Certification

Preparation
Guide

Nephrology Nursing
Certification Commission
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Copyright © 2016 Nephrology Nursing Certification Commission (NNCC). All rights reserved. No
part of this booklet may be reproduced or transmitted in any form or by any means, electronic or
mechanical, without permission in writing from NNCC.
CCHT Certification
Center for Nursing Education and Testing (C-NET)
Preparation Guide NNCC collaborates with The Center for Nursing Education
and Testing (C-NET) whose expertise in the areas of test
development, administration, and evaluation is unequaled.
Contents C-NET works with the NNCC to ensure that all of the
About the Nephrology Nursing Certification examinations offered are reliable, valid, and meet industry
Commission (NNCC)………………………………………1 standards. C-NET provides a full range of test development
Examination Development………………………………2 and test administration services, including:
Frequently Asked Questions……………………………..3  Performing practice analysis surveys of specialty areas
Preparing to Take the Examination…………………….5
 Developing test specifications (blueprint)
Resources……………………………………………………5
NNCC Policies………………………………………………5  Leading item-writing sessions
Exam Content……………….……………………………...6  Pilot testing of questions
CCHT Certification Preparation Test……………………8  Statistical analysis of whole test and test questions
Preparation Test Answers ……………………………..…14
 Reporting results of testing to Board and test committees

About the Nephrology Nursing Certification Relationship to Professional Associations

A professional association is an organization of members for
Commission (NNCC)
whom educational and professional offerings and events are
provided. They promote professional growth, provide
Mission
approved continuing education, promote, recognize, and
The Nephrology Nursing Certification Commission (NNCC) endorse certification, but they do not administer certification
exists to establish certification mechanisms to promote examinations. Examples of professional associations are:
patient safety and to improve the quality of care provided to
nephrology patients.  American Nephrology Nurses Association (ANNA)
 National Kidney Foundation (NKF)

Philosophy  National Association of Nephrology Technicians/

Technologists (NANT)
NNCC supports the philosophy that there should be a
diversity of examinations that effectively will provide the  American Society of Nephrology (ASN)
opportunity for certification at various levels of education,
The NNCC does not have members or provide educational
experience, and clinical practice within the specialty of
programming. The NNCC promotes professional growth by
nephrology.
developing and implementing certification examinations for
nephrology nurses and technicians.
Commission
NNCC was established in 1987 to develop and implement ABNS and ABSNC Accreditation
certification examinations for nephrology nursing. NNCC is a
The American Board of Nursing Specialties (ABNS),
national, separately incorporated, and independent
established in 1991, is a not-for-profit, membership
organization that collaborates with the Center for Nursing
organization focused on consumer protection and improving
Education and Testing (C-NET) in test development, test
patient outcomes by promoting specialty nursing
administration, and test evaluation. It is the goal of NNCC to
certification. The Accreditation Board for Specialty Nursing
promote the highest standards of nephrology clinical
Certification (ABSNC), formerly the ABNS Accreditation
practice through the development, implementation,
Council, is the only accrediting body specifically for nursing
coordination, and evaluation of all aspects of the
certification. ABSNC accreditation is a peer-review
certification and recertification processes. The NNCC is a
mechanism that allows nursing certification organizations to
charter member of the American Board of Nursing
obtain accreditation by demonstrating compliance with the
Specialties (ABNS). The ABNS is a membership organization
highest quality standards in the industry.
that maintains a national peer review program for nursing
specialty certifications. The NNCC is a charter member of the ABNS, and the
Certified Nephrology Nurse (CNN) certification program was
one of the first national certification programs to be
recognized and accredited. ABSNC accreditation was
granted for the CCHT examination in November 2016.

Copyright © 2019. Nephrology Nursing Certification Commission.

