ccht Exam Review 2025
Q: AAMI standard for conventional dialysis requires the total microbial count to be less than
A: 200 CFU/mL
abnormal levels of this electrolyte can cause cardiac arrhythmias and even death
Potassium
Acceptable interdialytic weight gains are
3-5% of TW
The AAMI standard for endotoxin levels in conventional daily's are is
Less than 2 EU/mL
albumin is an important test that tells about the patient------------status
nutritional
All of the follow are phosphate binders EXCEPT
Vitamin B12
numbness and tingling
Not a sign or symptom of an infected access
Asepsis
Absence of disease producing organisms
AAMI chemical analysis of water used for hemodialysis is tested
Annually
A 58- year old patient who is blind comes to treatment accompanied by his wife. What approach should the dialysis tech use when interacting with the patient?
Describe the activities in the immediate environment
A dialysis technician observed a drop of blood on the surface of a patient's machine. What action should the tech take?
Clean the machine surface immediately
About one ounce (30 ml) fluid is on the floor
A dialysis technician observes all of the below on the treatment floor, which one poses an environment risk?
A females dialysis technician has been caring for a male patient for several months. The patient tells the dialysis tech that he is lonely and depressed. He asks the tech to go out to dinner with him. In addition to politely declining the patients invitation, what action should the dialysis technician take?
Refer the patient to the social worker
A fistula connects
an artery to a vein
A marker used to determine the middle molecule clearance of a dialyzer is
Vitamin B12
A mixed bed DI tank contains
cations and anions
Nephron is made up of
A glomerulus and a tubule system
A patient complains of pain at venous needle site. The dialysis technician observes there is swelling distal to the venous needle site and that the venous pressure is rising. The tech should suspect
An infiltration
A patient who is to receive their first dialysis treatment is prone to
dialysis disequilibrium syndrome
a patient tells the technician that the dietitian reviewed high-potassium foods with her. during the conversation she states she routinely eats the following food. which one is highest in potassium?
bananas
slow pulse of 54 beats/minute would indicate the patient has:
bradycardia
A reason why a dialysis technician is to be certified is:
It's a CMS requirement
A rise in transmembrane pressure in a low flux dialyzer during hemodialysis is indicative of
clotting in the extracorporeal circuit
A teammate asks you to document the normal saline he just gave to Mr. Smith. You would
never document something that someone else did
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A true aneurysm can be dangerous because it
may rupture and cause the patient to bleed profusely
A patient's laboratory results indicate that the predialysis BUN level was lower than the post dialysis BUN level. When interpreting these findings the technician should seek the answer to which of these questions.
Was the post dialysis sample drawn correctly
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a rapid pulse of 104 beats/minute would indicate that the patient has:
tachycardia
A patient's target weight is 154.0 lb (70 kg) and the patient's pre treatment weight is 158.4 lb (72 kg). For a four-hour treatment, how many mL/hour must the patient lose to reach dry weight?
500
AAMI standard for conventional dialysate requires the total microbial count be less than
100 CFU/mL
abnormal levels of this electrolyte can cause cardiac arrhythmias and even death
Potassium
Acceptable interdialytic weight gains are
3-5% of TW
The AAMI standard for endotoxin levels in conventional dialysate is
less than two (2) EU/mL
Albumin is an important test that tells about the patients' __________ status.
nutritional
All of the following are phosphate binders EXCEPT :
Renagel
Phos-Lo
Tums
Vitamin B12
Vitamin B12
All of the following may be. signs and symptoms of an infected access EXCEPT :
fever and swelling of the access
numbness and tingling
redness and warmth
tenderness and drainage
Numbness and tingling
Before a hemodialysis treatment, the technician removes the cap from the fistula needle and accidentally touches the chair with the tip of the needle. Which of these actions should the technician take first?
discard the needle
Dialysate that is too hot will cause
hemolysis
Target weight is defined as the
weight at which the patient has no edema or fluid in the lungs and BP is normal.
