Scenario interview questions

Editorial Team / Admin · Jan 10, 2015

What are your thoughts on these scenarios? While we at AN are happy to help, we would like to see what your thoughts are and where you need guidance.

RN-PD, BSN · Jan 10, 2015

1.I would do vital signs and I would call the doctor and let him know and ask him which inhaler to give, I don't know what they mean by what i would access or how i would chart this scenario

2.I would go to the patient with reaction to transfusion and discontinue the transfusion

3.first I would check his blood sugar level and respect my hospital protocol if he is in hypo

If you have an older patient that has been in bed 2 weeks, is short of breath, and has a

respiratory rate of 40, what do you do? - i would do his vital signs+ blood sugar level and call the doctor to let him know, I think is pneumonia

4. I don't know the answer to this question

5. I would see the patient who is sick, i would ask the interviewer what they mean by sick(vomiting?) if vomiting i would give him a bowl sit them up, if no the lateral position, do their vital signs

6.I would try to listen to the doctor to see what is the problem and help him find the nurse in charge of the patient

7. I would go to the patient with low blood pressure

I am sorry if I am wrong, i really need guidance. Thank you!

Studentnurse365 · Jan 10, 2015

For seasoned nurses: Is it typical for these types of questions to be asked during an interview?

Gooselady, BSN, RN · Jan 11, 2015

I think it's becoming more common. In my first hospital job, we had to take and PASS a test that asked questions like this. About half of us 'flunked' (got below 80%) and we had to retake it. Most of us 'flunked' because we'd not worked with a RRT before, and that happened to be the answer to a couple of questions.

If I had a patient with a transfusion reaction, another in shock and a third with a bad pressure, I'd be having a VERY BAD DAY!

The point is to determine your 'level' of critical thinking, and OP, your answers are excellent.

Usually there is SOME kind of 'test' either before or after hire. I just took a one page, seven question test for my private duty agency, that asked me if I'd wrap foil around a dish before I heated it in the microwave. Another question was about the proper temperature for food storage in a refrigerator. They were multiple choice I handed it back and the HR lady said "wow, that was fast!" so that I wanted to jerk it out of her hands and recheck it I guess they want people with REASONABLE intellectual capacity to provide for home services. Can't blame them, nor the hospitals giving candidates the OP's test.

ebrooks1013 · Jan 11, 2015

Wouldn't you check for an obstruction of the high pressure alarm is sounding? New grad here just curious

RescueNinjaKy · Jan 11, 2015

Personally my answers would have been to check mar. See what diagnosis, and what orders. Check vs and give oxygen if sob. If asthmatic I will be giving albuterol as per order. And assess for therapeutic response.

I would go to the transfusion reaction first if the patient doesn't already have a nurse at the bedside since usually a nurse should be there while administering blood to monitor for reactions. If there is a nurse there already I will go on to the shock patient. Reasoning is anaphylactic shock can kill you pretty quick, and the transfusion needs to be stopped immediately.

For a non communicative diabetic patient I will do two types of focused assessment. First to see if there if a problem with communication in terms of language barrier, level of understanding, and deficits in mental status or hearing/speech. The other type would be to assess for coping self care ability. If it is unable to cope then I will assess why and maybe call doctor to see if a psych/social services consult needed. For the older patient who is immobile for 2 weeks and is sob with 40 rr I will call RRT and assess lung sounds and give oxygen. I would suspect pulmonary embolism r/t dvt.

#4 I have no idea but I will check the patient first then the ventilator as airway is an important factor. Checking patient comes before checking machine for me.

I would probably ask first what kind of sick to assess for more information. If it's breathing/chest pain/change of mental status/dizziness then I will go to that patient first. If not then I will go to the pain patient first since pain management is a rising priority in all units. I would delegate a cna to assist the patient to the bathroom. I would love to help prep the surgical patient but it's not a priority at the moment.

I will tell the doctor in a calm manner that I am nurse blah and I am responsible for patients in bed a to whatever. That I do not have that particular patient assigned and if there isn't anything else that is related to my patients then I must be on my way. And then walk away from him. If he continues to harass me then I will document such and alert my supervisor.

Assess what kind of sick and what kind of hypotension. Check if sufficient map. Alert doctor and inform of situation and anticipate for orders of fluids/vasopressors

RescueNinjaKy · Jan 11, 2015

Those are my answers and as a new grad I could totally be wrong

RNinCali15 · Oct 23, 2015

What hospital was this at?

NurseStorm, BSN, RN · Nov 17, 2015

1. I would elevate the HOB, get vitals, but primarily RR and sp02. I would apply 02, auscultate the chest then check the mar for a bronchodilator order either via MDI or nebulizer. If none ordered, I would call the doctor and get an order for same. I would give pt the bronchodilator (usually ventolin), and then reassess a few minutes later, asking them to call before I get back if they are not improving/worsening.

- I guess to answer a little more clearly, I would access an sp02 monitor, 02 (perhaps nasal cannula or NRB if severely desating), stethoscope and medication/medication order. I would chart this following my initial assessment (entered room, pt c/o difficulty breathing and noted to be short of breath. RR ____, sp02 ____. 02 at __L applied. Auscultated chest for _____ (eg. markedly decreased air entry to bases bilaterally, with expiratory wheezes heard throughout all lung fields, and mildly decreased a/e throughout). PRN ventolin 4 puffs given via spacer, (or order received... ). 5 minutes later patient noted less difficulty with breathing, RR now ___, sp02 ___, chest _____. Will continue to monitor closely and give more frequent PRN/receive order for more frequent PRN if required.

- OR if this was cerner or a computer charting that is similar I would chart a focused respiratory assessment, including all the above details and then under comment of one of the areas I would describe entering the room, etc. and make sure the action of med administration is noted as well as the post assessment. Hope that helps?

