I85PREP
⌘ K
CCHT-A study materials
CCHT-A study resources

CCHT-A practice questions

One question at a time. Build your CCHT-A understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Clinical Practice

Which assessment finding best confirms that an arteriovenous fistula is functioning?

  1. Cool, pale skin over the access site
  2. A palpable thrill with an audible bruit Correct answer.
  3. Serous drainage at the needle puncture
  4. A weak pulse felt distal to the anastomosis

Explanation

Turbulent flow through the fistula creates a palpable thrill and an audible bruit, which are the standard bedside indicators of patency. A distal pulse reflects hand perfusion rather than access flow, and cool pale skin or drainage suggests complications rather than adequate function.

Question 2Clinical Practice

Which needle has the largest internal diameter for cannulating a fistula?

  1. 17 gauge
  2. 14 gauge Correct answer.
  3. 16 gauge
  4. 15 gauge

Explanation

Needle gauge is inversely related to lumen size: the lower the gauge number, the larger the internal diameter. A 14-gauge needle therefore provides the greatest blood flow and is used for higher-flow treatments.

Question 3Clinical Practice

What is the most effective step before cannulating a patient's access?

  1. Apply alcohol to the needle bevel
  2. Rinse the needles with heparin
  3. Wear a gown and shoe covers
  4. Hand hygiene and site antisepsis Correct answer.

Explanation

Clean hands combined with an appropriate antiseptic skin prep and full drying time are the most effective measures for preventing access-related bloodstream infection. Other items are either not required for routine cannulation or do not reduce contamination.

Question 4Clinical Practice

Which item of personal protective equipment is required when initiating a hemodialysis treatment?

  1. N95 respirator for every patient
  2. Sterile surgical gown
  3. Clean gloves and a face shield Correct answer.
  4. Lead apron

Explanation

Standard precautions require gloves plus eye and face protection whenever splashing or spraying of blood is likely, as it is when connecting lines and removing needles. A sterile gown, lead apron, and respirator are not routine requirements for this task.

Question 5Clinical Practice

Ultrafiltration during hemodialysis removes which of the following?

  1. Red cells and platelets filtered from blood
  2. Diffused solutes such as urea and creatinine
  3. Protein-bound toxins removed from plasma
  4. Water removed by a pressure gradient Correct answer.

Explanation

Ultrafiltration moves plasma water across the dialyzer membrane in response to a hydrostatic pressure gradient, and dissolved solutes are dragged along with it. Solute movement by concentration difference is diffusion, while cells and proteins are too large to cross the membrane.

Question 6Clinical Practice

A patient becomes hypotensive with nausea and yawning during treatment. What is the first action?

  1. Increase the ultrafiltration rate
  2. Give the scheduled dose of epoetin
  3. Administer an oral potassium supplement
  4. Lay the patient flat with feet elevated Correct answer.

Explanation

Yawning, nausea, and a falling blood pressure signal intradialytic hypotension, and the immediate response is to restore venous return by placing the patient supine with the legs elevated. Ultrafiltration should then be reduced or paused and the patient assessed for fluid replacement.

Question 7Clinical Practice

How should hemodialysis bloodlines and the dialyzer be primed before use?

  1. With sterile water and a bicarbonate solution
  2. With heparinized saline in the venous line only
  3. With the patient's own blood at the start of treatment
  4. With normal saline, removing all air Correct answer.

Explanation

Priming fills the extracorporeal circuit with normal saline and displaces all air so that the patient is not exposed to air emboli or residual manufacturing chemicals. Sterile water is not isotonic and must never be infused.

Question 8Clinical Practice

A patient with a suspected air embolism should be placed in which position?

  1. Sitting upright to ease breathing
  2. Prone with the head turned
  3. Supine with legs elevated
  4. Left lateral, head down Correct answer.

Explanation

The left lateral head-down position traps air in the apex of the right ventricle away from the pulmonary outflow tract, slowing obstruction of blood flow. The blood pump should be stopped immediately and 100% oxygen given.

Question 9Clinical Practice

During cannulation the arterial needle infiltrates. What should the technician do first?

