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1 1Q & A REVIEW FOR THE CCHT EXAMINATIONQ & A REVIEW FOR THE CCHT EXAMINATION

Golden Seal & Black Cohosh[DeDication]

[Dedication text]

SET A �From DTTH, the number ONE resource for Dialysis Technicians.

�Hundreds of the highest quality review questions.

�Complete with detailed answers and rationale.

http://www.dialysistechniciantraininghub.net/


PREFACE

As I was starting out my career in dialysis, there were two books that I considered as my reference to everything. First, i read the Core Curriculum for the Dialysis Technician from cover to cover. It is perhaps the best textbook out there regarding dialysis. It has been used as a resource for almost all dialysis training modules out there whether it is for school or for clinic training. I’ve also read the Handbook of Dialysis by John T. Daugirdas which is also an excellent resource. It gives a bit more depth and delivers a deeper look on dialysis. In my view, the Core Curriculum will suffice as your textbook but for people who wants an advanced eye on the details, Handbook of Dialysis is a great book to study.

This Q&A reviewer that I wrote is a culmination of all the training and exams that I have taken all throughout my dialysis career. I’ve basically gone through the dialysis textbooks that dialysis schools and clinics have their students study, then isolated and compiled all the necessary information that new and old dialysis technicians alike will need and lastly translated them into hundreds of questions.

This Q&A reviewer has two purposes: One, to ensure dialysis technicians pass the CCHT exam by giving them a comprehensive reviewer that tackles everything that they need to know to pass it and two, to equip dialysis technicians AFTER passing the CCHT exam with the skills and knowledge needed to provide the best possible care to our patients.

I wish you all the best in your dialysis technician career and more power!

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4 Q & A REVIEW FOR THE CCHT EXAMINATION

PRACTICE EXAM 100 items

1. Which condition caused by CKD causes a burningsensation on hands and feet, a “pins and needles”feeling, and restlessness in the legs?

a. Uremia

b. Neuropathy

c. Pericarditis

d. Amyloidosis

2. What is the newest type of home hemodialysis inthe United States?

a. Short daily home hemdialysis

b. Nocturnal home hemodialysis

c. Conventional home hemodialysis

d. In-center hemodialysis

3. If the confirmed result of Total Chlorine testingfrom the primary carbon filter indicates a level ofgreater than 0.1ppm, what is the next step?

a. the result is within normal limitsb. the result is too high and dialysis treatments

must be discontinuedc. testing is performed after the secondary carbon

filter.d. the primary carbon filter must be bypassed


4 5Q & A REVIEW FOR THE CCHT EXAMINATION

4. What causes pre-treatment hypertension in mosthemodialysis patients?

a. Obesityb. Stressc. Fluid overloadd. Medications

5. Which of these could result to hypotension?

a. Dehydration

b. Cardiovascular disease

c. Both A and B

d. Neither A nor B

6. Post treatment, a patient’s temperature increasedfrom 96.6.F to 97.8F.

a.This is a normal temperature as patients’ temperatures are expected to rise post treatment.

b.This is considered a fever which should beinvestigated

c. An order should be obtained for a painmedication to alleviate the headache

d. The patient should be told to take it easyand rest for two hours after getting home



7. Which of the following is NOT part of thehemodialysis care team?

a. Patientb. Renal dieticianc. General practitionerd. Social worker

8. What is NOT a cause of High Blood Urea Nitrogen(BUN) levels?

a. Increased tissue breakdownb. Gastrointestinal bleedingc. Poor protein calorie intaked. Not enough dialysis

9. What should a dialysis technician look out for toknow that a patient may have lost body weight?

a. Grayish skin colorb. Sunken eyesc. Cracked fingernailsd. Fluid build-up in ankles and fingers

10. How can a dialysis patient control their fluid intake?

a. Consume ice cream since it’s not consideredfluid

b. Eat more sweet and salty foodc. Use a large cup instead of a small cupd. Use lemon wedges to stimulate saliva



11. Fluid overload in the long term can cause

a. Congestive heart failureb. Shortness of breathc. Nausea and vomitingd. Painful muscle cramps

12. What is the first thing a dialysis technician shoulddo during pre-dialysis access examination?

a. Listen to patient complaints of pain,numbness or swelling

b. Observe the skin for cleanliness andintactness

c. Compare both hands for color, temperaturechanges, grip strength

d. Listen to the bruit or swooshing sound ofthe entire access

13. The __________ needle is always placed antegrade orwith the flow of blood.

a. Venousb. Arterialc. Retrograded. Vascular

14. Buttonholes, or constant cannulation sites, havemany advantages, including

a. They are suitable for AVFs with only smallsegments available

b. Dialysis treatment duration can be made alot shorter



c. The patient can recover in just a monthd. It can avoid fluid overload

15. When collecting lab specimens, you should

a. Keep the lab tubes on top of the dialysismachine

b. Shake blood tubes to ensure proper mixingof blood and tube additives

c. Fill the tube just before the vacuum isexhausted

d. Keep filled tubes upright and refrigerated

16. The recommended sodium limit for in-househemodialysis patients per day is

a. 1-3 gramsb. 2-4 gramsc. 0 gramsd. 5 grams

17. After administering the Heparin bolus through thevascular access, how long should you wait beforeinitiating the dialysis treatment?

a. 5 minutesb. 3 to 4 minutesc. 2 to 3 minutesd. there is no waiting time



18. Use of an arm board to support an arterial venousaccess extremity requires

a. the consent of the dialysis technicianb. approval from the Board of Directorsc. approval from the facility administratord. a physician’s order

19. During intradialytic monitoring, checks should becomplete every 30 minutes and should include allEXCEPT

a. Arterial and venous pressureb. Vascular access visible and line connections

intactc. Body mass indexd. Blood and dialysate flows

20.After starting the dialysis treatment, what shouldthe dialysis technician do?

a. Say hello to the patientb. Perform vascular access assessmentc. Record and compare to previous BP readingd. Advise patient to take a rest for an

hour before starting treatment

21. All are possible causes of dysrhythmia EXCEPT

a. Underlying heart diseaseb. Chronic kidney disease



c. Removal of antiarrhythmic medicationsduring dialysis

d. Complications and emergencies duringdialysis

22. Recirculation of blood should not exceed _____minutes to prevent deoxygenation and celldestruction.

a. 10b. 20c. 30d. 40

23. In case of a severe allergic reaction, dialysis must be discontinued without returning the patient’s blood.

a. Always trueb. Sometimes truec. Always falsed. Sometimes false

24. A traditional three-times-a-week dialysis scheduleonly replaces about _____% of healthy kidneyfunction.

a. 15b. 30c. 45d. 70



25. Which of the following is NOT an approvedtreatment intervention for cramps?

a. A saline bolus

b. Gloves filled with hot water

c. Opposing force

d. Giving of Tylenol

26. Once rinseback is completed, what should be doneprior to removing a patient’s venous needle?

a. Check patient’s standing blood pressure

b. Check patient’s weight

c. Flush the needle with 20 ml of normal saline

d. Ask patient to wear a face mask

27. Why was the Health Insurance Portability andAccountability Act made into law?

a. For patients to have easy access to theirhealth insurance

b. It established rules about the security andprivacy of health data

c. For dialysis facilities to know exactly whattheir accountabilities are

d. It established rules that dialysis techniciansneed to follow during treatment



28. Peritoneal dialysis (PD) differs from hemodialysis inwhich of the following ways?

a. PD requires both vascular access andabdominal access

b. PD cannot be done at homec. PD access is by an intra-abdominal catheterd. Sterile dialysate is not required for PD.

