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CCHT Exam Part A ACCURATE
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Name two guidelines concerning hand washing. A) Use hand sanitizer only, no rinsing needed; Clinic sinks can be shared with other purposes B) When decontaminating hands via alcohol, rub until dry; Clinics must have dedicated 'clean' sinks for handwashing only C) Wash hands only at the beginning of the shift; Use any sink available in the clinic D) Use antibacterial soap only; Dry hands with a shared towel Correct Answer: B Rationale: Alcohol-based hand rubs should be rubbed until dry for effectiveness. Dedicated 'clean' sinks ensure no cross-contamination during handwashing.
2. Which statements about Hepatitis B are correct? A) It is minimally transmissible and dies immediately on surfaces B) It is highly transmissible and can live on surfaces for up to a week C) It is only transmitted via blood transfusion D) It cannot survive outside the body Correct Answer: B Rationale: Hepatitis B virus is highly contagious and can survive outside the body on surfaces for up to a week. 3. How should a patient who is Hepatitis B positive be safely dialyzed? A) Use shared machines and supplies after disinfecting B) Use an isolation room with a dedicated machine and supplies C) Dialyze in a common area with other patients D) Use disposable equipment only Correct Answer: B Rationale: Isolation rooms and dedicated machines and supplies prevent cross- infection in dialysis units. 4. If a staff member is immune to Hepatitis B due to vaccination, what will their lab results show? A) Positive Anti-HBc only B) Positive Anti-HBs only
C) Positive Anti-HBc and Anti-HBs D) Negative for all Hepatitis B markers Correct Answer: C Rationale: Immunity from vaccination shows positive antibodies against core (Anti-HBc) and surface antigen (Anti-HBs).
5. A staff member tests positive for IgM to Hepatitis B. What does this indicate? A) Chronic infection B) Past resolved infection C) Recent or acute infection D) Vaccination response Correct Answer: C Rationale: IgM positivity indicates recent or acute Hepatitis B infection. 6. What is the CDC recommendation for Hepatitis C screening? A) Screen all patients for liver enzyme elevation regularly B) Only screen high-risk patients once C) Screen only symptomatic patients D) Screen annually with biopsy Correct Answer: A Rationale: The CDC recommends monitoring all patients for liver enzyme elevation to identify Hepatitis C infection early. 7. How can patients with antibiotic-resistant infections be safely treated in dialysis units? A) No special precautions needed B) Follow standard precautions and sanitize all reusable equipment before reuse C) Use disposable equipment only D) Isolate all infected patients regardless of infection type Correct Answer: B Rationale: Standard precautions and thorough sanitation prevent transmission of resistant organisms. 8. When a dialysis patient is infected with CRC (Carbapenem-resistant organisms), what type of precautions should be used? A) Droplet precautions B) Airborne precautions C) Contact isolation precautions D) No special precautions Correct Answer: C Rationale: Contact isolation is required for organisms like CRC to prevent spread via touch or surface contact.
Correct Answer: C Rationale: Radial cephalic AV fistulas have the best long-term patency and lowest complication rates.
14. What precaution should patients with stage 4 or 5 CKD follow? A) No special precautions needed B) Wear a medical bracelet that discourages use of vessels that may be needed for dialysis C) Avoid all medications D) Wear compression stockings only Correct Answer: B Rationale: Medical bracelets alert healthcare providers to preserve vascular sites for dialysis access. 15. What are the advantages of a proximal radial artery AV fistula? A) Faster healing and easier cannulation B) Good for patients with advanced arteriosclerosis and helps inhibit steal syndrome C) Cheapest option available D) No advantages over distal fistulas Correct Answer: B Rationale: Proximal radial artery fistulas are better for patients with vascular disease and reduce steal syndrome risk. 16. What are two advantages of a graft versus a fistula? A) Lower infection risk and longer lifespan B) Quicker healing time and easier to cannulate C) Less expensive and no need for surgery D) No advantages Correct Answer: B Rationale: Grafts heal quicker and are easier to cannulate but have higher infection and thrombosis risk. 17. What is the most common complication of AV fistulas? A) Infection B) Thrombosis C) Steal syndrome D) Aneurysm Correct Answer: B Rationale: Thrombosis is the most frequent cause of fistula failure. 18. What can result when a patient is dialyzed at a high blood flow rate (BFR) with small needles?