During a hemodialysis treatment the technician responds to a low venous pressure alarm. The most likely cause for this alarm is:
Disconnection of the bloodline
During a hemodialysis treatment, a patient says to the technician, 'Three hours of time have passed according to the clock on the wall, but the machine shows that only 2.5 hours have passed. What could be the problem?' The technician should understand that the
machine was in bypass for 30 minutes
Biohazardous waste includes any material exposed to:
blood
Decreasing the patient's prescribed blood flow rate affects the rate of
diffusion
During a hemodialysis treatment, a patient's venous needle infiltrates. Which of these actions should the dialysis technician take first?
stop the blood pump
During hemodialysis a patient goes into cardiac arrest. The first action for the dialysis technician is
Call for assistance
Dialysate pH should be
Between 6.9 and 7.6
During hemodialysis, the air detector on Ms. Foster's machine alarms and foam is visible in the venous drip chamber. The immediate action of the dialysis technician should be to:
Clamp the venous line
during predialysis data collection, it would be best for the technician to ask the patient which of these questions?
How have you been since your last dialysis treatment?
During the hemodialysis treatment, a patient complains of feeling chilled. In addition to getting the patient a blanket, which of these actions should the technician take?
take the patient's temperature
during the set-up of a hemodialysis machine, the alarm test for conductivity fails. which of these actions should the dialysis technician take?
Notify the equipment technician
ESRD specific tests such as BUN, Creatinine, and URR are
indicators of the adequacy of the renal replacement therapy
excess fluid is forced out of the blood and into the dialysate during dialysis by which principle?
ultrafiltration
Feed conductivity minus product conductivity divided by feed conductivity X 100 is the formula for calculating
percent resistivity
Fifteen minutes before the end of a hemodialysis treatment, a patient complains of dizziness and nausea. These symptoms are most likely due to:
hypotension
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Fluid to be removed divided by the treatment time tells us
the ultrafiltration rate
Germicide rebound occurs due to
Inadequate dialyzer priming
A semipermeable membrane is a porous barrier that:
Allows for only certain sized particles to cross
Mrs. Smith's target weight is 62 kg. Her pretreatment weight when she came in for treatment on Monday was 67 kg. The priming saline amount is 240 mL, the rinseback amount is 200 mL, fluid from medications is 100 mL, and she is not allowed any fluids during treatment. What is the total amount of fluid weight to be removed during her treatment?
5,540 mL
Based on Mrs. Smith's total amount of fluid to be removed, what is the ultrafiltration rate per hour (mL/hr) for her 4-hour treatment?
1,385 ml/hr
Hives, itching, tightness of the chest and respiratory distress may be signs and symptoms of
anaphylaxis (severe allergic reaction)
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Hyperkalemia can lead to
cardiac arrest
if a patient develops an infection post transplant, the largest contributing factor would most likely be:
immunosuppressive medication
If the extracorporeal circuit clots and it must be discarded, it would be most important to monitor the patient's serum level of
hemoglobin
During dialyzer reprocessing, the blood compartment is tested to
Check dialyzer for total cell volume
Infection control protocols for hemodialysis equipment should include which of these actions by the caregiver?
using gloves when touching the machine
Lidocaine is administered
intradermally
Low albumin levels in the dialysis patient have been linked with
Higher hospitalization and death rates
A medication that dialyzes off easily is
Digoxin
Mr. jones demonstrates how to wash his access. this is a an example of which adult learning principle
psychomotor
Mr. jones suffers from constipation. he goes to the drug store to buy a laxative. Mr. jones should avoid which medication?
milk of magnesia
Mr. Roberts verbalizes how to hand crank his blood pump in the event of an emergency. this is an example of which adult principle?
cognitive
Mrs. pruitt's temperature is elevated post-hemodialysis treatment. which of these actions should the dialysis technician take?
Notify the nurse
Mrs. smith arrives for dialysis treatment complaining of shortness of breath. her pre-dialysis weight is 4.7 kilograms above the last post-treatment weight. the dialysis technician reweighed and verified the weight. which of the actions should the dialysis technician take next?
notify the nurse of the need for an assessment
Ms. Foster complains of shortness of breath. While calling for the nurse the dialysis technician notices there is air in the extracorporeal circuit she/he should place Ms. Foster in
trendelenburg position on left side
One reason that normal saline is used to prime and perform recirculation for the extracorporeal circuit prior to treatment is to remove
Air
Normal body pH
7.35-7.45
One disadvantage of a fistula is an increase in
Time to mature
One cause of aneurysms and pseudoaneurysms is:
Poor rotation of sites
the air detector alarms during treatment. if the machine is working properly, the dialysis technician should expect which of these events to have occurred
blood pump has stopped
pain at the venous needle site, along with respiratory difficulty and chest pain could be an indicator of
sterilant infusion
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Patient exposure to chloramines during the hemodialysis treatment may cause
hemolysis
One sign and symptom of fluid overload is
hypertension
Solutions that have a higher osmolarity than body fluids are called?
hypertonic
Sam's TW is 70 kilograms (kg). He arrives for treatment today at a weight of 70 kg. He complains of shortness of breath and you notice his ankles are swollen. You notify the charge nurse. What do you think will be the plan for Sam's treatment today?
