At 0530 the only RN scheduled for an in-center morning shift calls out sick. An LPN and two certified technicians are on site, and the first patients are arriving. What should the charge LPN do FIRST?

Hold treatment starts until an RN is physically present in the facility

Start stable patients and have an RN available by phone for questions

Start treatments and have the medical director co-sign the flow sheets

Start only patients with fistulas, since catheter care requires an RN

Six weeks after creation of a brachiobasilic AV fistula, a patient reports that the fingers on the access hand become cold, pale, and painful during treatment. The radial pulse is weak. What does the nurse suspect?

Arterial steal syndrome reducing perfusion to the hand

Venous hypertension from a central vein stenosis

Infiltration of the venous needle into surrounding tissue

Early thrombosis of the fistula outflow vein

A nurse is initiating treatment through a tunneled central venous catheter filled with a heparin lock. Which action requires correction?

Flushing the lock solution into the patient before aspirating it

Scrubbing the hub with antiseptic after removing the cap

Aspirating slightly more than the labeled fill volume

Having both the nurse and the patient wear masks during catheter access

While a patient's internal jugular catheter is being disconnected, one limb is left open and unclamped as the patient sits up. The patient suddenly coughs, becomes short of breath, and reports chest pain. What should the nurse do FIRST?

Clamp the catheter, turn the patient onto the left side head-down, give oxygen

Sit the patient fully upright and give oxygen by nasal cannula at 2 L/min

Flush the open lumen with saline to clear any entrained air from the line

Turn the patient onto the right side with the head of the bed raised

A patient started maintenance hemodialysis three years ago and is only now being registered on the deceased donor kidney waitlist. How will the patient's waiting time generally be calculated?

From the date maintenance dialysis began

From the date of waitlist registration

From the date of the first transplant center visit

From the date the evaluation was completed

A patient has repeatedly disrupted treatments by verbally abusing staff, but has made no physical threats. The facility is considering involuntary discharge. What do the CMS Conditions for Coverage require before discharge?

Document resolution efforts, give 30 days' notice, and notify the Network

Discharge the patient that day and let the family find another unit

Move the patient to the last shift without telling the care team

Have the patient sign a behavior contract and refuse treatment if it is broken

During pre-treatment assessment of a patient's AV fistula, the nurse notes an enlarged aneurysmal segment with thin, shiny skin and a small scab that bleeds slightly when touched. What is the MOST appropriate action?

Avoid cannulating the area and arrange urgent surgical evaluation

Cannulate directly through the scab to avoid a new puncture

Apply a pressure dressing and cannulate the segment as usual

Cannulate the aneurysm only with the arterial needle

When initiating through a tunneled catheter, the nurse cannot aspirate the lock solution from the arterial lumen, though the venous lumen aspirates easily. What should the nurse do FIRST?

Reposition the patient and reattempt gentle aspiration

Flush the arterial lumen forcefully with a 10 mL syringe

Instill a thrombolytic into the lumen without delay

Reverse the lines and start at the prescribed flow

At the end of treatment, the dialyzer and venous chamber are visibly clotted and venous pressure is rising. What should the nurse do regarding rinseback?

Do not return the blood; discard the circuit and document

Rinse back at a high blood flow to push clots through

Rinse back slowly with extra saline to dissolve the clots

Give a heparin bolus into the circuit, then rinse back fully

A transplant candidate's calculated panel-reactive antibody (cPRA) is reported as 98%. Which statement BEST explains this result?

The patient has HLA antibodies incompatible with about 98% of donors

The patient matches about 98% of HLA antigens with the average donor

The patient has a 98% chance of a negative crossmatch with any donor

The patient's blood type is compatible with about 98% of donors

Certified Hemodialysis Nurse (CHN) Exam

Free Certified Hemodialysis Nurse Practice Questions

10 sample questions for the Certified Hemodialysis Nurse (CHN) Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Supervision/Management, Dialysis and Related Issues, Professional Development, Environmental Control.

