Pre-Interview Practical Assessment

[Labelle13]

Hi Everyone,

I just had an pre-interview assessment today for an RN position at Women's Shelter today and we had to answer this one question: It was a scenario about a 2 week old baby who lost 10% of its birth weight and is dehydrated the mom is new to Canada and doesn't speak English how would you handle the situation and what symptoms in your assessment would you look for? Basically I answered along the lines of assesment for...dehydration, sunken fontanels, sunken eyes, crying with no tears.. i would assess for respiratory infection crackles at lung bases, productive cough, amount and colour etc.. amount of wet diapers.. skin turgor.. obtain blood work for RBCs, elevated WBCs.. urine analysis. I would also assess for signs of abuse such as bruising, is the baby appropriately dressed, are there any unexplained injuries. The mother's behaviour If there is signs of abuse notify hcp and appropriate authorities document. I would get an interpreter. To ask the mom questions does she breast feed or bottle feed? Any complications during her pregnancy review the child immunization records. Any recent cold or flu ask about their living situation does she have other children. Financial situation? Is she on government assistance? Then i would collaborate with social work if abuse is not suspected. Social work can refer her to the proper resources such as housing, ESL classes to improve her prospective income. Etc.. thats what I wrote among those lines. Do you think I am on the right track? Any feedback would be great. They gave us no way to prepare since the job ad was already taken down. Thanks

[dishes, BSN, RN]

Did the employer authorize you to reveal their interview question on a public forum?

[Labelle13]

I changed the question it is not exactly verbatim. Sorry,I should have mentioned that in the original post

[dishes, BSN, RN]

A.You should not be revealing any part of an interview question on a public forum

B. You missed assessing for key physical reasons a two week old baby might be dehydrated and jumped to looking for abuse.

[Labelle13]

What did I miss? And I didnt jump straight to abuse. I assessed for feeding habits of the new born and respiratory infections and I mentioned poverty as a factor as to why perhaps the new born is not eating well...

[dishes, BSN, RN]

You asked does she breast or bottle feed, that is not an adequate assessment.

How often does the baby feed? for how long? would you assess the baby's palette? would you ask what happens after the baby feeds? would you ask if the baby vomits? is it projectile vomiting?

[Labelle13]

I only had 30 minutes to answer so I couldnt go into detail about every single medical assessment. However, because the mother is new to the country and does not

Speak english you also have to

Look and consider the social determinants of health as being a factor as well.

[dishes, BSN, RN]

For the safety of the baby and mother, I would hope you would be using an interpreter as you would not be able take an accurate medical history without one. Thirty minutes is plenty of time to do the approipriate history and physical assessment if you know how to focus your assessment based on this baby's symptoms. What if the baby has a cleft palate and you didn't assess for this? Why do you think poverty is a cause of the baby's dehydration and weight loss in this case? How does 'poverty' cause dehydration and weight loss to a baby living in a women's shelter? Do you think the city/province provides funds for women's' shelters but they don't provide funds for food for the mothers and children living in the shelters?

[Labelle13]

Yes I did state on the test that i would use a medical interpreter due to confidentiality and to ensure that the proper medical terminology js used. And you have to look at the question drom all angles there is a reason why they stated the mother is a newcomer to Canada and does not speak english so it doesnt hurt to think the child maybe dehydrated due to being malnourished due to poverty or from long term illness due to the environment he or she lives in. There are 24 points so I think it is important to look at the questions from different aspects and to also involve the interdisciplinary team to assist.

[dishes, BSN, RN]

Yes, you have to look at the question from all angles but your assessment of the possible physical causes for the patient's symptoms was incomplete. The baby is two weeks old, living in a shelter where the mother has access to food and water and your going to make poverty a source, but your not going to take a focused history or do a physical assessment on the baby's digestive system?

[Labelle13]

The question did not state the mother and child lived in the shelter. It is a new admission scenario. I see where I missed parts that pertained to the baby's digestive tract. I had to think on the spot and it's hard to think of everything. But I am confident with my answer I touched all basis. So we will see where it goes...

[dishes, BSN, RN]

You not only missed assessing the baby's digestive system, you did not say what you would do about the baby's dehydration. You did not say what symptoms mean the baby should be taken to the emergency department or what symptoms mean the baby should be seen by the physician. This baby is at risk of dying and you would fail to rescue this baby because you do not understand how to prioritize an assessment.

You would ask about immunization of this two week old baby, what immunization were you expecting the baby to have had?

You would waste time talking about poverty and the mother taking English classes to become employed and better able to provide for the baby, why?