EHPLE Nursing common mistakes
EHPLE Nursing · Understand the traps and how to avoid them.
Choosing the answer that is clinically ideal rather than the one that matches the nurse's legal scope and the setting described, e.g., selecting 'independently adjust the insulin sliding scale' when the item asks what an LPN/LVN should do.
Candidates study ideal textbook care and forget that licensure level, standing orders, and facility policy constrain what the nurse may do without a repeat prescription or RN assessment.
What to do instead
Before answering, underline the role named in the stem (student, LPN, RN, charge nurse) and the setting. Eliminate any option requiring an independent assessment, care plan change, or dose change the named role cannot legally perform; the correct option is usually 'report to the RN/provider' or 'implement the existing order and document'.
Answering priority questions by picking the most dramatic-sounding intervention instead of applying a structured framework such as ABC, Maslow, or acute-before-chronic.
Under time pressure, candidates react to keywords like 'bleeding' or 'pain' without checking whether an airway or circulation threat is present elsewhere in the options, and they confuse 'first' with 'most important'.
What to do instead
Use a fixed two-pass routine: pass one, sort options into airway/breathing/circulation, safety, then psychosocial; pass two, ask 'which action must happen before any other option is even possible?' Practise 20 prioritisation items per session and write the framework used beside each answer.
Interpreting a single abnormal vital sign or lab value in isolation and acting on it, rather than trending it against the client's baseline and the clinical picture.
Exams present one striking number (potassium 5.6, BP 88/50) and candidates forget to ask whether it is new, expected for the condition, or a lab artefact.
What to do instead
For every value, state three things in writing: the normal range, the client's own baseline, and the trend. Then link it to a sign (e.g., peaked T waves, urine output). Only answer once the value is tied to a physiological consequence.
Mixing up the direction of client teaching, e.g., telling a newly diagnosed hypertensive client to 'stop the medication when the reading is normal' or teaching a prenatal client to count fetal movements only after 40 weeks.
Candidates recall the topic but not the client's stage of illness or gestation, so they apply the wrong phase of teaching (initial versus discharge) and the wrong timeline.
What to do instead
Anchor each teaching item to a timeline: what is taught before discharge, what is taught at follow-up, and what is an emergency warning sign. Build one-page 'red flag' lists per condition (preeclampsia, postpartum haemorrhage, hypoglycaemia) and rehearse them aloud.
Applying adult norms to paediatric clients, such as expecting an infant's heart rate to be 60–100, giving adult fluid volumes, or treating a toddler's separation anxiety as a behavioural problem.
Most study material is adult-weighted, so candidates default to adult ranges and adult communication strategies for children at different developmental stages.
What to do instead
Memorise age-banded paediatric vital signs and urine output (1–2 mL/kg/h for infants) as a table, and pair each age band with its developmental task (trust, autonomy, initiative). For every paediatric item, first name the age and the developmental stage, then answer.
Responding to a client expressing suicidal ideation or hallucinations by changing the subject, offering reassurance ('you'll be fine'), or promising secrecy.
Candidates apply general 'therapeutic communication' instincts (reassure, distract) that are actually non-therapeutic in mental health, and they fear saying the wrong thing.
What to do instead
Use the four-step response: acknowledge the feeling, ask directly about intent and plan, state that safety is the priority, and stay with the client while arranging observation. Eliminate any option that minimises, gives false reassurance, or agrees to keep the information confidential.
Confusing primary, secondary, and tertiary prevention when the stem asks for a specific level, e.g., labelling mammography screening as primary prevention or cardiac rehabilitation as secondary.
The categories overlap in practice, and candidates answer by 'how good the intervention sounds' rather than by whether disease is absent, present, or already causing disability.
What to do instead
Apply a single test: is there no disease (primary), early/undetected disease (secondary), or existing disease with the goal of limiting disability (tertiary)? Sort a list of 15 interventions into the three columns until it is automatic.
Calculating a dose correctly but then failing to apply the safety checks the item is actually testing, such as not questioning an order that exceeds the maximum safe dose or not verifying a paediatric weight-based dose against a stated weight.
Candidates treat calculations as pure arithmetic and stop once they have a number, missing that many items test the follow-up judgement after the calculation.
What to do instead
After every calculation, run a four-point check: units match, result is within the stated safe range, route and frequency are appropriate, and the client's weight/age supports it. If any check fails, the answer is 'hold and clarify with the prescriber'.
Ignoring the wording of the question task, e.g., answering 'what should the nurse do first' with an assessment when the stem already states the assessment is complete, or answering 'which finding requires immediate follow-up' with a normal finding described in unusual words.
Candidates skim the stem, recognise a familiar condition, and jump to a memorised answer before reading the final line that defines the required response.
What to do instead
Read the last line of the stem first to identify the task verb (assess, implement, evaluate, teach, report), then read the scenario. Re-read the chosen option against that verb before confirming.
Overlooking infection-control and medication-rights details embedded in otherwise straightforward items, such as selecting a glove type that is wrong for the task or accepting an order read back by a second nurse without independent verification.
These details are treated as background knowledge and are not rehearsed as decision points, so candidates pick the option that sounds most helpful rather than the one that satisfies the standard.
What to do instead
Build a one-page checklist of standard precautions (when gloves versus gown versus mask), hand-hygiene moments, and the rights of medication administration including independent double-check for high-alert drugs. Apply the checklist explicitly to every item that mentions a procedure or a medication.