29. Which of the following kidney structures connects with and delivers urine directly to the ureter?

a. Pelvisb. Calyxc. Glomerulusd. Cortex

30. Mrs. Smith, a 89-year-old widow, asks to have hertreatment shortened by 20 minutes today so shecan get home and watch her favorite soap opera.You explain that:

a. This will be okay because a few minuteshere and there don’t make any difference

b. She can leave, but she must do an extra 20 minutes next treatment

c. It is very important to get the prescribedtime, every dialysis treatment, to avoidmedical complications

d. Center policy does not permit patients todiscontinue treatment early



31. Diffusion is movement of particles

a. By filtration through a biocompatiblemembrane

b. From an area of higher concentration to anarea of lower concentration

c. Into a vacuum created when fluids areforced through a membrane

d. Into a space made by solutions moving in acountercurrent flow

32. When does ultrafiltration during dialysis occur?

a. Water is removed from blood because thereis a pressure gradient across a membrane

b. Phosphorus is removed from blood becausedialysate is low on phosphorus

c. A higher concentration of sodium causeswater to move from body compartmentsinto the dialysate

d. A suction device is applied to the venoustrap and a Harvard Clamp is applied to thearterial side of the blood set

33. Which of the following is a way to remove solutes?

a. Convectionb. Suctionc. Surface aread. Irradiation



34. Dialysate is the fluid that helps remove wasteproducts from the body. It contains a number ofsubstances. Choose the group below that might beprescribed for a dialysate solution:

a. Bicarbonate, sodium, potassium

b. Magnesium, creatinine, calcium

c. Choloride, glucose, urea

d. Beta-2-microglobulin, calcium, sodium

35.Which of the following best describes thetransducer?

a. Pump that moves blood through theextracorporeal circuit

b. Device inside the machine that converts airpressure into an electronic signal

c. Tubing that carries blood from the patient’saccess to the dialyzer and back to the access

d. System that removes water from the blood

36. The normal range of resting respirations in an adultis

a. 12 to 20 breaths/min

b. 20 to 40 breaths/min

c. 30 to 50 breaths/min

d. 60 to 100 breaths/min



37. The purpose of priming the extracorporeal circuitwith saline during setup is

a. To remove air and germicide beforeinitiating treatment

b. To be certain fibers are thoroughly filledwith germicide before initiating dialysis

c. To assess ultrafiltration capacity of thedialyzers and check for leaks

d. To maintain fiber noncompliance until thedialysis begins

38. Mrs. Smith’s dry weight is 62 kg. Her pretreatmentweight when she came in for treatment on Mondaywas 67 kg. For her treatment the priming salineamount is 240 mL, the rinseback amount is 200mL, fluid from medications is 100 mL, and she isnot allowed any fluid during the treatment. Whatis the total amount of fluid weight to be removedduring her treatment?

a. 5,000 mLb. 5,230 mLc. 5,540 mLd. 5,820 mL

39. Which of the following tests must be performed onnew dialyzers?

a. Hgb – hemoglobinb. TIBC - total iron binding capacityc. CBC - complete blood countd. TCV - total cell volume



40. Which of the following is the definition of “contacttime”?

a. Amount of time the germicide is rinsedthrough the dialyzer

b. Amount of time between dialyzer usesc. Amount of time the germicide remains in

the dialyzerd. Time it takes to reprocess the dialyzer

41. Which is the most common way that watertreatment systems are disinfected?

a. Heatb. Ozonec. Chemicald. Minerals

42. According to AAMI standards, the total microbialcount of dialysate shall not exceed?

a. 200 CFU/mLb. 400 CFU/mLc. 800 CFU/mLd. 1,000 CFU/mL

43. Large amounts of aluminum in water used fordialysate could cause

a. Fever/chillsb. Liver problemsc. Bone diseased. Diarrhea



44. Which of the following is a limitation of a reverseosmosis (RO) system?

a. Removes bacteria and endotoxin

b. Removes solutes from the water

c. Thin film composite membranes breakdown when exposed to chlorine andchloramines

d. Produces purified water

45. Water used for dialysate must be treated becausedialysis patients

a. Have strict fluid restrictions and drink onlypure water

b. Drink large amounts of water despite theirrestrictions

c. Are exposed to large volumes of waterduring dialysis

d. Are able to excrete contaminants indialysate during dialysis

46. Which of the following methods kills bacteria, butwill not destroy all of them completely?

a. Asepsis

b. Disinfection

c. Exposure to chemical sterilants

d. Open-flame irradiation



47. Which of the following is a step in the port/catheterpredialysis assessment?

a. Cleansing the catheter site

b. Connecting the catheter to the bloodlines

c. Assessing the blood flow rate through thecatheter

d. Assessing the ease of heparin removaland saline flushing before connecting thebloodlines

48. When assessing a fistula or graft, which of thefollowing need to be felt prior to starting dialysis?

a. Pulse and deep accessb. Bruit and deep accessc. Bruit and thrilld. Pulse and thrill

49. Mrs. Barnett is a 55-year-old woman whose kidneysare failing due to hypertension. She does not havediabetes or cardiac problems. If her blood vesselsare in good condition, what type of access ispreferable?

a. A femoral catheterb. A forearm loop graftc. An arteriovenous fistulad. A cuffed, tunneled catheter



50. Dialysate conductivity measures

a. The total electrical charge of a solutionb. The total number of thermistors in a

solutionc. The total number of mL per solutiond. The total number of gradients in a solution

51. The two compartments of the dialyzer area. Conventional and high fluxb. Convection and adsorptionc. Blood and dialysated. Hollow fiber and flat plate

52. Kidney failure is a chronic illness that causes manychanges for the person with the disease and his orher family and friends. The dialysis team memberwith special training in helping people adjust tothese changes is the

a. Nurseb. Physicianc. Social workerd. Technician

53. Which is the best definition for dry weight?

a. Postdialysis weight at which all or mostexcess fluid has been removed

b. Weight gained between treatmentsc. Predialysis weightd. Amount of weight to be removed during

treatment



54. The leading cause of chronic kidney disease foradults in the United States is

a. Hypertensionb. Glomerulonephritisc. Diabetesd. Urinary obstruction

55. What is the functional unit of the kidney, or thestructure in the kidney that does the work?

a. Medullab. Cortexc. Calyxd. Nephron

56. All of the following medical problems may occurdue to chronic kidney diseases EXCEPT for

a. Anemiab. Indigestionc. Sleeping problemsd. Pericarditis

57. A semipermeable membrane is a filter that

a. Allows only certain sized particles to crossb. Prevents fungal between particlesc. Can distinguish between particlesd. Is biocompatible, non toxic, and

hypoallergenic



58. What is the purpose of a proportioning system?

a. Monitors the dialysate flow rate

b. Monitors for blood leaks

c. Checks the conductivity of the dialysate

d. Make dialysate by mixing fresh concentratewith fixed amounts of treated water

59. What are the two types of ultrafiltration systems?

a. Volumetric UF control and flow control

b. Flow rate and UFR

c. TMP and UFR

d. Proportioning system and flow control

60. Although dialysate delivery systems have back-upmonitoring systems, it is critical that

a. The monitoring systems be checked andcalibrated on a schedule recommended bythe manufacturer

b. Conductivity and pH be verified byindependent meters before each dialysistreatment and whenever the dialysate ischanged

c. All alarm systems be tested prior to eachdialysis treatment

d. All of the above



61. Which of the following is NOT a possiblecomplication of “flipping” the needle in AVFcannulation?

a. Stretching the needle holeb. Steal syndromec. Infiltrationd. Stenosis

62.Which of the following is a long term complicationof fistulas?

a. Infiltrationb. Thrombosisc. Bruitd. Recirculation

63. The instrument used for measuring blood pressureis called

a. Sphygmonanometerb. Spirometerc. Bronchoscoped. Tachometer

64. For which of the following situations would you usethe stand-and-pivot technique to transfer a patient?

a. Patient is brought into the dialysis clinic on astretcher

b. Patient can bear weight once standing, buthas trouble getting up from the dialysischair



c. Patient can get out the dialysis chair withoutany problems

d. Patient is complaining of dizziness andnausea

65.What are the functions of the kidneys that dialysisreplaces?

a. Removal of wastes

b. Regulation of blood pressure

c. Removal of excess fluids

d. All of the above

66. Dialyzers are reprocessed mainly because?

a.Reprocessing reduces the cost of dialysistreatments

b. Reprocessing shortens the dialysistreatment

c. Reprocessing is safer for staff

d. Reprocessing reduces the amount of plasticin landfills

67. Which of the following is a germicide used fordialyzer reprocessing?

a. Alcohol

b. Hydrogen peroxide



c. Peracetic acidd. Acetone

68. Which of the following is a problem in dialyzerreprocessing that may cause bacteria or endotoxincontamination of the dialyzer?