CCHT Certification Preparation Guide 1
ICE and NCCA Accreditation
Examination Development
NNCC is a long-time member of the Institute for
Credentialing Excellence (ICE), a non-profit professional Valid and reliable tests do not arise spontaneously from item
membership association dedicated to providing writers. They are carefully planned to ensure that they are
educational, networking, and advocacy resources for the legally defensible and psychometrically sound. A test has a
credentialing community. ICE is a leading developer of specific blueprint, or test plan, which identifies what content
standards for both certification and certificate programs and needs to be included on the test. In addition, there is a list of
is both a provider of and a clearing house for information on the key content or activities performed by technicians. Both
trends in certification, test development and delivery, the blueprint and the key content/activities serve as item-
assessment-based certificate programs, and other writing guides or “test specifications” for the item writers.
information relevant to the credentialing community.
Where do these test specifications come from? The content
To help ensure the health, welfare, and safety of the public, of the CCHT examination is based on a job analysis survey of
ICE created its accrediting body, the National Commission technicians that identifies the key tasks/activities performed
for Certifying Agencies (NCCA) in 1987. Certification by entry-level hemodialysis technicians. A national task
programs (organizations that assess professional compe- force is brought together to plan the survey content. This task
tence) that receive NCCA accreditation demonstrate force includes technicians, as well as clinical educators and
compliance with its Standards for the Accreditation of
clinical managers of technicians. Following data collection,
Certification Programs, which were the first standards for
the task force reviews the survey results and makes
professional certification programs developed by the
recommendations for the CCHT test specifications. Most
industry. NCCA accreditation was granted for the CCHT
importantly, a job analysis is performed every five years to be
examination in December 2015.
sure the test reflects current practice and is kept up to date.
Organizational Structure The group that oversees CCHT test development is the
The NNCC is composed of nine commissioners, including one NNCC Clinical/Technical Examination Board, which is made
public member. The commission is comprised of members of up of technicians and nurses who work with technicians.
each examination board. Officers of the NNCC include the There is also a CCHT Test Committee that writes the actual
President, President-Elect, Secretary, and Treasurer. The test questions. Item writers, who are certified technicians
NNCC staff includes an Executive Director, Director of from a variety of geographic and practice settings, write test
Certification Services, and Certification Specialists. The questions to meet the CCHT blueprint requirements.
management firm is Anthony J. Jannetti, Inc. in Pitman, New Members of both the Clinical/Technical Board and the Test
Jersey. Committee are considered “content experts” concerning
the knowledge and skills needed by hemodialysis
Examination Board
technicians for safe practice.
The Clinical/Technical Examination Board is made up of
representatives from the CCHT and CCHT-A Test Committees. Each question on the test can be linked directly to the
The purpose of the Exam Board is to establish, review, and tasks/activities in the job analysis survey. The Test Committee
update eligibility criteria relevant to certification. The meets in person twice a year to review, evaluate, and write
members develop knowledge and activity statements for test questions. To be certain that the test content is
practice analyses in collaboration with the testing agency accurate, all questions are supported using the Core
(C-NET) and the commission (NNCC). In addition, the Exam Curriculum for the Dialysis Technician, the regulations in the
Board participates in review of the job analysis role CMS Conditions for Coverage for End-Stage Renal Disease
delineation survey tool and data analysis, updates to the Facilities, and other references.
examination blueprint, and completes audits of certification
and recertification applications for quality assurance. The test consists of 150 questions that match the test
blueprint. About 25 of the questions are new experimental or
CCHT Test Committee “pilot” questions that are not scored. Pilot testing of new
Members of the CCHT Test Committee must meet education questions allows for the evaluation of questions to determine
requirements, be NNCC certified, and have dialysis expertise. if they are valid before they become scored questions.
They are responsible for writing and reviewing questions
The passing score of the test is determined by a panel of
relevant to the examination. Along with the testing agency
technicians who serve as subject matter experts (SMEs). Both
representative, members review current item statistics and
experienced and newly certified technicians serve on this
develop and revise items as needed.
panel. This group performs a standard setting procedure
CMS Conditions for Coverage (Angoff) in which each test question is reviewed to
determine its level of difficulty. Finally, the passing score is
In 2008 the Centers for Medicare and Medicaid Services
determined. It is based on the SME panel’s estimation of the
(CMS) mandated that hemodialysis technicians providing
level of difficulty required to identify individuals who have an
direct patient care in dialysis clinics must be certified under a
state certification program or a nationally recognized acceptable level of knowledge and skill. Therefore, each
certification program, such as the CCHT, within 18 months of candidate’s test score is measured against a predetermined
employment. Technicians who are not certified after 18 standard, not against the performance of other test takers.
months will not be permitted to continue working as a A score of about 74% correct is required to pass the CCHT
hemodialysis technician until the credential is earned. examination.

Copyright © 2019. Nephrology Nursing Certification Commission.

2 CCHT Certification Preparation Guide
Frequently Asked Questions
What is certification? How do I apply for the CCHT exam?

Certification is the formal recognition of specialized 1. Download and complete all sections of the application
knowledge, skills, and experience. It is demonstrated by the from the NNCC website, www.nncc-exam.org. Be sure
achievement of standards identified by a nursing specialty to to include the last four (4) digits of your Social Security
promote optimal health outcomes. Certification validates number as well as all required signatures.
knowledge and competence in a specialty and is an
2. Attach a copy of your high school diploma or
essential component of specialty nursing practice. It must
documentation to verify your General Educational
be designed to protect the public from unsafe and
Development (GED), and proof of name change, if
incompetent caregivers, and it allows consumers of health applicable. The high school diploma or GED must be
care to easily identify competent caregivers. from a government-approved program, e.g.,
recognized by a state board of education.
Why should I get certified?
3. Diplomas NOT issued within the 50 United States or its
The number one reason to become certified is to help ensure territories must be accompanied by a credential
patient safety. Additional reasons include professional evaluation report showing U.S. equivalence.
recognition, validation of skills, self-confidence in decision-
making, and enhanced credibility. Certification is a 4. Mail the application form, a copy of your high school
requirement by the Centers for Medicare and Medicaid diploma, with the appropriate payment, to C-NET.
Services (CMS) for dialysis technicians since 2008. Certified (No personal checks will be accepted.)
technicians have an up-to-date knowledge base, in part
due to required ongoing professional education.
Certification has been linked to patient safety, optimal How will I know my application was received?
patient outcomes, decreased errors, improved patient Within a four (4) week processing period, you will receive
satisfaction, increased staff retention, and job satisfaction. In either an examination permit containing instructions for
an ideal world, employers would recognize, support, and scheduling your exam or an incomplete application letter,
reward certification. requesting further information or documentation. (Note:
incomplete applications are subject to an incomplete
application fee.)

Am I ready to earn the CCHT?