A) Hemolysis of red blood cells B) Improved dialysis efficiency C) Reduced bleeding risk D) No effect Correct Answer: A Rationale: High BFR with small needles can cause mechanical trauma and hemolysis.
19. What are signs and symptoms of severe recirculation due to stenosis? A) pH above 7.4 and bright red blood B) pH below 7 and very dark blood C) Hypertension and bradycardia D) Low potassium and pale blood Correct Answer: B Rationale: Severe recirculation reduces dialysis efficiency, causing acidic (pH <7) and dark venous blood. 20. What are responsibilities of the medical director of a dialysis facility? A) Ordering supplies only B) Being knowledgeable and responsible for the integrity of the water treatment system C) Only managing staff schedules D) Performing dialysis treatments Correct Answer: B Rationale: The medical director oversees water quality to ensure patient safety. 21. Prior to beginning dialysis, what must the physician's order include? A) Diet plan and exercise routine B) Specific dialyzer, blood flow rate (BFR), and duration C) Patient consent only D) Insurance details Correct Answer: B Rationale: Dialyzer type, BFR, and treatment duration are essential for safe, effective dialysis. 22. To sit for the CCHT-A exam, a technician must have: A) No prior experience needed B) Hold another national certification such as CCHT and have worked at least 5, hours as a hemo tech C) Only a high school diploma D) Medical degree Correct Answer: B Rationale: The CCHT-A requires prior certification and substantial clinical experience.
Correct Answer: B Rationale: Thomas Graham coined the term dialysis.
28. What was the primary anticoagulant used in the first artificial kidney? A) Heparin B) Hirudin C) Warfarin D) Aspirin Correct Answer: B Rationale: Hirudin was used as an anticoagulant in early dialysis devices. 29. What material was used in the hollow tubes of Dr. Kolff's first bio-compatible rotating drum dialyzer? A) Cellophane B) Teflon C) Silicone D) PVC Correct Answer: A Rationale: Cellophane membranes were used for their semi-permeable properties. 30. The first AV shunt for CKD was placed: A) Internally using synthetic grafts B) Externally using Teflon tubes C) Using autologous vein only D) Using metal connectors Correct Answer: B Rationale: Early AV shunts were external, made with Teflon tubing. 31. Which US President signed the bill that allowed Medicare coverage for CKD treatment? A) Reagan B) Nixon C) Carter D) Ford Correct Answer: B Rationale: President Nixon signed legislation expanding Medicare to cover ESRD. 32. In 1989, the FDA approved which drug that diminished the need for blood transfusions in CKD? A) Erythropoietin (Epogen, Mircera) B) Warfarin
C) Aspirin D) Insulin Correct Answer: A Rationale: Erythropoietin stimulates RBC production, reducing transfusion need.
33. An electrolyte is a substance that dissolves in water to form: A) Covalent compounds B) Ionized particles C) Non-ionized molecules D) Suspended solids Correct Answer: B Rationale: Electrolytes dissociate into ions in solution, enabling conductivity. 34. What happens to a patient if dialysate contains too much sodium? A) Cells swell due to fluid intake B) Fluid leaves cells, causing shriveling; patient may get hypotensive, thirsty, and have headaches C) No effect on cells D) Patient becomes hyperkalemic Correct Answer: B Rationale: High sodium in dialysate causes fluid shifts out of cells, leading to dehydration symptoms. 35. With osmosis, water moves from areas of: A) High solute concentration to low solute concentration B) Low solute concentration to high solute concentration C) Equal solute concentration D) Random movement Correct Answer: B Rationale: Osmosis moves water toward higher solute concentration to balance levels. 36. What is the major plasma buffer in the body? A) Phosphate B) Bicarbonate C) Hemoglobin D) Ammonia Correct Answer: B Rationale: Bicarbonate is the primary buffer maintaining blood pH. 37. Kidney failure causes retention of hydrogen ions. What is the result? A) Respiratory alkalosis B) Metabolic acidosis
A) High protein intake B) Low dietary protein intake and overhydration C) Kidney failure D) Dehydration Correct Answer: B Rationale: Low protein diet and excess fluid dilute urea levels.