a. Use of proper storage conditionsb. Correct contact time usedc. Use of heat and citric acidd. Improperly prepared germicide

69. Which of the following are two criteria for rejectinga reprocessed dialyzer?

a. Less than 80% of original fiber bundlevolume, aesthetic appearance

b. Label incomplete, dialyzer not heparinizedc. Patient preference, access is recirculatingd. HIV status, hyperkalemia present

70. The water softener performs the following activity

a. Removes calcium and magnesium fromwater

b. Removes chlorine and chloramines fromwater

c. Adds calcium and magnesium waterd. Kills bacteria in the water

71. Which of the following is an acceptable level of postsoftener hardness?

a. 0.8 grain per gallonb. 1.1 grain per gallon



c. 1.5 grain per gallond. 2.0 grain per gallon

72. How frequently should the carbon tanks bechecked for chlorine and chloramines?

a. Each shiftb. Weeklyc. Monthlyd. Annually

73. Which of the following best describes the DialyzerReprocessing Manual?

a. Record of the date and results of all qualityassurance and quality control evaluationsfor the center

b. Summary of all reuse specifications, policies,procedures, training materials, manuals andmethods, and samples of forms and labels

c. Log of the dates of preventive maintenance,repairs, and results of scheduled testing onall hemodialysis equipment

d. Record of testing required by regulatoryagencies on any germicides or cleaningagents uded in dialyzer reuse

74. What organization sets the standards and recommendations for dialyzer reprocessing?

a. FDA - U.S. Food and Drug Administrationb. CDC - Center for Disease Control and

Prevention



c. AAMI - Association for theAdvancement of Medical Instrumentation

d. CMS - Centers for Medicare and MedicaidServices

75. Which of the following should be done to preventneedle sticks?

a. Recapping needlesb. Throwing used needles into

puncture-resistant, color-coded containersc. Break or bend the needled. Leaving needles on the medicine carts

76. Why was the Council of Nephrology Nurses andTechnicians (CNNT) established?

a. To provide scholarships to deservingindividuals who wish to be dialysistechnicians

b. To make health policies that aid professionalpractices and patient care

c. To oversee the research and developmentaspect of dialysis machines

d. To provide financial assistance to dialysiscenters across the country

77. What happens in the body when a patient suffersfrom pruritis?

a. High phosphorus and serum calcium levelsb. Secondary hyperparathyroidism



c. Both A and Bd. Neither A nor B

78. What do you call the condition where there is toomuch sodium in the blood?

a. Hyperkalemiab. Hyponatremiac. Hypokalemiad. Hypernatremia

79. What happens if bleach and peracetic acid aremixed?

a. A strong disinfectant is created, effectivelyeliminating fungus

b. A watery solution is created which no longerhas any disinfecting properties

c. An explosion occurs requiring evacuation ofthe premises for at least 48 hours

d. A chemical reaction occurs, producing toxicchlorine gas

80. How often do you need to conduct a CompleteBlood Count (CBC) test on patients with CKD?

a. Monthlyb. When neededc. Predialysisd. Postdialysis



81. How often should the Hemoglobin test be givenwhen a stable Hgb/Hct level is achieved?

a. Every 1-2 weeksb. Every 10 daysc. Every 2-4 weeksd. Every 5 days

82. Why should you conduct a Hepatitis C Virus HCVAntibody test to CKD patients once a year?

a. Someone who tests positive may be able tospread the Hepatitis C virus.

b. It is a routine test for any patient who startson a dialysis treatment.

c. A CHT should know if a patient is infectedso she can increase the dialysate duringtreatment.

d. This test can determine if the CKD patient isresponding positively to the treatment.

83. What are the three processes that make up thewater treatment system for hemodialysis?

a. Pre-treatment, acid concentrate mixing,water purification

b. Pre-treatment, saline solution, distributionc. Pre-treatment, water purification,

distributiond. Pre-treatment, dialysate testing, distribution



84. A water softener DOES NOT

a. Remove calcium and magnesium from theincoming water

b. Work with the brine tankc. Remove fine carbon particles, resin beads

and other debrisd. Prevents hard mineral deposits from

accumulating and damaging the ROmembranes

85. What can be an adverse effect of too much zinc inthe water used for dialysis?

a. Hemolysisb. Anemiac. Hypertensiond. Degenerative brain disease

86. What is NOT TRUE about bicarbonate concentrate?

a. Commercial liquid bicarbonate is available.b. It can diffuse the patient’s blood and

replenish the body’s buffer stores.c. A batch can be mixed using a bicarbonate

concentrate system mixer.d. It is tested for bacterial contamination and

endotoxin.

87. Pre-treatment water samples are collected afterthe RO has operated for at least how long?

a. 5 minutesb. 10 minutesc. 15 minutesd. 30 minutes



88. Total water hardness is checked at the end of eachtreatment day and includes monitoring of the saltlevel in the brine tank. The salt level in the tankshould be

a. Completely fullb. At least three quarters fullc. At least one half fulld. Below the water level

89. Which electrolyte plays a vital role in nerve andmuscle function and unstable levels can causearrhythmias?

a. Phosphorusb. Potassiumc. Sodiumd. None of the above

90. What should a patient do to get on the nationaltransplant list?

a. Talk to family members who wish to give upone of their kidneys

b. Talk to your doctor and get in touch with theUnited Network for Organ Sharing

c. Plead to the doctors in the biggest hospitalsin the country

d. Contact Medicare and see what they can dofor you.

91. Dialysis makes up for the loss of kidney function,except for

a. Removing excess fluid and wasteb. Restoring electrolyte balance



c. Making erythropoietin and activatingvitamin D

d. Controlling blood pressure

92. What is NOT TRUE about peritoneal dialysis?

a. It allows working-age patients to keep theirjobs.

b. It requires patients to seek treatment indialysis centers.

c. It uses part of the patient’s body as a filter.d. Patients using PD have some remaining

kidney function.

93. Which is NOT a part of pre-treatment assessments?

a. Vital signsb. Patient’s general dispositionc. Vascular accessd. Emotional stability

94. What can affect the accuracy of taking a patient’sbody temperature?

a. Room temperatureb. Patient’s liquid intakec. Patient’s weightd. Sunlight streaming through the windows

95. Hypotension is related to a number of factorsexcept:

a. Recent medication dosingb. Dialysate levels



c. Patient’s strength and enduranced. Stability of hormone levels

96.The reason why potassium dialyzes and RBC's donot is

a. Potassium has a smaller molecular weightb. Potassium has a higher molecular weightc. RBC's are not water solubled. RBC's have a negative charge

97. Patients presenting to dialysis below their targetweight should

a. Have their target weight decreasedb. Receive fluid replacement during the

treatmentc. Be re-weighed and evaluated for the cause

of weight lossd. Receive education on proper fluid intake

98. Who is considered the best source of a patient’scurrent disposition?

a. The patient’s physicianb. A teammate who knows the patient wellc. The patient him/herselfd. A family member

99. A post treatment patient assessment

a. is completed to verify that the patient isstable, to determine the patient’s dischargestatus, and to evaluate the effectiveness ofthe treatment plan



b. is compared to the patient’s pretreatmentassessment findings

c. requires the licensed nurse to notify thephysician as needed of changes in thepatient status

d. all of the above

100.When taking a patient’s blood pressure who also has an irregular heart beat with an automatic BP cuff

a. It has no effect on the recorded bloodpressure

b. The recorded blood pressure will be toohigh

c. The recorded blood pressure will be too lowd. The recorded blood pressure may not be

accurate


4 5answers and rationalesQ & a reView For tHe CCHt eXaMination

Contents

Section title

section subtitle

chapter title ............................................................................................................................chapter subtitle .............................................................................................................

Subhead 1 ...................................................................................................................

�From DTTH, the number ONE resource for Dialysis Technicians.

�Hundreds of the highest quality review questions.

�Complete with detailed answers and rationale.



