Table of Contents

1. Exam Overview
2. Clinical Practice Area (48-52%)
3. Technical Practice Area (21-25%)
4. Environment Practice Area (13-17%)
5. Role Responsibilities Practice Area (10-14%)
6. Practice Questions (50 MCQs)
7. Answer Key with Explanations

CCHT Exam Structure

• Questions: 150 multiple-choice (25 unscored pilot questions)
• Time Limit: 3 hours
• Passing Score: 74% (approximately 111 correct answers)
• Administered by: Nephrology Nursing Certification Commission (NNCC)
• Cost: $225

Test Blueprint Distribution

Cognitive Levels

• Knowledge (8-13%): Recall of facts, terms, concepts, principles
• Comprehension (23-28%): Understanding concepts beyond basic recall
• Application (63-67%): Applying knowledge to solve clinical problems

Core Content Areas

Core Content Areas

Core Content Areas

Core Content Areas

Clinical Questions (25 questions - 50%)

1. Which vascular access is preferred for chronic hemodialysis? A) Central venous catheter B) AV graft C) AV fistula D) Temporary catheter

2. Normal glomerular filtration rate (GFR) for healthy kidneys is: A) >60 mL/min/1.73m² B) >90 mL/min/1.73m² C) >120 mL/min/1.73m² D) >150 mL/min/1.73m²

3. The absence of a bruit in an AV fistula indicates: A) Normal function B) High flow rate C) Access clotting D) Arterial stenosis

4. Standard hemodialysis treatment frequency is: A) 2 times per week B) 3 times per week C) 4 times per week D) Daily

5. A patient’s weight before dialysis is 75 kg and target weight is 72 kg. The ultrafiltration goal is: A) 1,000 mL B) 2,000 mL C) 3,000 mL D) 4,000 mL

6. Trendelenburg position is used to treat: A) Hypertension B) Hypotension C) Muscle cramps D) Nausea

7. The primary mechanism of solute removal in dialysis is: A) Filtration B) Diffusion C) Convection D) Absorption

8. Heparin is used during hemodialysis to: A) Lower blood pressure B) Prevent blood clotting C) Increase filtration D) Remove toxins

9. Dialysis disequilibrium syndrome is caused by: A) Fluid overload B) Rapid solute shifts C) Access clotting D) Infection

10. Normal blood flow rate during hemodialysis is: A) 100-200 mL/min B) 200-300 mL/min C) 300-500 mL/min D) 500-700 mL/min

11. The rope ladder cannulation technique: A) Uses the same sites repeatedly B) Rotates needle sites C) Is only for grafts D) Prevents all complications

12. Pre-dialysis assessment should include: A) Weight only B) Vital signs only C) Access assessment only D) All of the above

13. Kt/V measures: A) Blood pressure control B) Fluid removal efficiency C) Dialysis adequacy D) Access flow rate

14. Target hemoglobin for dialysis patients is: A) 8-10 g/dL B) 10-12 g/dL C) 12-14 g/dL D) 14-16 g/dL

15. First use syndrome is caused by: A) Contaminated water B) Ethylene oxide residue C) Inadequate anticoagulation D) Rapid fluid removal

16. The functional unit of the kidney is: A) Glomerulus B) Tubule C) Nephron D) Collecting duct

17. AV fistula maturation typically takes: A) 1-2 weeks B) 2-4 weeks C) 6-8 weeks D) 3-6 months

18. Chronic kidney disease stage 5 is defined as GFR: A) <30 mL/min/1.73m² B) <20 mL/min/1.73m² C) <15 mL/min/1.73m² D) <10 mL/min/1.73m²

19. The most common dialysis complication is: A) Access infection B) Hypotension C) Muscle cramps D) Air embolism

20. Normal pre-dialysis potassium level should be: A) 2.0-3.0 mEq/L B) 3.5-5.0 mEq/L C) 5.0-6.0 mEq/L D) 6.0-7.0 mEq/L

21. Ultrafiltration removes: A) Only small molecules B) Only large molecules C) Excess fluid D) Electrolytes only

22. Peritoneal dialysis uses which body cavity? A) Pleural cavity B) Pericardial cavity C) Peritoneal cavity D) Synovial cavity

23. Bone disease in dialysis patients is primarily due to: A) Calcium excess B) Phosphorus retention and vitamin D deficiency C) Protein malnutrition D) Fluid overload

