DHA exam sample questions

A

1. A. Call for help and restore a closed system per local protocol

   Submerging the tube end in sterile water or reconnecting per protocol limits air entry while help arrives.

2. B. Clamp the tube near the chest until a new unit arrives

   Prolonged clamping can cause tension pneumothorax if air continues to leak.

3. C. Raise the drainage unit to chest level to reconnect it

   Lifting the unit allows backflow of fluid into the pleural space.

4. D. Cover the insertion site with a sterile occlusive dressing

   This is the response when the tube comes out of the chest, not when it disconnects from the unit.

D

1. A. An expected therapeutic magnesium effect

   Therapeutic magnesium preserves reflexes and normal breathing; loss of both indicates toxicity.

2. B. A postictal state after an unwitnessed seizure

   Postictal drowsiness does not explain absent patellar reflexes during magnesium infusion.

3. C. Opioid-related sedation from labor analgesia

   Opioids can depress breathing but do not abolish deep tendon reflexes.

4. D. Magnesium toxicity

   Absent reflexes, drowsiness, and slow breathing are classic signs of magnesium toxicity.

C

1. A. Heart rate and blood pressure trends during the episode

   Vital signs are nonspecific and often normal in genuine pain, so they cannot replace self-report.

2. B. The absence of grimacing or guarding

   Calm appearance does not exclude significant pain, especially when patients cope quietly.

3. C. The patient's report alongside functional and clinical findings

   Self-report is the most reliable indicator when the patient can communicate, supported by functional and clinical assessment.

4. D. A behavioral pain scale scored by observing the face and movement

   Observational scales are intended for patients who cannot self-report; this patient can describe the pain.

D

1. A. Serum sodium

   Furosemide can lower sodium, but muscle weakness is most characteristic of hypokalemia.

2. B. Serum calcium

   Loop diuretics increase calcium loss, but potassium is the key concern with weakness.

3. C. Blood urea nitrogen

   BUN reflects hydration and renal function; it does not explain muscle weakness the way potassium loss does.

4. D. Serum potassium

   Loop diuretics cause potassium loss, and hypokalemia presents with muscle weakness and arrhythmias.

D

1. A. Take an extra dose of rapid-acting insulin before exercising

   Exercise lowers glucose; extra insulin increases hypoglycemia risk.

2. B. Skip the pre-exercise snack so that glucose does not run too high

   Skipping carbohydrate before exercise raises hypoglycemia risk.

3. C. Inject the insulin dose into the thigh just before running

   Injecting into an exercising limb speeds absorption and can cause hypoglycemia.

4. D. Check glucose before exercise and carry fast-acting carbohydrate

   Exercise lowers glucose; checking glucose beforehand and carrying fast-acting carbohydrate lets the child prevent and treat hypoglycemia.

D

1. A. Staying in bed will make you feel worse, so you need to get up.

   This lectures the patient and can increase guilt rather than build engagement.

2. B. Why do you feel there's no reason to get up?

   'Why' questions can feel judgmental and ask for an explanation the patient may not be able to give.

3. C. Rest today, and we can try again when you feel more motivated.

   Waiting for motivation reinforces withdrawal; in depression, activity usually comes before motivation.

4. D. Let's choose one small task to try together this morning.

   A small, achievable shared goal supports behavioral activation without overwhelming the patient.

A

1. A. Dispose of it immediately in a sharps container

   Used needles go uncapped into a puncture-resistant sharps container at the point of use.

2. B. Recap it immediately with both hands, then take it to the bin

   Two-handed recapping is a leading cause of needlestick injury, whatever the timing.

3. C. Bend the needle before disposal to prevent reuse

   Bending or breaking needles increases the risk of injury and is prohibited.

4. D. Remove the needle from the syringe by hand first

   Manually unscrewing or removing needles exposes the hand to the sharp; the whole device is discarded.

C

1. A. Assessing a patient with new chest pain

   New symptoms require registered-nurse assessment.

2. B. Teaching a new insulin regimen before discharge

   Teaching requires nursing knowledge and judgment and is not delegated to an assistant.

3. C. Assisting with routine hygiene

   Routine hygiene for a stable patient is a standard task delegable to a trained assistant.

4. D. Evaluating the response to pain medication

   Evaluation of a medication's effect is a nursing judgment and is not delegated.

B

1. A. Esophageal variceal bleeding

   Varices typically present with hematemesis or melena, not tremor and confusion alone.

2. B. Hepatic encephalopathy

   Confusion with asterixis is characteristic of hepatic encephalopathy from ammonia buildup.

3. C. Ascites-related breathlessness

   Ascites can impair breathing but does not cause asterixis.

4. D. Cholestatic pruritus

   Itching from bile salts does not explain confusion or a flapping tremor.

C

1. A. Ask her to agree to a no-harm safety contract

   No-harm contracts are not evidence-based and do not keep a patient safe; she still needs continuous presence and urgent assessment.

2. B. Notify the provider and recheck her mood in 30 minutes

   Notifying the provider is right, but leaving her for 30 minutes leaves an immediate self-harm risk unsupervised.

3. C. Stay with her and arrange urgent mental-health assessment

   Statements of self-harm require the nurse to stay with her for safety and arrange an urgent mental-health assessment.

4. D. Remove harmful objects from the room, then notify the provider urgently

   Removing means is part of safety, but doing it before ensuring continuous observation leaves her alone at a moment of risk, and notifying the provider alone does not arrange urgent mental-health assessment.

