DaVita Annual Competency Exam Dialysis
Technician PCT Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
Section 1: Hemodialysis Principles & Machine Setup
(Questions 1–30)
Q1: The three primary transport mechanisms that occur across the dialyzer membrane during
hemodialysis are:
A. Filtration, absorption, and secretion
B. Diffusion, osmosis, and ultrafiltration [CORRECT]
C. Active transport, passive transport, and pinocytosis
D. Dialysis, hemofiltration, and hemodiafiltration
Correct Answer: B
Rationale: The best answer is diffusion, osmosis, and ultrafiltration. These are the three
fundamental mechanisms—diffusion moves solutes down concentration gradients, osmosis moves
water across the membrane, and ultrafiltration removes excess fluid through pressure-driven
convection. Per DaVita policy and CMS guidelines, understanding these principles is essential for
every PCT to grasp how the dialyzer actually cleans the blood.
,Q2: During treatment setup, you notice the dialysate conductivity reading is 12.8 mS/cm when it
should be 13.8–14.0 mS/cm. What does this indicate?
A. The dialysate temperature is too high
B. The bicarbonate concentrate is depleted or improperly mixed [CORRECT]
C. The blood pump speed is too slow
D. The venous pressure alarm is malfunctioning
Correct Answer: B
Rationale: The best answer is that the bicarbonate concentrate is depleted or improperly mixed.
Low conductivity usually means insufficient electrolytes in the dialysate, and since bicarbonate is a
major contributor to conductivity, that's your first suspect. In the clinic we always check the
concentrate jugs and mixing ratios when conductivity runs low—never start treatment until this is
corrected.
Q3: Countercurrent flow in the dialyzer means:
A. Blood and dialysate flow in opposite directions to maximize concentration gradients [CORRECT]
B. Blood and dialysate flow in the same direction for faster clearance
C. Blood flows through the dialyzer twice for better urea removal
D. The dialysate flows backward through the machine to clean it
Correct Answer: A
Rationale: The best answer is that blood and dialysate flow in opposite directions to maximize
concentration gradients. This design keeps the freshest dialysate meeting blood that still has high
urea levels, maintaining the steepest diffusion gradient along the entire membrane length. Per
DaVita policy, this is why our dialyzers are engineered with blood entering at the bottom and
dialysate entering at the top.
Q4: The semipermeable membrane in a dialyzer allows:
A. Only water molecules to pass through
,B. Small and middle molecular weight solutes and water to pass, while retaining blood cells and
large proteins [CORRECT]
C. All substances including blood cells to pass freely
D. Only electrolytes to pass, blocking all water movement
Correct Answer: B
Rationale: The best answer is that small and middle molecular weight solutes and water pass while
retaining blood cells and large proteins. The membrane pores are sized precisely—urea,
creatinine, potassium, and water move freely, but albumin, blood cells, and clotting factors stay in
the blood. In the clinic we monitor for membrane leaks because if large molecules start crossing,
that's a dialyzer breach.
Q5: A patient asks why their Kt/V was 1.1 last month and the doctor wants it above 1.2. What does
Kt/V measure?
A. The amount of fluid removed during dialysis
B. The adequacy of dialysis based on urea clearance normalized to body water volume
[CORRECT]
C. The blood flow rate through the access
D. The number of treatments per week
Correct Answer: B
Rationale: The best answer is that Kt/V measures dialysis adequacy based on urea clearance
normalized to body water volume. The K is dialyzer clearance, t is treatment time, and V is urea
distribution volume. Per DaVita policy and CMS guidelines, we target single-pool Kt/V ≥ 1.2 for
adequacy—below that means the patient isn't getting enough dialysis and may need longer
treatments or better access flow.
Q6: The Urea Reduction Ratio (URR) is calculated using:
A. Pre-BUN minus post-BUN divided by pre-BUN, multiplied by 100 [CORRECT]
, B. Post-BUN minus pre-BUN divided by post-BUN, multiplied by 100
C. Pre-BUN plus post-BUN divided by treatment time
D. Pre-BUN multiplied by post-BUN divided by body weight
Correct Answer: A
Rationale: The best answer is pre-BUN minus post-BUN divided by pre-BUN, multiplied by 100. This
gives the percentage reduction in blood urea nitrogen achieved during treatment. In the clinic we
aim for URR ≥ 65%—so if a patient's pre-BUN is 80 and post-BUN is 28, that's (80-28)/80 = 0.65 or
65%, right at target.
Q7: You're setting up a machine and the arterial pressure alarm triggers immediately upon starting
the blood pump at 200 mL/min. The reading shows -250 mmHg. What's your first action?
A. Increase the blood pump speed to overcome the negative pressure
B. Check for kinks in the arterial line, needle position, and access patency [CORRECT]
C. Ignore it and wait for the alarm to self-correct
D. Immediately clamp the venous line and stop the pump
Correct Answer: B
Rationale: The best answer is to check for kinks in the arterial line, needle position, and access
patency. High negative arterial pressure means the pump is having trouble pulling blood—usually
from a kinked line, needle against the vessel wall, or access flow problem. In the clinic we never just
crank up the speed; we troubleshoot the cause first because forcing it can damage the access or
cause hemolysis.