What if I need to test right away?
To be eligible to sit for the CCHT Exam, you must: Expedited review, or FAST TRACK, is a service for applicants
who need to test right away. Instead of your application
 Have a minimum of a high school diploma or its being processed in the order in which it was received, C-NET
equivalent, General Educational Development (GED), pulls your application to the front of the line for immediate
and submit a copy of a government-approved high processing. FAST TRACK exam permits will be issued within 1
school diploma. to 3 business days from the time the application is received
 Have successfully completed a training program for by C-NET. Examination permits are issued only to applicants
clinical hemodialysis technicians that included both with completed, approved applications. (Note: there is an
classroom instruction and supervised clinical experience.* additional fee for FAST TRACK.)
 Provide the number of hours spent in clinical, hands-on
patient care experience obtained as part of the training
program and the facility name where the clinical training What study resources are available?
occurred.* • The test blueprint and practice questions included in this
booklet
AND • References used by the CCHT item writers, which include
 Provide the name of your employer, if you have held a current editions of:
position as a clinical hemodialysis technician within the o Core Curriculum for the Dialysis Technician.
last eighteen (18) months.* o Kallenbach’s Review of Hemodialysis for Nurses and
Dialysis Personnel.
 If unemployed for (18) months or longer, you must provide o The regulations in the CMS Conditions for Coverage
proof of current retraining and hands-on experience.* for End-Stage Renal Disease Facilities.
• The Online Practice Test (found on www.nncc-exam.org)
* Designated signatures are required o 50 multiple-choice questions available in two modes:
 Practice Mode: provides the correct answer and
(Please refer to the Certification Application booklet for rationale after each question
additional information.)  Test Mode: holds the results until the end of the test
o Results display percentage correct by blueprint area
o 90-day access to the test
o Several scrambled versions of the same 50 questions
are offered for retesting

Copyright © 2019. Nephrology Nursing Certification Commission.

CCHT Certification Preparation Guide 3
What is the recommended timeline for getting certified?

Begin job as a Review CCHT Begin filling out CCHT After application
hemodialysis Blueprint to get application, gathering approval, schedule
technician and/or familiar with test required documents & test with computer Deadline for
complete training content employer signatures testing company earning CCHT
program

month 1 month 12 month 15 month 18

Download CCHT Take CCHT Online Submit application Retest if necessary

application from Practice Test to C-NET
NNCC-exam.org

Are there secrets or tricks to help me pass the exam? When will I get my results and how do I interpret them?
Caution: Test preparation websites offering alternative Your Score Report will be available to you at the end of your
and/or shortcuts to test preparation should be avoided. examination. If you pass the exam, the report will reflect your
Exam content is confidential and is not shared with any score as well as notify you of when to expect your certificate
individuals involved in test preparation activities. "Tricks” of in the mail and when your name will appear in the NNCC
testing and "shortcut” methods for test preparation are Certified Directory. If you were unsuccessful on the exam,
specifically avoided when creating this exam. NNCC tests
the report will reflect your score and a breakdown of the test
candidates on content and not on their test taking skills. If
subareas – the Dialysis Practice Areas on the CCHT Test
you have any questions about the best methods to prepare,
please call NNCC toll free at (888) 884-6622. Our goal is that Blueprint – with the percent of questions you answered
exam candidates will best use their time and money to correct in each. This breakdown of subarea scores will help
reach the end result of demonstrating their excellence in you determine the blueprint areas in which you are weak
nephrology clinical care through certification. and need further study.

What should I expect the day of the test? What if I need to retest?
You should arrive at the testing center 30 minutes before There is no limit to the number of times you can take the
your test is scheduled to begin. Bring your valid government- exam. If you are unsuccessful on the exam, you may
issued photo ID and examination permit. The name on your
reapply by mailing in a new application. You can avoid the
ID must match the name on your exam permit. Directions to
paperwork and 3-4 week processing time by registering
the testing center can be found in the email confirming you
have successfully scheduled your test. Be sure to know the online at www.cnetnurse.com and applying through the
best route to the testing center and pay attention to traffic expedited FAST TRACK process, as long as C-NET has one
reports. complete paper application on file for you for the current
calendar year. Once you apply through the FAST TRACK
• Nothing is permitted in the testing room, so you are
encouraged to leave personal items at home or locked process, you will be processed within 3 business days. (Note:
in your car. Lockers are available in some, but not all, there is an additional fee for FAST TRACK.) See page 3,
testing centers to secure personal valuables, such as “What if I need to test right away?”
purses or wallets.
• Cell phones and all other electronic devices are not
permitted.
• Upon arrival you will give the proctor your photo
ID. You will then have your photo taken, and sign a
roster and other regulation sheets. The proctor will read
the testing site rules upon registering you for the test.
• Once seated at your computer, you will be given a
short tutorial explaining the test setup and keyboard
key functions just before your test begins.
• You will have three (3) hours to complete the exam.
• Your photo ID will be returned upon completion of the
exam.

Copyright © 2019. Nephrology Nursing Certification Commission.

4 CCHT Certification Preparation Guide
Preparing to take the Examination NNCC Policies
Physical and Emotional Preparation Statement of Nondiscrimination

• Think positively. It is the policy of NNCC that no individual shall be excluded