24. Normal saline contains how much sodium chloride? A) 0.45% B) 0.9% C) 1.8% D) 3.0%

25. Central venous catheter tips should be positioned in the: A) Superior vena cava B) Right atrium C) Inferior vena cava D) Subclavian vein

Technical Questions (12 questions - 24%)

26. Acceptable bacterial count for dialysis water is: A) <100 CFU/mL B) <50 CFU/mL C) <10 CFU/mL D) <1 CFU/mL

27. Reverse osmosis removes: A) Only bacteria B) Only chemicals C) Bacteria, viruses, and dissolved substances D) Only chlorine

28. Dialysate flow rate typically ranges from: A) 100-300 mL/min B) 300-500 mL/min C) 500-800 mL/min D) 800-1000 mL/min

29. The most common cause of low conductivity alarm is: A) Exhausted concentrate supply B) Depleted salt in brine tank C) Residual sterilant D) Clotted dialyzer

30. Chloramines must be removed because they: A) Cause equipment corrosion B) Are toxic to red blood cells C) Reduce filtration D) Increase bacteria growth

31. High venous pressure alarm may indicate: A) Decrease in blood flow rate B) Kink in arterial blood tubing C) Separation of venous tubing D) Clotting of blood in access

32. When the dialysis machine goes into bypass: A) Arterial pressure increases B) Heparin is not administered C) Dialysate stops flowing through dialyzer D) Ultrafiltration does not occur

33. Dialysate temperature is typically set at: A) 35°C B) 36°C C) 37°C D) 38°C

34. Which component removes endotoxins? A) Ultrafilter B) Resin bed C) Deionization tank D) Softener

35. Normal conductivity range for dialysate is: A) 10.0-12.5 mS/cm B) 13.0-15.5 mS/cm C) 16.0-18.5 mS/cm D) 19.0-21.5 mS/cm

36. Feed water refers to: A) Ground water B) Carbonated water C) Water entering the treatment system D) Treated water

37. Air embolism is prevented by: A) Slower blood flow B) Air detection systems C) Higher ultrafiltration D) Warmer dialysate

Environment Questions (8 questions - 16%)

38. Standard precautions include: A) Hand hygiene only B) Hand hygiene, PPE, and safe injection practices C) Only wearing gloves D) Only environmental cleaning

39. Hand washing with soap and water is required when: A) At end of shift B) If latex allergy present C) If hands are visibly soiled D) Every 30 minutes

40. Hepatitis B positive patients must be: A) Dialyzed in main area with extra precautions B) Dialyzed with dedicated machine in assigned area C) Required to wear masks D) Treated with universal precautions only

41. Which disinfectant is commonly used for machine disinfection? A) Alcohol B) Bleach C) Peracetic acid D) Hydrogen peroxide

42. Proper body mechanics for lifting includes: A) Bending at the waist B) Holding objects close to body C) Using back muscles primarily D) Standing with feet together

43. Dialysis patients are more susceptible to infections because: A) Their diet is restricted in vitamin C B) They have weakened immune systems C) Their kidneys cannot filter toxins D) They are allergic to antibiotics

44. The term “reuse” refers to cleaning and disinfecting: A) Dialyzers B) Bloodlines C) Catheters D) Needles

45. MRSA requires which type of precautions? A) Standard precautions only B) Contact precautions C) Droplet precautions D) Airborne precautions

Role Responsibilities Questions (5 questions - 10%)

46. If a technician doesn’t know the answer to a patient’s question, they should: A) Make their best guess B) Tell patient it’s not important C) Refer to appropriate team member D) Look it up later

47. Patient confidentiality requires: A) Only protecting written records B) Not discussing patients in public areas C) Only protecting computer files D) Telling family members everything

48. Legally, if treatment was performed but not documented: A) It was insignificant B) It was confidential C) It was not done D) It was partially complete

49. QAPI (Quality Assessment and Performance Improvement) programs aim to: A) Reduce staffing costs B) Achieve better patient outcomes C) Increase treatment times D) Reduce documentation

50. Which statement about patient empowerment is correct? A) Patients should not be involved in their care B) Only nurses should educate patients C) Patients who track their data feel more in control D) Self-management creates anxiety

Clinical Questions (1-25)

1. C) AV fistula AV fistula is the gold standard for chronic hemodialysis due to lower infection rates, better longevity, and superior blood flow compared to grafts or catheters.

