Scenario questions for interviews

[toomanypants]

Hi PICU nurses,

I just had a video interview for a critical care position for new graduate RNs at a children's hospital. I was presented with a scenario, which I suspected was coming. I, however, was caught off guard a little bit. I'm pretty sure I did not answer well, as I was flustered and immediately felt incompetent.

The scenario: 5 year old girl comes to the floor from the ED. She is febrile, has a PIV, and is on 5L of oxygen.

Can you help me understand what are important assessments for this patient and history questions to ask of the parents? What orders would I expect the MD to write? And what in the world does a nurse do when s/he is alone when noticing the patient is now cyanotic with a RR of 8?

I feel like I hit some of the points they were looking for, but I am not sure I was able to show them my critical thinking and reasoning ability. I'm now suddenly aware of how little I know.

Sorry if it's in the wrong forum. The questions were specific to the PICU position.

Thanks!

[Double-Helix, BSN, RN]

Febrile and on that much O2 are major red flags for impending shock. You need to know her hemodynamic stability- namely HR and rhythm, BP, capillary refill and her respiratory status- rate and rhythm, color, work of breathing, lung sounds, SpO2, ABG or VBG results. For history, the most important questions center around the history of the present illness (how long has she had a fever, what other symptoms, any vomiting/diarrhea, what has her fluid intake been like, known exposure to bacteria/viruses?) and medical history (any immunocomprise, cardiac history, or other medical conditions)

PALS guidelines for management of septic and hypovolemic shock should give you a good idea of what the MD should order and what interventions you can expect to stabilize the patient. Fluid, antibiotics and vasopressors will be front line. Blood cultures and ABG/VBG should also be drawn, if not done in the ER.

If you ever find a patient cyanotic and hypoventilating, you start giving breaths with supplemental oxygen and a bag/mask and call for help.

[toomanypants]

Thanks for replying! Now I'm certain I did not answer well.

[NotReady4PrimeTime, RN]

You're a new grad. Cut yourself some slack! There are lots of peds floor nurses who wouldn't have thought immediately of shock given that basic information. Only those of us who have been around for a while would see the ominous fever-and-high-O2-requirement combo as impending cardiorespiratory failure secondary to shock. Even if you were only able to articulate some basic assessments and interventions, you'd have scored some points.

[toomanypants]

Thank you for that NotReady. I am still suffering embarrassment, since I feel like my answers were a little nonlinear and perhaps not comprehensive. But I was able to articulate most components of the necessary head to toe along with some interventions for new onset cyanosis. So I hope you are correct about the points :). BTW, I have bookmarked almost all the threads you've started or answered here in the peds forum. I really hope I get the critical care job so I can use them as a reference.

[NotReady4PrimeTime, RN]

If not this job, then the next one. I can relate to your embarrassment. My first new-grad interview for an intermediate care nursery back in 1995 felt like an ambush. It wasn't at all what I expected of an interview... more like an 18 page oral exam on everything that could befall a sick neonate. "Can you tell me the difference between RDS and TTN?" Ummm. No. (Might help if I knew what TTN is.) "What is the phenobarbital loading dose for neonatal abstinence syndrome? And the maintenance dose?" Errrr. "Can you list 15 causes of hyperbilirubinemia of the neonate?" Well. Ummm. Errrr. I can think of 5, will that do? I felt like such a dolt! But you now what? I got the job. The interviewers could tell that I'd done some reviewing and that I really wanted the job. And those things come with education and experience. I have a feeling you did a lot better than you think you did. Fingers crossed for you!