random ED interview question i got asked

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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!

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Still not enough info -- I'd also asked for ESI/triage level, vitals, hx of current complaint. People can lose a lot of blood to a femur fracture, and if you've fractured a femur, it's probably not an isolated injury ... I'd want to explore that one further (because I like trauma, and I will no doubt be swamped with plenty of trauma patients when I go back to work just for saying so, hahaha). Also concerned about sepsis and ectopic in the other two, because those could be life threats associated with those complaints. Skype interview? I love technology! Hope you get the job. :)

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I would address the preg pt first....if she is in preterm labor, that must be dealt with quickly.....for the babys sake. If she is an ectopic, also impt to be dealt with promptly. A reg labor needs to be moved OB. Remember...with a preg pt, you actually have TWO patients you are caring for. Then I would move on to the femur....the fever can likely wait a short while.

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Specializes in ER, ICU.

They are probably looking for your critical thinking skills rather than a "right" answer. Any one of those patients could be the sick one. My answer would have been, in the absence of any further information, I would do a quick ABC assessment on each patient, gather vitals, then decide how to procede, i.e. re-triage the patients for acuity. I would be looking for altered vital signs, level of pain, or any disability. In reality I would have much more information such as their ESI number. Even after you were given more information, it wasn't enough to change anything.

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Specializes in Adult/Ped Emergency and Trauma.

Well I AM PROUD OF YOU !!!!!!

I would have liked your answer as a ER Coordinator, your thought process immediately kicked off the first step of the Nursing Process which is assessment.

When you think back to Test Exam Questions, if further assessment was an answer, IT WAS USUALLY RIGHT!!!

YOU DID GREAT, and Kudos on the SKYPE Interview, Wow, things sure are changing out there still !!!!!!

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Access the leg 1st fx'd femur, can result in a fat embolism which can lead to in respiratory distress..... fx can also cause hemorrahge.

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Specializes in Pediatrics, ER.

For those who said they'd treat the infection last, the JC will eat you alive. Catching sepsis early in the ER is key now. Fever over 100.4 with tachycardia is criteria enough to initiate a rapid sepsis protocol.

OP, there isn't enough to make an informed prioritizing decision with the information the NM gave you. How far along is the pregnancy? Is there a chance it's ectopic and she's bleeding out from a burst tube, or is she having pain because she's 39 weeks and crowning? Is the fracture open or closed, and how's the CSM? How high is the fever, how old are they, what is the source of infection, and are there any other symptoms?

You did the right thing by telling her you didn't have enough info, because you DIDN'T! I think maybe it was a trick question. I hope it was, otherwise that's not an ER I'd want to work in!!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I think (because this is what I'd be looking for if it were me) the interviewer wanted to see if a person would recognize that there wasn't enough info and would ask appropriate questions, as well as consider the possible life threats that could be lurking in any of these patients' presenting complaints. I think it's a good question/scenario. :)

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Specializes in ER, IICU, PCU, PACU, EMS.

I agree with Lunah.

I would also like to say....how wonderful to work in an ED with a morning tea break! :D

I want to work there too!

Best of luck to you, I'm sure you did great.

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The abd. pain pt. with positive pregnancy test is at risk for ectopic pregnancy or miscarriage.

The leg pain pt. with fractured femoral neck is at risk for acute pain and avascular necrosis of the femoral head.

The patient with fever r/t infection is at risk for sepsis.

Which is going to kill you the quickest? My vote is the sepsis.

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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.

Femur fractures can be life threatening- there's an artery right there that can get severed from the bone edges.

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Femur fractures can be life threatening- there's an artery right there that can get severed from the bone edges.

Femoral shaft fractures can result in significant blood loss because they are generally caused by high energy impact, which is more likely to cause damage to the surrounding blood vessels. This is a femoral neck fracture, which is more often seen in elderly folks who trip over a throw rug or take a spill stepping off a curb. The likelihood of significant blood loss is much, much less.

Femoral neck fractures are also highly unlikely to cause fat embolism because the bone composition in the femoral neck is red marrow. The bone composition of the femoral shaft is yellow fat, which is what can embolize.

I still vote for the sepsis.:twocents:

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

Two points here.

1) This is not a real "question" - I've seen this before, it's just an "evaluation" question. It's really designed to get information about YOU and your thinking, not a right or wrong answer. We use this sometimes to get personality assessments while putting the nurse in the comfort zone of dealing with things they routinely do.

2) The WORST answer would be "go ask the MD/NP/PA".....

3) The BEST answer is if you are able to think of a worst case scenario for each, assume they have it, and mention what you expect the interventions/diagnostics would be.

4) But again, this is not a real question with a real answer - it's more about listening to you and assessing your thinking: do you do more independent nursing processes or dependent.

-Mark Boswell

MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P

"Support CEN Certification & Your Local ENA"

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