2. B) >90 mL/min/1.73m² Normal GFR is >90 mL/min/1.73m². GFR 60-89 indicates mild decrease, and <60 indicates moderate to severe kidney disease.

3. C) Access clotting The bruit is a whooshing sound created by turbulent flow in the access. Absence of bruit indicates no flow, typically due to clotting.

4. B) 3 times per week Standard hemodialysis is typically 3 times per week for 3-4 hours per session, providing adequate solute and fluid removal.

5. C) 3,000 mL Weight difference: 75-72 = 3 kg. Conversion: 1 kg = 1,000 mL, so 3 kg = 3,000 mL ultrafiltration goal.

6. B) Hypotension Trendelenburg position (feet elevated above heart) uses gravity to increase venous return and blood pressure.

7. B) Diffusion Diffusion is the primary mechanism where solutes move from high concentration (blood) to low concentration (dialysate) across the membrane.

8. B) Prevent blood clotting Heparin anticoagulation prevents blood clotting in the extracorporeal circuit, ensuring proper blood flow through the dialyzer.

9. B) Rapid solute shifts Disequilibrium syndrome occurs when rapid solute removal creates osmotic imbalances, causing brain swelling and neurological symptoms.

10. C) 300-500 mL/min Blood flow rates of 300-500 mL/min provide optimal clearance while maintaining patient safety and access integrity.

11. B) Rotates needle sites Rope ladder technique rotates needle sites along the access to prevent stenosis and aneurysm formation from repeated punctures at the same location.

12. D) All of the above Comprehensive pre-dialysis assessment includes weight, vital signs, and access evaluation to ensure safe treatment.

13. C) Dialysis adequacy Kt/V measures dialysis adequacy by calculating urea clearance relative to patient size. Target Kt/V is ≥1.2 for adequate dialysis.

14. B) 10-12 g/dL Target hemoglobin is 10-12 g/dL for dialysis patients, balancing anemia treatment with cardiovascular risks of higher levels.

15. B) Ethylene oxide residue First use syndrome results from sensitivity to ethylene oxide residue or other sterilizing agents used in new dialyzer manufacturing.

16. C) Nephron The nephron, consisting of glomerulus, tubules, and collecting duct, is the functional unit responsible for filtration, reabsorption, and secretion.

17. C) 6-8 weeks AV fistula maturation requires 6-8 weeks minimum for the vein to develop adequate size and flow for successful cannulation.

18. C) <15 mL/min/1.73m² CKD stage 5 (kidney failure) is defined as GFR <15 mL/min/1.73m² and typically requires dialysis or transplantation.

19. B) Hypotension Hypotension is the most common complication during dialysis, usually caused by excessive or rapid fluid removal.

20. B) 3.5-5.0 mEq/L Normal potassium is 3.5-5.0 mEq/L. Levels >6.0 mEq/L can cause dangerous cardiac arrhythmias requiring immediate dialysis.

21. C) Excess fluid Ultrafiltration primarily removes excess fluid from the blood using transmembrane pressure, helping achieve the patient’s target weight.

22. C) Peritoneal cavity Peritoneal dialysis uses the peritoneal cavity and its membrane as a natural filter for waste and fluid removal.

23. B) Phosphorus retention and vitamin D deficiency Chronic kidney disease-mineral bone disorder results from phosphorus retention, decreased vitamin D activation, and secondary hyperparathyroidism.

24. B) 0.9% Normal saline (0.9% NaCl) is isotonic with blood and used for volume replacement during hypotensive episodes.

25. A) Superior vena cava Catheter tips in the superior vena cava provide optimal flow while avoiding complications from right atrial placement.

Technical Questions (26-37)

26. C) <10 CFU/mL Dialysis water must contain <10 CFU/mL bacteria and <0.25 EU/mL endotoxins to prevent patient complications.

27. C) Bacteria, viruses, and dissolved substances Reverse osmosis removes bacteria, viruses, dissolved minerals, chemicals, and other contaminants, producing ultrapure water for dialysis.

28. C) 500-800 mL/min Dialysate flow rate is typically 500-800 mL/min, which is higher than blood flow rate to maximize concentration gradient for diffusion.