6 A1answers and rationalesQ & a reView For tHe CCHt eXaMination

1. Which condition caused by CKD causes a burning sensationon hands and feet, a “pins and needles” feeling, andrestlessness in the legs?

a. Uremiab. Neuropathyc. Pericarditisd. Amyloidosis

Option B is the correct answer. Neuropathy symptoms include burning of the hands and feet, a “pins and needles” feeling, and restlessness in the legs. The cause is not known, though secondary hyperparathyroidism, sodium imbalance, and high serum calcium levels have been considered. Options A, C, and D are other conditions caused by CKD.

2. What is the newest type of home hemodialysis in the UnitedStates?

a. Short daily home hemdialysisb. Nocturnal home hemodialysisc. Conventional home hemodialysisd. In-center hemodialysis

Option A is the correct answer. SDHHD is the newest type of home hemodialysis in the United States; 92 centers offer it as of 2006. These new dialysis machines are designed for faster, easier set up and clean up. SDHHD is more practical. Options B, C, and D are incorrect.

3. If the confirmed result of Total Chlorine testing from the primary carbon filter indicates a level of greater than 0.1ppm, what is the next step?

a. the result is within normal limitsb. the result is too high and dialysis treatments

must be discontinuedc. testing is performed after the secondary carbon

filterd. the primary carbon filter must be bypassed


A2 Q & A REVIEW FOR THE CCHT EXAMINATION

Option C is the correct answer. The maximum Total Chlorine level is 0.1 ppm. The next step would be is to do testing after the secondary carbon filter every thirty minutes while primary carbon filter is being replaced. Bypassing primary carbon filter will not remove contaminants in the water.

4. What causes pre-treatment hypertension in mosthemodialysis patients?

a. Obesityb. Stressc. Fluid overloadd. Medications

Option C is the correct answer. While options A, B, and D may possibly cause hypertension, fluid overload is the common cause of pre-treatment hypertension. Prevent hypertension caused by fluid overload by: calculating the fluid goal correctly, asking patients if they’ve taken their BP pills, and encouraging patients to follow their fluid limits.

5. Which of these could result to hypotension?

a. Dehydrationb. Cardiovascular diseasec. Both A and Bd. Neither A nor B

Option C is the correct answer. Both dehydration and cardiovascular disease can cause hypotension.

6. Post treatment, a patient’s temperature increased from 96.6.F to 97.8F

a. This is a normal temperature as patients’temperatures are expected to rise posttreatment.

b. This is considered a fever which should beinvestigated


A2 A3answers and rationalesQ & a reView For tHe CCHt eXaMination

c. An order should be obtained for a painmedication to alleviate the headache

d. The patient should be told to take it easy andrest for two hours after getting home

Option A is the correct answer. A rise in temperature of 2°F over the patient’s baseline temperature with accompanying symptoms, which may include nausea, vomiting, headache, hypotension, tachycardia, hot flushed skin, and dry mucous membranes or any temperature over 100°F needs to be re-assessed. Hemodialysis patients tend to have low baseline (predialysis) temperatures, for unknown reasons.

7. Which of the following is NOT part of the hemodialysis careteam?

a. Patientb. Renal dieticianc. General practitionerd. Social worker

Option C is the correct answer. Dialysis is provided by a team that includes technicians, nurses, dietitians, social workers, doctors and patients. Option C is incorrect. HD care team is composed of a nephrologist (a licensed physician who specializes in kidney diseases) not a general practitioner.

8. What is NOT a cause of High Blood Urea Nitrogen (BUN)levels?

a. Increased tissue breakdownb. Gastrointestinal bleedingc. Poor protein calorie intaked. Not enough dialysis

Option C is the correct answer. Common causes of High Blood Urea Nitrogen (BUN) include excess protein intake, inadequate dialysis, gastrointestinal bleeding, increased tissue breakdown (catabolism), and missed treatment(s). Eating too little protein is a common cause of Low Blood Urea Nitrogen (BUN).



9. What should a dialysis technician look out for to know that a patient may have lost body weight?

a. Grayish skin colorb. Sunken eyesc. Cracked fingernailsd. Fluid build-up in ankles and fingers

Option D is the correct answer. Signs that a patient has lost body weight, even if postdialysis weight is unchanged, include: fluid build-up in the ankles and fingers, shortness of breath, or the patient saying he or she can’t lay flat in bed. Inform your charge nurse of body weight loss. Target weight may be adjusted as per doctor’s order.

10. How can a dialysis patient control their fluid intake?

a. Consume ice cream since it’s not consideredfluid

b. Eat more sweet and salty foodc. Use a large cup instead of a small cupd. Use lemon wedges to stimulate saliva

Option D is the correct answer. Encourage your patients to follow their fluid limits, usually 4 cups or 1 liter per day. Some helpful tips include: using lemon wedges to stimulate saliva, limiting sodium and sugar intake, using small cups, and knowing your fluids (all foods that are liquid at room temperature, such as ice cream, popsicle, frozen yogurt, and sherbet, are fluids.) Options A, B, and C are incorrect.

11. Fluid overload in the long term can cause

a. Congestive heart failureb. Shortness of breathc. Nausea and vomitingd. Painful muscle cramps



Option A is the correct answer. Long-term fluid overload may lead to congestive heart failure (CHF). CHF is a condition characterized by the heart’s inability to pump out blood fully. Shortness of breath and edema are signs of CHF. Options C and D are unrelated with fluid overload.

12. What is the first thing a dialysis technician should do during pre-dialysis access examination?

a. Listen to patient complaints of pain, numbnessor swelling

b. Observe the skin for cleanliness and intactnessc. Compare both hands for color, temperature

changes, grip strengthd. Listen to the bruit or swooshing sound of the

entire access

Option B is the correct answer. Always perform a physical examination – Look, Listen, & Feel - of the patient’s access before initiating treatment. Observe for cuts, rashes, scratches, infections, drainage, aneurysms, or skin erosion over the access. Report any abnormal signs to your charge nurse for assessment. Options A, C, and D are procedures taken after ensuring cleanliness and intactness of skin.

13. The __________ needle is always placed antegrade or with theflow of blood.

a. Venousb. Arterialc. Retrograded. Vascular

Option A is the correct answer. The venous needle should always be placed antegrade (in the direction of blood flow) to prevent turbulence when the blood returns from the extracorporeal circuit. The arterial needle can be placed antegrade or retrograde (into the flow of blood.)



14. Buttonholes, or constant cannulation sites, have manyadvantages, including

a. They are suitable for AVFs with only smallsegments available

b. Dialysis treatment duration can be made a lotshorter

c. The patient can recover in just a monthd. It can avoid fluid overload

Option A is the correct answer. Option A is one of the advantages of buttonholes. Other advantages include possibility of self-cannulation, less painful needle insertion, post-dialysis bleeding is shorter, and infiltrations are eliminated. Option B, C, and D are incorrect.

15. When collecting lab specimens, you should

a. Keep the lab tubes on top of the dialysismachine

b. Shake blood tubes to ensure proper mixing ofblood and tube additives

c. Fill the tube just before the vacuum isexhausted

d. Keep filled tubes upright and refrigerated

Option D is the correct answer, filled tube must be kept upright and refrigerated. General rules when collecting lab specimens include: do not place lab tube on top of dialysis machine, fill the tube to the correct level until vacuum is exhausted, and gently invert the tube 8-10 times (shaking the tube can cause blood cells to rupture).

16. The recommended sodium limit for in-house hemodialysispatients per day is

a. 1-3 gramsb. 2-4 grams



c. 0 gramsd. 5 grams

Option B is the correct answer. The recommended sodium limit for in-center HD is most often 2–4 grams per day. Options A, C, and D are incorrect.

17. After administering the Heparin bolus through the vascularaccess, how long should you wait before initiating thedialysis treatment?

a. 5 minutesb. 3 to 4 minutesc. 2 to 3 minutesd. there is no waiting time

Option A is the correct answer. Initiate dialysis treatment five (5) minutes after administering heparin loading dose. Heparin is given to keep the patient’s clotting time at a prescribed limit. Options B, C, and D are incorrect.

18. Use of an arm board to support an arterial venous accessextremity requires

a. the consent of the dialysis technicianb. approval from the Board of Directorsc. approval from the facility administratord. a physician’s order

Option D is the correct answer. Use of restraints such as an arm board requires a doctor’s order. Option A, B and C are not necessary.