A

1. A. Consistency makes fluid-related trends easier to interpret

   Comparable timing, clothing, and scale reduce variation unrelated to changes in body fluid.

2. B. It allows comparison with the patient's ideal body weight

   Ideal body weight is a nutritional reference; consistent conditions are about detecting day-to-day fluid change.

3. C. Daily weight mainly measures changes in body fat

   Rapid day-to-day changes mostly reflect fluid balance, not fat mass.

4. D. It replaces the need for an intake and output chart

   Daily weights complement intake and output records; they do not replace them.

A

1. A. Review all medicines for interactions and duplicate effects

   OTC sleep aids (e.g., sedating antihistamines) can add to sedation and anticholinergic effects.

2. B. Advise taking it on alternate nights to limit any interactions

   Alternate-night use does not prevent interactions with other medicines.

3. C. Record it once it becomes a regular medicine

   Intermittent OTC products also need to be recorded because they can interact whenever taken.

4. D. Advise that it is safe because it is non-prescription

   OTC products can interact significantly with prescribed medicines.

A

1. A. Obstructed outflow causing bladder distention

   When drainage is much less than inflow and pain rises, clots are likely blocking outflow.

2. B. Expected bladder spasms that an antispasmodic will relieve

   Spasms are common but do not explain the drainage deficit.

3. C. Reduced urine production from dehydration

   Drainage is mostly irrigant, so lower urine production cannot explain the imbalance.

4. D. A need to increase the irrigation rate

   Increasing inflow with a blocked outflow worsens distention.

B

1. A. Give the prescribed oral analgesic and reassess in an hour

   Treating the headache as a simple symptom masks a possible hypertensive encephalopathy and delays escalation.

2. B. Check neurologic status and arrange urgent medical review

   Severe headache with very high blood pressure in glomerulonephritis can signal hypertensive encephalopathy and seizures; neurologic checks and urgent medical review are needed.

3. C. Restrict sodium and fluids and start daily weights

   Sodium and fluid restriction with daily weights are part of ongoing management, but they do not address an acute hypertensive emergency with a severe headache.

4. D. Give a stock antihypertensive now to lower the pressure rapidly

   Antihypertensives need a prescription, and an uncontrolled rapid fall in blood pressure can cause cerebral ischemia; urgent medical review comes first.

C

1. A. Correct each inaccurate statement to keep the patient oriented

   Repeated correction increases frustration and agitation in dementia.

2. B. Give an as-needed sedative routinely each evening

   Routine sedation increases fall and delirium risk; non-drug measures come first.

3. C. Maintain a predictable routine and reduce unnecessary stimulation

   Consistent routines and a calm evening environment reduce sundowning.

4. D. Keep a routine but schedule baths and visitors in the evening

   Routine helps, but adding activity in the evening increases stimulation when the patient is most vulnerable.

A

1. A. Clean, then disinfect for the labeled contact time

   Visible soil is removed first, then the disinfectant is applied for the manufacturer's wet contact time.

2. B. Spray with disinfectant and wipe it dry at once

   Wiping dry immediately shortens the contact time and can make disinfection ineffective.

3. C. Disinfect it without first removing the visible soil

   Organic material inactivates or shields organisms from disinfectant, so cleaning comes first.

4. D. Store it for cleaning at the end of the shift

   Storing it dirty risks contaminating clean areas or being reused uncleaned.

D

1. A. Respecting the patient's right to make choices

   This describes autonomy.

2. B. Avoiding actions that may cause harm

   This describes nonmaleficence.

3. C. Distributing care fairly among patients

   This describes justice.

4. D. Acting to promote the patient's welfare

   Beneficence is the duty to act for the patient's good and welfare.

D

1. A. Recheck the temperature in one hour before notifying the provider

   Neutropenic fever is an emergency; waiting an hour delays antibiotics that should start within about 60 minutes.

2. B. Give a stock IV antibiotic now, before cultures are drawn

   Antibiotics must start rapidly but need a prescription, and cultures are drawn first when this does not delay treatment.

3. C. Inspect the IV site and report if redness or pus is present

   Neutropenic patients often cannot form pus or redness, so absent local signs do not exclude infection.

4. D. Report urgently and prepare for cultures and prompt IV antibiotics

   Febrile neutropenia needs immediate escalation, cultures, and rapid empirical IV antibiotics.

C

1. A. Uterine atony requiring continued fundal massage

   A firm uterus argues against atony, so massage alone will not stop this bleeding.

2. B. Normal lochia rubra for the first postpartum day

   Heavy continuous bleeding exceeds normal lochia rubra.

3. C. Genital tract laceration or another bleeding source

   Persistent bleeding with a firm uterus suggests a laceration, hematoma, or coagulopathy.

4. D. Bladder distention displacing the uterus

   A distended bladder causes a displaced, often boggy uterus; the uterus here is firm.

D

1. A. Wound healing well, no concerns

   This is a conclusion without the observations that support it.

2. B. Moderate amount of drainage noted on the outer dressing

   'Moderate' is unmeasured and open to interpretation; size, color, and type should be stated.

3. C. Patient appears comfortable with the wound

   This is an inference about comfort, not a description of the wound.

4. D. Dressing has a 2 cm area of fresh red drainage

   Measured size, color, and type of drainage are specific, objective observations.