• Study and prepare for the examination so that you feel from the opportunity to participate in the NNCC certification
confident. programs on the basis of race, ethnicity, national origin,
• Moderate anxiety is normal and may be helpful - you religion, marital status, sexual orientation, gender identity,
may be more mentally and physically alert. age, or disability.
• Even though some test takers may finish the exam
early, use as much of the allotted time as you need to Denial, Suspension, or Revocation of Certification/
think through and answer the questions. Recertification
• Get a good night's sleep. The occurrence of any of the following actions will result in
• Eat a good meal with protein before the examination. the denial, suspension, or revocation of the certification:
• Gather all the materials you need to take the test the  Failure to meet all eligibility criteria for certification/
night before the exam (e.g., photo ID, directions to recertification
testing center, etc.).  Falsification of the NNCC application
• Allow plenty of time and arrive early.  Falsification of any materials or information requested by
• If you are distracted by other candidates, ask for a seat the NNCC
where you will be less likely to notice the other  Any restrictions such as revocation, suspension,
candidates. probation, or other sanctions by a nursing or other
• Reference books, notes, or other study materials may regulatory authority
not be brought into the examination room.  Misrepresentation of certification status
 Cheating on the examination
 Applicable state and/or federal sanctions
Tips on Answering Examination Questions
 Failure to meet continuing education criteria
• Read the questions carefully and focus on key words in  Failure to meet work experience requirements
the question such as “first,” “most likely,” “most
important,” “best.” Falsifying any materials, including continuing education
• As you read the question, anticipate the correct requirements for recertification (number of contact hours or
answer. dates), may lead to permanent loss of CCHT certification.
• Read each of the four choices carefully. Even if the first The NNCC reserves the right to investigate all suspected/
option sounds correct, read all options before choosing reported violations and, if appropriate, notify the certificant's
the answer. employer/State Board of Nursing or other regulatory
• Do not “read into” the question. Answer the question authority. The certificant will be notified in writing of NNCC's
based only on the information presented, even if you decision(s)/action(s).
think the answer is too obvious or too easy.
• Do not spend too much time on any one question. Appeal Process
Make a note of the questions of which you are
An applicant who has been denied certification, failed an
uncertain and return to them later if you have time.
examination, or had certification revoked has the right of
• There is no penalty for guessing, so you should make an
appeal. This appeal must be submitted in writing to the
educated guess if you are not sure of an answer.
President of the NNCC within thirty (30) days of notification.
The appeal shall state specific reasons why the applicant
feels entitled to certification. At the applicant’s request, the
Resources President shall appoint a committee of three (3) NNCC
NNCC: members who will meet with the applicant and make
recommendations to the NNCC. The committee will meet in
www.nncc-exam.org
conjunction with a regularly scheduled NNCC meeting.
(888) 884-6622 The applicant will be responsible for his/her own expenses.
Like us on Facebook The final decision of the NNCC will be communicated in
Follow us on LinkedIn writing to the applicant within thirty (30) days following the
NNCC meeting. Failure of the applicant to request an
C-NET: appeal or appear before the committee shall constitute a
www.cnetnurse.com waiver of the applicant’s right of appeal.
(800) 463-0786

Copyright © 2019. Nephrology Nursing Certification Commission.

CCHT Certification Preparation Guide 5
Content of the CCHT Examination

The CCHT examination is designed to test the knowledge needed to provide safe care to patients who are receiving hemodialysis
treatments. There are two dimensions in the test blueprint, Dialysis Practice Areas and Cognitive Levels. Dialysis Practice Areas
include four sections: Clinical, Technical, Environment, and Role Responsibilities. Specific technician activities are tested in each
dialysis area. There are also three Cognitive Levels: Knowledge, Comprehension, and Application. These are described in this
booklet on page 7, “Types of Questions on the CCHT Examination.”
Each question on the test fits into one Dialysis Practice Area and one Cognitive Level. This is shown on the blueprint grid. The entire
test is mapped out in this manner to guide the item writers when they are developing the test.

I. Clinical (48-52%) III. Environment (13-17%)

Questions in the Clinical area deal with patient care before, Questions in this area deal with infection control and other
during, and after a dialysis treatment. Sometimes a patient safety issues in the dialysis setting. These issues include
case is described and several questions follow, such as the chemical spills, transfer of patients from wheelchair to
case of Ivan Jackson in the Prep Test at the end of this treatment chair, using correct body mechanics to avoid
booklet. Other questions are individual items that stand injury. The Environment area makes up 15% of the test
alone. The Clinical area is the largest part of the test, making content. Examples of the kinds of technician activities tested
up 50% of the test content. Examples of the kinds of in the Environment area include:
technician activities tested in the Clinical area include: 1. Using dialysis/standard precautions.
1. Using aseptic technique for dialysis procedures. 2. Using chemicals to disinfect environmental surfaces.
2. Evaluating patient’s access pre-dialysis. 3. Following infection control precautions, e.g., isolation,
3. Cannulating patient’s access. vaccinations, supplies.

4. Monitoring patient during dialysis treatment, e.g., vital 4. Using proper body mechanics.
signs. 5. Maintaining an unobstructed emergency exit
5. Discontinuing patient’s dialysis treatment with pathway.
arteriovenous fistula or graft.

IV. Role Responsibilities (10-14%)

II. Technical (21-25%) Questions in this area deal with roles of various staff members
Questions in this area deal with principles of water treatment, in the dialysis facility, as well as communication skills. These
components of the extracorporeal circuit, and actions to skills include interactions between technicians and patients
take when alarms sound or machine-related problems that maintain professional boundaries, as well as respect the
occur. The Technical area is the second largest part of the patients’ privacy, dignity, and confidentiality. The Role
test, making up 23% of the test content. Examples of the Responsibilities area makes up 12% of the test content.
kinds of technician activities tested in the Technical area Examples of the kinds of technician activities tested in the
include: Role Responsibilities area include:

1. Participating in monitoring the water treatment system. 1. Maintaining patient’s confidentiality.

2. Checking conductivity and pH of dialysate solution with 2. Maintaining appropriate caregiver/patient

an independent device. relationships.

3. Mixing concentrates from powder (bicarbonate, 3. Using appropriate communication techniques/skills

electrolyte solution). with patients (verbal/nonverbal).

4. Processing patient’s laboratory samples. 4. Identifying roles and responsibilities of care-team

members.
5. Identifying/reporting/documenting an adverse event,
e.g., equipment set-up problems. 5. Communicating patient’s dialysis treatment outcomes
to appropriate personnel.

The complete list of activities can be found on the NNCC

website in the CCHT section. Click on “The Exam,” then on
“Exam Specifications.”

Copyright © 2019. Nephrology Nursing Certification Commission.

