Certified Hemodialysis Bio-Medical Technician Practice Test

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Exam Code: CHBT
Exam Name: CHBT (Certified Hemodialysis Bio-Medical Technician)
Number of Questions: 150 multiple-choice questions.
Duration: 3 hours (180 minutes).
Passing Score: Determined by BONENT (typically a scaled score).
Exam Delivery: Computer-based testing at approved testing centers.
Certification Body: Board of Nephrology Examiners Nursing and Technology (BONENT)
Certification: CHBT (Certified Hemodialysis Bio-Medical Technician)

DOMAIN I: MEDICAL MACHINE MAINTENANCE (24%)
- Basic hydraulic and electronic circuitry
- Purpose and operation of dialysis-related medical equipment
- Purpose and use of test equipment and maintenance
- Maintenance for medical equipment (e.g.- water treatment equipment- dialysis equipment- testing equipment- and mechanical/electrical systems)
- Maintenance of machines to complete all scheduled treatments

DOMAIN II: QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT (QAPI) (7%)
- QAPI principles related to biomed responsibilities
- Alerts and recalls- or risk management investigations related to medical equipment

DOMAIN III: WATER TREATMENT SYSTEM MANAGEMENT (30%)
- Procedures for the processing of water samples
- AAMI analysis water samples
- Regulatory requirements for water quality
- Clinical manifestations for out-of-range test results
- Cultures and endotoxins for water treatment system
- Water system cleaning and disinfection requirements
- Theory and test methods of water treatment component operation
- Valve tags- component labels- directional tape- system schematic- valve legend
- State regulatory requirements for alternate water treatment plan and update as needed
- Requirement for secure water room

DOMAIN IV: CONCENTRATE SYSTEMS MANAGEMENT (11%)
- Bicarb and acid
- Principles for testing of specific gravity- conductivity- or pH
- Knowledge of concentrate chemistry
- Cultures and endotoxins of dialysate
- Maintenance of concentrate equipment
- Concentrate equipment cleaning and disinfection requirements

DOMAIN V: REPROCESSING OF DIALYZER (4%)
- Principles for reprocessing programs
- Reprocessing equipment (e.g.- automated- manual)
- Water treatment systems for reprocessing equipment
- Physical plant requirements for a reprocessing program

DOMAIN VI: LIFE SAFETY EQUIPMENT AND PHYSICAL PLANT MAINTENANCE (9%)
- Requirements for life safety equipment
- Inspections on life safety equipment
- Vendors for repair of life safety equipment
- Routine inspections of physical plant as per quality requirements
- Vendors for repairs related to physical plant

DOMAIN VII: DOCUMENTATION PRACTICES (7%)
- Documentation of repair and maintenance (e.g.- water treatment- medical equipment- physical plant)
- Documentation practices
- Review- audit- and trend logs

DOMAIN VIII: PROFESSIONAL RESPONSIBILITY (8%)
- Work-related vocabulary- symbols- abbreviations- etc.
- Confidentiality of patient and employee information
- Regulatory organizations (e.g.- AAMI- CMS- OSHA)
- Maintenance of professional certification
- Support staff on technical issues related to medical equipment
- Types of and safe handling of medical waste
- Support staff in-service related to biomedical and clinical equipment
- Infection control procedures

