1
Certified Hemodialysis
Technician (CHT)
Examination
Comprehensive Practice
Examination – Version 2
(Advanced/Detailed) a
well detailed one 2025 /
2026 written and graded
A+ upgraded
, 2
EXAM OVERVIEW
Certification Body: Board of Nephrology Examiners Nursing and Technology (BONENT)
Exam Format: 150 multiple-choice questions
Time Limit: 3 hours (180 minutes)
Content Domains:
• Patient Care – 45%
• Infection Control – 18%
• Water Treatment – 15%
• Machine Technology – 12%
• Education and Professional Development – 10%
Target Audience: Experienced dialysis technicians, nephrology professionals, and candidates
preparing for BONENT CHT certification
Difficulty Level: Advanced / Complex (high-level conceptual, multi-step application, and
intricate scenario-based questions)
SECTION 1: PATIENT CARE (Questions 1–68)
Domain Weight: 45%
1. A 62-year-old patient with a history of diabetes and coronary artery disease presents for
hemodialysis. Pre-dialysis weight is 84.6 kg, target dry weight is 81.2 kg, and the prescribed
treatment time is 3.5 hours. The physician orders a maximum ultrafiltration rate of 10
mL/kg/hr. Based on this information, what is the maximum total fluid that can be safely
removed during this treatment, and what action should the technician take?
, 3
A) 3.4 L can be removed; proceed with the calculated ultrafiltration rate of 971 mL/hr
B) 2.96 L can be removed; the prescribed fluid removal of 3.4 L exceeds the safe limit and the
provider should be notified
C) 3.4 L can be removed; this is within the safe limit as the calculated UFR is 971 mL/hr
D) 2.84 L can be removed; adjust the treatment time to 4 hours to achieve the target
- detailed answer 100% correct :- B
Rationale: The patient's fluid gain is 84.6 kg − 81.2 kg = 3.4 kg (3.4 L). The maximum safe
ultrafiltration rate is 10 mL/kg/hr × 84.6 kg = 846 mL/hr. Over 3.5 hours, the maximum safe fluid
removal is 846 mL/hr × 3.5 hr = 2,961 mL (2.96 L). The prescribed removal of 3.4 L would require
a UFR of 971 mL/hr, which exceeds the safe limit. The technician should notify the provider to
adjust the prescription. Option A uses incorrect calculations. Option C incorrectly states the UFR
is within limits. Option D suggests an alternative but the correct action is to notify the provider.
2. A patient undergoing hemodialysis develops severe muscle cramps during the third hour of
a 4-hour treatment. The patient's pre-dialysis weight was 72.5 kg, target dry weight is 70.0 kg,
and the ultrafiltration rate has been set at 900 mL/hr. The technician observes that the
patient has consumed 500 mL of water during the treatment. Which of the following factors is
the MOST significant contributor to the patient's cramping?
A) The patient's fluid intake during treatment
B) The ultrafiltration rate of 900 mL/hr
C) The total fluid removal of 3.6 L
D) Electrolyte imbalance from the dialysate composition
- detailed answer 100% correct :- C
Rationale: Muscle cramps during hemodialysis are most commonly caused by aggressive fluid
removal leading to hypovolemia and reduced muscle perfusion. The total fluid removal of 3.6 L
(900 mL/hr × 4 hr) exceeds the patient's fluid gain of 2.5 L (72.5 kg − 70.0 kg), meaning the
patient is being pulled below dry weight. Option A (fluid intake) would partially offset this but is
not the primary cause. Option B (UFR of 900 mL/hr) is a contributing factor but the total volume
removed (which exceeds the gain) is more significant. Option D may contribute but is less
commonly the primary cause.
3. A technician is performing a pre-dialysis assessment on a patient with an AV fistula. The
technician notes that the fistula has a palpable thrill that is weaker than the previous
, 4
treatment, and the bruit is now high-pitched and continuous rather than the usual low-
pitched intermittent sound. The patient reports no pain or redness at the site. What is the
MOST appropriate interpretation and action?
