random ED interview question i got asked

[Skylar86]

Hi guys.

I just finished having a skype interview for a position in the emergency department. I felt that the interview went really well except one question in particular which I felt I didn't answer very well at all.. I was wanting to get your thoughts on it.. what would your answer have been?

the question:

"You just came back from morning tea and have three new patients to look after. One has abdo pain, one has leg pain, and the other has a fever.. how do you prioritize your care?"

i found the question difficult in that there really wasn't enough info to go by. I kind of stumbled a bit and it took me awhile to answer but i think i said something along the lines of..

"Well I would need to know more about them so I would have asked whoever handed them over to me for more information and advice on who they thought I should see first" then i think i went on and talked about pain...

Then the interview said "Well what if I told you that the abdo pain tested positive for pregnancy, the leg pain was a fractured neck of femur, (and i think she said the fever was related to an infection)"

what would your answer have been? is that enough info for you to decide who you would see first? would you have based your priority on pain or? its driving me nuts! i just need to know so i am prepared in my next interview.. cheers!

[Orange Tree]

Well, what is the "care"? What are the orders? I would have been confused, too.

[Juwon]

Not a nurse but from a EMT standpoint you would treat the fever first then abdominal pain and then leg pain last. Leg is last because a fracture is not a life threatening condition....wow you had a skpe interview, that's different.

[Juwon]

Not a nurse but from a EMT standpoint you would treat the fever first then abdominal pain and then leg pain last. Leg is last because a fracture is not a life threatening condition....wow you had a skpe interview, that's different.

[tenderlovingcare]

I will treat the infection last and treat the pain first because it's considered as the 5th vital sign. Ask the cause of pain between the two. But I'm thinking to treat the abdl pain 1st if the pt is pregnant. We wanna make sure that the baby is safe as well as the mother.

[wooh, BSN, RN]

I don't think there was so much a "right" answer, because already you're getting conflicting priorities as answers. And while I'm sure some people will think there is a "right" answer, there's not.

This was a chance to show how you'd think through it.

So in other words, they're not looking for A,B, then C. They're looking for A because blah, then B because blah, then C because blah, unless blah, in which case, C first, then A then B.

[TinyRNgrl]

"Leg is last because a fracture is not a life threatening condition".

Ummm, ok. An unstable femur fx could very well be a life threat. Just sayin.

[emmanewgrad]

1st. Assess the the femur fx pt. (Lower extremity color, pulse, Rom, temp, pain , type of fx); then the fever, how high is it? Pt could go into seizures. 3rd: pregnant pt, assess pts pain, any bleeding, burning upon voiding? How far into the pregnancy? Usually , ed will transfer pts 20 weeks pregnant to ob floor.If no bleeding , collect urine sample. Notify ed Dr of pts pain and pertinent infoas collected and earlier if serious acute distress noted.

[LouisVRN, RN]

Personally I would have treated the abd pain in a pregnant pt first. Especially if its early in pregnancy could be ectopic which is life threatening and unless she is in labor which also probably would take priority abd pain during pregnancy is not normal. Leg pain in a femur fracture is pretty much expected and even if it was something abnormal like a dvt not likely to be life threatening on an immediate basis. Likewise a fever unless its in a neutropenic pt is likely to be lifethreatening and there's very little that can be done as far as emergent treatment.

[Genista, BSN, RN]

I agree with previous post that they are looking more at your critical thinking skills than the "one correct answer" per se.

I honestly don't think there's enough info here to triage these 3 just on what they gave you.

For example- I would want to know how many weeks pregnant is the abd. pain woman (ectopic?) and where the pain is, Any bleeding? How much?, if >20 weeks, is baby moving? For femur fx, is there bone visible, bleeding,how is skin color,pulse etc.? Fever- How old is this person (newborn,child,adult, elderly) How high is the fever? Other symptoms? Immunocompromised? It would entirely depend on the details as to how to sort these folks.

[Juwon]

I don't think there was so much a "right" answer, because already you're getting conflicting priorities as answers. And while I'm sure some people will think there is a "right" answer, there's not.

This was a chance to show how you'd think through it.

So in other words, they're not looking for A,B, then C. They're looking for A because blah, then B because blah, then C because blah, unless blah, in which case, C first, then A then B.

yeah that makes total sense that they are looking for her rationales in handing various types of problems.... Anyways, hope you got the job OP.

[jadelpn, LPN, EMT-B]

Wow!! That was a LONG getting a cup of tea LOLOLOL!!! Where you said "look after" as opposed to triage, I would assume that they have been triaged and put into a room. Look at your orders--and unless you have been gone a really long time, I would also assume that suspected fracture will need an x-ray has it been ordered--do you have an order to medicate? Assess pain and medicate for x-ray. Abdominal pain will need an ultrasound--has it been ordered? If so, does that patient need to be drinking water?(CHECK CAREFULLY--pt may need to be NPO for possible surgery, but some ultrasounds require water drinking.)tech can bring pt water while you are medicating fracture, then patient teaching to abdominal pain on ultrasound, assess pain--does she have a pain med order?

Also, while checking orders, look at fever's vitals. Are they leaning toward getting septic? Do they need blood cultures and a urine? That can be done by tech while you are taking care of the pain of the other 2 first....