19. During intradialytic monitoring, checks should be completeevery 30 minutes and should include all EXCEPT

a. Arterial and venous pressureb. Vascular access visible and line connections

intact



c. Body mass indexd. Blood and dialysate flows

Option C is the correct answer. Options A, B, and D should be included in the intradialytic monitoring, along with the blood pressure, heart rate, vascular access intactness, maintenance anticoagulation amount, and fluid removal and/or replacement. Body mass index is often required in patient’s nutritional assessment.

20. After starting the dialysis treatment, what should the dialysis technician do next?

a. Say hello to the patientb. Perform vascular access assessmentc. Record and compare to previous BP readingd. Advise patient to take a rest for an hour before

starting treatment

Option C is the correct answer. While undergoing dialysis, the BP should be stable when compared with baseline BP. Sudden changes in BP reading, such as a drop of 20 mmHg, a BP below 90/60, or a sudden increase should be reported to the charge nurse for proper evaluation.

21. All are possible causes of dysrhythmia EXCEPT

a. Underlying heart diseaseb. Chronic kidney diseasec. Removal of antiarrhythmic medications during

dialysisd. Complications and emergencies during dialysis

Option B is the correct answer. Options A, C, and D are all possible causes of dysrhythmia. Chronic kidney disease is a condition characterized by a chronic, progressive loss of kidney function.



22. Recirculation of blood should not exceed _____ minutes toprevent deoxygenation and cell destruction.

a. 10b. 20c. 30d. 40

Option C is the correct answer. Recirculating blood for more than 30 minutes can cause deoxygenation and cell destruction. Options A, B, and D are incorrect.

23. In case of a severe allergic reaction, dialysis must be discontinued without returning the patient’s blood.

a. Always trueb. Sometimes truec. Always falsed. Sometimes false

Option A is the correct answer. Patient’s blood should not be returned in cases where the dialysis treatment needs to be interrupted such as when a patient develops a severe allergic reaction. Report to the charge nurse symptoms of allergic reaction once observed.

24. A traditional three-times-a-week dialysis schedule onlyreplaces about _____% of healthy kidney function.

a. 15b. 30c. 45d. 70

Option A is the correct answer. A regular three times a week dialysis only replaces 15% of normal kidney function.



25. Which of the following is NOT an approved treatmentintervention for cramps?

a. A saline bolusb. Gloves filled with hot waterc. Opposing forced. Giving of Tylenol

Option D is the correct answer. Hypertonic saline bolus, hot compress, and use of opposing force may help relieve cramps. Tylenol is NOT an approved intervention for cramps.

26. Once rinseback is completed, what should be done prior toremoving a patient’s venous needle?

a. Check patient’s standing blood pressureb. Check patient’s weightc. Flush the needle with 20 ml of normal salined. Ask patient to wear a face mask

Option A is the correct answer. Checking patient's blood pressure after blood is returned ensures it is not too low for discharge. Checking patient's weight is done after ensuring patient is stable for discharge. Other options are incorrect.

27. Why was the Health Insurance Portability and AccountabilityAct made into law?

a. For patients to have easy access to their healthinsurance

b. It established rules about the security andprivacy of health data

c. For dialysis facilities to know exactly what theiraccountabilities are

d. It established rules that dialysis techniciansneed to follow during treatment



Option B is the correct answer. This law requires healthcare providers to protect the confidentiality of PHI (Protected Health Information). Options A, C, and D are incorrect.

28. Peritoneal dialysis (PD) differs from hemodialysis in whichof the following ways?

a. PD requires both vascular access andabdominal access

b. PD cannot be done at homec. PD access is by an intra-abdominal catheterd. Sterile dialysate is not required for PD.

Option C is the correct answer. Hemodialysis requires a vascular access while peritoneal dialysis utilizes intra-abdominal catheter access. Options A, B, and D are incorrect about PD.

29. Which of he following kidney structures connects with anddelivers urine directly to the ureter?

a. Pelvisb. Calyxc. Glomerulusd. Cortex

Option B is the correct answer. Calyx is the cup-shaped opening that sends drops of urine into the ureter. Options A, C, and D are incorrect.

30. Mrs. Smith, a 89-year-old widow, asks to have her treatmentshortened by 20 minutes today so she can get home andwatch her favorite soap opera. You explain that:

a. This will be okay because a few minutes hereand there don’t make any difference

b. She can leave, but she must do an extra 20 minutesnext treatment



c. It is very important to get the prescribed time,every dialysis treatment, to avoid medicalcomplications

d. Center policy does not permit patients todiscontinue treatment early

Option C is the correct answer. Since traditional three-times-a-week dialysis only replaces 15% of the healthy kidney’s function, every minute counts. Encourage patients to complete prescribed treatment regimen, unless complications necessitate its termination. Options A, B, and D are incorrect.

31. Diffusion is movement of particles

a. By filtration through a biocompatiblemembrane

b. From an area of higher concentration to an areaof lower concentration

c. Into a vacuum created when fluids are forcedthrough a membrane

d. Into a space made by solutions moving in acountercurrent flow

Option B is the correct answer. Diffusion is the movement of dissolved particles across a semipermeable membrane from the side with the higher concentration to the side with the lower concentration.

32. When does ultrafiltration during dialysis occur?

a. Water is removed from blood because there is apressure gradient across a membrane

b. Phosphorus is removed from blood becausedialysate is low on phosphorus

c. A higher concentration of sodium causes waterto move from body compartments into thedialysate



d. A suction device is applied to the venous trapand a Harvard Clamp is applied to the arterialside of the blood set

Option A is the correct answer. In dialysis, ultrafiltration occurs because of the pressure gradient between two sides of the semi-permeable material. The rate of UF depends on the transmembrane pressure and the characteristics of the dialyzer. Option B, C, and D are false.

33. Which of the following is a way to remove solutes?

a. Convectionb. Suctionc. Surface aread. Irradiation

Option A is the correct answer. Convection (solute drag) refers to the movement of solutes with the water across a semipermeable membrane. In dialysis, convection adds to the clearance achieved through diffusion. Options B, C, and D are incorrect.

34. Dialysate is the fluid that helps remove waste productsfrom the body. It contains a number of substances. Choosethe group below that might be prescribed for a dialysatesolution:

a. Bicarbonate, sodium, potassiumb. Magnesium, creatinine, calciumc. Choloride, glucose, uread. Beta-2-microglobulin, calcium, sodium

Option A is the correct answer. Option A lists the usual substances prescribed for a dialysate solution.

35. Which of the following best describes the transducer?

a. Pump that moves blood through theextracorporeal circuit

b. Device inside the machine that converts airpressure into an electronic signal



c. Tubing that carries blood from the patient’saccess to the dialyzer and back to the access

d. System that removes water from the blood

Option B is the correct answer. Option A describes a blood pump. Option C is blood tubing or “lines,” while Option D describes ultrafiltration system.

36. The normal range of resting respirations in an adult is

a. 12 to 20 breaths/minb. 20 to 40 breaths/minc. 30 to 50 breaths/mind. 60 to 100 breaths/min

Option A is the correct answer. The normal resting respirations in an adult is 12 to 20 breaths/min. Resting respirations more than the normal should be reported to the charge nurse.

37. The purpose of priming the extracorporeal circuit withsaline during setup is

a. To remove air and germicide before initiatingtreatment

b. To be certain fibers are thoroughly filled withgermicide before initiating dialysis

c. To assess ultrafiltration capacity of the dialyzersand check for leaks

d. To maintain fiber noncompliance until thedialysis begins

Option A is the correct answer. Rinsing and filling the extracorporeal chamber with saline is done to remove air and germicide. Options B, C, and D are incorrect.

38. Mrs. Smith’s dry weight is 62 kg. Her pretreatment weightwhen she came in for treatment on Monday was 67 kg. Forher treatment 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 fluid during the treatment. What is the total amount of fluid weight to be removed during her treatment?

a. 5,000 mLb. 5,230 mLc. 5,540 mLd. 5,820 mL

Option C is the correct answer. Amount of fluid weight to be removed is obtained by adding the desired weight loss in mL and the patient’s fluid intake during dialysis. In the case above:

39. Which of the following tests must be performed on newdialyzers?

a. Hgb – hemoglobinb. TIBC - total iron binding capacityc. CBC - complete blood countd. TCV - total cell volume

Option D is the correct answer. Total Cell Volume (TCV) measures the ability of the dialyzer to transport solutes and ultrafilter. Options A, B, and C are routine lab tests done to check blood levels.

