6 2 0 2 D E S S AP • T H C C
CCHT Exam 2026
CCHT Certified Clinical Hemodialysis Technician
COMPREHENSIVE REVIEW — I PASSED!
2026 ✓
CCHT Examination — Comprehensive Review
D I A LYS I S P R I N C I P L E S · M A C H I N E O P E R AT I O N S · VA S CU L A R A CC E SS · CO M P L I C AT I O N S · I N F E C T I O N
CO N T R O L
CERTIFICATION CCHT — NNCO ORGANIZATION National Nephrology Certification
Organization
PROGRAM Hemodialysis Technician Certification ACADEMIC YEAR
EXAM TITLE CCHT Exam 2026 — Comprehensive TOTAL QUESTIONS 120+ Comprehensive Questions
Review
DOMAIN All CCHT Domains — Full Certification FORMAT Multiple Choice / True-False / Definition
Prep
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover all CCHT domains: clinical, technical, water treatment, infection control, vascular access, and professional
responsibilities.
▸ Verified answers with detailed rationales are provided for comprehensive certification preparation.
▸ Pay close attention to machine alarms, safety protocols, emergency procedures, and complications management.
CCHT 2026 — FULL CERTIFICATION EXAMINATION REVIEW Questions 1 – 120+
1. Define osmosis as it relates to dialysis.
A. Movement of solutes from high to low concentration.
B. A process by which molecules of a solvent pass through a semipermeable membrane from a less concentrated
solution into a more concentrated one, equalizing concentrations on each side.
C. Active transport requiring ATP.
D. Movement of fluid due to hydrostatic pressure gradient.
CORRECT ANSWER B — Solvent molecules pass through a semipermeable membrane from less concentrated to more
concentrated solution, equalizing concentrations
RATIONALE Osmosis is the passive movement of water (solvent) across a semipermeable membrane from an area of
lower solute concentration to higher solute concentration until equilibrium is reached. In dialysis, osmosis
contributes minimally to water removal compared to ultrafiltration, but it is important in understanding fluid
shifts between body compartments (ICF/ECF) during treatment.
,2. Which of the following is CORRECT about online clearance (OLC) testing?
A. OLC tests are completed eight times per treatment.
B. OLC tests are used to project serum albumin levels.
C. The result of an OLC test is known as a KECN with an expected range of 300 to 400.
D. Sodium is used to estimate clearance of urea.
CORRECT ANSWER D — Sodium is used to estimate clearance of urea
RATIONALE Online clearance (OLC) testing uses the principle that sodium clearance closely approximates urea clearance.
The machine measures conductivity changes at the dialyzer inlet and outlet to calculate ionic dialysance,
which estimates urea Kt/V in real time without blood sampling. The result is expressed as KECN (effective
ionic clearance).
3. When is hand sanitizer acceptable to use in the dialysis setting?
A. After using the restroom.
B. When hands are visibly soiled.
C. When caring for a C. diff patient.
D. When leaving the patient station.
CORRECT ANSWER D — When leaving the patient station
RATIONALE Alcohol-based hand sanitizer is appropriate when hands are not visibly soiled and when moving between
clean activities. Hand sanitizer should NOT be used after restroom use (soap and water required), when hands
are visibly soiled (soap and water required), or with C. difficile patients (alcohol does not kill C. diff spores —
soap and water required).
4. Which of the following is included in Fresenius Medical Care's mission statement?
A. Improving the quality of life of patients.
B. Adopting the practices of other successful medical facilities.
C. Developing the best dialysis products.
D. Increasing financial stability of Fresenius Medical Care.
CORRECT ANSWER A — Improving the quality of life of patients
RATIONALE Fresenius Medical Care's mission is centered on improving the quality of life of patients with kidney disease
through innovative products, services, and care delivery. Their philosophy emphasizes patient-centered care
and continuous improvement in dialysis outcomes rather than purely financial or competitive goals.
5. Which of the following is true about near misses in the dialysis setting?
A. They do not have to be reported if no patient injury occurred.
B. They are not referred to as "good catches."
C. They help identify staff members who are more likely to make mistakes.
D. They help identify risks to patient safety and reduce the risk of patient injury.
CORRECT ANSWER D — They help identify risks to patient safety and reduce the risk of patient injury
RATIONALE Near misses (also called "good catches") are events that could have caused harm but were caught before
reaching the patient. Reporting near misses is essential for QAPI programs — they reveal system
vulnerabilities and allow proactive correction before actual patient harm occurs. They are NOT used
punitively to identify "mistake-prone" staff.
