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Practice CCHT Exam
Practice Exam
| Question | Answer |
|---|---|
| What is the appropriate management of a patient with asymptomatic hypotension (BP 95/60) during dialysis? | |
| A patient on peritoneal dialysis (PD) comes for hemodialysis backup. What is an important consideration? | |
| What is the appropriate management of a patient with chronic hypotension (baseline SBP <100 mmHg)? | Adjust UF goals, consider cooler dialysate, midodrine, and assess for cardiac dysfunction |
| What is the most common cause of intradialytic hypotension? | Excessive ultrafiltration exceeding vascular refilling capacity |
| What is the technician's role in emergency preparedness in the dialysis unit? | Know emergency protocols, participate in drills, and be prepared to respond appropriately |
| What is the appropriate response when a patient complains of nausea and vomiting during dialysis? | Stop ultrafiltration, check blood pressure, and notify the nurse |
| What is the purpose of priming the extracorporeal circuit before dialysis? | To flush air from the circuit and coat the membrane with saline |
| A needlestick injury occurs while cannulating a patient. What is the first action? | Immediately wash the area with soap and water, then report to supervisor |
| What is the appropriate response when a patient experiences syncope (fainting) during dialysis? | Stop UF, place supine with legs elevated, assess vital signs, and evaluate cause |
| A patient's potassium level is reported as 6.8 mEq/L pre-dialysis. What does this indicate? | Hyperkalemia requiring immediate attention |
| What is the appropriate response when a patient develops severe itching (uremic pruritus) during dialysis? | Assess for causes, ensure adequate dialysis, cool dialysate, and notify nurse for possible medication |
| What is the appropriate action when a patient has an external bleeding wound during dialysis? | Apply standard precautions, use appropriate PPE, control bleeding and properly dispose of contaminated materials |
| What is the appropriate management of a patient who develops severe muscle cramps resistant to fluid replacement? | Consider hypertonic saline or mannitol per protocol, reduce UF rate, and massage affected muscles |
| What is the clinical significance of a patient having a palpable aneurysm at their AV fistula cannulation site? | It contraindicates buttonhole cannulation and may require surgical evaluation |
| What is the purpose of routine environmental cultures in the dialysis unit? | To monitor water dialysate quality, and detect bacterial contamination in the environment |
| What is the purpose of the air detector in the venous line? | To detect and prevent air embolism |
| What is the function of the pressure holding test on the dialysis machine? | To verify dialyzer membrane integrity and detect leaks before patient connection |
| What is the appropriate patient education regarding vascular access protection? | Protect the access arm: no blood draws, BP, IVs, or tight clothing; check thrill daily |
| When monitoring a patient during dialysis, which finding requires the most immediate intervention? | Venous needle dislodgement with blood visible |
| What is the appropriate needle direction when cannulating an AV graft? | Toward the heart (antegrade flow) for both needles |
| What is the appropriate procedure after a patient with infectious diarrhea leaves the dialysis station? | Terminal cleaning with EPA-registered disinfectant effective against C. Difficile if suspected, thorough disinfection of all surfaces and equipment |
| What is the typical dialysate flow rate (Qd) used in hemodialysis? | 500-800 mL/min |
| What is the appropriate response when discovering a patient has ingested food during dialysis? | Notify the nurse as food intake during dialysis can cause hypotension and cramping |
| What is the appropriate needle gauge for routine adult AV fistula cannulation? | 15-16 gauge. Standard for most adult dialysis |
| What is the appropriate isolation precaution for a patient with MRSA colonization in a dialysis unit? | Contact precautions: gloves and gown for patient contact, dedicated equipment |
| What is the purpose of the "dry weight" in hemodialysis? | The estimated weight of the patient with minimal excess fluid |
| What is the appropriate response when asked to perform a task beyond your scope of practice? | Politely decline, explain it is outside your scope, and offer to get appropriate licensed personnel |