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Question: 1233
During a QAPI audit, you find that dialysis machine maintenance delays are due to poor communication
between shifts. What is the best corrective action?
A. Train staff to perform maintenance independently
B. Increase maintenance staff numbers
C. Reduce maintenance frequency
D. Implement a digital maintenance scheduling system
Answer: D
Explanation: Implementing a digital maintenance scheduling system improves communication and
coordination, addressing the root cause and aligning with QAPI principles. Increasing maintenance staff
numbers does not resolve communication issues. Reducing maintenance frequency compromises
equipment reliability. Training staff to perform maintenance independently may not address scheduling
issues.
Question: 1234
The biomed audits 36 months of water-system logs and finds that daily chlorine checks at the first carbon
bed exit port are documented as �<0.1 ppm� for 1,142 consecutive days. AAMI RD52:2023 Annex D.3
mandates exact numerical values to three decimal places (e.g., 0.067 ppm) for trend analysis. Which
statistical consequence violates CMS �494.40(a)(3) action-level response?
A. Coefficient of variation cannot be calculated
B. Inability to detect 14-day upward drift >0.05 ppm
C. Missing lot numbers for DPD reagent strips
D. No secondary verification signature
Answer: B
Explanation: CMS �494.40(a)(3) requires facilities to trend chlorine levels and initiate corrective action
before the 0.1 ppm action level is reached. Recording only �<0.1 ppm� collapses all values below the
detection limit into a single category, masking gradual resin exhaustion and preventing early detection of
drifts as small as 0.003 ppm/day. Exact three-decimal values enable Shewhart control charting and 14-day
linear regression forecasting. Coefficient of variation is irrelevant for bounded data. Reagent lot numbers
are expiration controls. Secondary signatures are internal policy.
Question: 1235
During a dialysis session, the machine displays a "CVP" alarm. What does CVP stand for, and what
should the Hemodialysis Bio-Medical Technician investigate?
A. Circuit Volume Pressure; adjust the blood pump speed
B. Conductivity Variation Parameter; recalibrate the dialysate sensor
C. Central Venous Pressure; check the venous access for blockages
D. Clearance Verification Protocol; verify the dialyzer efficiency
Answer: C
Explanation: CVP (Central Venous Pressure) measures pressure in the venous line of the dialysis circuit.
A CVP alarm indicates potential blockages or issues in the venous access, which the Hemodialysis Bio-
Medical Technician should investigate. Conductivity Variation Parameter is not a standard term. Circuit
Volume Pressure is incorrect, as CVP is specific to venous pressure. Clearance Verification Protocol is
unrelated to pressure alarms.
Question: 1236
A patient experiences metabolic acidosis during dialysis, and the technician notes a dialysate pH of 6.8.
The bicarbonate concentrate is within specifications. What is the most likely cause?
A. Contamination of the dialysate with chloramines
B. Excessive acid concentrate delivery by the proportioning system
C. Failure of the carbon filter in the water treatment system
D. Incorrect calibration of the pH meter
Answer: B
Explanation: Metabolic acidosis with a low dialysate pH (6.8) is likely due to excessive acid concentrate
delivery, reducing the buffering capacity of the bicarbonate. Chloramine contamination or carbon filter
failure could cause other symptoms like hemolysis but not directly lower pH. Incorrect pH meter
calibration is possible but less likely if other parameters are consistent.
Question: 1237
Central delivery manifold cleaning: 1% Minerva peracetic 40 �C recirculated 45 minutes, CT 1800. Post-
rinse residual 0.4 ppm by test strip. Required?
A. Additional 20-minute bisulfite
B. Extra 2000 L rinse
C. Accept <0.5 ppm
D. Repeat peracetic cycle
Answer: A
Explanation: 2026 limit 0.1 ppm residual; 20-minute 0.1% bisulfite reduces to <0.05 ppm.
Question: 1238
Bacterial retesting is done 24 hours post-system disinfection, revealing 90 CFU/mL. Which regulatory
standard informs the next action?
A. Maximum allowable 50 CFU/mL, stop treatments
B. Action level 200 CFU/mL, continue normal operations
C. Maximum allowable 100 CFU/mL, remain on alert and repeat test
D. Action level 0.5 EU/mL, initiate root cause analysis
Answer: C
Explanation: AAMI maximum for bacteria is 100 CFU/mL; staying below this post-disinfection means
