considered, and the prescription is set by the physician.

Question 48Dialysis Procedures and Equipment

Which condition most likely causes a high venous pressure alarm?

  1. Clotting within the venous drip chamber Correct answer.
  2. A blood flow rate set too low
  3. Disconnection of the arterial needle from the access
  4. A kink in the arterial blood line

Explanation

Venous pressure rises when resistance downstream of the sensor increases, as with clotting, kinking of the venous line, infiltration, or a poorly positioned needle. Arterial-side problems produce low or negative arterial pressure alarms instead.

Question 49Dialysis Procedures and Equipment

A decreasing (more negative) arterial pressure reading during treatment is most consistent with which problem?

  1. An air bubble at the air detector
  2. A kink in the arterial line Correct answer.
  3. Excessive ultrafiltration
  4. A clot in the venous drip chamber

Explanation

Arterial pressure is measured between the access and the blood pump, so a more negative value means the pump is pulling against increased resistance or reduced supply. Needle malposition, arterial line kinking, and access stenosis are common causes.

Question 50Dialysis Procedures and Equipment

What is the AAMI maximum allowable level of total chlorine in water used to prepare dialysate?

  1. 0.01 mg/L
  2. 1.0 mg/L
  3. 0.1 mg/L Correct answer.
  4. 0.5 mg/L

Explanation

AAMI standards set the maximum total chlorine level at 0.1 mg/L in product water for dialysis. Testing is required before each patient shift and after carbon bed replacement because chlorine can cause hemolysis.