6 CCHT Certification Preparation Guide
Type of Questions on the CCHT Examination
Several different types of questions appear on the CCHT examination. Some questions require a basic recall of knowledge,
while others test the technician’s ability to comprehend a concept. Most of the questions ask the technician to apply knowledge
in a clinical situation. The CCHT test blueprint specifies the percent of each type of question in the test. Examples of each of
these types of questions appear below with the correct answer marked with a checkmark (  ).

A. Recall of Knowledge (8-13%) C. Application of Knowledge (63-67%)

Test questions at the knowledge level ask the Test questions at the application level ask the technician to
technician to remember specific facts, common apply previously learned facts and concepts to new
terms, basic concepts, and principles. Definitions situations and to solve problems. These questions present an
of terms are examples of recall items. on-the-job situation and ask what problem is occurring or
what action to take in the situation.
1. A shortage of oxygen-carrying red blood cells is called
3. A patient’s laboratory results reveal a significant drop
1. uremia. in hemoglobin. Which medication would the
2. anemia.  technician expect the nurse to administer to the
patient during dialysis treatments?
3. hypoxemia.
1. Calcitriol (Calcijex).
4. leukopenia.
2. Doxercalciferol (Hectoral).

B. Comprehension (23-28%) 3. Vancomycin (Vancocin).

Test questions at the comprehension level go beyond basic
recall to determine the technician’s deeper understanding 4. Erythropoietin (Epogen). 
of a concept. Words used to describe comprehension
include: interpret, compare, contrast, explain, estimate, and
translate.

2. The technician would expect a patient’s anemia to

be monitored by which of these laboratory tests?

1. Calcium.

2. Phosphorous.

3. Hemoglobin. 

4. Albumin.

Distribution of 150 Question in the CCHT Exam

(Accepted April 2018, Effective 2019)
Cognitive Level
A. B. C.
Total
Knowledge Comprehension Application
Dialysis Practice Area
I. 71-78
6-8 18-20 48-50
Clinical (48-52%)

II. 32-38
4-5 8-10 20-23
Technical (21-25%)

III. 19-25
1-3 6-8 12-14
Environment (13-17%)

IV. 15-20
1-3 3-4 10-14
Role (10-14%)

12-19 35-42 90-101

Total 150
(8-13%) (23-28%) (63-67%)

Copyright © 2019. Nephrology Nursing Certification Commission.

CCHT Certification Preparation Guide 7
 5. The technician is unsure which one of a patient’s
CCHT Certification Preparation Test
arteriovenous (AV) graft’s anastomoses is arterial and
This Preparation Test has been developed to give you which one is venous. In order to differentiate between
experience with the type of questions that are on the CCHT the two, the technician should
examination. None of these questions will appear on the
actual exam. On page 12, the correct answers and 1. cannulate both sides of the graft and observe the
rationales for each of the questions are given. Compare
your answers with the correct answers. color of the blood.

1. Which of the following practices helps to build a 2. apply a tourniquet to the arm and feel for venous
patient’s immunity to hepatitis B? resistance.

1. Isolation. 3. compress the graft in the middle and palpate each

side.
2. Decontamination.
4. determine the anatomical structure of the area and
3. Vaccination. palpate the radial pulse.

4. Sequestration.

6. At the end of a patient’s treatment, which of these

2. A patient asks the technician, “What does uremia findings, if observed by the technician, should be
reported to the nurse?
mean?” The technician’s response should be based on
the understanding that uremia is 1. A pulse rate of 55 beats per minute.

1. a decrease in the number of red blood cells. 2. Temperature of 98°F (36.3°C).

2. an increase in the serum potassium level. 3. A weight loss of 6.6 lb (3 kg).

3. a decrease in urine output. 4. Blood pressure of 122/68 mm Hg.

4. an increase of wastes in the blood.

7. A patient asks the dialysis technician, “Why am I getting

vitamin D therapy?” Which of these responses would be
3. A central venous catheter may be used as a vascular
accurate?
access when a

1. patient has a limb amputation. 1. “Vitamin D prevents infection.”

2. patient has inadequate blood vessels in the limbs. 2. “Vitamin D protects nervous tissue.”

3. patient’s dialysis adequacy needs to be reduced. 3. “Vitamin D is needed for healthy bones.”

4. patient has an allergy to expanded 4. “Vitamin D stimulates production of red blood

cells.”
polytetrafluoroethylene (Gore-Tex).

4. Before a dialysis treatment, the patient tells the 8. Why are dialysis patients more likely to become infected
with germs like methicillin-resistant Staphylococcus
technician, “Yesterday, I felt terrible and vomited up
aureus (MRSA)?
some blood. I feel much better today.” The technician
can expect the patient’s treatment will be modified by 1. Their diet is usually restricted in vitamin C.

1. decreasing the heparin dose. 2. They usually have weak immune systems.

2. decreasing the erythropoietin (EPO) dose. 3. Their kidneys cannot filter out toxins.

3. increasing the dialysis flow rate. 4. They often have allergies to most antibiotics.

4. increasing the ultrafiltration rate.

Copyright © 2019. Nephrology Nursing Certification Commission.

8 CCHT Certification Preparation Guide
---------------------------------------------------------------------- 12. During the last hour of his hemodialysis treatment, Mr.
Ivan Jackson, 63 years old, has been receiving in-center Jackson’s blood pressure measures 82/40 mm Hg. After
hemodialysis for three years. Mr. Jackson’s pre-dialysis changing the fluid removal rate, the technician should
blood pressure is 143/92 mm Hg. take which of the following actions?

--------------------------------------------------------------------- 1. Stop the blood pump.