| A patient develops acute shortness of breath and hypoxia 15 minutes into dialysis. The blood pump stops. What should be suspected? | Air embolism-a medical emergency requiring immediate left lateral Trendelenburg position and 100% oxygen |
| How should used dialyzers and blood tubing be disposed? | As regulated medical waste (biohazard) in appropriate containers |
| During treatment, the patient complains of back pain and chest tightness. The blood appears cherry-red. What is the most likely cause? | Acute hemolysis due to hypotonic dialysate, overheated dialysate, or chemical contamination |
| What is the appropriate PPE when cleaning a blood spill? | Gloves, gown, and face protection (mask/eye protection) |
| What is the purpose of terminal cleaning in the dialysis unit? | Thorough disinfection of all surfaces and equipment after patient discharge or at end of day |
| What is the appropriate action when a patient's family member has active shingles (herpes zoster)? | Assess if the patient is immune-compromised and consider precautions; the family member should not visit if rash is weeping |
| What is the appropriate action when a patient has an external bleeding wound during dialysis? | Apply standard precautions, use appropriate PPE, control bleeding, and properly dispose of contaminated materials |
| What is the technician's responsibility regarding professional boundaries on social media? | Maintain professional boundaries; do not friend patients, share patient information, or discuss work inappropriately online |
| What is the significance of a serum albumin level of 2.8 g/dL in a dialysis patient? | Significant protein malnutrition associated with increased mortality risk |
| What is the consequence of dialysate contamination with bacteria? | Pyrogenic reactions, inflammation, and B2-microglobulin amyloidosis due to back filtration and endotoxin transfer |
| What is the appropriate education for a patient starting home hemodialysis training? | Education must include access care, machine operation, infection control, emergency procedures, and when to call for help |
| What is the most appropriate explanation for why dialysis patients must limit fluid intake? | Excess fluid causes fluid overload, hypertension, heart failure, and makes ultrafiltration more difficult |
| What is the purpose of reverse osmosis (RO) in dialysis water treatment? | To remove dissolved contaminants, bacteria, and endotoxins by forcing water through a semipermeable membrane |
| What does a "conductivity" alarm on the dialysis machine indicate? | The dialysate ionic concentration is outside acceptable range |
| What is the technician's role in maintaining professional appearance? | Maintain professional grooming, clean scrubs, and visible ID badge to project competence and trust |
| What is the appropriate response when a patient reports their fistula feels "different" and is cooler than usual? | Assess for thrill and bruit immediately; notify nurse if absent as this suggests thrombosis |
| During dialysis, the patient's venous pressure alarm sounds. The pressure reading is 250 mmHg. What is the most likely cause? | Venous needle against vessel wall or clotting in venous line |
| What is the appropriate blood flow rate for a patient with a central venous catheter? | Lower rates (200-300 mL/min) due to catheter limitations |
| A patient's hemoglobin drops from 10.5 g/dL to 7.8 g/dL over two weeks. What is the most likely cause? | Blood loss from the access, GI bleeding, or hemolysis |
| What is the appropriate patient education regarding ESRD and cardiovascular disease? | Cardiovascular disease is the leading cause of death in ESRD; controlling BP, fluid, phosphorus, and smoking cessation are essential |
| A patient on dialysis develops chest pain and shortness of breath. The technician notices the patient is pale and diaphoretic. What is the priority action? | Stop dialysis, return blood to the patient, and call for emergency assistance |
| A patient's pre-dialysis weight is 72 kg, and their dry weight is 68 kg. How much fluid should be removed during this treatment? | 4 liters |
| What is the significance of a rising trend in pre-dialysis BUN and creatinine? | Declining residual renal function or inadequate dialysis |
| What is the primary responsibility of a hemodialysis technician regarding patient confidentiality? | Protect patient health information and only share with authorized healthcare team members |