40. Which of the following is the definition of “contact time”?

a. Amount of time the germicide is rinsed throughthe dialyzer

b. Amount of time between dialyzer usesc. Amount of time the germicide remains in the

dialyzerd. Time it takes to reprocess the dialyzer



Option C is the correct answer. Option C is the correct definition of contact time. Each type of germicide has a recommended contact time. Options A, B, and D are incorrect.

41. Which is the most common way that water treatmentsystems are disinfected?

a. Heatb. Ozonec. Chemicald. Minerals

Option C is the correct answer. Use of chemical disinfectant, such as bleach, is the common type of water treatment system disinfection. Heat and ozone disinfection may also be used.

42. According to AAMI standards, the total microbial count ofdialysate shall not exceed?

a. 200 CFU/mLb. 400 CFU/mLc. 800 CFU/mLd. 1,000 CFU/mL

Option A is the correct answer. The Total Microbial Count of dialysis water should not exceed AAMI standard of 200 colony forming units. Action must be taken for dialysate water with 50 CFU/mL. Testing for bacteria and endotoxin should be done at least once a month.

43. Large amounts of aluminum in water used for dialysatecould cause

a. Fever/chillsb. Liver problemsc. Bone diseased. Diarrhea



Option C is the correct answer. Patients exposed to high levels of aluminum for an extended period may suffer from aluminum-related bone disease (ARDB). This condition can cause muscle weakness, bone pain, and fractures.

44. Which of the following is a limitation of a reverse osmosis(RO) system?

a. Removes bacteria and endotoxinb. Removes solutes from the waterc. Thin film composite membranes break down

when exposed to chlorine and chloraminesd. Produces purified water

Option C is the correct answer. One of the limitations of an RO system is that TFC membranes break down when exposed to chlorine and chloramines. As such, carbon tanks are installed before the membrane to remove these. Options A, B and D are incorrect.

45. Water used for dialysate must be treated because dialysispatients

a. Have strict fluid restrictions and drink only purewater

b. Drink large amounts of water despite theirrestrictions

c. Are exposed to large volumes of water duringdialysis

d. Are able to excrete contaminants in dialysateduring dialysis

Option C is the correct answer. If dialysis water have contaminants (harmful substances), they may enter the blood through the dialyzer and cause disease, injury, or even death to a patient.



46. Which of the following methods kills bacteria, but will notdestroy all of them completely?

a. Asepsisb. Disinfectionc. Exposure to chemical sterilantsd. Open-flame irradiation

Option B is the correct answer. Some bacteria form a biofilm which protects them from disinfection. Options C and D are procedures that can completely eradicate bacteria.

47. Which of the following is a step in the port/catheterpredialysis assessment?

a. Cleansing the catheter siteb. Connecting the catheter to the bloodlinesc. Assessing the blood flow rate through the

catheterd. Assessing the ease of heparin removal and

saline flushing before connecting the bloodlines

Option D is the correct answer. Ensure the patency of the port/catheter by checking the ease of saline flushing and heparin removal. Options A, B, and C are not procedures taken in predialysis port assessment.

48. When assessing a fistula or graft, which of the followingneed to be felt prior to starting dialysis?

a. Pulse and deep accessb. Bruit and deep accessc. Bruit and thrilld. Pulse and thrill

Option C is the correct answer. Prior to initiating dialysis, be sure to check for bruit and thrill. Any unusual or abnormal finding should be reported to the charge nurse for appropriate intervention.



49. Mrs. Barnett is a 55-year-old woman whose kidneys arefailing due to hypertension. She does not have diabetes orcardiac problems. If her blood vessels are in good condition,what type of access is preferable?

a. A femoral catheterb. A forearm loop graftc. An arteriovenous fistulad. A cuffed, tunneled catheter

Option C is the correct answer. An AVF is the most preferred type of access for any patient with blood vessels that are in good condition. AVF lasts longest and poses least risk, including infection. Other types of vascular access, such as Options A, B, and D, are recommended in patients with poor or damaged blood vessels.

50. Dialysate conductivity measures

a. The total electrical charge of a solutionb. The total number of thermistors in a solutionc. The total number of mL per solutiond. The total number of gradients in a solution

Option A is the correct answer. Dialysate conductivity measures the total electrical charge of a solution. Options B, C, and D are incorrect.

51. The two compartments of the dialyzer are

a. Conventional and high fluxb. Convection and adsorptionc. Blood and dialysated. Hollow fiber and flat plate

Option C is the correct answer. The dialyzer is composed of two compartments: the blood and dialysate compartment.



52. Kidney failure is a chronic illness that causes many changesfor the person with the disease and his or her family andfriends. The dialysis team member with special training inhelping people adjust to these changes is the

a. Nurseb. Physicianc. Social workerd. Technician

Option C is the correct answer. The social worker helps the patient, family and friends cope with the chronic illness. Each member of the HD health care team plays a unique role in the management of patients with chronic kidney disease.

53. Which is the best definition for dry weight?

a. Postdialysis weight at which all or most excessfluid has been removed

b. Weight gained between treatmentsc. Predialysis weightd. Amount of weight to be removed during

treatment

Option A is the correct answer. Dry weight is the postdialysis weight without excess fluid. When target dry weight is achieved, there are no signs of dehydration or fluid overload; absence of excess fluid in the lungs, breathing is normal; and blood pressure is within normal. Option B, C, and D are incorrect definitions for dry weight.

54. The leading cause of chronic kidney disease for adults in theUnited States is

a. Hypertensionb. Glomerulonephritisc. Diabetesd. Urinary obstruction



Option C is the correct answer. About 45% of patients with chronic kidney diseases are caused by diabetes.

55. What is the functional unit of the kidney, or the structure inthe kidney that does the work?

a. Medullab. Cortexc. Calyxd. Nephron

Option D is the correct answer. Nephrons are the functional unit of the kidney. These are tiny blood purification filter in the kidney, made up of a tubule and glomerulus. Options A, B, and C are other parts of the kidney.

56. All of the following medical problems may occur due tochronic kidney diseases EXCEPT for

a. Anemiab. Indigestionc. Sleeping problemsd. Pericarditis

Option B is the correct answer. The kidneys play a myriad of functions in the body; loss of its function can lead to medical problems such as anemia, sleeping problems, and pericarditis. Option B, indigestion is not directly related to loss of kidney function.

57. A semipermeable membrane is a filter that

a. Allows only certain sized particles to crossb. Prevents fungal between particlesc. Can distinguish between particlesd. Is biocompatible, non toxic, and hypoallergenic

Option A is the correct answer. Option A best defines a semi-permeable member. A semi-permeable membrane allows certain particles to cross while keeping others out. Nephrons and dialyzers are semi-permeable.



58. What is the purpose of a proportioning system?

a. Monitors the dialysate flow rateb. Monitors for blood leaksc. Checks the conductivity of the dialysated. Make dialysate by mixing fresh concentrate with

fixed amounts of treated water

Option D is the correct answer. A proportioning system mixes liquid concentrate with measured amounts of treated water to form dialysate and deliver it to the dialyzer. It has two types: fixed-ratio pumps and servo-controlled mechanisms. Options A, B, and C do not describe a proportioning system.

59. What are the two types of ultrafiltration systems?

a. Volumetric UF control and flow controlb. Flow rate and UFRc. TMP and UFRd. Proportioning system and flow control

Option A is the correct answer. Volumetric UF control uses two chambers that fill and drain to control the volume of dialysate going to and coming from the dialyzer. Meanwhile, flow control uses sensors in the fluid path to and from the dialyzer to control and monitor the flow rate of the dialysate.

60. Although dialysate delivery systems have back-upmonitoring systems, it is critical that

a. The monitoring systems be checked andcalibrated on a schedule recommended by themanufacturer

b. Conductivity and pH be verified by independentmeters before each dialysis treatment andwhenever the dialysate is changed

c. All alarm systems be tested prior to eachdialysis treatment

d. All of the above



Option D is the correct answer. Although modern, advanced dialysis machines are equipped with monitoring systems, the dialysis staff person is still the most important monitor of all. Options A, B, and C list essential checks done to keep patients safe.