43. What is the recommended GFR for CKD stage 3b? A) 45-59 mL/min/1.73m² B) 30-44 mL/min/1.73m² C) 15-29 mL/min/1.73m² D) <15 mL/min/1.73m² Correct Answer: B Rationale: Stage 3b CKD is defined by GFR between 30-44 mL/min/1.73m². 44. Which lab value should be included when assessing increased risk for CKD? A) Blood glucose B) Creatinine C) Cholesterol D) Hemoglobin Correct Answer: B Rationale: Creatinine reflects kidney function and is essential for CKD risk assessment. 45. A patient is considered stage 5 CKD when: A) GFR is 60 mL/min B) They require maintenance dialysis for survival C) They have proteinuria only D) They have normal kidney function Correct Answer: B Rationale: Stage 5 CKD is kidney failure requiring dialysis or transplant. 46. A patient with nephrosclerosis may exhibit: A) Elevated liver enzymes B) Blood in urine, proteinuria, and uncontrolled hypertension C) Decreased blood pressure D) No symptoms Correct Answer: B Rationale: Nephrosclerosis causes vascular damage resulting in these symptoms. 47. What is a common clinical manifestation of renal cell carcinoma? A) Jaundice B) Blood in urine (hematuria)
C) Abdominal pain only D) Hypertension Correct Answer: B Rationale: Hematuria is a common presenting sign of renal cell carcinoma.
48. Which may cause postrenal acute renal failure? A) Diabetes B) Obstruction in the ureter or urethra C) Glomerulonephritis D) Dehydration Correct Answer: B Rationale: Obstruction downstream causes backpressure and renal failure. 49. What is the target blood pressure for patients with CKD recommended by JNC? A) <140/90 mmHg B) <130/80 mmHg C) <150/95 mmHg D) No target Correct Answer: B Rationale: Tight BP control slows CKD progression. 50. A patient presents with chest pain, fever, chills, and pericardial friction rub. Echocardiogram confirms pericardial tamponade. What is the next procedure? A) Cardiac catheterization B) Pericardiocentesis (needle removal of fluid) C) Coronary artery bypass graft D) No treatment needed Correct Answer: B Rationale: Pericardiocentesis relieves tamponade by draining fluid. What is the proper procedure regarding the removal of chlorine and chloramines in a two tank system? - Ans - If sampling reveals there is a chlormaine >0.1ppm leaving first tank, second tank must be sampled Polymade membranes used for RO: - Ans - Have a wide pH tolerance, are very susceptible to degredation by free chlorine What is an advantage of RO water treatment? - Ans - Rejects bacteria, viruses, and pyrogenic material if membrane is intact What type of water is produced by deionozers? - Ans - Water of high ionic purity
Which of the following dialyzers is used currently - Ans - Hollow tube The glomerular filtration rate is an important index to renal function and in the normal adult is approximately - Ans - 125ml/min/1.73m The most likely cause of post renal failure is - Ans - Benign prostatic hypertrophy What percentage of transplanted kidneys is functional 1 year after transplantion - Ans - 90% Failure to excrete beta2 Microglobulin in patients with kidney failure predisposed to - Ans - Amyloidosis Uremia may cause which of the following conditions - Ans - Itching edema and anemia Blood test for ferritin are performed in hemodialysis patients - Ans - To check for iron stores Which of the following phosphate binders would best control hyperphosphamia me with the fewest side effects and patients with end-stage kidney disease - Ans - Lanthanum carbonate In the dialysis water may be removed from - Ans - The interstitial compartment Which site in the hemodialysis pathway has the highest positive pressure - Ans - Blood entering the dialyzer fibers Water moves from one body compartment to another by - Ans - Osmotic forces Biocompability to the best illustrated by - Ans - Reprocess dialyzer that have had a better biocompability than the new ones A patient with kidney disease has anemia but the elevator phosphorus levels ankle edema and elevated blood pressure what is the most likely range of his glomerular filtration rate? - Ans - 60 - 90ml/min Adding extra sodium chloride to the dialsyate will? - Ans - Draw water out of the cells and tissues into the blood What does the expression KT/v signify with regard to hemodialysis? - Ans - Prescribed dose of dialysis. Acute Tubular necrosis may be caused by - Ans - Shock and hypotension
