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How to Answer ANY Clinical Scenario Question in a New Grad Nursing Interview

Updated: Mar 9, 2023

Parts 2-4 of this video down below:

The key that helps a nurse give a good interview is understanding why the interviewer is asking the question, and what they need to hear from the candidate.

Let’s start with the scariest question first. The clinical scenario question! Most interviews have some version of the clinical scenario question.

These questions are super intimidating for new grads because what new nurses don’t realize is that when they walk into the room, what they see is the same information that an attending physician sees.

There are many versions of this question, but you answer them all the same, so don’t let this question intimidate you! This question may look like:

What would you do if you found your patient vomiting?

What would you do if you found your patient vomiting blood?

What would you do if you found your patient bleeding?

Why do we Ask this Question?

What we are assessing for is whether you freeze. If you look stunned and we can tell your mind is either blank or going in a thousand directions, but you can’t think of anything to say, that tells us you aren’t ready. As an interviewer, there are 3 questions I ask myself. Do I trust this person? Do I want to work with this person? Do I think it would be fair to this person to give them the job? By that last question, I mean if I choose this candidate, am I setting them up to fail because they are just not ready to handle this job? Retention is a huge issue for new nurses, and we need to know the we are picking the candidate we can set up for success.

No Lone Rangers!

Another thing we REALLY don’t want to hear from you is that you will try to handle the situation all by yourself. As a charge nurse, it worries us to have a floor nurse who doesn’t tell us when their patients are unstable. For example, when we find out a patient’s blood pressure has been unstable for an hour, and they never escalated it or got any help because they thought they could handle it. Nursing is a team effort, and things need to be escalated quickly, so that there aren’t delays in care and possibly death. We definitely want to see that you know that your role is to get the right people in the room when things go south.

The Formula

Are you ready for how to answer every single one of these questions while checking all of the boxes that your interviewer needs to hear? Write these steps down! I’ll list them out, and then we will go through each one and run through the scenarios listed above.

Call for help, stay at the bedside, assess the patient, perform an appropriate intervention, and call the MD and anticipate what they will order.

Call for help: The scariest new grads are the ones who don’t ask for help when they are in trouble. Your job as a new grad is not to handle everything by yourself and know what to do in every situation on day one. Your job is to know when your patient is in trouble and get help. If your charge finds out you’ve had a patient who has been unconscious, has unstable vital signs, is bleeding out, is seizing, or anything that requires immediate attention, and you have been trying to handle it alone without telling your charge, doctor, or rapid response, you are in trouble! This causes a delay in care and may lead to death. We can’t help you if we don’t know your patient is in trouble. Now this is where it gets tricky. How do you know who you need to notify and how? You have a few options and it’s better to er on the side of caution.

Rapid response: Typically one nurse and one respiratory therapist whose job is to help with emergency clinical situations. It’s almost always a good idea to loop them in these scenarios. If you think something could be going on with your patient that could turn south later, you should have this patient on rapid response’s radar.

Charge nurse: Your charge nurse is your resource once you graduate having a preceptor orient you. Whenever I am charge, and I notice one of my nurses has an unstable patient, I ask how I can help. If they left me out of it, it would be inappropriate. My job is to support the floor nurses in keeping their patients safe. They can press the call button and ask for someone to send me in, they can call me, they can ask the nursing assistant to come get me, or in emergencies they can press the staff assist button and all available nurses will come running to that room. Staff assist is alarming and a bit disruptive because everyone drops what they are doing with their own patients and comes to save your patient. The staff assist button usually saved for when you don’t have the luxury of pulling out your phone and calling your charge nurse. For example if a patient is trying to strangle you, if a patient is bleeding out and you need to hold pressure and your hands are too bloody to use a phone, if your patient is having a seizure and you are too busy protecting their head and airway to use your phone, your patient is choking and turning blue with a low spO2. Things like that. The staff assist button is usually next to the code blue button. If a patient has lost a pulse or has stopped breathing, call a code blue. Always loop in your charge when something unexpected and concerning is happening with your patient.