  1. Flush the needle with saline to clear the clot
  2. Stop, remove the needle, and apply pressure Correct answer.
  3. Continue treatment while watching the swelling
  4. Advance the needle deeper to reach the vessel

Explanation

An infiltrated needle lies outside the vessel, so treatment must not continue through it. The needle is withdrawn, firm pressure is applied to prevent hematoma formation, and ice is typically used before a new site is chosen.

Question 10Clinical Practice

A pre-pump arterial pressure alarm reads -250 mmHg. Which condition most likely explains this?

  1. A dialysate conductivity error
  2. A clot in the venous drip chamber
  3. A kink in the arterial bloodline Correct answer.
  4. An excessively high blood flow setting

Explanation

Pre-pump pressure becomes more negative as resistance to drawing blood rises, which occurs with a kinked or clamped arterial line, an access stenosis, or a needle lying against the vessel wall. Venous problems and dialysate errors do not change the pre-pump reading in this way.

Question 11Clinical Practice

Which situation causes a high transmembrane pressure alarm?

  1. Air in the arterial line
  2. An empty bicarbonate jug
  3. A disconnected venous return line
  4. Clotting within the dialyzer fibers Correct answer.

Explanation

Transmembrane pressure rises when resistance across the membrane increases, most often from clotting or fouling of the hollow fibers or a requested ultrafiltration rate the dialyzer cannot deliver. The response is to check the ultrafiltration goal and replace the dialyzer if it is clotting.

Question 12Clinical Practice

The conductivity alarm sounds during treatment. What is the appropriate first response?

  1. Recalibrate the blood pump
  2. Add bleach to the dialysate jug
  3. Continue treatment and recheck in one hour
  4. Stop the pump and check the dialysate mixing Correct answer.

Explanation

Abnormal conductivity means the dialysate is not at the prescribed concentration, so blood must not continue to circulate through the dialyzer. The blood pump is stopped, the dialysate is not returned to the patient, and the cause such as incorrect mixing or an empty jug is investigated.

Question 13Clinical Practice

How often should the chlorine level of product water be tested in a dialysis facility?

  1. Before each patient shift begins Correct answer.
  2. Only after the carbon tanks are changed
  3. Once each month by an outside lab
  4. Weekly, before the first treatment

Explanation

Carbon tanks can exhaust suddenly, so chlorine and chloramine must be checked before each shift and after any carbon tank backwash, replacement, or other disturbance. Monthly or weekly checks would allow undetected exposure of patients to hemolytic levels of chlorine.

Question 14Clinical Practice

Which medication reverses the effect of heparin?

  1. Sodium citrate
  2. Naloxone
  3. Protamine sulfate Correct answer.
  4. Vitamin K

Explanation

Protamine sulfate binds heparin and neutralizes its anticoagulant activity, and it is used when bleeding must be controlled rapidly, such as after a prolonged bleeding time at the end of treatment. Vitamin K reverses warfarin, and naloxone reverses opioids.

Question 15Clinical Practice

Which action best prevents infection in a patient with a tunneled central venous catheter?

  1. Mask and sterile gloves for dressing changes Correct answer.
  2. Applying antibiotic ointment under an occlusive dressing
  3. Using the catheter for blood draws between treatments
  4. Cleaning the exit site with tap water daily

Explanation

Catheter-related bloodstream infection is reduced when hub and exit-site care uses aseptic technique, including a mask for the patient and caregiver plus sterile gloves and dressing supplies. Unnecessary use of the catheter and nonsterile cleaning increase risk.

Question 16Clinical Practice

A technician receives a needlestick from a used fistula needle. What should be done first?

  1. Squeeze the site hard to make it bleed
  2. Scrub the site with bleach solution
  3. Apply a tourniquet above the injury
  4. Wash with soap and running water Correct answer.

Explanation

Immediate washing with soap and running water removes contaminating blood from the wound; the site is then reported so that post-exposure evaluation and prophylaxis can begin promptly. Squeezing, tourniquets, and caustic agents can damage tissue and are not recommended.