close monitoring continues, not full shutdown.
Question: 1239
A technician is troubleshooting a water treatment system where the RO unit�s permeate flow rate is
significantly reduced. What is the most likely cause?
A. RO membrane fouling
B. Carbon filter breakthrough
C. Ultrafilter failure
D. Water softener malfunction
Answer: A
Explanation: Reduced permeate flow rate in the RO unit is most likely due to RO membrane fouling,
which restricts water passage. Carbon filter breakthrough affects organic load, not flow rate directly.
Ultrafilter failure impacts downstream endotoxins. Water softener malfunction causes hardness issues, not
flow reduction.
Question: 1240
A technician receives an alert for high total organic carbon (TOC) in water from a UV/RO system,
measured at 1.5 mg/L (recommended <0.5 mg/L). What is the first corrective action?
A. Flush distribution loop with hyperchlorite solution
B. Replace UV lamp and verify quartz sleeve cleanliness
C. Calibrate TOC analyzer with reference standard
D. Reduce system recycle time
Answer: B
Explanation: High TOC after UV/RO indicates possible ineffective UV oxidation from lamp aging or
sleeve fouling; replacing and cleaning supports adequate organic reduction.
Question: 1241
A dialysis machine�s ultrafiltration system fails to maintain the prescribed fluid removal rate, despite
correct settings. The technician observes that the transmembrane pressure (TMP) is consistently low.
What is the most likely cause of this issue in the hydraulic system?
A. Clogged dialyzer membrane
B. Leaking venous pressure transducer
C. Faulty ultrafiltration pump
D. Miscalibrated flow sensor
Answer: C
Explanation: The ultrafiltration pump controls fluid removal by creating the necessary pressure gradient
across the dialyzer. A faulty pump can result in low TMP, leading to inadequate fluid removal. A
clogged dialyzer membrane would increase TMP due to resistance. A leaking venous pressure transducer
affects blood circuit monitoring, not ultrafiltration. A miscalibrated flow sensor may cause flow rate
errors but is less likely to directly impact TMP.
Question: 1242
Clinic's acid concentrate storage tanks are cleaned, but recurrent contamination persists. What step is
critical to review?
A. Stock rotation procedures
B. Concentrate delivery hose sterilization
C. Room humidity levels
D. Acid concentrate chemical provider credentials
Answer: B
Explanation: Persistent contamination despite tank cleaning often traces to unsterilized delivery hoses,
which can harbor pathogens and transfer them during refilling.
Question: 1243
During QAPI review, monthly machine cultures reveal a spike in endotoxin levels in specific stations,
but only during evening shifts. What is the most logical QAPI-driven investigation step?
A. Replace all machine filters immediately
B. Assess for deviations in evening shift disinfection protocols
C. Initiate mass retraining of all staff
D. Increase RO system backwash cycle duration facility-wide
Answer: B
Explanation: Deviations in disinfection protocols by evening staff could cause station-specific endotoxin
issues; targeted investigation isolates the root cause, in line with QAPI methodologies.
Question: 1244
A technician disinfects a concentrate system but finds residual disinfectant in the dialysate. What is the
most likely cause?
A. Contaminated rinse water
B. Inadequate rinse cycle
C. Faulty conductivity sensor
D. Overuse of disinfectant
Answer: B
Explanation: Residual disinfectant in the dialysate is most likely due to an inadequate rinse cycle, which
fails to remove all disinfectant from the system. Contaminated rinse water would introduce other
contaminants. A faulty conductivity sensor affects monitoring, not rinse efficacy. Overuse of disinfectant
could contribute but is less likely than an inadequate rinse.
Question: 1245
Carbon tank GAC exhaustion shows chloramine breakthrough 0.18 mg/L at 42 000 bed volumes. Empty
bed contact time 2.8 min.
What is the new minimum EBCT required by AAMI?
A. 4.0 min with coconut shell media
B. 3.2 min with fresh GAC lot
C. 5.6 min using two tanks in series
D. 6.0 min with catalytic carbon
Answer: C
Explanation: AAMI RD62 requires total chloramine <0.1 mg/L. Breakthrough curve shows 50% at 38
000 BV. Series tanks double BV to 84 000, EBCT 5.6 min guarantees <0.05 mg/L.
Question: 1246
A dialysis facility receives a recall notice for a water treatment system filter due to potential microbial
contamination. As the Hemodialysis Bio-Medical Technician, what is your first step to manage this risk?