The nurse will get an order to increase the TW
Symptoms of hyperkalemia may include
numbness and tingling
The accuracy of the lab results depends on adherence to proper lab draw technique. You must ensure that labs are drawn?
at the right time, right site, and right order
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Short frequent hemodialysis treatments in patients with high BUN (blood urea nitrogen) are performed to prevent
dialysis disequilibrium syndrome
prior to cannulation a technician notices the skin over the patient's fistula is reddened and warm to touch. these symptoms are most likely due to
infection
The medication used to treat anemia is
Epogen
The most important monitor in the dialysis setting is
teammate
The extracorporeal circuit consists of the
blood lines and the dialyzer
The normal range of resting respirations in an adult is
12-20 breaths per minute
the dextrose used in the dialysate for peritoneal dialysis can cause
hyperglycemia
The leading cause of chronic kidney disease for adults in the United States
diabetes
The organization that has as a goal to 'improve the care and outcomes of all individuals with kidney disease' is called
KDOQI
the dialysis technician's role in patient education is to
reinforce educational information provided
The most important intervention to prevent the spread of infection
Perform hand hygiene
The movement of fluid from the tissues toward a higher concentration of sodium in the blood is and example of
Osmosis
The functional unit of the kidney, or the structure in the kidneys that does the work is the...
Nephron
The bruit in a AV fistula or graft is detected by
Listening with a stethoscope
The national standard, based on the KDOQI guidelines for the urea reduction rate (URR) is a ratio greater than
65%
KDOQI
Kidney Disease Outcomes Quality Initiative
The most important member of the patient care team is the
patient
The medication used to improve calcium absorption is
Zemplar
How do you know if a patient can safely disconnect themselves in an emergency
Let the patient show you after a treatment
'Dwell time' in peritoneal dialysis is defined as:
The amount of time the peritoneal fluid remains in the abdomen
Dialysate conductivity measures
the total electrical charge of a solution
name two compartments of the dialyzer
blood and dialysate
Which statement is true about kidney transplantation
The is a shortage of available kidney donors
The usual fluid allowance for a person with kidney failure is
1.0 to 1.5 liters daily
The scale says a patient weights 70kg this is the same as weighing how many pounds
154
The organization that sets the standards for dialysis water quality is called
AAMI
total cell volume (TCV) is a indirect measure of the
performance of the dialyzer
Total chlorine levels in the water are tested
before each patient shift or every four hour
The purpose of using counter currant flow is to
Increase the rate of waste removal
water moves across a membrane from an area of lower solute concentration to an area of higher solute concentration by which principle
osmosis
water softener
Operates on the principle of ion exchange
What are the typical signs of fluid overload
edema and shortness of breath
The usual heparin sodium concentration for anticoagulation during hemodialysis is
1,000 u/mL
To determine the patency of an arteriovenous vascular access, the dialysis technician should initially fell for the presence of
A thrill
Ultrafiltration is influenced by
Transmembrane pressure
Waste products are removed during dialysis by which principle
Ultrafiltration
The water softener removes
calcium and magnesium
The reprocessed dialyzer is carefully rinsed prior to patient use to remove
Residual germicide
The part of the cell wall of bacteria that, when released m, can cause fever in hemodialysis patients is
Endotoxin
the venous needle in an AV fistula
Should be placed antegrade
The total pressure that exists across the dialyzer membrane is called
Transmembrane pressure
The substance that may be added to the municipal drinking water to make it clearer
Alum
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What is the most accurate measure of dialysis adequacy
Kt/V
Which component in dialysis is used to correct metabolic acidosis
Bicarbonate
What is most likely to cause high venous pressure alarm
Kinking of the venous blood line
What lab tests are used to monitor anemia in the ESKD patients
Hemoglobin/ hematocrit
which learning domain is knowledge based
cognitive
What is the desired outcome when the patient performs fistula exercises
Enlargement of the vein
What is a classic sign of hemolysis
Cranberry juice colored blood in the venous line
Which food is highest in phosphorus
Ice cream
when fluid replacement is necessary during the hemodialysis treatment, which of the following solution is used?