Question 17Clinical Practice

A patient develops severe cramping in the legs near the end of treatment. Which action is most appropriate initially?

  1. Decrease the ultrafiltration rate Correct answer.
  2. Increase the blood flow to maximum
  3. Give an oral potassium binder
  4. Administer a heparin bolus

Explanation

Cramps during dialysis usually reflect rapid volume removal and intracellular fluid shifts, so slowing ultrafiltration and giving saline or a small amount of hypertonic saline relieves symptoms. Raising blood flow or giving heparin does not address the underlying cause.

Question 18Clinical Practice

Which dialysate potassium concentration is typically used for a patient with a pre-dialysis potassium of 5.9 mEq/L?

  1. 2 mEq/L Correct answer.
  2. 4 mEq/L
  3. 5 mEq/L
  4. 0 mEq/L

Explanation

A 2 mEq/L potassium bath creates a gradient that lowers an elevated serum potassium while limiting the risk of rebound hypokalemia and arrhythmia. A 0 mEq/L bath is rarely used because potassium can drop too rapidly.

Question 19Clinical Practice

Signs of hemolysis during treatment include which of the following?

  1. Fever with chills 20 minutes into treatment
  2. Pale plasma and a drop in conductivity
  3. Cherry-red blood and sudden back pain Correct answer.
  4. Bradycardia with hypertension

Explanation

Rupture of red cells releases hemoglobin, giving the blood in the lines a dark cherry-red appearance, and patients often report sudden back or chest pain. Treatment must be stopped and the cause, such as hypotonic dialysate or a kinked line, identified.

Question 20Clinical Practice

A febrile reaction with chills occurring shortly after treatment starts is most likely caused by which factor?

  1. Endotoxin contamination of the dialysate Correct answer.
  2. Hypokalemia from the dialysate
  3. An air leak in the arterial line
  4. A kink in the venous return line

Explanation

Chills and fever appearing soon after the start of treatment suggest pyrogens or endotoxin in the dialysate or water system entering the blood. The treatment is stopped, the circuit is not returned to the patient, and the water and dialysate system is investigated.

Question 21Clinical Practice

A patient's BUN falls from 72 to 24 mg/dL. What is the urea reduction ratio?

  1. 48%
  2. 67% Correct answer.
  3. 72%
  4. 33%

Explanation

The urea reduction ratio equals the fall in BUN divided by the pre-dialysis BUN, multiplied by 100. Here (72 - 24) / 72 = 0.667, or about 67%, which meets the commonly targeted minimum of 65%.

Question 22Clinical Practice

Access recirculation is suspected when which finding occurs?

  1. Arterial urea is nearly equal to venous urea Correct answer.
  2. Arterial pressure becomes more negative over time
  3. Venous pressure falls steadily during treatment
  4. The bruit becomes louder after each treatment

Explanation

Recirculation means dialyzed blood returns to the arterial needle and is drawn back into the circuit, so the arterial sample resembles the venous sample and clearance falls. It is quantified by comparing systemic arterial, circuit arterial, and circuit venous urea values.

Question 23Clinical Practice

Why is sodium modeling used during hemodialysis?

  1. To reduce osmotic shifts that cause symptoms Correct answer.
  2. To raise the dialysate calcium level
  3. To increase potassium removal during treatment
  4. To reduce the heparin requirement

Explanation

A higher dialysate sodium early in treatment and a gradual decline maintain plasma osmolality so that water does not shift rapidly into cells. This limits the hypotension, cramping, and disequilibrium symptoms driven by osmotic gradients.

Question 24Clinical Practice

The total cell volume test of a reused dialyzer is performed to evaluate which property?

  1. Clearing of fibers after reprocessing Correct answer.
  2. Membrane pore size for middle molecules
  3. Residual chlorine level
  4. Dialysate pH stability

Explanation

Total cell volume measures the volume of the blood compartment, which falls when fibers are clotted or plugged during reprocessing. A result below 80% of the original volume indicates reduced clearance and the dialyzer is discarded.

Question 25Clinical Practice

A patient is HBsAg positive and dialyzing in-center. Which practice is required?