A. Continue using the system with additional water testing
B. Switch to bottled water for dialysis treatments
C. Replace the affected filters and validate system performance
D. Wait for manufacturer guidance before taking action
Answer: C
Explanation: Replacing the affected filters and validating system performance is the most effective first
step to eliminate the risk of microbial contamination while ensuring the water treatment system remains
operational. Continuing to use the system with additional water testing does not address the contaminated
filters. Switching to bottled water for dialysis treatments is impractical and not a standard practice.
Waiting for manufacturer guidance before taking action delays critical risk mitigation.
Question: 1247
During regular cleaning, brine tank overflow is detected in the water room. Which risk does this pose per
secure room requirements?
A. Increased bacterial counts only
B. Potential chemical spill and cross-contamination hazard
C. Higher conductivity in source water
D. Reduced effectiveness of water softening
Answer: B
Explanation: Overflow can cause hazardous spills and contaminate other water treatment components in a
secure room.
Question: 1248
A technician is troubleshooting a sudden �No Water� alarm on a dialysis machine mid-treatment. The
machine shows unstable dialysate temperature and flow rates. What hydraulic subsystem should be
examined first?
A. Heparin pump function
B. Water supply inlet solenoid valve
C. Blood pump occlusion sensor
D. Drainage manifold
Answer: B
Explanation: A failed or blocked inlet solenoid valve can interrupt water supply, leading to interruptions
in dialysate preparation and unstable temperatures and flow, often triggering �No Water� alarms.
Question: 1249
A technician is troubleshooting a water treatment system where the total chlorine levels post-carbon
filtration exceed the AAMI limit of 0.1 ppm. The carbon filters were replaced recently, and water flow
rates are normal. What is the most likely cause of this issue?
A. Malfunctioning chlorine injection system
B. Excessive water flow rate through the carbon tank
C. Inadequate contact time with the carbon bed
D. Channeling in the carbon bed
Answer: D
Explanation: Channeling in the carbon bed occurs when water creates preferential flow paths, reducing
contact with the carbon and allowing chlorine to pass through, exceeding the AAMI limit of 0.1 ppm.
Recently replaced filters rule out exhausted carbon. Excessive flow rate could reduce contact time, but
normal flow rates are reported. Inadequate contact time is less likely with normal flow and new filters. A
chlorine injection system is not typically used in dialysis water treatment, as the goal is to remove
chlorine, not add it.
Question: 1250
A 52-station clinic mixes 45:1 acid (lot 25ACID-11B) with 1.72:1 bicarb (lot 25BIC-09D) on 2026
Fresenius 2008T machines. At 06:12 am the central SCADA alarms �CONCENTRATE
CONDUCTIVITY LOW � BAY 4�. Technician measures: acid jug residual 1.8 L, bicarb jug 0.4 L, acid
specific gravity 1.068 (spec 1.070 � 0.003), bicarb pH 8.31 (spec 8.25�8.35), final dialysate conductivity
13.6 mS/cm (set 13.9). Which parameter triggered the alarm?
A. Acid specific gravity 1.068
B. Bicarb jug near-empty
C. Bicarb pH 8.31
D. Final dialysate 13.6 mS/cm
Answer: B
Explanation: 2008T machines alarm when either jug drops below 0.5 L to prevent air entrainment and
proportioning error. Acid SG is within tolerance, bicarb pH perfect, and 13.6 mS/cm is still within �5%
of set-point. The 0.4 L bicarb volume forces the machine into bypass after 90 seconds.
Question: 1251
A staff nurse uses the abbreviation �CMS� in a handover note regarding compliance checks on dialysis
machines. What does �CMS� stand for in this clinical context?
A. Clinical Maintenance Status
B. Centers for Medicare & Medicaid Services
C. Complete Microbiological Screening
D. Corrected Machine Sensitivity
Answer: B
Explanation: CMS is the federal regulatory agency for dialysis facility compliance and funding in the
United States.
Question: 1252
Patient on high-flux dialyzer develops acute dyspnea, hypoxemia SpO2 88% at 90 minutes. Dialysate
calcium 2.2 mEq/L, patient pre-treatment ionized Ca 1.08 mmol/L, post 0.71 mmol/L. Water aluminum
0.032 mg/L. Diagnosis?
A. Microbubble embolism
B. Anaphylaxis to endotoxin
C. Dialyzer membrane reaction
D. Aluminum-induced hypocalcemia
Answer: D
Explanation: Aluminum 0.032 mg/L exceeds 0.01 mg/L transfer threshold; high-flux membranes permit