2. Increase his dialysate flow rate.

9. The technician prepares and cannulates Mr. Jackson’s 3. Place him in Trendelenburg position.
arteriovenous (AV) fistula. An AV fistula is an example of
4. Administer five 4-gram glucose tablets.
1. a peripheral access.

2. a central venous access. ***

3. a temporary access. ---------------------------------------------------------------------

4. an artificial graft access. Questions 13-15 are individual items.

---------------------------------------------------------------------

10. Mr. Jackson says to the technician, “The doctor says that
I have mineral bone disorder. What does that mean?” 13. Legally, if a treatment was performed but not charted in
The technician is not sure about the answer. Which of the patient’s record, it was
these responses by the technician would be
1. insignificant.
appropriate?
2. confidential.
1. “It’s not a problem that will affect your quality of
life.” 3. only partially billable.

2. “It’s pretty complicated. I’ll ask the nurse to 4. not done.

explain it to you.”

3. “It’s nothing to worry about. I think it involves your

thyroid gland.” 14. The most common cause of a low conductivity alarm
during hemodialysis is
4. “It’s more important right now for you to focus on
your fluid retention.” 1. an exhausted concentrate supply.

2. depleted salt in the brine tank.

11. The technician notices that Mr. Jackson has a notebook 3. residual sterilant.
in which he records results of his blood tests, weights,
4. a clotted dialyzer.
and medications. The technician should have which of
these understandings about Mr. Jackson’s
recordkeeping?
15. A patient who has diabetes mellitus should be observed
1. Documentation of patient data is the responsibility for signs of low blood sugar, which include
of dialysis staff members, not patients.
1. fever and chills.
2. Compulsive, repetitive behaviors are a patient's
attempt to control anxiety. 2. anxiety and confusion.

3. Patients who feel insecure in a dialysis facility keep 3. thirst and weight gain.

journals in case legal action is required. 4. low blood pressure and heart rate.

4. Patients who are involved with self-managing their

care feel empowered.

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CCHT Certification Preparation Guide 9
--------------------------------------------------------------------- 20. After her hemodialysis treatment, Mrs. Chase’s standing
Linda Chase, 65 years old, undergoes hemodialysis blood pressure is 90/58 mm Hg. She complains of
treatments for four hours, three times per week. Her target “feeling dizzy” but insists that she can walk to the scale.
weight has been established at 154 lb (70 kg). The technician's initial response should be to

--------------------------------------------------------------------- 1. assist her to the scale.

16. Mrs. Chase’s weight before her hemodialysis treatment 2. instruct her to sit down.
today is 158.4 lb (72 kg). The technician determines that
the fluid to be removed during today's treatment should 3. inform the charge nurse.
be how many mL?
4. administer normal saline.
1. 4,000

2. 2,000
21. At Mrs. Chase’s next treatment, the technician suspects
3. 400 that her access is clotted. The technician's suspicion
would be true if
4. 200
1. there was redness over the area.

2. there was swelling over the area.

17. At her target post-dialysis weight of 154 lb (70 kg), Mrs.
Chase is likely to be 3. a bruit was absent.

1. edematous. 4. a thrill was present.

2. dehydrated. ***

3. normotensive. ---------------------------------------------------------------------
Questions 22-30 are individual items.
4. hypotensive.
---------------------------------------------------------------------

18. Mrs. Chase begins her hemodialysis treatment. The

22. A patient asks the technician why a high venous
water supply to the water treatment system is called
pressure alarm is sounding. The technician should
1. ground water. explain that a high venous pressure alarm might indicate
a
2. carbonated water.
1. decrease in the blood flow rate.
3. desalinated water.
2. kink in the arterial blood tubing.
4. feed water.
3. separation of venous blood tubing.

4. clotting of blood in the access.

19. Mrs. Chase overhears a nurse discussing a QAPI (Quality
Assessment and Performance Improvement) meeting
and asks, “What does QAPI mean?” The technician
23. In hemodialysis, the term “reuse” refers to the cleaning
should understand that the primary goal of QAPI in a
and disinfecting of
dialysis facility is to
1. dialyzers.
1. achieve better patient outcomes.
2. bloodlines.
2. promote hierarchical management.
3. catheters.
3. improve the ratio of staff to patients.
4. needles.
4. increase fragmentation of care.

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10 CCHT Certification Preparation Guide
24. A 30-year-old male, new to hemodialysis, is scheduled 28. Which of the following occurs when the dialysis machine
for treatments at 6:00 AM, three times a week. He tells alarms and goes into bypass?
the technician, “I’ve walked a mile every morning for
1. Arterial pressure increases after the dialyzer.
years. I guess I’ll have to give that up now.” Which of
these responses by the technician would be best? 2. Heparin is not administered.

1. Suggest that he limit his walking to days when he 3. Dialysate stops flowing through the dialyzer.
has no dialysis treatment scheduled.
4. Ultrafiltration does not occur.
2. Explore his willingness to participate in a physical
therapy program.

3. Suggest that he substitute a nonphysical activity, 29. Care providers must wash their hands with soap and
such as reading, for walking, water instead of using an alcohol-based hand rub in
which of these situations?
4. Explore changing his dialysis schedule to hours that
would let him continue his usual routine. 1. At the end of each shift.

2. If they have latex allergy.

25. A hemodialysis patient tests positive for hepatitis B 3. If they have weeping dermatitis.
surface antigen. The technician should take which of
4. When their hands are visibly soiled.
these actions to prevent the spread of hepatitis B?

1. After dialyzing the patient in the main treatment

area, rinse the machine. 30. The technician is asked to move a heavy box of supplies
to the treatment unit. The box is on the floor of the
2. Ask the nurse to vaccinate the patient.
supply room. When handling the box, the technician
3. Require the patient to wear a mask during should
hemodialysis treatments.
1. bend at the waist.
4. Dialyze the patient using a dedicated machine in
2. hold the box close to the body.
an assigned area.
3. lift the box using the back muscles.