  1. Dedicated machine and separate room or area Correct answer.
  2. Reuse of the dialyzer for that patient only
  3. Double the standard precautions with gowns and masks for all staff
  4. Treatment only in the isolation ward of a hospital

Explanation

Hepatitis B surface antigen-positive patients are dialyzed in a separate room or designated area with dedicated equipment and staff assignment to prevent transmission to susceptible patients. Hepatitis C and HIV patients, by contrast, do not require separate machines.

Question 26Clinical Practice

Which assessment is completed before a routine hemodialysis treatment begins?

  1. Testing the machine for residual disinfectant
  2. Recording pre-dialysis weight and vital signs Correct answer.
  3. Measuring the dialyzer total cell volume
  4. Calculating the post-treatment urea reduction ratio

Explanation

Pre-dialysis weight and vital signs establish the baseline for setting an ultrafiltration goal and detecting instability before treatment. Dialyzer volume, urea reduction ratio, and residual disinfectant testing occur at other points in the process.

Question 27Clinical Practice

Which water treatment component removes bacteria and endotoxins from product water?

  1. Ultrafilter Correct answer.
  2. Water softener
  3. Carbon tank
  4. Brine tank

Explanation

An ultrafilter has a pore size small enough to retain bacteria and endotoxin before dialysate is used. Carbon tanks remove chlorine and chloramine, while softeners and brine tanks alter mineral content.

Question 28Clinical Practice

What is the minimum spKt/V target for a patient receiving three hemodialysis treatments per week?

  1. 1.2 Correct answer.
  2. 1.6
  3. 1.0
  4. 0.8

Explanation

The standard minimum spKt/V for three-times-weekly hemodialysis is 1.2 per treatment. Higher values may be targeted for some patients, but 1.2 is the accepted minimum.

Question 29Clinical Practice

What is the typical pH range for bicarbonate-based dialysate?

  1. 7.0 to 7.4 Correct answer.
  2. 6.0 to 6.5
  3. 5.0 to 5.5
  4. 8.0 to 8.5

Explanation

Bicarbonate dialysate is formulated near physiologic pH, approximately 7.0 to 7.4. Strongly acidic pH values are associated with acetate-based dialysate or concentrate instability.

Question 30Clinical Practice

A palpable thrill and audible bruit over an arteriovenous fistula indicate which condition?

  1. The access is infiltrated
  2. The access is patent Correct answer.
  3. The access is infected
  4. The access is stenosed

Explanation

A thrill and bruit are caused by turbulent flow through a functioning fistula and indicate patency. Infection produces redness, warmth, or drainage, while stenosis often changes the character of the thrill or bruit.

Question 31Clinical Practice

Which action should a patient with a left forearm arteriovenous fistula avoid?

  1. Sleeping on the right side
  2. Wearing loose sleeves over the access arm
  3. Washing the access arm with soap
  4. A blood pressure check on the left arm Correct answer.

Explanation

Blood pressure measurement can compress the fistula and impair flow, so it should be avoided on the access arm. Loose clothing, sleeping on the non-access side, and gentle washing are acceptable.

Question 32Clinical Practice

When should a patient take a calcium-based phosphate binder?

  1. Once weekly
  2. At bedtime only
  3. With each meal Correct answer.
  4. Between meals

Explanation

Phosphate binders must be present in the gut when dietary phosphate is absorbed, so they are taken with meals. Dosing at bedtime or between meals limits binding of dietary phosphate.

Question 33Clinical Practice

Which needle gauge is most appropriate for a fistula treatment with a prescribed blood flow of 400 mL/min?

  1. 16 gauge
  2. 14 gauge
  3. 15 gauge Correct answer.
  4. 17 gauge

Explanation

A 15-gauge needle is commonly selected for blood flows above 350 mL/min because it provides adequate conductance without excessive trauma. Smaller-bore needles restrict flow, while larger needles are reserved for specific situations.

Question 34Clinical Practice

A patient gains 2.4 kg between treatments. The prescription includes 0.2 L for rinseback, and the patient will drink 0.3 L during treatment. What ultrafiltration volume should be set?