Question 1 · Supervision/Management
At 0530 the only RN scheduled for an in-center morning shift calls out sick. An LPN and two certified technicians are on site, and the first patients are arriving. What should the charge LPN do FIRST?
- A.Start stable patients and have an RN available by phone for questions
- B.Start treatments and have the medical director co-sign the flow sheets
- C.Start only patients with fistulas, since catheter care requires an RN
- D.Hold treatment starts until an RN is physically present in the facility
Show answer and explanation
Answer: D. Hold treatment starts until an RN is physically present in the facility
The CMS Conditions for Coverage require a registered nurse to be present in the facility whenever in-center patients are being dialyzed, so treatments cannot begin until RN coverage arrives. Telephone RN availability or physician co-signature does not satisfy the on-site requirement, and limiting starts to fistula patients still leaves patients dialyzing without an RN present.
Question 2 · Dialysis and Related Issues
Six weeks after creation of a brachiobasilic AV fistula, a patient reports that the fingers on the access hand become cold, pale, and painful during treatment. The radial pulse is weak. What does the nurse suspect?
- A.Arterial steal syndrome reducing perfusion to the hand
- B.Venous hypertension from a central vein stenosis
- C.Infiltration of the venous needle into surrounding tissue
- D.Early thrombosis of the fistula outflow vein
Show answer and explanation
Answer: A. Arterial steal syndrome reducing perfusion to the hand
Steal syndrome occurs when the access diverts arterial flow away from the distal hand, causing coolness, pallor, pain that worsens during dialysis, and a diminished pulse; it needs prompt reporting because severe cases cause tissue loss. Venous hypertension causes swelling and a warm, edematous limb, and thrombosis causes loss of thrill and bruit rather than distal ischemia.
Question 3 · Dialysis and Related Issues
A nurse is initiating treatment through a tunneled central venous catheter filled with a heparin lock. Which action requires correction?
- A.Scrubbing the hub with antiseptic after removing the cap
- B.Flushing the lock solution into the patient before aspirating it
- C.Aspirating slightly more than the labeled fill volume
- D.Having both the nurse and the patient wear masks during catheter access
Show answer and explanation
Answer: B. Flushing the lock solution into the patient before aspirating it
The lock solution must be aspirated and discarded before the catheter is flushed; pushing a concentrated heparin lock into the patient can cause systemic anticoagulation and bleeding. Scrubbing the hub after cap removal, aspirating a little more than the fill volume, and masking during catheter access are all recommended practices.
Question 4 · Dialysis and Related Issues
While a patient's internal jugular catheter is being disconnected, one limb is left open and unclamped as the patient sits up. The patient suddenly coughs, becomes short of breath, and reports chest pain. What should the nurse do FIRST?
- A.Clamp the catheter, turn the patient onto the left side head-down, give oxygen
- B.Sit the patient fully upright and give oxygen by nasal cannula at 2 L/min
- C.Flush the open lumen with saline to clear any entrained air from the line
- D.Turn the patient onto the right side with the head of the bed raised
Show answer and explanation
Answer: A. Clamp the catheter, turn the patient onto the left side head-down, give oxygen
An open central catheter limb can draw in air, and sudden dyspnea, cough, and chest pain suggest air embolism; the nurse stops further air entry by clamping, positions the patient on the left side in Trendelenburg to trap air in the right heart, and gives 100% oxygen. Sitting upright lets air travel toward the brain, and flushing the lumen pushes more air into the circulation.
Question 5 · Dialysis and Related Issues
A patient started maintenance hemodialysis three years ago and is only now being registered on the deceased donor kidney waitlist. How will the patient's waiting time generally be calculated?
- A.From the date maintenance dialysis began
- B.From the date of waitlist registration
- C.From the date of the first transplant center visit
- D.From the date the evaluation was completed
Show answer and explanation
Answer: A. From the date maintenance dialysis began
Under current national allocation policy, waiting time for adults is credited from the start of maintenance dialysis or from registration with a GFR of 20 mL/min or less, whichever is earlier, so this patient receives credit for the three years on dialysis. Counting only from registration, evaluation, or the first visit would penalize patients referred late, which the policy was changed to prevent.