61. Which of the following is NOT a possible complication of“flipping” the needle in AVF cannulation?

a. Stretching the needle holeb. Steal syndromec. Infiltrationd. Stenosis

Option D is the correct answer. “Flipping” the needle should not be done as it can stretch the needle hole, tear the lining of the vessel, or cause infiltration. Option D, stenosis, is the narrowing of a blood vessel and is not a possible complication of needle-flipping.

62. Which of the following is a long term complication of fistulas?

a. Infiltrationb. Thrombosisc. Bruitd. Recirculation

Option B is the correct answer. Thrombosis is the formation of blood clot in the blood vessel and is a possible long-term complication of AVF. Option B is the correct answer.

63. The instrument used for measuring blood pressure is called

a. Sphygmonanometerb. Spirometerc. Bronchoscoped. Tachometer



Option A is the correct answer. A sphygmomanometer (blood pressure cuff) and stethoscope is used to measure the blood pressure. Most machines are capable of reading blood pressure, but dialysis technicians are expected to know how to take a manual BP.

64. For which of the following situations would you use thestand-and-pivot technique to transfer a patient?

a. Patient is brought into the dialysis clinic on astretcher

b. Patient can bear weight once standing, but hastrouble getting up from the dialysis chair

c. Patient can get out the dialysis chair without anyproblems

d. Patient is complaining of dizziness and nausea

Option B is the correct answer. Stand-and-pivot technique is used when the patient is capable of partial weight bearing. Option A, C, and D do not require the use of this patient transfer technique.

65. What are the functions of the kidneys that dialysis replaces?

a. Removal of wastes

b. Regulation of blood pressure

c. Removal of excess fluids

d. All of the above

Option D is the correct answer. The three functions of the kidneys that dialysis replaces are the removal of wastes, blood pressure regulation, and removal of excess fluids in the body.



66. Dialyzers are reprocessed mainly because?

a. Reprocessing reduces the cost of dialysistreatments

b. Reprocessing shortens the dialysis treatmentc. Reprocessing is safer for staffd. Reprocessing reduces the amount of plastic in

landfills

Option A is the correct answer. Although dialyzer reprocessing may help reduce biohazard waste (Option D), the main non-medical reason for reprocessing dialyzers is the cost. Therefore, the answer is Option A. Medically, dialyzer reuse helps minimize hypersensitivity reactions or “first-use syndrome.”

67. Which of the following is a germicide used for dialyzerreprocessing?

a. Alcoholb. Hydrogen peroxidec. Peracetic acidd. Acetone

Option C is the correct answer. Peracetic acid is the most common germicide used for dialyzer reprocessing. When diluted, peracetic acid breaks down into oxygen, water, and biodegradable acetic acid. Options A, B, and D are disinfectants but are not used for dialyzer reprocessing.

68. Which of the following is a problem in dialyzer reprocessingthat may cause bacteria or endotoxin contamination of thedialyzer?

a. Use of proper storage conditionsb. Correct contact time usedc. Use of heat and citric acidd. Improperly prepared germicide



Option D is the correct answer. Germicidal agents used for dialyzer reprocessing should be properly prepared to ensure that it efficiently disinfects the dialyzer. Options A, B, and C are proper ways of ensuring safe reuse dialyzer.

69. Which of the following are two criteria for rejecting areprocessed dialyzer?

a. Less than 80% of original fiber bundle volume,aesthetic appearance

b. Label incomplete, dialyzer not heparinizedc. Patient preference, access is recirculatingd. HIV status, hyperkalemia present

Option A is the correct answer. The correct answer is Option A. KDOQI guidelines recommend that dialyzers with less than 80% of original TCV value, be discarded. Also, do not use dialyzers with unusual aesthetic appearance such as dialyzers with many cracks, many discolored fibers, or defective plastic housing. Options B, C, and D are incorrect.

70. The water softener performs the following activity

a. Removes calcium and magnesium from waterb. Removes chlorine and chloramines from waterc. Adds calcium and magnesium waterd. Kills bacteria in the water

Option A is the correct answer. Water softener takes out some calcium and magnesium through ion exchange – this process involves removing and trading calcium and magnesium with sodium ions, thereby forming sodium chloride. Options B, C, and D are incorrect.

71. Which of the following is an acceptable level of postsoftener hardness?

a. 0.8 grain per gallonb. 1.1 grain per gallon



c. 1.5 grain per gallond. 2.0 grain per gallon

Option A is the correct answer. Hardness should not exceed 1 grain per gallon (gpg), which equals 17.24 parts per million (ppm). Water softeners should be monitored by measuring water hardness post-softener at the start and end of each day.

72. How frequently should the carbon tanks be checked forchlorine and chloramines?

a. Each shiftb. Weeklyc. Monthlyd. Annually

Option A is the correct answer. Carbon tanks must be checked for chlorine and chloramines each shift. If the total chlorine result exceeds AAMI recommended levels, dialysis treatment should be stopped. Exposure to contaminant, especially chlorine and chloramines, through dialysate water can pose health risks to dialysis patients. Options B, C, and D are incorrect.

73. Which of the following best describes the DialyzerReprocessing Manual?

a. Record of the date and results of all qualityassurance and quality control evaluations forthe center

b. Summary of all reuse specifications, policies,procedures, training materials, manuals andmethods, and samples of forms and labels

c. Log of the dates of preventive maintenance,repairs, and results of scheduled testing on allhemodialysis equipment

d. Record of testing required by regulatoryagencies on any germicides or cleaning agentsuded in dialyzer reuse



Option B is the correct answer. Option B defines Dialyzer Reprocessing Manual. Every dialysis technician is expected to know this manual. Options A, C, and D are incorrect.

74. What organization sets the standards and recommendations for dialyzer reprocessing?

a. FDA - U.S. Food and Drug Administrationb. CDC - Center for Disease Control and Preventionc. AAMI - Association for the Advancement of

Medical Instrumentationd. CMS - Centers for Medicare and Medicaid

Services

Option C is the correct answer. AAMI crafts voluntary standards for dialyzer reprocessing and water treatment. The AAMI Guidelines is adopted by dialysis centers across the country. Option C is the correct answer.

75. Which of the following should be done to prevent needlesticks?

a. Recapping needlesb. Throwing used needles into puncture-resistant,

color-coded containersc. Break or bend the needled. Leaving needles on the medicine carts

Option B is the correct answer. Used needles should be discarded in puncture-resistant, color-coded containers. Recapping needles, breaking or bending the needle, and leaving used needles on the medicine carts increases the risk of needle-stick injuries.

76. Why was the Council of Nephrology Nurses and Technicians(CNNT) established?

a. To provide scholarships to deserving individualswho wish to be dialysis technicians



b. To make health policies that aid professionalpractices and patient care

c. To oversee the research and developmentaspect of dialysis machines

d. To provide financial assistance to dialysiscenters across the country

Option B is the correct answer. The CNNT is a professional membership council that focuses on developing health policies that aid professional practices and patient care. Option A, C, and D are not included in the advocacies of CNNT.

77. What happens in the body when a patient suffers frompruritis?

a. High phosphorus and serum calcium levelsb. Secondary hyperparathyroidismc. Both A and Bd. Neither A nor B

Option C is the correct answer. Severe and constant itching in CKD patients are due to a number of causes that include high phosphorus and calcium levels, secondary hyperparathyroidism, dry skin, changes in calcium metabolism, and uremic toxins.

78. What do you call the condition where there is too muchsodium in the blood?

a. Hyperkalemiab. Hyponatremiac. Hypokalemiad. Hypernatremia

Option D is the correct answer. Hyperkalemia is a condition where there is too much potassium in the blood; hypokalemia low potassium level in the blood; and hyponatremia low sodium level in the blood.



79. What happens if bleach and peracetic acid are mixed?

a. A strong disinfectant is created, effectivelyeliminating fungus

b. A watery solution is created which no longer hasany disinfecting properties

c. An explosion occurs requiring evacuation of thepremises for at least 48 hours

d. A chemical reaction occurs, producing toxicchlorine gas

Option D is the correct answer. Mixing peracetic acid and bleach results in the creation of chlorine gas which is highly toxic to anyone who breathes it.