| What is the appropriate evacuation procedure for a dialysis patient during a fire emergency? | Stop dialysis, return blood if safe and time permits, disconnect patient, and evacuate using appropriate assistance |
| How should a technician respond when a patient refuses treatment? | Notify the nurse and document the refusal |
| What is the appropriate management of muscle cramps that occur frequently during dialysis? | Assess UF goal, dry weight accuracy, sodium balance; consider sodium modeling, longer treatments, or carnitine supplementation |
| What is the technician's responsibility when observing a physician performing a procedure incorrectly? | Speak up immediately if patient safety is at risk and report concerns through appropriate channels |
| What is the importance of mentoring new dialysis technicians? | Mentoring transfers knowledge, promotes safety, and strengthens the healthcare team |
| What is the appropriate bleach concentration for disinfecting blood spills in the dialysis unit? | 1:10 Dilution of household bleach (approximately 0.5% sodium hypochlorite) |
| What is dialysis disequilibrium syndrome (DDS)? | a neurological condition caused by rapid osmotic shifts during dialysis |
| What does it mean if the arterial pressure reading is highly negative (e.g., -250 mmHg)? | The blood pump is pulling to hard due to access or line issues |
| What is the significance of a prolonged bleeding time after needle removal from a fistula? | It may indicate excessive anticoagulation, platelet dysfunction, or access outflow problems requiring evaluation |
| What is the recommended angle for needle insertion when cannulating an arteriovenous (AV) fistula? | 25-35 degrees |
| What is the correct sequence for donning personal protective equipment (PPE) when preparing to cannulate a patient? | Gown, mask/face shield, then gloves |
| What is the significance of a patient's ferritin level of 1200 ng/mL? | Iron overload, possibly from excessive IV iron supplementation |
| What is the appropriate response to a "blood leak" alarm during dialysis? | Check if blood is actually present; if confirmed, stop dialysis and do not return blood |
| What is the minimum recommended water treatment for dialysis facilities? | Softener and carbon tanks with reverse osmosis |
| What is the significance of a test showing chloramine breakthrough in the water treatment system? | The carbon tank is exhausted and requires replacement; chloramines can cause hemolytic anemia |
| What is the significance of a rising trend in pre-dialysis serum phosphate? | Hyperphosphatemia requiring assessment of diet and phosphate binder adherence |
| What is the typical blood flow rate (Qb) range for adult hemodialysis? | 200-500 mL/min |
| What is the function of the pressure holding test on the dialysis machine? | To verify dialyzer membrane integrity and detect leaks before patient connection |
| What is the appropriate cannulation site for the arterial needle in an AV fistula? | Away from the arterial anastomosis, typically 1-2 inches distal to it, pointing toward the heart |
| A patient with a tunneled catheter complains of chest pain and dyspnea during line connection. The technician notices swelling in the neck and face. What is the most likely cause? | Catheter malposition or central vein stenosis causing superior vena cava syndrome |
| What is the significance of a patient's interdialytic weight gain of 5 kg over 2 days? | Excessive fluid gain requiring assessment of adherence and possibly longer or more frequent dialysis |
| What action should be taken if a blood leak is detected by the machine's blood leak detector? | Stop dialysis immediately and assess the dialyzer for membrane rupture |
| What dietary restriction is most important for preventing hyperkalemia in dialysis patients? | Restricting high-potassium foods like bananas, oranges, and tomatoes |
| What is the typical dialysate sodium concentration used in hemodialysis? | 135-145 mEq/L - similar to normal plasma sodium |
| What is the appropriate management of a patient with ESRD who is found to be anemic with hemoglobin of 8.5 g/dL? | Evaluate for iron deficiency and consider erythropoiesis-stimulating agents (ESAs) per protocol |
| Which patients in a dialysis unit should be isolated or dialyzed in a separate area? | Patients with active bloodborne infections (HBV) or antibiotic-resistant organisms |
Created by:
Villaneday