  1. 3.2 L
  2. 2.9 L Correct answer.
  3. 2.6 L
  4. 2.4 L

Explanation

The ultrafiltration goal equals interdialytic weight gain plus rinseback plus oral intake during treatment: 2.4 + 0.2 + 0.3 = 2.9 L. Omitting either additional volume would leave the patient above the target weight.

Question 35Clinical Practice

For a 70 kg patient, which ultrafiltration rate is most consistent with the commonly recommended maximum of 10 mL/kg/hour?

  1. 1500 mL/hour
  2. 300 mL/hour
  3. 700 mL/hour Correct answer.
  4. 1200 mL/hour

Explanation

Multiplying 70 kg by 10 mL/kg/hour gives 700 mL/hour. Rates substantially above this are associated with more intradialytic instability.

Question 36Clinical Practice

During hemodialysis with unfractionated heparin, which activated clotting time (ACT) is a typical target range?

  1. 300 to 350 seconds
  2. 80 to 100 seconds
  3. 170 to 220 seconds Correct answer.
  4. 120 to 140 seconds

Explanation

Heparin therapy is commonly adjusted to an ACT of about 170 to 220 seconds, roughly 1.5 to 1.8 times baseline. This range reduces clotting while limiting bleeding risk.

Question 37Clinical Practice

During treatment, the venous pressure alarm sounds for a low value. Which cause is most likely?

  1. A wet venous pressure transducer protector
  2. A needle that has become dislodged Correct answer.
  3. A clotted dialyzer
  4. A kinked venous bloodline

Explanation

A low venous pressure reading reflects loss of resistance in the return path, such as a dislodged needle or disconnected line. Clotting or kinking obstructs flow and raises venous pressure.

Question 38Clinical Practice

Which set of symptoms suggests access-related steal syndrome?

  1. Bleeding from the access after needle removal
  2. Cool, painful fingers on the access side Correct answer.
  3. Warm, red skin over the access site
  4. A continuous machinery-like bruit

Explanation

Steal syndrome occurs when access flow diverts blood from the distal extremity, causing cool, pale, painful fingers and reduced pulses. Warm redness suggests infection, and prolonged bleeding suggests access or coagulation problems.

Question 39Clinical Practice

How should a post-dialysis BUN sample be obtained?

  1. After slowing blood flow to 50 to 100 mL/min for 15 seconds Correct answer.
  2. From the access before the treatment begins
  3. From the venous line while blood flow remains at 400 mL/min
  4. Immediately from the arterial needle at the end of treatment

Explanation

The post-dialysis sample should be drawn after ultrafiltration is stopped and blood flow is slowed briefly, which minimizes recirculation and reflects systemic BUN. Sampling at full flow can falsely lower the result.

Question 40Clinical Practice

Before a reprocessed dialyzer is used, which test confirms that germicide has been rinsed out?

  1. A residual disinfectant test Correct answer.
  2. A total cell volume measurement
  3. A dialysate conductivity check
  4. A blood leak test

Explanation

A residual disinfectant test verifies that chemical sterilant has been reduced below the safe limit before the dialyzer is returned to use. Total cell volume assesses fiber bundle integrity, and the blood leak test assesses the dialysate compartment.

Question 41Clinical Practice

The blood leak alarm sounds and the dialysate appears pink. What should the technician do first?

  1. Recirculate the dialysate
  2. Stop the pump and clamp the lines Correct answer.
  3. Continue treatment and monitor the color
  4. Increase blood flow to clear the dialyzer

Explanation

Pink dialysate and a blood leak alarm indicate a membrane breach, so blood flow must be stopped promptly and the lines clamped. The dialyzer is then replaced, and the blood is not returned unless the machine and circuit are managed according to policy.

Question 42Clinical Practice

Which reaction is most characteristic of first-use syndrome?

  1. Headache relieved by eating
  2. Chest pain and flushing at treatment start Correct answer.
  3. Leg cramps near the end of treatment
  4. Fever and chills six hours after treatment ends

Explanation

First-use syndrome is an anaphylactoid reaction that typically begins within minutes of starting treatment with chest pain, dyspnea, flushing, and hypotension. Delayed fever suggests a pyrogenic reaction, and cramps suggest fluid or electrolyte shifts.

