DHCA Nursing Exam common mistakes
DHCA Nursing Exam · Understand the traps and how to avoid them.
Choosing an answer that states a medication's purpose or mechanism instead of answering the question actually asked (e.g., asked for a pre-administration assessment, selects 'it lowers blood pressure').
Under time pressure candidates pattern-match a drug name to a familiar fact and stop reading the stem's final clause, so the stem's actual task is never identified.
What to do instead
Before reading the options, cover them and restate the stem's task in your own words (assess, intervene, evaluate, teach, prioritize). Reject any option that does not perform that task even if the fact is true.
Administering or selecting an answer to give a scheduled drug when a pre-administration parameter is outside the safe range (apical pulse below threshold before digoxin, potassium before insulin, blood pressure before an antihypertensive).
Candidates treat 'the drug is due' as the decision point and skip the parameter check because it feels like extra work rather than the core of safe administration.
What to do instead
Drill a fixed pre-administration checklist per high-risk drug class (vital sign or lab threshold, hold parameters, route, compatibility). Practice stems by first naming the hold parameter, then evaluating the option.
Selecting an answer that dilutes or delays a required intervention because it is 'safer' (reassessing, documenting, or calling the provider first) when the client is deteriorating.
Candidates conflate cautious nursing with correct nursing and have not internalized which findings are true emergencies that require immediate action.
What to do instead
Memorize a short list of findings that mandate immediate action (airway compromise, new unresponsiveness, chest pain with diaphoresis, severe hypoglycemia, postpartum hemorrhage). For any stem with one of these, eliminate options that are assessment-only or documentation-only.
Mixing up transmission-based precautions and PPE doffing order, or selecting standard precautions when a pathogen requires airborne or contact precautions.
Precautions are learned as a list rather than tied to specific organisms, and doffing is memorized as a sequence without understanding which step is most contaminating.
What to do instead
Build a two-column table of organisms and required precautions (e.g., tuberculosis, measles, varicella airborne; C. difficile and MRSA contact; influenza droplet). Rehearse doffing in the order gloves, goggles, gown, mask, with hand hygiene after glove removal and after mask removal.
Answering an ethics or legal item with a personal moral preference or an absolute rule instead of the client's right to autonomy and self-determination.
Candidates answer from personal values or from a memorized hierarchy without checking whether the client has decision-making capacity and has been informed.
What to do instead
Apply a fixed sequence: does the client have capacity, has informed consent been obtained, is there an advance directive, then who is the surrogate. Default to the competent client's stated choice and eliminate options that override it.
In maternal-newborn items, applying adult norms to fetal or neonatal data (e.g., treating a fetal heart rate of 110 as reassuring, or a newborn respiratory rate of 70 as normal).
Adult medical-surgical content dominates study time, so pediatric and neonatal reference ranges are learned late and recalled imprecisely.
What to do instead
Maintain a one-page reference card of fetal heart rate baseline and variability ranges, newborn vital signs, and newborn glucose and bilirubin thresholds, and review it before every practice set in this domain.
Choosing a pediatric intervention or dose based on adult practice without adjusting for weight, developmental stage, or route limitations.
Candidates translate adult knowledge directly and do not check whether an option is developmentally appropriate (e.g., expecting a toddler to cooperate with a procedure, or using an oral route in a child who is vomiting).
What to do instead
For every pediatric item, state the child's age and weight aloud and ask two questions: is this safe at this weight, and can a child this age do or tolerate this? Eliminate options that fail either test.
Escalating or restraining a client in mental health items before trying least-restrictive de-escalation, or missing a medical cause of acute behavioral change.
Candidates focus on behavioral management and forget that new agitation, confusion, or psychosis-like symptoms can be delirium, hypoxia, hypoglycemia, or drug toxicity.
What to do instead
Use the order assess for medical cause, then verbal de-escalation, then environmental and pharmacologic measures, then restraint only as a last resort with monitoring and documentation. Eliminate any option that skips the medical screen.
In critical care and emergency items, prioritizing a task (documentation, family notification, obtaining history) over airway, breathing, and circulation or over the immediate life-saving intervention.
Real-world multitasking habits carry into the exam, and candidates underestimate how strictly priority questions reward the ABC sequence.
What to do instead
Apply ABCDE explicitly to every emergency stem, then rank the remaining options by time-criticality. Any option that can wait more than a minute without harm is eliminated when a life-saving option exists.
Confusing the roles, delegation limits, and reporting obligations of the RN, LPN/LVN, and assistive personnel, or failing to recognize when an incident must be reported.
Scope-of-practice rules vary by jurisdiction and candidates learn them as vague impressions rather than as specific task lists.
What to do instead
Build a task-assignment table (assessment, teaching, initial evaluation, and unstable clients stay with the RN) and a separate list of mandatory reports (medication errors, needlestick, suspected abuse, unsafe practice). Apply the table mechanically to delegation stems.