Rhabdomyolysis Radiographic contrast material Which of the following statements about the nephron the working unit of the kidney is correct? - Ans - It makes about 180 liters of glomerular filtrate a day A recent study published in the New England Journal of Medicine compared hemodialysis three times a week with hemodialysis 6 times a week at the end of the 12 month follow up. The studies show that 6x of the group had? - Ans - Fewer deaths Which of the following statements about administering erythropoietin to a hemodialysis patient is correct? - Ans - Give supplemental iron ferret it is low the nephrotic syndrome is characterized by all of the following - Ans - Proteinuria greater than 3.5 G/d/1.72 m2 body surface area Hyperlipidemia Hypoalbuminemia A diet restricting all of the following is appropriate for a renal failure patient - Ans - Potassium phosphate fluids What is the sensitization test for a potentional kidney transplant recipients - Ans - Potential recipit sternum tested,with a multiple donor lymphocyte panel Which of the following immunosuppressive drugs used in kidney transplant patients have renal toxicity - Ans - Cyclosporine All of the following statements regarding kidney transplantation - Ans - The rate of death is 3 to 5% range during the first year Diabetes heart disease and older age decreases the success rate There he is a ten 10% to 15% lower success rate in the first transplant is rejected Another difference in peritoneal dialysis hemodialysis is - Ans - The patient is subject to constant dialysis in PD rather than the intermittent and dialysis in HD As part of the job of a dialysis technician one may be required to lift equipment or assist with patient transfers back pain sparring and injury prevention maneuvers include - Ans
- Lifting with the legs and holding the object close to the body
Which of the following substances is the most common impurity in tap water - Ans - Calcium carbonate Which of the following germicides is most commonly used to disinfect dialyzers of the United States - Ans - Peracetic acid Grounds for discarding a dialyzer include - Ans - It has been exposed to more than one germicide The following statements about new dialyzers is correct - Ans - They may be processed to reduce noxious chemicals or materials Which of the following statements about first use syndrome is correct - Ans - It may be reduced by repeated rinsing of the dialyzer The following may cause hemolysis of red blood cells during dialysis - Ans - Kink blood lines Warm dialysis fluid Inadequate water treatment A dialysis patient develops a purulent discharge at the exit site of a central catheter which of the following pathogens is most likely to be cultured - Ans - Staphylococcus aureus For patients in whom the primer solution is to be discarded what should the hemodialysis technician do? - Ans - Connect the arterial tubing and allow the priming solution to drain before connecting the Venus tubing What is the urea kinetic modeling calculation - Ans - It gives both minimum deliver and prescribed doses The urea reduction ratio has which of the following properties - Ans - It requires measurement of both pre and post dialysis blood urea nitrogen Which of the following veins is most suitable for hemodialysis catheter placement - Ans - Right internal jugular In placing a needle into a graft the hemodialysis technician may do which? - Ans - Use three sides to calculate the graft not just the top A thrombosis is least likely to develop which of the following vascular access methods - Ans - Fistula
Common sites of stenosis in pt with an fistula include all the following - Ans - The vein next to anastomosis Along the outflow vein The large draining vein of the arm near the shoulder A diabetic patient undergoing dialysis complains of tingling numbness and cold in the hand below the access site. the most likely causes - Ans - Steal syndrome What type of fstula ls likely to result in high blood flow with the - Ans - artery side to vein end Which of the following statements about sorbent dialysis is correct - Ans - In preparing the dialysate 6 liters of water are added to premix chemicals All of the following statements about vitamins in dialysis patients are true EXCEPT: - Ans - Dialysis does not remove water-soluble vitamins. In the dialysizer , water may be removed : - Ans - The interstitial compartment. The ultrafiltration coefficient of a dialyzer refers to the: - Ans - Fluid that passes through the membrane in 1 hour. The molecular weight cutoff of a dialyzer is 12,000 daltons. Which of the following molecules would not pass through the membrane into the dialysate? - Ans - Albumin Clearance of low molecular - weight molecules by dialysis is accomplished mostly by: - Ans - Diffusion A hollow fiber dialyzer has which of the following properties? - Ans - A very fine fiber tubes held in place by polyurethane material. Which of the following statements about the proportioning system is correct? - Ans - It relies on a continuous supply of fresh concentrate and treated water. An advantage of high-flux dialysis is: - Ans - Fast removal of fluid A disadvantage of high-flux dialysis is: - Ans - Pyrogen reactions are common. All of the following statements regarding home dialysis are true EXCEPT : - Ans - It cannot be done during sleep.
