CHT Certified Hemodialysis Technician 4 — Questions and Answers
Question 1: Which parameter is measured by the ionic dialysance monitor on modern dialysis machines as a real-time surrogate for urea clearance?
- Blood flow rate
- Dialysate conductivity changes (Correct answer)
- Transmembrane pressure
- Dialyzer fiber bundle volume
Correct answer: Dialysate conductivity changes
Ionic dialysance monitors measure changes in dialysate conductivity to estimate small-solute clearance as a real-time surrogate for urea Kt/V.
Question 2: A patient's pre-dialysis blood pressure is 200/110 mmHg. After initiating treatment and removing 1 L of fluid, BP falls to 80/50 mmHg. The technician should first:
- Stop ultrafiltration and administer a 200–300 mL normal saline bolus (Correct answer)
- Increase the ultrafiltration rate to remove fluid faster
- Immediately terminate treatment and return all blood
- Administer oral antihypertensive medication
Correct answer: Stop ultrafiltration and administer a 200–300 mL normal saline bolus
Intradialytic hypotension is managed first by stopping UF and administering a saline challenge to restore circulating volume.
Question 3: In dialyzer reprocessing with peracetic acid, the minimum residual volume that must be rinsed out before patient use is determined by:
- Dialyzer fiber count
- The manufacturer's priming volume (Correct answer)
- Required cell volume ratio retention
- Membrane surface area
Correct answer: The manufacturer's priming volume
The dialyzer must be rinsed thoroughly based on priming volume to dilute reprocessing chemicals below safe exposure limits before patient reuse.
Question 4: Hemolysis during dialysis can be identified by which characteristic change in the venous blood line?
- Dark, burgundy-colored blood
- Bright pink or cherry-red discoloration of blood (Correct answer)
- Formation of white fibrin strands
- Visible air bubbles in the blood
Correct answer: Bright pink or cherry-red discoloration of blood
Hemolysis causes red blood cells to rupture, releasing hemoglobin and turning the blood bright pink or cherry-red (port wine color).
Question 5: Which of the following dialysis access types typically provides the highest blood flow rates and lowest infection risk?
- Tunneled cuffed catheter
- Temporary non-tunneled catheter
- Synthetic AV graft
- Native AV fistula (Correct answer)
Correct answer: Native AV fistula
A native AV fistula provides the highest flow rates, best long-term patency, and lowest infection rates of all dialysis access types.
Question 6: The standard dialysate temperature for hemodialysis is set at approximately:
- 35.0°C
- 37.0°C (Correct answer)
- 38.5°C
- 40.0°C
Correct answer: 37.0°C
Standard dialysate temperature is set at 37.0°C to match body temperature, preventing heat loss or gain that could cause discomfort or cardiovascular stress.
Question 7: A patient on dialysis reports muscle cramps in both legs during the last hour of treatment. The MOST likely contributing factor is:
- Hypercalcemia from dialysate calcium
- Rapid or excessive fluid removal causing hypovolemia (Correct answer)
- Hyperkalemia from inadequate dialysis
- High dialysate sodium concentration
Correct answer: Rapid or excessive fluid removal causing hypovolemia
Intradialytic muscle cramps are most commonly caused by rapid or aggressive ultrafiltration leading to volume depletion and reduced muscle perfusion.
CHT Certified Hemodialysis Technician 4
Which parameter is measured by the ionic dialysance monitor on modern dialysis machines as a real-time surrogate for urea clearance?