CHT Certified Hemodialysis Technician 2 — Questions and Answers
Question 1: Which water treatment component is primarily responsible for removing chloramines from municipal water supplies before dialysis?
- Reverse osmosis membrane
- Activated carbon tanks (Correct answer)
- Softener resin beds
- Deionization columns
Correct answer: Activated carbon tanks
Activated carbon tanks adsorb chloramines, which are not removed by softeners or reverse osmosis and can cause hemolytic anemia if present in dialysate.
Question 2: A patient on hemodialysis develops sudden rigors, fever of 103°F, and hypotension 30 minutes into treatment. The most likely cause is:
- Air embolism
- Dialyzer reaction Type A
- Pyrogenic reaction from endotoxin contamination (Correct answer)
- Hypovolemia from ultrafiltration
Correct answer: Pyrogenic reaction from endotoxin contamination
Pyrogenic reactions present with fever and rigors and are caused by endotoxin fragments entering the blood from contaminated dialysate.
Question 3: The primary purpose of the bicarbonate concentrate in dialysate preparation is to:
- Replace sodium lost during dialysis
- Correct metabolic acidosis in the patient (Correct answer)
- Prevent bacterial growth in the system
- Maintain dialyzer membrane integrity
Correct answer: Correct metabolic acidosis in the patient
Bicarbonate in dialysate diffuses into the patient's blood to buffer the metabolic acidosis that accumulates in renal failure.
Question 4: When priming a dialyzer with saline, the correct direction of flow through the blood compartment is:
- Arterial port to venous port (bottom to top) (Correct answer)
- Venous port to arterial port (top to bottom)
- Either direction is acceptable
- Simultaneous flushing from both ports
Correct answer: Arterial port to venous port (bottom to top)
Priming flows from the arterial (inlet) port upward to the venous (outlet) port to expel air from the blood compartment in the direction blood will travel.
Question 5: The Kt/V target recommended by KDOQI guidelines for thrice-weekly hemodialysis patients is a minimum of:
- 0.8
- 1.2 (Correct answer)
- 1.4
- 1.8
Correct answer: 1.2
KDOQI guidelines recommend a minimum single-pool Kt/V of 1.2 per treatment for patients on thrice-weekly hemodialysis schedules.
Question 6: A patient's AV fistula has a palpable thrill that has become very soft with a high-pitched bruit. This change most likely indicates:
- Successful maturation of the fistula
- Venous stenosis causing increased resistance (Correct answer)
- Arterial steal syndrome
- Normal variation between treatments
Correct answer: Venous stenosis causing increased resistance
A high-pitched bruit and diminished thrill indicate turbulent, high-velocity flow through a narrowed segment, suggesting venous stenosis.
Question 7: Which electrolyte abnormality is most immediately life-threatening in the dialysis patient with missed treatments?
- Hyperphosphatemia
- Hyperkalemia (Correct answer)
- Hypermagnesemia
- Hypernatremia
Correct answer: Hyperkalemia
Hyperkalemia causes fatal cardiac arrhythmias and is the most immediately dangerous electrolyte abnormality in patients who miss dialysis treatments.
CHT Certified Hemodialysis Technician 2
Which water treatment component is primarily responsible for removing chloramines from municipal water supplies before dialysis?