A) This is a normal variation; document and proceed with treatment
B) These findings suggest stenosis; notify the nurse and do not cannulate
C) These findings suggest infection; notify the nurse immediately
D) These findings suggest thrombosis; the access should not be used
- detailed answer 100% correct :- B
Rationale: A weaker thrill with a high-pitched, continuous bruit indicates stenosis—narrowing
of the vessel causing turbulent flow. This is a significant finding that requires evaluation before
cannulation, as stenosis can lead to thrombosis and access failure if not addressed. Option A is
incorrect—this is not a normal variation. Option C is incorrect—there are no signs of infection
(no pain, redness, or warmth). Option D is incorrect—thrombosis would present with absence
of thrill and bruit.
4. A patient with a central venous catheter (CVC) presents for hemodialysis. The technician
notes that the catheter exit site is clean and dry, but the patient reports intermittent chills
and a temperature of 38.1°C (100.6°F) since the last treatment. Blood cultures drawn at the
previous treatment are pending. What is the MOST appropriate action?
A) Proceed with treatment using the CVC
B) Notify the nurse and do NOT use the catheter until blood culture results are available
C) Use the CVC but administer prophylactic antibiotics
D) Use a different CVC lumen for treatment
- detailed answer 100% correct :- B
Rationale: The patient has fever and chills, which are concerning for catheter-related
bloodstream infection (CRBSI). The catheter should not be used until infection is ruled out, as
using an infected catheter can cause bacteremia and sepsis. Option A is unsafe. Option C
requires a provider order and does not address the source of infection. Option D is not
appropriate—using a different lumen does not eliminate the infection risk.
5. A hemodialysis patient's pre-dialysis laboratory results show a serum potassium of 6.2
mEq/L, phosphorus of 7.8 mg/dL, calcium of 8.1 mg/dL, and albumin of 3.2 g/dL. The
Certified Hemodialysis
Technician (CHT)
Examination
Comprehensive Practice
Examination – Version 2
(Advanced/Detailed) a
well detailed one 2025 /
2026 written and graded
A+ upgraded
, 2
EXAM OVERVIEW
Certification Body: Board of Nephrology Examiners Nursing and Technology (BONENT)
Exam Format: 150 multiple-choice questions
Time Limit: 3 hours (180 minutes)
Content Domains:
• Patient Care – 45%
• Infection Control – 18%
• Water Treatment – 15%
• Machine Technology – 12%
• Education and Professional Development – 10%
Target Audience: Experienced dialysis technicians, nephrology professionals, and candidates
preparing for BONENT CHT certification
Difficulty Level: Advanced / Complex (high-level conceptual, multi-step application, and
intricate scenario-based questions)
SECTION 1: PATIENT CARE (Questions 1–68)
Domain Weight: 45%
1. A 62-year-old patient with a history of diabetes and coronary artery disease presents for
hemodialysis. Pre-dialysis weight is 84.6 kg, target dry weight is 81.2 kg, and the prescribed
treatment time is 3.5 hours. The physician orders a maximum ultrafiltration rate of 10
mL/kg/hr. Based on this information, what is the maximum total fluid that can be safely
removed during this treatment, and what action should the technician take?
, 3
A) 3.4 L can be removed; proceed with the calculated ultrafiltration rate of 971 mL/hr
B) 2.96 L can be removed; the prescribed fluid removal of 3.4 L exceeds the safe limit and the
provider should be notified
C) 3.4 L can be removed; this is within the safe limit as the calculated UFR is 971 mL/hr
D) 2.84 L can be removed; adjust the treatment time to 4 hours to achieve the target
- detailed answer 100% correct :- B
Rationale: The patient's fluid gain is 84.6 kg − 81.2 kg = 3.4 kg (3.4 L). The maximum safe
ultrafiltration rate is 10 mL/kg/hr × 84.6 kg = 846 mL/hr. Over 3.5 hours, the maximum safe fluid
removal is 846 mL/hr × 3.5 hr = 2,961 mL (2.96 L). The prescribed removal of 3.4 L would require
a UFR of 971 mL/hr, which exceeds the safe limit. The technician should notify the provider to
adjust the prescription. Option A uses incorrect calculations. Option C incorrectly states the UFR
is within limits. Option D suggests an alternative but the correct action is to notify the provider.