, 6. A patient begins to experience faintness, double vision, and clammy hands. Which of the following is the MOST
likely cause?
A. Hypoglycemia.
B. Hyperkalemia.
C. Hypertension.
D. Hyperglycemia.
CORRECT ANSWER A — Hypoglycemia
RATIONALE Faintness, double vision (diplopia), and clammy (diaphoretic) skin are classic autonomic and
neuroglycopenic symptoms of hypoglycemia. Dialysis patients on insulin or sulfonylureas are at risk because
glucose (approximately 180 Da molecular weight) is removed during treatment with glucose-free dialysate.
Immediate blood glucose check and treatment with glucose are required.
7. What is the path of urine flow through the urinary tract?
A. Kidneys → urethra → bladder → ureters.
B. Ureters → kidneys → bladder → urethra.
C. Kidneys → ureters → bladder → urethra.
D. Bladder → ureters → kidneys → urethra.
CORRECT ANSWER C — Kidneys → ureters → bladder → urethra
RATIONALE Urine is produced in the kidneys (nephrons), drains through the ureters (one per kidney) via peristaltic waves
into the urinary bladder for storage, and is expelled through the urethra during micturition. This is the normal
anatomical pathway. Obstruction at any point (stones, tumors, BPH) can cause postrenal failure.
8. What is Fresenius Medical Care's goal for a single-pool Kt/V (spKt/V)?
A. 1.0.
B. 1.2.
C. 1.4.
D. 1.6.
CORRECT ANSWER C — 1.4
RATIONALE While the KDOQI minimum adequacy standard is spKt/V ≥ 1.2, Fresenius Medical Care sets a higher internal
goal of spKt/V ≥ 1.4. This provides a safety margin above the minimum, ensuring patients receive adequate
dialysis even with measurement variability. Higher Kt/V values are associated with improved survival in
hemodialysis patients.
9. What is the number one cause of chronic kidney disease?
A. Hypertension.
B. Glomerulonephritis.
C. Diabetes.
D. Polycystic kidney disease.
CORRECT ANSWER C — Diabetes
RATIONALE Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the United States, accounting for
approximately 45-50% of new dialysis patients. Diabetic nephropathy develops from chronic hyperglycemia
causing glomerular basement membrane thickening, mesangial expansion, and progressive
glomerulosclerosis. Hypertension is the second leading cause, accounting for approximately 28% of cases.
CCHT Exam 2026
CCHT Certified Clinical Hemodialysis Technician
COMPREHENSIVE REVIEW — I PASSED!
2026 ✓
CCHT Examination — Comprehensive Review
D I A LYS I S P R I N C I P L E S · M A C H I N E O P E R AT I O N S · VA S CU L A R A CC E SS · CO M P L I C AT I O N S · I N F E C T I O N
CO N T R O L
CERTIFICATION CCHT — NNCO ORGANIZATION National Nephrology Certification
Organization
PROGRAM Hemodialysis Technician Certification ACADEMIC YEAR
EXAM TITLE CCHT Exam 2026 — Comprehensive TOTAL QUESTIONS 120+ Comprehensive Questions
Review
DOMAIN All CCHT Domains — Full Certification FORMAT Multiple Choice / True-False / Definition
Prep
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover all CCHT domains: clinical, technical, water treatment, infection control, vascular access, and professional
responsibilities.
▸ Verified answers with detailed rationales are provided for comprehensive certification preparation.
▸ Pay close attention to machine alarms, safety protocols, emergency procedures, and complications management.
CCHT 2026 — FULL CERTIFICATION EXAMINATION REVIEW Questions 1 – 120+
1. Define osmosis as it relates to dialysis.
A. Movement of solutes from high to low concentration.
B. A process by which molecules of a solvent pass through a semipermeable membrane from a less concentrated
solution into a more concentrated one, equalizing concentrations on each side.
C. Active transport requiring ATP.
D. Movement of fluid due to hydrostatic pressure gradient.
CORRECT ANSWER B — Solvent molecules pass through a semipermeable membrane from less concentrated to more
concentrated solution, equalizing concentrations
RATIONALE Osmosis is the passive movement of water (solvent) across a semipermeable membrane from an area of
lower solute concentration to higher solute concentration until equilibrium is reached. In dialysis, osmosis
contributes minimally to water removal compared to ultrafiltration, but it is important in understanding fluid
shifts between body compartments (ICF/ECF) during treatment.
,2. Which of the following is CORRECT about online clearance (OLC) testing?