4. stand with the feet together.

26. Which of these parts of the water treatment system
removes endotoxins?

1. Ultrafilter.

2. Resin bed.

3. Deionization tank.

4. Softener.

27. A patient asks the technician, “Why do I need

ultrafiltration profiling?” The technician’s response should
be based on the understanding that the purpose of
ultrafiltration profiling is to

1. minimize clotting.

2. minimize hypotension.

3. maximize flow rate.

4. maximize clearance.
Copyright © 2019. Nephrology Nursing Certification Commission.
CCHT Certification Preparation Guide 11
CCHT Certification Preparation Test Answers
Below, you will find the correct answer to each of the Preparation Test questions, as well as a rationale explaining the correct
answer. Also indicated is the blueprint area that each question falls under, and a reference where the correct answer can be
found. The references used are:
 Medical Education Institute, Inc. (2018). Core Curriculum for the Dialysis Technician: A Comprehensive Review of
Hemodialysis (6th ed.). Madison, WI: MEI.
 Kallenbach, J. (2016). Review of Hemodialysis for Nurses and Dialysis Personnel (9th ed.). St. Louis, MO: Mosby.

1. Answer: 3
Blueprint Area: Clinical/Knowledge
Vaccination with hepatitis B vaccine helps to build immunity by stimulating the patient’s immune system to create antibodies
to hepatitis B.
Review of Hemodialysis for Nurses and Dialysis Personnel, p. 122; Core Curriculum, p. 215

2. Answer: 4
Blueprint Area: Clinical/Comprehension
Uremia is a build-up of wastes in the blood that would normally be excreted in the urine. It occurs in the last stage of kidney
failure or in patients who are not receiving adequate dialysis.
Core Curriculum, p. 29

3. Answer: 2
Blueprint Area: Clinical/Comprehension
In hemodialysis, a catheter can be placed in a large, central vein for temporary use during acute illness or when a patient’s
permanent access (fistula or graft) is maturing. A catheter may be used as a permanent dialysis access if the blood vessels in
the patient’s limbs are not able to support an arteriovenous (AV) fistula or graft. Patients who have central venous catheters
are at increased risk for bloodstream infections.
Review of Hemodialysis for Nurses and Dialysis Personnel, p. 157.

4. Answer: 1
Blueprint Area: Clinical/Application
Vomiting of blood indicates gastrointestinal bleeding. The technician should notify the nurse to assess the patient and
determine the cause of the bleeding. The technician would expect that the heparin--an anticoagulant (blood thinner)--would
be decreased in dose or not given at all.
Core Curriculum, p. 36

5. Answer: 3
Blueprint Area: Clinical/Application
The technician compresses the graft in the middle and feels the pulse (or thrill) on both sides. The stronger pulse will be
on the arterial side. The pulse or thrill will be faint or not palpable at the venous end.
Core Curriculum, p. 174

6. Answer: 1
Blueprint Area: Clinical/Application
A pulse rate of 55 beats per minute is outside the normal range of 60 to 100 beats per minute. Therefore, it should be reported
to the nurse.
Core Curriculum, p. 230

7. Answer: 3
Blueprint Area: Clinical/Application
Vitamin D controls the balance of calcium and phosphorus that is required for bone metabolism.
Core Curriculum, pp. 33-34

8. Answer: 2
Blueprint Area: Environment/Comprehension
Dialysis patients have weakened immune systems, which makes them more likely to become infected with pathogenic
organisms, such as MRSA.
Core Curriculum, p. 216

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12 CCHT Certification Preparation Guide
9. Answer: 1
Blueprint Area: Clinical/Knowledge
The definition of peripheral is “away from the center of the body.” The AVF is most commonly placed in the patient’s upper
extremity, from the distal (away from the body) lower arm to proximal (closer to the body) upper arm. The lower extremities
may also be used.
Core Curriculum, p. 353 - definition of “peripheral”

10. Answer: 2
Blueprint Area: Role/Application
If a technician does not know the answer to a patient’s question, the patient should be referred to the right member of the
care team, the nurse in this case. The other options do not address the patient’s concern and/or give wrong information.
Core Curriculum, pp. 66-67

11. Answer: 4
Blueprint Area: Role/Application
The dialysis technician should encourage the patient to actively participate in care. This allows the patient to feel more in
control. Self-management behaviors that encourage the patient to feel empowered include keeping a record of
medications, weights, and laboratory test results.
Core Curriculum, pp. 65-66

12. Answer: 3
Blueprint Area: Clinical/Application
The Trendelenburg position involves raising the patient's feet higher than the heart and increasing blood flow to the head via
gravity. Placing the patient in the Trendelenburg position, decreasing/discontinuing fluid removal, and giving the patient
normal saline are interventions used to increase the patient's blood pressure.
Review of Hemodialysis for Nurses and Dialysis Personnel, pp. 169-170.

13. Answer: 4
Blueprint Area: Role/Comprehension
Legally, if something was not charted (documented), it was not done.
Core Curriculum, p. 223

14. Answer: 1
Blueprint Area: Technical/Comprehension
The conductivity alarm is designed to notify the clinician when the dialysate solution is not in the proper solute range. The most
common cause of a low conductivity alarm is running out of either the acid or bicarbonate concentrate.
Core Curriculum, p. 115

15. Answer: 2
Blueprint Area: Clinical/Application
Low blood sugar (hypoglycemia) means below normal levels of sugar in the blood. In the patient with diabetes mellitus, this
can cause hunger, confusion, anxiety, sleepiness, or dizziness. The treatment is a fast-acting carbohydrate, such as juice.
Core Curriculum, p. 241, 348

16. Answer: 2
Blueprint Area: Clinical/Application
The conversion for desired weight loss is1 kg = 1,000 mL. The ultrafiltration goal for today's treatment will be 2,000 mL (2 kg).
Core Curriculum, p. 235, see Table 8; Review of Hemodialysis for Nurses and Dialysis Personnel, p. 339, Box 27-1.