Question 43Clinical Practice

What interdialytic weight gain is generally recommended for a hemodialysis patient?

  1. No more than 1 to 2 kg per day Correct answer.
  2. No more than 5% of weight per day
  3. No more than 3 kg per day
  4. No more than 0.5 kg per day

Explanation

Limiting interdialytic weight gain to about 1 to 2 kg per day helps keep ultrafiltration rates safe and reduces cardiovascular strain. Larger gains usually require higher ultrafiltration rates and increase the risk of hypotension and cramping.

Question 44Clinical Practice

When should a technician perform hand hygiene during a dialysis shift?

  1. Only before cannulation
  2. At the start and end of the shift
  3. Before and after each patient Correct answer.
  4. Only after removing gloves

Explanation

Hand hygiene is required before and after every patient contact and after glove removal to prevent cross-transmission. Limiting hand hygiene to shift endpoints or selected procedures does not meet standard precautions.

Question 45Clinical Practice

Which dialysate calcium concentration is most commonly used for routine maintenance hemodialysis?

  1. 1.5 mEq/L
  2. 3.5 mEq/L
  3. 2.5 mEq/L Correct answer.
  4. 1.0 mEq/L

Explanation

A dialysate calcium concentration of 2.5 mEq/L is commonly used for routine maintenance therapy. Higher concentrations may be used for hypocalcemia, and lower concentrations may be used for hypercalcemia.

Question 46Clinical Practice

Which action best prevents dialysis disequilibrium syndrome in a patient with a very high BUN?

  1. A dialysate sodium of 150 mEq/L
  2. A larger surface-area dialyzer
  3. A higher ultrafiltration rate
  4. Slower blood flow in early sessions Correct answer.

Explanation

Disequilibrium syndrome results from rapid removal of urea and a resulting osmotic gradient in the brain. Slower blood flow and shorter initial treatments reduce the rate of solute removal and lower the risk.

Question 47Clinical Practice

Which statement best describes the relationship between URR and Kt/V?

  1. Higher URR usually means higher Kt/V Correct answer.
  2. They measure unrelated processes
  3. Kt/V uses only the pre-dialysis BUN
  4. URR rises when treatment time is shortened

Explanation

Both URR and Kt/V estimate urea removal, so a greater percentage reduction in BUN generally corresponds to a higher Kt/V. Kt/V also incorporates clearance, treatment time, and urea distribution volume, making it more comprehensive than URR alone.

Question 48Clinical Practice

Why can calcium carbonate precipitate form in bicarbonate dialysate?

  1. Bicarbonate dialysate is always acidic
  2. Calcium and magnesium are absent
  3. Calcium binds bicarbonate at an alkaline pH Correct answer.
  4. The dialysate is heated above 40°C

Explanation

Bicarbonate raises dialysate pH, and at alkaline pH calcium can combine with carbonate to form an insoluble precipitate. Separate acid and bicarbonate concentrates plus adequate mixing help prevent this.

Question 49Clinical Practice

What is the main benefit of using a dialysate temperature of 35°C to 36°C for a patient with frequent intradialytic hypotension?

  1. It increases urea clearance
  2. It raises the patient's core temperature
  3. It improves hemodynamic stability Correct answer.
  4. It shortens the treatment time

Explanation

Cooler dialysate promotes peripheral vasoconstriction and helps maintain blood pressure during ultrafiltration. It does not materially increase urea clearance or shorten treatment, and it may cause shivering if too cold.

Question 50Clinical Practice

Which effect does increasing dialysate flow rate from 500 to 800 mL/min have on urea clearance?

  1. No change in clearance
  2. A proportional doubling of clearance
  3. A decrease in clearance
  4. A modest increase in clearance Correct answer.

Explanation

Urea clearance rises with greater dialysate flow but plateaus as the concentration gradient becomes limiting. The increase is therefore modest rather than proportional to the flow change.