What is 'hypoglycemia'? - Ans - Low blood sugar, or, below normal levels of sugar in the blood. What are notable symptoms of hypoglycemia? - Ans - In a patient with diabetes mellitus, this can cause hunger, confusion, nervousness, sleepiness, or dizziness. How should you intervene when hypoglycemia occurs in your patient? - Ans - A fastacting carbohydrate is needed, such as juice. What is the conversion of desired weight loss? HINT: 1 kg = - Ans - 1 kg = 1,000 mL edematous - Ans - An accumulation of an excessive amount of watery fluid in cells, tissues, or body cavities. Think 'edema'. How is the EDW to be considered? - Ans - The target post-dialysis weight or estimated dry weight is the patient's weight without excess fluid. The water supply to the water treatment system is called? - Ans - FEED WATER. 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. What is the main objective of QAPI? - Ans - Quality Assessment and Performance Improvement is a program required as part of Medicare's Conditions for Coverage. This includes improving safety outcomes, and increasing patient satisfaction. Which part of the water treatment system removes endotoxins? - Ans - An ultrafilter is a fine membrane filter that removes very small particles. It is the most effective water treatment component for removing bacterial endotoxins. What is the purpose of UF profiling? - Ans - the purpose of UF profiling is to minimize hypotension. Explain what UF profiling does? - Ans - UF profiling removes fluid from the patient's blood in a systematic pattern. It typically removes more fluid in the first part of the hemodialysis treatment. The entire purpose is to reduce hypotension. What might a high venous pressure alarm indicate? - Ans - Clotting of blood in the access stenosis - Ans - the abnormal narrowing of a passage in the body
What is a 'thrombus' - Ans - When a blood clot forms in a blood vessel and remains there What is an 'embolism' - Ans - A clot that travels from the site where it formed to another location in the body Amyloidosis - Ans - a waxy protein building up in the patients soft tissues, bones, joints... this will cause carpal tunnel, joint pain, bone cysts, and fractures What is the function of the electrolyte 'Sodium' - Ans - Sodium helps keep body water in balance. It will also help send nerve cell signals What does the electrolyte potassium do? - Ans - - controls nerves/muscles (heart)
- keeps body's water balanced
- helps body to use glucose What does the electrolyte Calcium do? - Ans - - controls blood clotting, enzymes, hormones, nerves, and muscles
- found in bones/teeth What is the consequence of 'hypocalcemia'? - Ans - this is low levels of Calcium in the blood, and this can occur when the blood does not/cannot absorb Calcium.... or if phosphorus levels are too high. When phosphorus levels are to high calcium and phosphorus can bond and blood calcium levels will drop. What are some symptoms of Hypocalcemia? - Ans - - numbness - seizures
- tetany (tremors, facial twitches, muscle spasms, and muscle pain) What is Hyperphospatemia? - Ans - This is when there is to much Phosphorus in the blood putting patient at risk for symptoms from itching to even bone disease. What is the purpose of phosphate binders? - Ans - These are taken when a patient has hyperphospatemi. Phosphate binders must be taken with every meal/snack... the binders will bind phosphate in the gut so less will be absorbed. Erythroprotein - Ans - A protein created by the kidneys which will tell bone marrow to make RBC's. In a dialysis patient, EPO will be given by injection. How much of a patient's blood will be outside the body during a dialysis treatment? - Ans - Only about 1/2 cup of blood at a time Solution - Ans - a mixture of a solvent and a solute where:
