Answered wrong on Interview Question - page 3

by missrn208

10,373 Views | 46 Comments

Hi Everyone, I just came back from an interview and realized that I answered an important prioritizing question wrong in my interview. My professor for my coronary care course helped me in getting the interview and I am going... Read More


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    I agree with the majority: SOB trumps pain. That should be patient #1.

    #2 is the chest pain d/t possible MI; #3 is the other pain patient. #4 (or last if other patients end up coming in) is the update-seeker.

    Always remember the ABCs.

    If it's any consolation, I've botched my fair share of interview questions too. Happens to almost all of us.,.live and learn.
    nursel56 likes this.
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    SOB, by NLCEX and HESI standards is NOT considered a critical sign, but chest pain is.

    Depending on whether you go by that or the strict definition of ABC, you could argue that either the chest or the post-op patient is first.

    But someone's pain medication never, ever comes before a potential emergency.

    I had that same question for a fellowship interview in Ohio - I think you'll be fine!
    gigglestarsRN likes this.
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    I would have chosen the patient with SOB. Always follow your ABC's. Don't beat yourself up over though. Today I answered a question wrong on the interview. I totally knew the answer but could not get it off my tongue. It happens. All you can do is wait and see.
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    I always did everything at once because they are all obviously important tasks,but to give the best answer. Lets just remember in reality.....I probably would have to delegate . While your at the desk, tell the family you will be able to tell them something as soon as you update yourself on all the newest test results so you can have a full understanding of whats going on, but first you have to stablize three other patients. Instruct them to the free coffee and comfy sofa. The family will feel better only hearing this from the Primary Nurse.
    At the same time with the phone at your chin be dialing recovery to tell them to hold on the patient who is SOB from the O.R. for twenty minutes or so. (In any case the SOB patient would come first.) With your right index finger, motion over to an already overloaded CNA if you have one and ask if they can get a set of vitals and an EKG on the chest pain/dizziness client, press another out-going line and call the house officer or PA, then medicate your pain patient.
    Of course answering an NCCLEX review question like "oh SOB" easy ABCs; airway first is probably going to look good at interview, but answering the question and going a little bit out of the norm to explain how and why you are doing the steps will resonate with the interviewer. It is what they actually look for. This is just an opinion.

    SM
    Last edit by sarasmileRN on Nov 27, '12 : Reason: correct
    gigglestarsRN likes this.
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    LOL Depending on who it is that wants the update, that person might be your 1st priority. Just kidding. Unless it's the spouse of somebody powerful who can get you fired. Talk about reality.
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    Quote from missrn208
    I said the SOB was a primary concern but if they were just coming and they had the nurse with them I would go to the chest heaviness and then give pain meds and then go to the post-op nurse to get report, I'm not sure if deferring to the RN bringing the patient to the floor is a good idea....
    That RN likely has more experience than the floor nurse does, probably more than two floor nurses put together. I mean if it was specified that this person already has a recovery room nurse with them and they haven't turned over care yet, then I might not go see them first either.

    I wouldn't stress about it either way. They just want to hear you talk it through and make sure you're not totally off the reservation.
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    Quote from BostonTerrierLoverRN
    To make you feel a little better, last Tuesday my best friend's wife, who just finished her MD Fellowship in a North Texas Pediatric Emergency Program, had her first interview at a mid sized City's Level II ED.

    She was asked ("pimped out" they call it when senior MDs put Jr. MDs on the spot) to give a PALS example of a choking infant(doll) where nervously, and with sweaty hands sent the poor baby "flying across the room like a lawn dart!" To make matters worse, she picked the baby up by the head causing the MD to holler, "You reckon you might need a C-Spine Allignment there?" Causing her once again to drop it like a hot potato.

    She graduated 3rd/100, in her 4 yr class. I will hold this over her head for a long time to come. I have already bought her some 3M grip gloves for Christmas- I think if you let them know you messed up they'll be alright about it if the rest of the interview went well. Nurses are harsh self critics, were also human

    Your actions following a mistake say tons about your character!!

    LOL. So darn funny. It happens. 3M grips. . .lol. . . you are cool. Too true about nurses. . .and they can be on the unforgiving side--depends on how well you are liked---very capricious.

    I bet they were all have a laugh somewhere over that fellow's incident. Funny thing is, in RL, people don't tend to handle babies like they do dolls.

    Thanks for the laugh.
    BostonTerrierLoverRN likes this.
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    Quote from Esme12
    I agree with Boston.......If the OR patient coming from the PACU with a nurse and that nurse was still with them......I would check and be sure that nurse needed nothing (so I guess checking that patient first) then I would go to the dizzy chest pain as that can be a PE, MI or cardiac arrhythmia....I would then treat the pain and delegate the family member until I had time.

    I mean really how far off in transit is this pt from recovery? Upon report, I'd see about getting the PACU RN to deal with the SOB--if someone is having SOB post-op recovery, they shouldn't be sending him out, and the ologist needs to address the issue with the recovery nurse. Having done recovery, that's definitely how we'd handle it. Now, I may have to be on the phone while I'm going into see the the angina, syncope patient, but I mean you learn to deal. You do an assessment and you should have already called for EKG for the angina, etc. People are supposed to work as a team; therefore, you get another nurse, who is not as busy with a higher priority issue, to check the pt/chart and order/ and MAR for the particular pain medicine. That's how we rolled on the floors or in the unit. No one can be everywhere at once. So you get the resident or whomever is covering to check out your angina/syncope pt, after reviewing stuff with him or her, as well as meds, and if the SOB post-recovery pt is now stable and en route, you make sure you have what you need for his admit to your floor or unit, and get that rolling. On the way to getting things you need for this, you speak to the family member and kindly but quickly as possible. You also check in on the patient that received pain meds, and then you roll in with the new admit from the PACU. The resident or covering person will usually find you, and if they just write orders and walk away, they will hear a good deal of crap from me--but if they have any sense, they will find you as you are in with new admit, and let you know about orders and plan for angina/syncope patient. And you know, it goes on like this all day or night, and you somehow manage to get everyone's meds done, labs up-to-date, notes up-to-date, and orders up-to-date--although, depending on how things go from there with these and other patients, you may have stay a bit to catch up on your documentation.

    That's kind of how it rolls, and you learn to adapt and deal and delegate and do your very best while prioritizing and being as careful and supportive as possible. You do the best you can, pray you have a good deal of people with which to work--so sadly not always the case, and you go the heck home, only to get some sleep and come back in in a few hours to do it all over again. Such is nursing!


    Don't sweat the interview. Some people may answer differently depending upon how the information was presented--that is, was the PACU patient still in PACU with SOB? Did the SOB just start in transit? These things make a difference in terms of how you handle prioritization. But a fresh post-op patient shouldn't be released from recovery if unstable, and SOB, if real and not just an anxious response post-anesthesia, is a form of "unstable."

    At any rate, that patient should be going to a unit bed if PE is suspected. Depending on all pertinent factor with the patient, they'd try to confirm PE without imaging/scanning--and if the person was tachypneic, tachycardic, desaturating, or hypercapneic, there is no way he should have been sent out to the floor--and if there was a strong suspicion of SOB being r/t to PE and not other probable issues, treatment in a ICU would ensue. In that situation, the patient shouldn't be coming alone, and a physician should be right on top of this patient. Even in the unit, someone would be getting the EKG on the other angina patient, while you are working to assess and treat/stabilize the SOB/R/O PE patient.

    You'll get it as you work it. Don't beat yourself up. As strongly as I feel about controlling pain, I do my best to get another good nurse to give the pain med if I could, but you know, I have to do first things first--and preventing patients that are at least potentially seriously problematic from getting worse--or a least treating them efficiently by way of the best practices is the priority. You will learn to function as if you have roller blades on at work.
    Esme12 likes this.
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    I would've said SOB first.

    Pain is the 6th vital sign but it doesn't mean it's the most important vital sign.

    When in doubt, think of your ABCs.
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    Quote from Kooky Korky
    LOL Depending on who it is that wants the update, that person might be your 1st priority. Just kidding. Unless it's the spouse of somebody powerful who can get you fired. Talk about reality.
    Hehe, I was thinking, "Who is it that's interviewing me?" If the interviewers are wearing business attire, family member at the desk is seen first, followed by pain, and ignore the other two as if they'll die, they won't be filling out a customer service survey anyway, so who cares what happens to them? The bigshots don't, they only care about customer service. (I kid! Ok, I actually only half kid!)
    Chest pain first. My rationale for chest pain being first, is PACU RN is with the SOB, nobody is with the chest pain. If PACU RN can't handle the patient on her own, she shouldn't have left the PACU with him. These being adult patients, cardiac arrest is more likely than respiratory arrest. And while we all think ABC, even CPR is now CAB.
    Ntheboat2 likes this.


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