Scenario interview question

NICUismylife, ADN, BSN, RN · Oct 17, 2016

I'm just a student, but my first instinct is MI, or possibly AAA.

Passed out and not breathing: call a code blue and initiate BLS/ACLS

Atl-Murse · Oct 17, 2016

Abdominal aorta aneurysm. Call code, OR . not looking good for the pt

Mmsmichelle · Oct 17, 2016

Thank you for the answers

What should I do before I call a code? I know I should call the code when the patient passout

But what should be my inntial action/nursing intervention when I see the vitals? Should I provide more fluid? My answer was provide more fluid and notify physician and they were keep asking me and then what are u going to do? And what do u think the doctor will tell u to do? And they said they don't send pt to emmergy. I don't know what they exactly want from me?

Meriwhen, ASN, BSN, MSN, RN · Oct 18, 2016

But what should be my initial action/nursing intervention when I see the vitals?

Assess the patient. Doesn't need to be a full head-to-toe (you don't have the time to do that right now), but focus on the problem and see what's going on. The MD is going to want to know that when you call them.

And look to see if there are standing orders for IV fluids, O2, meds, etc. Those you can implement without having to wait for MD orders.

If your facility has a rapid response-type code for deteriorating patients, call it.

What should I do before I call a code? I know I should call the code when the patient pass out?

If the patient is not breathing, the first thing you always do is call the code. Given the info you provided, I also vote for AAA resulting in hypovolemic shock. Your patient is going south fast and you need the code team in there yesterday if you want him to make it.

After you've called the code, start BLS until they get there...unless they are a DNR. If it's not clear whether he is a DNR, start BLS until someone produces proof that he is.

If you have help, also get O2 on him and IV access started if he doesn't already have it.

That Guy, BSN, RN, EMT-B · Oct 18, 2016

Im sorry but you should be able to answer some of this on your own if this isn't homework, which I pray it is.

NuGuyNurse2b · Oct 18, 2016

Im sorry but you should be able to answer some of this on your own if this isn't homework, which I pray it is.

if it's a new grad interview, it's not so easy. nursing school teaches to pass NCLEX, where questions have options to select from. Interview questions are open answers, which presents a challenge for new grads once options aren't readily available to help get the gears grinding. Training for a minimum of 2 years to answer written tests doesn't necessarily prepare you for verbal interaction.

That Guy, BSN, RN, EMT-B · Oct 19, 2016

if it's a new grad interview, it's not so easy. nursing school teaches to pass NCLEX, where questions have options to select from. Interview questions are open answers, which presents a challenge for new grads once options aren't readily available to help get the gears grinding. Training for a minimum of 2 years to answer written tests doesn't necessarily prepare you for verbal interaction.

Then we are doing something terribly wrong if you don't know what to do when the answers aren't presented to you in the form of a multi choice test and sitting right in front of you.

NuGuyNurse2b · Oct 19, 2016

Then we are doing something terribly wrong if you don't know what to do when the answers aren't presented to you in the form of a multi choice test and sitting right in front of you.

who's 'we'? are you doing anything about it other than shading...

Lev, MSN, RN, NP · Oct 19, 2016

Where did this scenario come from? There are any number of things wrong with this patient: severe GI bleeding, hypovolemic shock, right sided MI, aortic dissection. Temp is kind of low - could be sepsis.

If this was a patient on the floor I would immediately call a rapid response and obtain 2 more IVs. If this was an ER patient, I would start fluids, get bloodwork, EKG, monitor, a couple lines, and call my coworkers and the doc in the room stat.

The doctor will probably order IV fluids, labs, cardiac monitoring and transfer to a critical care unit.

If the patient is passed out and not breathing, you need to initiate rescue breathing with a bag-mask (ambu bag) and call a code blue.

In general, with scenario questions - you need to think safety first, then immediate nursing interventions, and then call for help.

CoffeeRTC, BSN, RN · Oct 19, 2016

yep...all depends on your setting. In a LTC setting, my answer will be different :)

i would retake the vitals first and assess . Really, this is an issue I'm working on with the staff. I was called to assess a resident who "is dying and turning blue." Resident had PVD and discolored lower extremities and was cool from being outside and couldn't breath because they were just smoking. Yes, really.

On the above.... call the md/ find code status/ grab our "code cart"/ 02/ 911 and then worry about the paperwork later.

WKShadowNP, DNP, APRN · Oct 19, 2016

The part of the question that stands out to me is where the purported interviewer is asking "what do you think is wrong with the patient?" That is a hell of a thing to ask a nurse. It seems to be asking for a medical diagnosis.

But to keep it simple, just as in BLS or first responder classes they want you to GET HELP first. Then manage the most life threatening things first. You'll have a team helping in this situation if you activated the RRT or whatever your facility utilizes.