Question 6 · Supervision/Management
A patient has repeatedly disrupted treatments by verbally abusing staff, but has made no physical threats. The facility is considering involuntary discharge. What do the CMS Conditions for Coverage require before discharge?
- A.Discharge the patient that day and let the family find another unit
- B.Move the patient to the last shift without telling the care team
- C.Document resolution efforts, give 30 days' notice, and notify the Network
- D.Have the patient sign a behavior contract and refuse treatment if it is broken
Show answer and explanation
Answer: C. Document resolution efforts, give 30 days' notice, and notify the Network
Before an involuntary discharge for disruptive behavior, the facility must reassess the patient, document ongoing problems and its efforts to resolve them, obtain the medical director's and attending physician's involvement, give 30 days' written notice, and notify the ESRD Network and State survey agency; immediate discharge is reserved for a severe, immediate threat to health and safety. Same-day discharge, unilateral schedule changes, and refusing care under a contract skip these protections.
Question 7 · Dialysis and Related Issues
During pre-treatment assessment of a patient's AV fistula, the nurse notes an enlarged aneurysmal segment with thin, shiny skin and a small scab that bleeds slightly when touched. What is the MOST appropriate action?
- A.Cannulate directly through the scab to avoid a new puncture
- B.Avoid cannulating the area and arrange urgent surgical evaluation
- C.Apply a pressure dressing and cannulate the segment as usual
- D.Cannulate the aneurysm only with the arterial needle
Show answer and explanation
Answer: B. Avoid cannulating the area and arrange urgent surgical evaluation
Thin, shiny skin, ulceration, or spontaneous bleeding over an aneurysm are warning signs of impending rupture, which can cause life-threatening hemorrhage; the area must not be cannulated and needs urgent surgical evaluation. Cannulating through the scab or through the aneurysm with any needle increases rupture risk.
Question 8 · Dialysis and Related Issues
When initiating through a tunneled catheter, the nurse cannot aspirate the lock solution from the arterial lumen, though the venous lumen aspirates easily. What should the nurse do FIRST?
- A.Flush the arterial lumen forcefully with a 10 mL syringe
- B.Instill a thrombolytic into the lumen without delay
- C.Reposition the patient and reattempt gentle aspiration
- D.Reverse the lines and start at the prescribed flow
Show answer and explanation
Answer: C. Reposition the patient and reattempt gentle aspiration
Positional problems are common, so the first step is to reposition the patient (or have them cough or change arm position) and try gentle aspiration again. Forceful flushing would push the heparin lock and any clot into the patient, a thrombolytic requires an order and comes after simple measures fail, and starting without removing the lock gives the patient the lock solution.
Question 9 · Dialysis and Related Issues
At the end of treatment, the dialyzer and venous chamber are visibly clotted and venous pressure is rising. What should the nurse do regarding rinseback?
- A.Do not return the blood; discard the circuit and document
- B.Rinse back at a high blood flow to push clots through
- C.Rinse back slowly with extra saline to dissolve the clots
- D.Give a heparin bolus into the circuit, then rinse back fully
Show answer and explanation
Answer: A. Do not return the blood; discard the circuit and document
Returning blood from a clotted circuit risks sending clots into the patient, so the blood is not returned, the circuit is discarded, and the estimated blood loss and cause are documented. Saline does not dissolve clots, high flow pushes clots toward the patient, and a heparin bolus will not dissolve clots that have already formed.
Question 10 · Dialysis and Related Issues
A transplant candidate's calculated panel-reactive antibody (cPRA) is reported as 98%. Which statement BEST explains this result?
- A.The patient matches about 98% of HLA antigens with the average donor
- B.The patient has HLA antibodies incompatible with about 98% of donors
- C.The patient has a 98% chance of a negative crossmatch with any donor
- D.The patient's blood type is compatible with about 98% of donors
Show answer and explanation
Answer: B. The patient has HLA antibodies incompatible with about 98% of donors
cPRA estimates the percentage of deceased donors to whom the candidate has unacceptable HLA antibodies, so a 98% cPRA means the patient is highly sensitized and will be incompatible with most donors; such candidates receive allocation priority. It does not describe HLA match, likelihood of a negative crossmatch, or ABO compatibility.

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