17. Answer: 3
Blueprint Area: Clinical/Comprehension
The target post-dialysis weight or estimated dry weight is the patient's weight without excess fluid. When estimated dry weight
is reached, there are no signs of fluid overload or dehydration and blood pressure is normal.
Review of Hemodialysis for Nurses and Dialysis Personnel, p. 162

18. Answer: 4
Blueprint Area: Technical/Comprehension
Feed water is the water that comes from outside of the dialysis center. Feed water must pass through all parts of a water
treatment system before it is used for mixing concentrates and making dialysate.
Core Curriculum, p. 343

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CCHT Certification Preparation Guide 13
19. Answer: 1
Blueprint Area: Role/Application
Each dialysis facility must have a QAPI program as part of Medicare's Conditions for Coverage. This systematic approach
includes improving safety outcomes and increasing patient satisfaction.
Core Curriculum, p. 12

20. Answer: 2
Blueprint Area: Clinical/Application
Hypotension, low blood pressure, occurs most often when too much fluid is removed during dialysis. Symptoms reported by the
patient include muscle cramps, headache, feeling warm, dizzy or faint, and nausea. A patient with hypotension is at
increased risk for falling. To prevent the patient from falling, the technician should ask the patient to sit down and place the
patient in the Trendelenburg position. The Trendelenburg position (raising the feet higher than the heart) could help to improve
the patient's blood pressure.
Core Curriculum, p. 263

21. Answer: 3
Blueprint Area: Clinical/Application
The arteriovenous fistula (AVF) is created surgically by connecting the patient's artery to a vein. This allows the high pressure
arterial blood to flow into the vein, causing the vein to enlarge. The flow from the artery to the vein causes a whooshing sound
known as a bruit. The absence of the bruit is a sign that the access is clotted.
Core Curriculum, p. 182

22. Answer: 4
Blueprint Area: Technical/Comprehension
A clotting access will cause an increase in venous pressure due to outflow obstruction. Resistance to flow can be caused by
narrowing of the vessel (by stenosis or clotting) and results in high venous pressure.
Core Curriculum, p. 127, see Table 8; Review of Hemodialysis for Nurses and Dialysis Personnel, p. 175

23. Answer: 1
Blueprint Area: Environment/Knowledge
Many dialyzers are cleaned and disinfected to be used again by the same patient instead of being thrown away after one
treatment. This is called “reuse.”
Core Curriculum, p. 135

24. Answer: 4
Blueprint Area: Role/Application
Staying active in life is important for patients who require dialysis therapy. Walking is an excellent exercise that will contribute
to the patient’s physical and mental well-being. Patients new to dialysis need support and information so they can understand
how they can help themselves live better while coordinating their treatment schedule.
Core Curriculum, p. 65, 69

25. Answer: 4
Blueprint Area: Environment/Application
Hepatitis B is a highly contagious virus. According to CMS regulations, patients who are positive for hepatitis B must be dialyzed
in a dedicated area, on a separate machine, with separate supplies and equipment from other patients.
Core Curriculum, p. 215

26. Answer: 1
Blueprint Area: Technical/Knowledge
An ultrafilter is a fine membrane filter that removes very small particles. It is the most effective water treatment component for
removing bacterial endotoxins.
Core Curriculum, p. 292, 361

27. Answer: 2
Blueprint Area: Technical/Application
Ultrafiltration profiling removes fluid from the patient's blood in a systematic pattern (typically removing more fluid in the first
part of the hemodialysis treatment) designed to reduce hypotension. Hypotension episodes can be reduced while still
accomplishing the ultrafiltration goal.
Review of Hemodialysis for Nurses and Dialysis Personnel, pp. 87-88

Copyright © 2019. Nephrology Nursing Certification Commission.

14 CCHT Certification Preparation Guide
28. Answer: 3
Blueprint Area: Technical/Application
When the dialysis machine goes into bypass, the dialysate flow bypasses the dialyzer and goes directly to the drain. The
dialysate in the dialyzer stops flowing. Bypass keeps unsafe dialysate from reaching the patient and causing harm.
Core Curriculum, p. 111, 337

29. Answer: 4
Blueprint Area: Environment/Application
According to the Centers for Disease Control and Prevention (CDC), alcohol-based hand rubs are not appropriate when
hands are visibly dirty, contaminated, or soiled. Soap and water should be used.
Core Curriculum, p. 212, see Table 2; Review of Hemodialysis for Nurses and Dialysis Personnel, p. 118

30. Answer: 2
Blueprint Area: Environment/Application
Good body mechanics are necessary to avoid fatigue, muscle strain or injury. The proper way to lift objects is to stand with
feet shoulder-width apart and bend from the hips and knees. The hands are placed around the object, holding it close to
the body before lifting it. It is important to bend the knees, keep the back straight, and use arm and leg muscles to lift.
Core Curriculum, pp. 220-221

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CCHT Certification Preparation Guide 15
 Nephrology Nursing Certification Commission
PO Box 56
Pitman, NJ 08071-0056
888-884-6622
www.nncc-exam.org
Copyright © 2016. Nephrology Nursing Certification Commission.