A. OLC tests are completed eight times per treatment.
B. OLC tests are used to project serum albumin levels.
C. The result of an OLC test is known as a KECN with an expected range of 300 to 400.
D. Sodium is used to estimate clearance of urea.
CORRECT ANSWER D — Sodium is used to estimate clearance of urea
RATIONALE Online clearance (OLC) testing uses the principle that sodium clearance closely approximates urea clearance.
The machine measures conductivity changes at the dialyzer inlet and outlet to calculate ionic dialysance,
which estimates urea Kt/V in real time without blood sampling. The result is expressed as KECN (effective
ionic clearance).
3. When is hand sanitizer acceptable to use in the dialysis setting?
A. After using the restroom.
B. When hands are visibly soiled.
C. When caring for a C. diff patient.
D. When leaving the patient station.
CORRECT ANSWER D — When leaving the patient station
RATIONALE Alcohol-based hand sanitizer is appropriate when hands are not visibly soiled and when moving between
clean activities. Hand sanitizer should NOT be used after restroom use (soap and water required), when hands
are visibly soiled (soap and water required), or with C. difficile patients (alcohol does not kill C. diff spores —
soap and water required).
4. Which of the following is included in Fresenius Medical Care's mission statement?
A. Improving the quality of life of patients.
B. Adopting the practices of other successful medical facilities.
C. Developing the best dialysis products.
D. Increasing financial stability of Fresenius Medical Care.
CORRECT ANSWER A — Improving the quality of life of patients
RATIONALE Fresenius Medical Care's mission is centered on improving the quality of life of patients with kidney disease
through innovative products, services, and care delivery. Their philosophy emphasizes patient-centered care
and continuous improvement in dialysis outcomes rather than purely financial or competitive goals.
5. Which of the following is true about near misses in the dialysis setting?
A. They do not have to be reported if no patient injury occurred.
B. They are not referred to as "good catches."
C. They help identify staff members who are more likely to make mistakes.
D. They help identify risks to patient safety and reduce the risk of patient injury.
CORRECT ANSWER D — They help identify risks to patient safety and reduce the risk of patient injury
RATIONALE Near misses (also called "good catches") are events that could have caused harm but were caught before
reaching the patient. Reporting near misses is essential for QAPI programs — they reveal system
vulnerabilities and allow proactive correction before actual patient harm occurs. They are NOT used
punitively to identify "mistake-prone" staff.
, 6. A patient begins to experience faintness, double vision, and clammy hands. Which of the following is the MOST
likely cause?
A. Hypoglycemia.
B. Hyperkalemia.
C. Hypertension.
D. Hyperglycemia.
CORRECT ANSWER A — Hypoglycemia
RATIONALE Faintness, double vision (diplopia), and clammy (diaphoretic) skin are classic autonomic and
neuroglycopenic symptoms of hypoglycemia. Dialysis patients on insulin or sulfonylureas are at risk because
glucose (approximately 180 Da molecular weight) is removed during treatment with glucose-free dialysate.
Immediate blood glucose check and treatment with glucose are required.
7. What is the path of urine flow through the urinary tract?
A. Kidneys → urethra → bladder → ureters.
B. Ureters → kidneys → bladder → urethra.
C. Kidneys → ureters → bladder → urethra.
D. Bladder → ureters → kidneys → urethra.
CORRECT ANSWER C — Kidneys → ureters → bladder → urethra
RATIONALE Urine is produced in the kidneys (nephrons), drains through the ureters (one per kidney) via peristaltic waves
into the urinary bladder for storage, and is expelled through the urethra during micturition. This is the normal
anatomical pathway. Obstruction at any point (stones, tumors, BPH) can cause postrenal failure.
8. What is Fresenius Medical Care's goal for a single-pool Kt/V (spKt/V)?
A. 1.0.
B. 1.2.
C. 1.4.
D. 1.6.
CORRECT ANSWER C — 1.4
RATIONALE While the KDOQI minimum adequacy standard is spKt/V ≥ 1.2, Fresenius Medical Care sets a higher internal
goal of spKt/V ≥ 1.4. This provides a safety margin above the minimum, ensuring patients receive adequate
dialysis even with measurement variability. Higher Kt/V values are associated with improved survival in
hemodialysis patients.
9. What is the number one cause of chronic kidney disease?
A. Hypertension.
B. Glomerulonephritis.
C. Diabetes.
D. Polycystic kidney disease.
CORRECT ANSWER C — Diabetes
RATIONALE Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the United States, accounting for
approximately 45-50% of new dialysis patients. Diabetic nephropathy develops from chronic hyperglycemia
causing glomerular basement membrane thickening, mesangial expansion, and progressive
glomerulosclerosis. Hypertension is the second leading cause, accounting for approximately 28% of cases.
