CCHT - Certified Clinical Hemodialysis Technician Patient Assessment and Monitoring 1 — Questions and Answers
Question 1: A patient arrives for hemodialysis and their pre-treatment weight is 4.2 kg above their established dry weight. What should the technician do FIRST?
- Begin treatment immediately at the maximum ultrafiltration rate
- Verify the weight on a calibrated scale and document the finding before notifying the nurse (Correct answer)
- Independently lower the patient's recorded dry weight in the system
- Shorten the treatment session to limit total fluid removal
Correct answer: Verify the weight on a calibrated scale and document the finding before notifying the nurse
Before acting on a significantly elevated fluid gain, the technician must confirm the measurement is accurate using a calibrated scale, then document and report it to the nurse so an appropriate ultrafiltration goal can be safely ordered.
Question 2: During hemodialysis, a patient suddenly becomes confused and short of breath, and the technician observes foam or bubbles in the venous blood line. Which complication should be suspected?
- Hypertensive urgency
- Hemolysis
- Air embolism (Correct answer)
- Hypoglycemia
Correct answer: Air embolism
Visible air or foam in the venous blood line combined with acute neurological changes and respiratory distress are classic signs of air embolism, a life-threatening emergency requiring immediate clamp of the venous line and positional management.
Question 3: Before cannulating a patient's arteriovenous fistula (AVF), which assessment finding confirms the access is patent and ready for use?
- Absence of bruit on auscultation and absence of thrill on palpation
- Presence of bruit on auscultation and thrill on palpation (Correct answer)
- A firm, non-compressible vessel wall with no pulsation
- Skin discoloration and warmth directly over the fistula site
Correct answer: Presence of bruit on auscultation and thrill on palpation
A functioning AVF produces turbulent blood flow that is felt as a thrill (vibration on palpation) and heard as a bruit (swooshing sound on auscultation). Absence of either finding suggests thrombosis or inadequate flow and must be reported before cannulation.
Question 4: Three hours into a hemodialysis session, a patient develops painful bilateral leg cramps. Their blood pressure has decreased from 138/82 mmHg at treatment start to 108/66 mmHg. What should the technician do first?
- Administer IV calcium gluconate per standing order
- Decrease the ultrafiltration rate and notify the nurse (Correct answer)
- Increase the blood flow rate to speed treatment completion
- Terminate the treatment and transfer the patient to the emergency department
Correct answer: Decrease the ultrafiltration rate and notify the nurse
Muscle cramps accompanied by a significant blood pressure drop indicate the ultrafiltration rate is exceeding the patient's plasma refill capacity. Reducing the UF rate is the immediate first response, followed by notifying the nurse, who may also order a saline bolus.
Question 5: Midway through a patient's dialysis session, the technician notes that the patient's temperature has risen from 36.7°C (98.1°F) at baseline to 38.1°C (100.6°F). What is the most appropriate next action?
- Continue treatment and recheck temperature in 30 minutes without intervention
- Increase the dialysate temperature to match the patient's current body temperature
- Notify the nurse immediately and assess the access site and catheter for signs of infection (Correct answer)
- Administer acetaminophen and document without escalating to nursing staff
Correct answer: Notify the nurse immediately and assess the access site and catheter for signs of infection
A rising fever during hemodialysis may indicate bacteremia, particularly from an infected access site or catheter. The technician must notify the nurse promptly so blood cultures can be obtained and the patient evaluated for systemic infection before continuing treatment.
Question 6: While preparing a patient with a tunneled hemodialysis catheter for treatment, the technician observes redness, swelling, and purulent drainage at the catheter exit site. Which additional finding is most critical to report to the nurse immediately?
- Catheter blood flow rate reading below 350 mL/min
- Patient's oral temperature of 38.4°C (101.2°F) (Correct answer)
- Patient reports not eating breakfast before the session
- The catheter dressing was last changed four days ago
Correct answer: Patient's oral temperature of 38.4°C (101.2°F)
Exit-site infection with a concurrent fever above 38°C strongly suggests the infection may have entered the bloodstream, causing bacteremia or sepsis. This combination requires urgent nursing and physician notification, possible blood cultures, and evaluation before treatment proceeds.
CCHT - Certified Clinical Hemodialysis Technician Patient Assessment and Monitoring 1
A patient arrives for hemodialysis and their pre-treatment weight is 4.2 kg above their established dry weight.
What should the technician do FIRST?