Certified Clinical Hemodialysis
Technician - Advanced
Final Test Review
(Questions & Solutions)
2025
1
, I. Clinical Knowledge (12 Questions)
1. A 58-year-old patient with end-stage renal disease begins his first
hemodialysis session. Forty-five minutes in, he reports a pounding
headache and nausea. His pre-dialysis BUN was 100 mg/dL, and
circuit sampling shows a post-filter BUN of 15 mg/dL. Which change
in future prescriptions best reduces the risk of dialysis disequilibrium
syndrome?
A. Increase blood flow rate to speed clearance
B. Use a smaller surface-area dialyzer and slower blood flow
C. Administer mannitol at the end of each session
D. Switch to acetate-based dialysate
ANS: B
Rationale: Slower blood flow and a smaller dialyzer surface reduce
rapid solute removal, preventing sharp osmotic gradients in the brain.
2. During a mid-treatment hypotensive episode (BP drop from 150/85
to 90/50 mmHg despite target ultrafiltration), which adjustment is
most effective?
A. Administer 10 mL/kg hypertonic saline
B. Increase dialysate sodium concentration
C. Raise dialysate temperature by 1 °C
D. Switch to a high-flux dialyzer
ANS: B
Rationale: Higher dialysate sodium elevates plasma osmolality,
drawing fluid into vessels and improving BP without excess volume
removal.
3. A patient’s blood pressure rises from 140/80 to 170/95 mmHg
during dialysis. Which factor most likely causes intradialytic
hypertension?
2
, A. Excessive ultrafiltration rate
B. High dialysate calcium concentration
C. Inadequate reduction of dialysate sodium
D. Excess bicarbonate in dialysate
ANS: C
Rationale: A dialysate-to-plasma sodium gradient that’s too high can
lead to sodium loading and extracellular volume expansion, raising
BP.
4. Mid-dialysis, a patient complains of severe calf cramps. Vital signs
stable, ultrafiltration unchanged. What dialysate change best
alleviates cramps?
A. Reduce dialysate potassium
B. Lower dialysate temperature
C. Increase dialysate calcium concentration
D. Switch buffer to acetate
ANS: C
Rationale: Increasing dialysate calcium stabilizes neuromuscular
excitability, relieving cramps without altering hemodynamics.
5. A patient with predialysis potassium of 6.2 mEq/L uses 2.0 mEq/L
dialysate but remains hyperkalemic post-treatment. What
prescription change optimizes potassium removal?
A. Decrease blood flow rate
B. Raise dialysate potassium to 3.0 mEq/L
C. Lower dialysate bicarbonate
D. Reduce dialysate potassium to 1.0 mEq/L
ANS: D
Rationale: Lowering dialysate potassium increases the gradient for
potassium diffusion out of blood, enhancing removal.
6. A tunneled catheter patient is at high risk for bloodstream
3
Technician - Advanced
Final Test Review
(Questions & Solutions)
2025
1
, I. Clinical Knowledge (12 Questions)
1. A 58-year-old patient with end-stage renal disease begins his first
hemodialysis session. Forty-five minutes in, he reports a pounding
headache and nausea. His pre-dialysis BUN was 100 mg/dL, and
circuit sampling shows a post-filter BUN of 15 mg/dL. Which change
in future prescriptions best reduces the risk of dialysis disequilibrium
syndrome?
A. Increase blood flow rate to speed clearance
B. Use a smaller surface-area dialyzer and slower blood flow
C. Administer mannitol at the end of each session
D. Switch to acetate-based dialysate
ANS: B
Rationale: Slower blood flow and a smaller dialyzer surface reduce
rapid solute removal, preventing sharp osmotic gradients in the brain.
2. During a mid-treatment hypotensive episode (BP drop from 150/85
to 90/50 mmHg despite target ultrafiltration), which adjustment is
most effective?
A. Administer 10 mL/kg hypertonic saline
B. Increase dialysate sodium concentration
C. Raise dialysate temperature by 1 °C
D. Switch to a high-flux dialyzer
ANS: B
Rationale: Higher dialysate sodium elevates plasma osmolality,
drawing fluid into vessels and improving BP without excess volume
removal.
3. A patient’s blood pressure rises from 140/80 to 170/95 mmHg
during dialysis. Which factor most likely causes intradialytic
hypertension?
2
, A. Excessive ultrafiltration rate
B. High dialysate calcium concentration
C. Inadequate reduction of dialysate sodium
D. Excess bicarbonate in dialysate
ANS: C
Rationale: A dialysate-to-plasma sodium gradient that’s too high can
lead to sodium loading and extracellular volume expansion, raising
BP.
4. Mid-dialysis, a patient complains of severe calf cramps. Vital signs
stable, ultrafiltration unchanged. What dialysate change best
alleviates cramps?
A. Reduce dialysate potassium
B. Lower dialysate temperature
C. Increase dialysate calcium concentration
D. Switch buffer to acetate
ANS: C
Rationale: Increasing dialysate calcium stabilizes neuromuscular
excitability, relieving cramps without altering hemodynamics.
5. A patient with predialysis potassium of 6.2 mEq/L uses 2.0 mEq/L
dialysate but remains hyperkalemic post-treatment. What
prescription change optimizes potassium removal?
A. Decrease blood flow rate
B. Raise dialysate potassium to 3.0 mEq/L
C. Lower dialysate bicarbonate
D. Reduce dialysate potassium to 1.0 mEq/L
ANS: D
Rationale: Lowering dialysate potassium increases the gradient for
potassium diffusion out of blood, enhancing removal.
6. A tunneled catheter patient is at high risk for bloodstream
3