0.9% normal saline
What is not a symptom of uremia
elevated hematocrit
What is a cause of hypotension during and after dialysis treatment
Removing too much fluid
What is not a possible cause of an increased temperature pre dialysis
The patient has fluid overload
What is considered to be safe water for dialysis
Dialysis quality water
What is the largest needle gauge
18 gauge
What actions would increase diffusion during dialysis
Using a bath that will provide a greater concentration gradient
Fluid
Diffuses from the patients blood during dialysis
hand hygiene
the most important technique used in preventing and controlling transmission of infection
What learning domain is behavioral
Affective
when cannulating, the tips of the needles should be at least
1.5" or the width of 2 fingers apart
What symptoms would indicate a need to increase the target weight
Hypotension and cramping
Your patient is to receive 2000 units of heparin. The vile you are using is 1000u/ml heparin. How many mls will you draw up for this patient
2.0
What type vascular access has the fewest complications
arteriovenous fistula
What is used to prevent air in bloodlines
Tighten all connections
What organization establishes the standards and recommendations for dialyzer reprocessing
AAMI
What would cause a high venous pressure alarm
Venous needle is against the wall of the vessel
What might indicate a need to decrease the heparin dose?
The patient just had surgery yesterday
What might indicate the need to increase heparin?
clotting in the extracorporeal circuit
What technician activities contributes to data collection used to measure quality outcomes
Ensuring accurate documentation
A decrease in transmembrane pressure in a high flux dialyzer during hemodialysis is indicative of
Clotting of the extra corporeal circuit
You have documented incorrectly on a patient's chart. How do you correct this?
Draw one line through it, date, time, sign, with the words "error"
What practice helps build a patients immunity to hepatitis B
Vaccination
A patient asks the technician " what does uremia mean?" The technicians response should be based on the understanding that uremia is
An increase of wastes in the blood
A central venous catheter may be used as a vascular access when a
Patient has inadequate blood vessels in the limbs
Before a dialysis treatment, the patient tells the technician "yesterday, I felt terrible and vomited up some blood. I feel much better today" the technician can expect the patients treatment will be modified by
Decreasing the heparin does
The technician is unsure which one of a patients AV grafts anastomoses is arterial and which is venous. In order to differentiate between the two the technician should
Compress the graft in the middle and palpate each side
At the end of a patient's treatment, which of these findings, if observed by the technician, should be reported to the nurse ?
A pulse rate of 55 beats per minute
A patient asks the dialysis technician "why am I getting vitamin D therapy?" What should the tech tell the patient
Vitamin d is needed for healthy bones
Why are dialysis patients more likely to become infected with germs like MSRA
They have weak immune systems
Legally, if a treatment was performed but not charted in the patient's record, it was
not done
The most common cause of a low conductivity alarm during hemodialysis is
An exhausted concentrate supply
A patient who has diabetes mellitus should be observed for signs of low blood sugar which include
Anxiety and confusion
A patient asks the technician why a high venous pressure alarm is sounding. The technician should explain that a high venous pressure alarm might indicate a
Clotting of the blood in the access
In hemodialysis the term "reuse" refers to the cleaning and disinfecting of
Dialyzers
A 30 year old male new to hemodialysis, is scheduled for treatments at 6:00 AM three times a week. He tells the technician "I've walked a mile every morning for years. I guess I'll have to give that up now." Which of these responses by the technician would be best
If a patient is exposed to bleach or germicide, what will you be expected to do?
Stop treatment, clamp venous blood line, take samples for analysis
Who may be able to tell you if a patient has gained or lost really weight?
The patient
What is the first step in a chair to chair or stand and pivot transfer?
Lock the wheels on the wheelchair
What is dialysis related amyloidosis
A build up of waxy protein that forms fibrils that deposit in tissues
If a patients own family is not supportive what can you do as a dialysis tech
Encourage the patient to reach out, ask what they need, and be their cheerleader
What is the first step in the cdc's scrub the hub protocol for cvc
Wash hands put on clean gloves
What must occur to stop the process of diffusion or osmosis
Equilibrium; the solutes or water level are the same on both sides of a membrane
Getting enough protein is important for people on dialysis because protein helps them to
Maintain muscle and tissues. Patient lose protein at each treatment
What are the key components of a water softener
A resin bed and sodium ions