2. I would go to the transfusion reaction first, stopping the transfusion, taking down the lines and saving for lab, and start running NS bolus. If there is another nurse present for the transfusion (As someone else had mentioned), I would have them notify the Dr and supervisor [while talking to her I would let her know what a sh*t show we are currently in, and are there float nurses or other help available?] and then follow protocol ie. Benadryl IV, perhaps epi depending on reaction, etc. If there is no other nurse available I will have to do these things myself first and stabilize this patient before moving on. Next I will go to the patient in shock. I will need to know what type of shock they are in before proceeding... if they are not in cardiogenic shock I will likely be administering some rapid fluid boluses, I will need to get orders for the patient and start to carry these out. I would call the dr. If someone is available to sit with this patient while the first bolus is infusing I will run over to the other patient with low blood pressure. I will need to determine why it is low (dehydration, medication, bleeding, ETC), and then address the issue. They may need a bolus as well, or it may be caused by something else. I would have to assess perfusion, cap refill, temp of extremities etc. as well as I&O. If they need a bolus, I would get an order and initiate this. I would quickly go back to my patient with shock and continue to treat, reassessing with another head to toe, vitals, etc. and hopefully the doctor may have arrived to assess as well.

-- Sorry I find it a little hard to answer when it's so vague (low bp, shock, reaction- be easier if more specific )

3. Why are they non communicative? If it is, for example a stroke patient and this is their baseline I would ensure we are doing frequent b.g checks, keeping a consistent diet with carb counts, and giving insulin timely. Since the patient will be unable to tell us if they are feeling low or high, we will need to be especially vigilant and watch for any change in LOC, tremors, etc. Frequent monitoring will be our best friend here. (If they are non communicative due to decreased LOC from low b.g this is different of course, but I don't think that is what they are asking..)

3. b?) Elevate HOB if not contraindicated, check sp02, auscultate chest. Apply 02. Suspecting pneumonia. Call dr. with update including full set of vitals. Expect orders for chest X-ray, blood cultures, CBC, CRP, blood gases, and perhaps other related labs depending on what meds they are on. Possibly may be looking at starting IV antibiotics at some point in the near future.. If RR doesn't settle down with 02 applied and change in positioning, may need to look at bronchodilators if indicated following assessment. Doctor should also come and assess.

4. I'm not entirely sure as I don't work with ventilators but my best bet would be first to assess the patient- is chest rise equal, any deviation of trachea? Are breath sounds equal? Then I would look to the tube- is it dislodged? is it blocked by secretions/do they need to be suctioned? Is there something wrong with the machinery itself? If I couldn't resolve it here, I would ask for someone to call RT and if necessary I could manually bag the patient until they arrive. (Remember your DOPE mneumonic- Dislodged/displaced tube, Obstructed tube, Pneumothorax (that's the unequal chest rise and/or deviated trachea) and Equipment

5. All of these have so many factors.. if it is an emergency surgery I will of course go to the surgery first.. If I know the person in pain is not due for meds yet, I will also try to quickly get the OR case ready. If the pt in pain is able to have meds and the OR case is non emergent, I will try to quickly provide pain relief to this pt or delegate for someone else to provide pain relief. If the floor has aids, I would get one of them to toilet the patient while I prep the OR case. Next I will go to the patient who feels sick and assess. I may need to provide some anti emetics, depending on what they mean by "feel sick" I may need to do a full assessment and it may be more serious than just needing meds but I suspect for the purposes of this question they just mean someone who is nauseous. Finally I will go to the person who wants someone to sit with them and apologize for the delay stating we had been busy but now I have everything taken care of so I can spend time with you and we can talk about what is going on without being interrupted.

6. I would state "Dr. ____, I am sorry but I am not the nurse in charge of that patient. Unfortunately I am not familiar with their case or care as I have a full case load of my own. I can get the charge nurse for you to discuss your concerns with" Then I would get the charge to try to deal with it before they have to throw the actual nurse of the patient "under the bus"

7. Again, depends on the whole clinical picture. Sick why? Have they been having narcotics and are now nauseated and vomiting from same? Low BP why? Are we suspecting septic shock, or any type of shock? If it is asymptomatic low bp from a non shock situation, and vomiting from something seemingly benign (aka not a bowel obstruction or something more serious). I would go provide an emesis basin to the patient vomiting, a cool cloth for their head, and check the MAR for anti emetics, preferably IV. If none ordered, I will call for an order. (If there is no immediate cause for the vomiting, I would do a head to toe and critically think about why the patient is now vomiting before calling the doctor). After giving meds, I will go to the low bp and assess, if they are low due to dehydration or low po intake I will perhaps need to initiate a bolus and/or oral rehydration. If it is due to shock or something more serious I would've seen this patient first.

Hope this helps... These questions are a little hard to answer due to the very sporifice detail given, it is not like a true clinical situation where you would have much more detail and therefore it would be much easier to prioritize who to see first. Our interview questions here in eastern Canada are more like these than the : Tell me about yourself, where do you see yourself in 5 years, whats your biggest strength etc. questions. But ours are often more clear with a bit more detail. Or, more open ended on one topic like question #1, which are easier to answer and give you a chance to really share your knowledge (ie. You have a newly diagnosed diabetic, what would you be teaching them in the first few days of admission?- I really nailed that one, they ran out of room )

NurseStorm, BSN, RN · Nov 17, 2015

Ugh, now after typing that all out, I see it's from January and OP hasn't been back for months :facepalm:

Oh well, hope someone will find it useful/helpful :confused:

Krondike · Mar 14, 2016

you are the real MVP!