80. How often do you need to conduct a Complete Blood Count(CBC) test on patients with CKD?

a. Monthlyb. When neededc. Predialysisd. Postdialysis

Option A is the correct answer. For patients with CKD and on regular dialysis, CBC is taken on a monthly basis to check for anemia and infection.

81. How often should the Hemoglobin test be given when astable Hgb/Hct level is achieved?

a. Every 1-2 weeksb. Every 10 daysc. Every 2-4 weeksd. Every 5 days

Option C is the correct answer. Routine hemoglobin test is done on every 2-4 weeks to monitor patient’s response to anemia treatment and check for possible blood loss. More frequent hemoglobin tests, such as Option A, B, and D, may be done in patients with unstable Hgb/Hct levels or under close monitoring.



82. Why should you conduct a Hepatitis C Virus HCV Antibodytest to CKD patients once a year?

a. Someone who tests positive may be able tospread the Hepatitis C virus.

b. It is a routine test for any patient who starts ona dialysis treatment.

c. A CHT should know if a patient is infected soshe can increase the dialysate during treatment.

d. This test can determine if the CKD patient isresponding positively to the treatment.

Option A is the correct answer. Hepatitis C is a viral condition that can be transmitted through exposure to infected blood. Annual HCV Antibody Test is recommended to prevent cross-contamination. Option B, C, and D are incorrect.

83. What are the three processes that make up the watertreatment system for hemodialysis?

a. Pre-treatment, acid concentrate mixing, waterpurification

b. Pre-treatment, saline solution, distributionc. Pre-treatment, water purification, distributiond. Pre-treatment, dialysate testing, distribution

Option C is the correct answer. Water treatment system is comprised of three processes: pre-treatment, water purification, and distribution.

84. A water softener DOES NOT

a. Remove calcium and magnesium from theincoming water

b. Work with the brine tankc. Remove fine carbon particles, resin beads and

other debrisd. Prevents hard mineral deposits from

accumulating and damaging the RO membranes



Option C is the correct answer. A water softener is capable of performing Options A, B, and D. Option C describes a cartridge prefilter installed in the RO system.

85. What can be an adverse effect of too much zinc in the waterused for dialysis?

a. Hemolysisb. Anemiac. Hypertensiond. Degenerative brain disease

Option D is the correct answer. Prolonged exposure to zinc can cause degenerative brain disease. High zinc levels can also cause nausea, vomiting, and fever. Options A, B, and C are possible complications due to high levels of other substances.

86. What is NOT TRUE about bicarbonate concentrate?

a. Commercial liquid bicarbonate is available.b. It can diffuse the patient’s blood and replenish

the body’s buffer stores.c. A batch can be mixed using a bicarbonate

concentrate system mixer.d. It is tested for bacterial contamination and

endotoxin.

Option D is the correct answer. Bicarbonate concentrate is not tested for bacterial contamination and endotoxin. Options A, B, and C are all facts about bicarbonate concentrate.

87. Pre-treatment water samples are collected after the RO hasoperated for at least how long?

a. 5 minutesb. 10 minutesc. 15 minutesd. 30 minutes



Option B is the correct answer. Pre-treatment water samples should be collected at least 10 minutes to complete recommended empty bed contact time. Collecting water immediately after running the system will not give you a representative sample.

88. Total water hardness is checked at the end of eachtreatment day and includes monitoring of the salt level inthe brine tank. The salt level in the tank should be

a. Completely fullb. At least three quarters fullc. At least one half fulld. Below the water level

Option D is the correct answer. The salt level should NOT be too high to prevent formation of a “salt bridge” where salt hardens at the top and looks full, even if there is no salt below. Option D is correct answer.

89. Which electrolyte plays a vital role in nerve and musclefunction and unstable levels can cause arrhythmias?

a. Phosphorusb. Potassiumc. Sodiumd. None of the above

Option B is the correct answer. Potassium plays a role in nerve and muscle function, as well as heart rhythm. Hyperkalemia or high potassium levels can cause arrhythmias. Potassium levels must be kept within very tight limits. Phosphorus play a vital role in the body’s use of energy. Sodium helps maintain fluid balance.

90. What should a patient do to get on the national transplantlist?

a. Talk to family members who wish to give up oneof their kidneys



b. Talk to your doctor and get in touch with theUnited Network for Organ Sharing

c. Plead to the doctors in the biggest hospitals inthe country

d. Contact Medicare and see what they can do foryou.

Option B is the correct answer. Patients who want to be included in the national transplant list should talk to their doctor and ask about how to get into national transplant list. UNOS keeps list of patients seeking kidney transplant.

91. Dialysis makes up for the loss of kidney function, except for

a. Removing excess fluid and wasteb. Restoring electrolyte balancec. Making erythropoietin and activating vitamin Dd. Controlling blood pressure

Option C is the correct answer. Dialysis may help restore electrolyte balance, control blood pressure and remove excess fluid and waste. However, dialysis cannot activate vitamin D and produce erythropoietin, so patients need to take erythropoietin and vitamin D medications.

92. What is NOT TRUE about peritoneal dialysis?

a. It allows working-age patients to keep theirjobs.

b. It requires patients to seek treatment in dialysiscenters.

c. It uses part of the patient’s body as a filter.d. Patients using PD have some remaining kidney

function.

Option B is the correct answer. Unlike hemodialysis where patients seek treatment in dialysis center, peritoneal dialysis is usually done at home.



93. Which is NOT a part of pre-treatment assessments?

a. Vital signsb. Patient’s general dispositionc. Vascular accessd. Emotional stability

Option D is the correct answer. Options A, B, and C are all included in the pre-treatment assessments. Although emotional stability is part of providing holistic care, it is secondary to physical assessment.

94. What can affect the accuracy of taking a patient’s bodytemperature?

a. Room temperatureb. Patient’s liquid intakec. Patient’s weightd. Sunlight streaming through the windows

Option D is the correct answer. External factors, such as direct sunlight, can affect accuracy of body temperature reading. Option A, B, and C have no effect on body temperature.

95. Hypotension is related to a number of factors except:

a. Recent medication dosingb. Dialysate levelsc. Patient’s strength and enduranced. Stability of hormone levels

Option C is the correct answer. Hypotension or low blood pressure is often related to a number of factors that include body’s hormone levels, dialysate levels and recent medication. Option C is unrelated to hypotension.

96. The reason why potassium dialyzes and RBC's do not is

a. Potassium has a smaller molecular weightb. Potassium has a higher molecular weight



c. RBC's are not water solubled. RBC's have a negative charge

Option A is the correct answer. The dialyzer's semipermeable membrane allows molecules that have a small molecular weight like potassium to pass through.

97. Patients presenting to dialysis below their target weightshould

a. Have their target weight decreasedb. Receive fluid replacement during the treatmentc. Be re-weighed and evaluated for the cause of

weight lossd. Receive education on proper fluid intake

Option C is the correct answer. Report to the charge nurse if patient consistently falls below target weight. The patient may need to be re-weighed and evaluated to determine cause of weight loss.

98. Who is considered the best source of a patient’s currentdisposition?

a. The patient’s physicianb. A teammate who knows the patient wellc. The patient him/herselfd. A family member

Option C is the correct answer. The patient is the best source of his/her current disposition. All other options may provide secondary source of information.

99. A post treatment patient assessment

a. is completed to verify that the patient is stable,to determine the patient’s discharge status, andto evaluate the effectiveness of the treatmentplan



b. is compared to the patient’s pretreatmentassessment findings

c. requires the licensed nurse to notify thephysician as needed of changes in the patientstatus

d. all of the above

Option D is the correct answer. All options are true about post treatment assessment.

100. When taking a patient’s blood pressure who also has an irregular heart beat with an automatic BP cuff

a. It has no effect on the recorded blood pressureb. The recorded blood pressure will be too highc. The recorded blood pressure will be too lowd. The recorded blood pressure may not be

accurate

Option D is the correct answer. In patients with irregular heartbeat, the automatic BP cuff may not give accurate reading. You will need to take a manual BP reading to monitor changes in blood pressure.


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