CCHT Patient Assessment and Monitoring 2

Question 1

At the beginning of a hemodialysis treatment, which of the following assessments should the technician perform before initiating treatment?

Accepted Answer

Obtain vital signs, pre-dialysis weight, assess vascular access, and review the treatment prescription

Answer

A comprehensive pre-treatment assessment includes vital signs (BP, HR, temperature, respirations), pre-treatment weight (to calculate ultrafiltration volume), vascular access assessment (bruit/thrill, appearance), and review of the treatment prescription to ensure all parameters are correct for that session.

Question 2

A patient's blood pressure drops from 148/88 mmHg at treatment start to 82/50 mmHg at 90 minutes into dialysis. Which parameter should the technician check first?

Accepted Answer

The ultrafiltration rate and total volume removed so far

Answer

A sudden significant drop in blood pressure during dialysis is most commonly caused by aggressive ultrafiltration (removing fluid faster than the vascular refilling rate). The technician should immediately check the ultrafiltration rate and the volume already removed to determine if over-ultrafiltration is the cause.

Question 3

During hemodialysis, a patient complains of severe headache and nausea 2 hours into treatment. Their blood pressure is 185/110 mmHg. What complication should the technician suspect?

Accepted Answer

Dialysis disequilibrium syndrome or hypertensive emergency

Answer

Severe headache and nausea with hypertension during dialysis suggests either dialysis disequilibrium syndrome (from rapid urea and osmolality shifts causing cerebral edema) or a hypertensive emergency. Both require immediate nursing and physician evaluation.

Question 4

During a routine hemodialysis treatment, the venous pressure alarm sounds repeatedly and the reading shows persistently elevated pressure. What is the most likely cause?

Accepted Answer

A clot or kink in the venous blood return line or access

Answer

Persistently elevated venous pressure indicates increased resistance in the blood return path from the dialyzer to the patient. The most common causes are a kink in the venous line, clotting in the venous line or venous needle, or outflow resistance at the vascular access (stenosis, needle malposition).

Question 5

What does a decrease in the bruit (audible sound) of an arteriovenous fistula suggest?

Accepted Answer

Possible stenosis or early thrombosis of the fistula

Answer

A decrease or change in the bruit of an AV fistula—particularly a change from a soft, continuous, low-pitched bruit to a high-pitched, discontinuous, or absent sound—indicates reduced blood flow, which may be due to stenosis or early thrombosis. This is a critical finding that must be reported immediately.

CCHT - Certified Clinical Hemodialysis Technician Practice Test

CCHT - Certified Clinical Hemodialysis Technician Practice Test

CCHT Patient Assessment and Monitoring 2