aluminum-citrate complex diffusion causing acute parathyroid suppression and ionized hypocalcemia.
Endotoxin causes fever, membrane reaction occurs in first 15 minutes, microbubbles cause chest pain.
Question: 1253
A state inspector requires an alternate water treatment plan due to a accurate outbreak of waterborne
pathogens in the region. The technician must develop a plan that meets state regulatory requirements.
Which component is essential to include in this alternate plan to ensure patient safety?
A. Mobile reverse osmosis unit with validated AAMI compliance
B. Backup generator specifications for water treatment equipment
C. Temporary water storage tanks with chlorine dosing
D. Vendor contact list for emergency water delivery
Answer: A
Explanation: State regulatory requirements for an alternate water treatment plan prioritize patient safety
by ensuring water quality meets AAMI standards. A mobile reverse osmosis unit with validated AAMI
compliance is essential to provide dialysis-grade water during system downtime. Backup generators
support power but not water purification. Temporary storage tanks with chlorine risk chemical
contamination. A vendor contact list is supplementary but not a core component.
Question: 1254
A dialysis machine�s conductivity alarm triggers during treatment, but the dialysate concentrate is within
specifications. The technician suspects a sensor issue. What test equipment should be used to verify
sensor accuracy?
A. Digital multimeter
B. Conductivity calibrator
C. pH meter
D. Temperature probe
Answer: B
Explanation: A conductivity calibrator is the appropriate equipment to verify the accuracy of the
conductivity sensor by providing a known standard for comparison. A digital multimeter tests electrical
properties, not conductivity. A pH meter measures acidity, not conductivity. A temperature probe
assesses temperature, which is a secondary factor.
Question: 1255
The physical plant inspection reveals the emergency generator room temperature at 92�F with outdoor
ambient 88�F. The radiator fan cycles every 8 minutes. NFPA 110-2022 requires maximum 104�F for
engine rooms. The biomed adds a 1,000 CFM exhaust louver. What is the minimum louver free area in
square feet to reduce temperature 10�F at 500 kW heat rejection?
A. 4.8 sq ft
B. 8.0 sq ft
C. 6.2 sq ft
D. 12.5 sq ft
Answer: C
Explanation: Heat removal formula Q = CFM � 1.08 � ?T. To remove 500,000 Btu/hr with 10�F ?T
requires CFM = 500,000 / (1.08 � 10) � 46,296 CFM. Louver free area = CFM / 4,000 fpm velocity =
11.57 sq ft gross; applying 55% free area for bird-screen louvers yields 6.2 sq ft minimum blade area.
4.8 sq ft is undersized. 8.0 sq ft is marginal. 12.5 sq ft is oversized.
Question: 1256
A regulatory organization updates infection control protocols, including new standards for surface
disinfection. What process must a certified technician follow to ensure compliance for their role?
A. Only verbally inform staff during workflow
B. Use current supplies until depleted before reviewing changes
C. Ignore changes if not enforced by local policy
D. Update written SOPs and provide in-service education to staff about new practices
Answer: D
Explanation: Professional responsibility mandates both written SOP updates and education of all affected
personnel upon regulatory changes to infection control.
Question: 1257
Water room door equipped with RFID badge + PIN, camera 1080p 30 fps, 30-day retention, crash bar,
�NO UNAUTHORIZED ENTRY� sign. 2026 CMS approval?
A. PIN must be 8-digit
B. Missing 90-day retention
C. Missing biohazard symbol
D. Fully compliant
Answer: D
Explanation: Meets all V756 elements: dual authentication, video, emergency egress, signage.
Question: 1258
A dialysis technician reports a hemodialysis machine�s blood pump stopping intermittently during
treatment. The Hemodialysis Bio-Medical Technician confirms no alarms or visible obstructions. What is
the most likely cause?
A. Inconsistent power supply to the pump
B. Faulty blood pump motor bearings
C. Misaligned rotor in the blood pump
D. Software glitch in the pump control system
Answer: B
Explanation: Intermittent stopping of the blood pump with no alarms or obstructions suggests faulty
motor bearings, which can cause irregular operation. An inconsistent power supply would likely trigger
alarms or affect other systems. A misaligned rotor would cause consistent issues, not intermittent ones. A
software glitch is less likely without error codes.
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