Q8: The venous pressure alarm sounds with a reading of +350 mmHg and rising. The patient has
no visible access problems. Most likely cause is:
A. The dialyzer is clotting or the venous line is kinked/obstructed [CORRECT]
B. The arterial needle is infiltrated
C. The conductivity is too low
Technician PCT Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
Section 1: Hemodialysis Principles & Machine Setup
(Questions 1–30)
Q1: The three primary transport mechanisms that occur across the dialyzer membrane during
hemodialysis are:
A. Filtration, absorption, and secretion
B. Diffusion, osmosis, and ultrafiltration [CORRECT]
C. Active transport, passive transport, and pinocytosis
D. Dialysis, hemofiltration, and hemodiafiltration
Correct Answer: B
Rationale: The best answer is diffusion, osmosis, and ultrafiltration. These are the three
fundamental mechanisms—diffusion moves solutes down concentration gradients, osmosis moves
water across the membrane, and ultrafiltration removes excess fluid through pressure-driven
convection. Per DaVita policy and CMS guidelines, understanding these principles is essential for
every PCT to grasp how the dialyzer actually cleans the blood.
,Q2: During treatment setup, you notice the dialysate conductivity reading is 12.8 mS/cm when it
should be 13.8–14.0 mS/cm. What does this indicate?
A. The dialysate temperature is too high
B. The bicarbonate concentrate is depleted or improperly mixed [CORRECT]
C. The blood pump speed is too slow
D. The venous pressure alarm is malfunctioning
Correct Answer: B
Rationale: The best answer is that the bicarbonate concentrate is depleted or improperly mixed.
Low conductivity usually means insufficient electrolytes in the dialysate, and since bicarbonate is a
major contributor to conductivity, that's your first suspect. In the clinic we always check the
concentrate jugs and mixing ratios when conductivity runs low—never start treatment until this is
corrected.
Q3: Countercurrent flow in the dialyzer means:
A. Blood and dialysate flow in opposite directions to maximize concentration gradients [CORRECT]
B. Blood and dialysate flow in the same direction for faster clearance
C. Blood flows through the dialyzer twice for better urea removal
D. The dialysate flows backward through the machine to clean it
Correct Answer: A
Rationale: The best answer is that blood and dialysate flow in opposite directions to maximize
concentration gradients. This design keeps the freshest dialysate meeting blood that still has high
urea levels, maintaining the steepest diffusion gradient along the entire membrane length. Per
DaVita policy, this is why our dialyzers are engineered with blood entering at the bottom and
dialysate entering at the top.
Q4: The semipermeable membrane in a dialyzer allows:
A. Only water molecules to pass through
,B. Small and middle molecular weight solutes and water to pass, while retaining blood cells and
large proteins [CORRECT]
C. All substances including blood cells to pass freely
D. Only electrolytes to pass, blocking all water movement
Correct Answer: B
Rationale: The best answer is that small and middle molecular weight solutes and water pass while
retaining blood cells and large proteins. The membrane pores are sized precisely—urea,
creatinine, potassium, and water move freely, but albumin, blood cells, and clotting factors stay in
the blood. In the clinic we monitor for membrane leaks because if large molecules start crossing,
that's a dialyzer breach.
Q5: A patient asks why their Kt/V was 1.1 last month and the doctor wants it above 1.2. What does
Kt/V measure?
A. The amount of fluid removed during dialysis
B. The adequacy of dialysis based on urea clearance normalized to body water volume
[CORRECT]
C. The blood flow rate through the access
D. The number of treatments per week
Correct Answer: B
Rationale: The best answer is that Kt/V measures dialysis adequacy based on urea clearance
normalized to body water volume. The K is dialyzer clearance, t is treatment time, and V is urea
distribution volume. Per DaVita policy and CMS guidelines, we target single-pool Kt/V ≥ 1.2 for
adequacy—below that means the patient isn't getting enough dialysis and may need longer
treatments or better access flow.
Q6: The Urea Reduction Ratio (URR) is calculated using:
A. Pre-BUN minus post-BUN divided by pre-BUN, multiplied by 100 [CORRECT]
, B. Post-BUN minus pre-BUN divided by post-BUN, multiplied by 100
C. Pre-BUN plus post-BUN divided by treatment time
D. Pre-BUN multiplied by post-BUN divided by body weight
Correct Answer: A
Rationale: The best answer is pre-BUN minus post-BUN divided by pre-BUN, multiplied by 100. This
gives the percentage reduction in blood urea nitrogen achieved during treatment. In the clinic we
aim for URR ≥ 65%—so if a patient's pre-BUN is 80 and post-BUN is 28, that's (80-28)/80 = 0.65 or
65%, right at target.
Q7: You're setting up a machine and the arterial pressure alarm triggers immediately upon starting
the blood pump at 200 mL/min. The reading shows -250 mmHg. What's your first action?
A. Increase the blood pump speed to overcome the negative pressure
B. Check for kinks in the arterial line, needle position, and access patency [CORRECT]
C. Ignore it and wait for the alarm to self-correct
D. Immediately clamp the venous line and stop the pump
Correct Answer: B
Rationale: The best answer is to check for kinks in the arterial line, needle position, and access
patency. High negative arterial pressure means the pump is having trouble pulling blood—usually
from a kinked line, needle against the vessel wall, or access flow problem. In the clinic we never just
crank up the speed; we troubleshoot the cause first because forcing it can damage the access or
cause hemolysis.
Q8: The venous pressure alarm sounds with a reading of +350 mmHg and rising. The patient has
no visible access problems. Most likely cause is:
A. The dialyzer is clotting or the venous line is kinked/obstructed [CORRECT]
B. The arterial needle is infiltrated
C. The conductivity is too low
