QCHP/DHP Nurse Exam common mistakes
QCHP/DHP Nurse Exam · Understand the traps and how to avoid them.
In an acute-change item (e.g., post-op client becomes dyspneic, or a client's BP drops), selecting 'notify the physician' or 'document the findings' as the first action instead of assessing and intervening at the bedside.
Candidates over-learn the principle of objective documentation and chain-of-command escalation, and apply it as a blanket first step; the exam instead tests the ABC/assessment-first sequence, with notification and documentation occurring after the immediate response.
What to do instead
Drill a fixed sequence for every 'first action' stem: assess the airway/breathing/circulation and vital signs, perform the independent nursing intervention the situation allows (reposition, oxygen per protocol, stop the infusion, raise the head of bed), then notify, then document. Physically cross out any option that is only 'document' or only 'call the provider' when the client is unstable.
Ordering client assignments or prioritisation by room number, by acuity label already written on the chart, or by 'who was admitted first' rather than by ABCs, unstable-over-stable and acute-over-chronic rules.
In practice, work is often organised by geography and by handed-over labels; under exam time pressure candidates default to that habit instead of re-triaging from the data given in the stem.
What to do instead
Practise 10-item prioritisation sets using an explicit three-pass rule: pass 1, does anyone have an airway/breathing/circulation threat? pass 2, who is unstable or newly changed versus stable and chronic? pass 3, who can safely wait? Write the rule at the top of your scratch paper before starting the domain.
Making dose-calculation errors by mixing mg and mcg, using pounds as kilograms, rounding at intermediate steps, or omitting a weight-based (mg/kg) step for a paediatric or low-weight client.
Candidates memorise formulas but not the unit-conversion discipline, and they round early because hand calculation feels slow; many also assume the ordered dose is already weight-adjusted.
What to do instead
Use one written method every time: convert everything to the ordered base unit in a single line, carry the units through and cancel them, keep full precision until the final answer, then round only at the end. Always ask 'does the stem give a weight in kg, and is the order mg/kg or a total dose?' Reject any answer whose magnitude is off by a factor of 1000.
Administering or continuing a high-alert drug without first checking its specific monitoring parameter - e.g., giving digoxin without an apical pulse, continuing magnesium sulfate with absent deep tendon reflexes or a respiratory rate of 10, titrating a heparin infusion without checking the aPTT/platelets, or giving an opioid without counting respirations.
Candidates learn drug names, classes and side-effect lists but never bind each high-alert drug to the one number that authorises or blocks administration, so the parameter-based answer option looks unfamiliar and gets skipped.
What to do instead
Build a one-page 'drug to number to threshold to action' table for the roughly 20 highest-yield agents (digoxin, magnesium sulfate, heparin, insulin, opioids, potassium, warfarin, aminoglycosides, chemotherapy) and rehearse it aloud: 'digoxin, apical pulse, below 60 in an adult, hold and notify'.
Mislabeling fetal heart rate decelerations - calling a late deceleration 'variable', or treating an early deceleration as an emergency - and then selecting the wrong intrauterine resuscitation step.
Candidates classify by the shape of the deceleration rather than by its timing relative to the contraction, and they memorise only one intervention (repositioning) for every abnormal pattern.
What to do instead
Classify by timing first: early mirrors the contraction and is benign; late begins after the peak, signals uteroplacental insufficiency, and requires maternal left lateral position, oxygen, stopping oxytocin, and provider notification; variable is abrupt and V- or U-shaped and suggests cord compression, so reposition (knee-chest, Trendelenburg) and consider a vaginal exam for prolapse.
Dismissing the red flags of severe preeclampsia - epigastric or right upper quadrant pain, a new persistent headache, or visual disturbance - as indigestion, a tension headache or fatigue, and delaying reporting.
The classic triad of hypertension, proteinuria and oedema is over-represented in study materials, so the hepatic-capsule and cerebral-vasospasm symptoms appear in the stem as distractors that candidates treat as unrelated complaints.
What to do instead
Memorise the 'report immediately' list for the hypertensive pregnant client: headache unrelieved by analgesia, visual changes, epigastric/RUQ pain, sudden facial or hand oedema, and clonus or hyperreflexia. These indicate severe features and imminent seizure risk regardless of the blood pressure reading, so the answer is always to report, keep the client quiet in a dark room, and prepare magnesium sulfate and seizure precautions.
Applying adult reference points to a child - judging an infant's respiratory rate or heart rate as abnormal because it exceeds adult values, treating a paediatric 'normal' blood pressure as hypotension, or assuming the ordered dose is already child-sized.
Adult values are rehearsed far more often and paediatric ranges are wide and age-dependent, so candidates fall back on the familiar numbers instead of the age-based chart.
What to do instead
Memorise infant versus child versus adolescent ranges for respiratory rate, heart rate and systolic BP, and learn that hypotension is a late, pre-arrest sign in children while tachypnoea and tachycardia are early. For every paediatric medication item, explicitly ask 'is this per kg and is this child's weight available?'
Selecting 'explore the client's feelings' or another therapeutic-communication option when the client is an immediate danger to self or others - actively suicidal with a plan, escalating with clenched fists, or responding to command hallucinations.
Therapeutic communication is heavily emphasised and is usually the 'nice' answer, so it is chosen reflexively; candidates miss that safety and environmental management outrank communication in the hierarchy.
What to do instead
Apply a fixed hierarchy to every psychiatric prioritisation item: is there an immediate physical threat (suicide, homicide, aggression, command hallucination, withdrawal/overdose)? If yes, the answer is safety - one-to-one observation, remove harmful objects, reduce stimulation, administer prescribed medication, call for help - and communication or exploration comes later.
Delegating RN-only responsibilities to unlicensed assistive personnel or practical nurses - assigning a UAP to perform the initial assessment, to teach a client about a new medication, to evaluate a wound, or to care for an unstable or newly admitted client - or accepting a physician's request that the nurse 'obtain' informed consent.
These items are written as realistic shift scenarios, and candidates answer from workplace habit (who actually does it on my unit) rather than from scope-of-practice rules; the consent item is missed because the nurse's signing role is confused with the physician's disclosing role.
What to do instead
Memorise the non-delegable core: assessment, diagnosis, planning, teaching, evaluation, and any task requiring clinical judgement belong to the RN. Then test each option against the five rights of delegation (task, circumstance, person, direction/communication, supervision). For consent, remember the physician obtains it, the nurse witnesses the signature and verifies the client's understanding.
Misclassifying levels of prevention - labelling a mammogram, a Pap smear or a TB screening as primary prevention, or labelling rehabilitation after a stroke as secondary prevention.
Candidates match on the disease rather than on the point in the disease process, so any activity with a named condition feels like 'prevention' in general.
What to do instead
Anchor on the timeline: primary acts before disease exists (immunisation, seat belts, smoking prevention, fluoride); secondary acts on existing but asymptomatic disease (screening, Pap, mammogram, BP and glucose screening, contact tracing); tertiary limits disability after disease (rehabilitation, support groups, medication adherence programmes, cardiac rehab). Ask 'has the disease started yet, and does the person know?'