2. A patient undergoing hemodialysis develops severe muscle cramps during the third hour of
a 4-hour treatment. The patient's pre-dialysis weight was 72.5 kg, target dry weight is 70.0 kg,
and the ultrafiltration rate has been set at 900 mL/hr. The technician observes that the
patient has consumed 500 mL of water during the treatment. Which of the following factors is
the MOST significant contributor to the patient's cramping?
A) The patient's fluid intake during treatment
B) The ultrafiltration rate of 900 mL/hr
C) The total fluid removal of 3.6 L
D) Electrolyte imbalance from the dialysate composition
- detailed answer 100% correct :- C
Rationale: Muscle cramps during hemodialysis are most commonly caused by aggressive fluid
removal leading to hypovolemia and reduced muscle perfusion. The total fluid removal of 3.6 L
(900 mL/hr × 4 hr) exceeds the patient's fluid gain of 2.5 L (72.5 kg − 70.0 kg), meaning the
patient is being pulled below dry weight. Option A (fluid intake) would partially offset this but is
not the primary cause. Option B (UFR of 900 mL/hr) is a contributing factor but the total volume
removed (which exceeds the gain) is more significant. Option D may contribute but is less
commonly the primary cause.
3. A technician is performing a pre-dialysis assessment on a patient with an AV fistula. The
technician notes that the fistula has a palpable thrill that is weaker than the previous
, 4
treatment, and the bruit is now high-pitched and continuous rather than the usual low-
pitched intermittent sound. The patient reports no pain or redness at the site. What is the
MOST appropriate interpretation and action?
A) This is a normal variation; document and proceed with treatment
B) These findings suggest stenosis; notify the nurse and do not cannulate
C) These findings suggest infection; notify the nurse immediately
D) These findings suggest thrombosis; the access should not be used
- detailed answer 100% correct :- B
Rationale: A weaker thrill with a high-pitched, continuous bruit indicates stenosis—narrowing
of the vessel causing turbulent flow. This is a significant finding that requires evaluation before
cannulation, as stenosis can lead to thrombosis and access failure if not addressed. Option A is
incorrect—this is not a normal variation. Option C is incorrect—there are no signs of infection
(no pain, redness, or warmth). Option D is incorrect—thrombosis would present with absence
of thrill and bruit.
4. A patient with a central venous catheter (CVC) presents for hemodialysis. The technician
notes that the catheter exit site is clean and dry, but the patient reports intermittent chills
and a temperature of 38.1°C (100.6°F) since the last treatment. Blood cultures drawn at the
previous treatment are pending. What is the MOST appropriate action?
A) Proceed with treatment using the CVC
B) Notify the nurse and do NOT use the catheter until blood culture results are available
C) Use the CVC but administer prophylactic antibiotics
D) Use a different CVC lumen for treatment
- detailed answer 100% correct :- B
Rationale: The patient has fever and chills, which are concerning for catheter-related
bloodstream infection (CRBSI). The catheter should not be used until infection is ruled out, as
using an infected catheter can cause bacteremia and sepsis. Option A is unsafe. Option C
requires a provider order and does not address the source of infection. Option D is not
appropriate—using a different lumen does not eliminate the infection risk.
5. A hemodialysis patient's pre-dialysis laboratory results show a serum potassium of 6.2
mEq/L, phosphorus of 7.8 mg/dL, calcium of 8.1 mg/dL, and albumin of 3.2 g/dL. The