29. A) Exhausted concentrate supply The conductivity alarm indicates when dialysate solution is not in proper solute range. Most common cause is running out of acid or bicarbonate concentrate.

30. B) Are toxic to red blood cells Chloramines cause hemolysis (destruction of red blood cells) when in contact with blood during dialysis, making their removal critical.

31. D) Clotting of blood in access High venous pressure typically indicates outflow obstruction, commonly caused by access clotting or stenosis.

32. C) Dialysate stops flowing through dialyzer When the machine goes into bypass, dialysate flow bypasses the dialyzer and goes directly to drain, stopping dialysate flow through the dialyzer.

33. C) 37°C Dialysate temperature of 37°C (body temperature) prevents thermal imbalance and hemolysis while maintaining patient comfort.

34. A) Ultrafilter Ultrafilter is a fine membrane filter that removes very small particles and is the most effective component for removing bacterial endotoxins.

35. B) 13.0-15.5 mS/cm Normal conductivity range for dialysate is 13.0-15.5 mS/cm, measuring the total dissolved solids in the solution.

36. C) Water entering the treatment system Feed water is the raw water that enters the treatment system from outside the dialysis center before processing.

37. B) Air detection systems Air detection systems with automatic clamps and alarms prevent air from entering the patient’s bloodstream during treatment.

Environment Questions (38-45)

38. B) Hand hygiene, PPE, and safe injection practices Standard precautions encompass hand hygiene, appropriate PPE use, safe injection practices, and proper handling of contaminated materials.

39. C) If hands are visibly soiled According to CDC guidelines, alcohol-based hand rubs are not appropriate when hands are visibly dirty, contaminated, or soiled.

40. B) Dialyzed with dedicated machine in assigned area CMS regulations require hepatitis B positive patients to be dialyzed in a dedicated area, on a separate machine, with separate supplies.

41. C) Peracetic acid Peracetic acid is effective against bacteria, viruses, and spores, making it ideal for dialysis machine disinfection between patients.

42. B) Holding objects close to body Proper lifting technique includes standing with feet shoulder-width apart, bending knees, keeping back straight, and holding objects close to body.

43. B) They have weakened immune systems Dialysis patients have weakened immune systems, making them more susceptible to infections from pathogenic organisms.

44. A) Dialyzers Reuse refers to the cleaning and disinfecting of dialyzers to be used again by the same patient instead of disposal after single use.

45. B) Contact precautions MRSA requires contact precautions including gowns, gloves, and dedicated equipment to prevent transmission.

Role Responsibilities Questions (46-50)

46. C) Refer to appropriate team member If a technician doesn’t know the answer to a patient’s question, they should refer the patient to the appropriate team member (nurse, physician).

47. B) Not discussing patients in public areas Patient confidentiality requires protecting all patient information, including not discussing patients in public areas where others might overhear.

48. C) It was not done Legal principle states that if something was not documented (charted), it was not done from a legal perspective.

49. B) Achieve better patient outcomes QAPI programs are systematic approaches to improving safety outcomes and increasing patient satisfaction as required by CMS.

50. C) Patients who track their data feel more in control Self-management behaviors like keeping records of medications, weights, and lab results help patients feel empowered and more in control.

Official References

• Core Curriculum for the Dialysis Technician (6th ed.) - Medical Education Institute
• Review of Hemodialysis for Nurses and Dialysis Personnel (9th ed.) - Kallenbach
• CMS Conditions for Coverage for End-Stage Renal Disease Facilities

Online Resources

• NNCC Website: www.nncc-exam.org
• NNCC Practice Test: 50 questions with rationales
• C-NET: www.cnetnurse.com

Exam Tips

1. Focus on areas with highest question count (Clinical = 50% of exam)
2. Practice application-level questions (65% of exam)
3. Review water treatment and infection control thoroughly
4. Understand scope of practice for technicians vs. nurses
5. Take the official NNCC practice test for $30

Next Steps After Certification

• Maintain certification through continuing education (30 hours every 3 years)
• Consider CCHT-A (Advanced) certification after 5 years and 5,000 hours
• Join professional organizations (NANT, ANNA)
• Pursue additional training in specialized areas

This learning module is based on the official NNCC CCHT Certification Preparation Guide and test blueprint. Success on the CCHT exam requires thorough understanding of all four practice areas with emphasis on clinical applications.