MD: It’s a good idea to let the doctor know about any changes in condition. This should happen quickly if it’s something concerning. You should follow an SBAR format letting the doctor know what is happening, what the patient is here for (they should already know), your assessment (what you see in the patient, what happened, vitals, labs, neuro check changes), and what you recommend (would you like EKG, CXR, labs).

Stay at the bedside: While it’s important to be aware of the patient’s latest labs and doctor’s notes, you don’t want to give the impression that you would see a patient that is unstable, and then in response go to the nurse’s station to do a chart dig at the computer while leaving that patient alone.

Assess the patient: Your assessment is going to vary depending on what the question is, but it’s always a good idea to start with vitals, to assess how oriented the patient is, and then go from there to decide if you might need to do a neuro check, a blood sugar, an EKG or any other assessment. Your assessment should be focused on what you see and we will go through examples with each scenario.

Perform an appropriate intervention: You have so many things you are allowed to do without a doctor’s order. Think about position changes. Are they having trouble breathing? Sit them up! Seizure? Turn them on their side. Mention these little things that you would do while waiting to hear from the doctor for extra points!

Call the MD and anticipate what they will order: If a patient is exhibiting anything unexpected, the doctor needs to know.

Now all of that may have seemed vague and overwhelming, but you’ll get the idea and see the pattern when we go through scenarios.

What would you do if you found your patient vomiting?

Ok, let’s follow the formula. Get help, stay, assess, intervene, and notify.

Get help: “I would quickly sit my patient up to protect their airway and grab a bucket. While I did that, I would press the call button and ask for the charge nurse to grab zofran. Once she’s at bedside I would loop her in on what I’d seen and possible causes. (New med, infection, no B.M. in a week, increased feeding tube rate). I’d also pause the tube feeding if the patient had been hooked up to it.”

Assess: “I’d like to grab vital signs, ask about pain, do a quick neuro assessment, and ask the patient what they think may have caused it. I’d make sure to take a look at the color and consistency of the emesis.”

Perform: “I’d make sure to keep the head of the bed at least 30 degrees to prevent aspiration.”

Call the M.D. and anticipate: “I’d let the doctor know the patient vomited, quantity, color, and consistency. I’d ask for an antiemetic if not previously ordered, and let the doc know zofran was given if that was the case. I would let them know of any usual assessment findings and ask if they would like any additional workup at this time. I’d keep in mind that depending on findings they may want an abdominal X-ray, an EKG, to discontinue a new medication that has nausea as a side effect, or a change in tube feeding rate.”

What would you do if you found your patient vomiting blood?

Get help: “I would sit my patient up and grab a bucket. While doing this I would call my charge nurse for extra help.”

Assess: “The first thing I would want to do is take vitals. Is the blood pressure low? Is the heart rate high? Are they dizzy? Does the pain have new abdominal pain? Is the patient oriented? Have they aspirated? Is the O2 sat ok?”

Perform: "I would position my patient in a way that they can protect their airway and they aren’t at risk for falling.”

Call the M.D. and anticipate: “I would loop in rapid response, and let them know background, hematemesis, and current assessment findings. I’d ask that they come to bedside to see the patient. I would also page the team saying ‘Re: pt. Anderson in 814-1. Large coffee ground emesis x1. BP 86/48 (61), HR 122, new 10/10 LUQ abd pain. Would you like a CBC? Blood? Fluids? Please come to bedside to assess. Thank you!’”

What would you do if you found your patient bleeding?

Get help: “I would press the call button and ask for the charge nurse while I try to figure out where the blood is coming from.”

Assess: “I’d take a look at how much blood had been lost and look until I find where exactly the blood is coming from. While doing this, I would talk to the patient to assess orientation and try to see what info they can give about what happened. I would apply just enough pressure with gauze at the site to stop the bleeding. I’d ask my charge to help me grab vital signs and I would ask about pain and dizziness. I would also think about what bleeding risks this patient might have (did they have a recent procedure, are they on a blood thinner, do they have any clotting disorders?).

Perform: “I would make sure the patient is in a position where they are not at risk for falling because they may because dizzy.”

Call the M.D. and anticipate: “I would ask rapid response to come to bedside to assist. I would also page the team alerting them to the situation and asking for help, “Pt. found with partially dehisced abd. wound. About 30 cc blood on sheets. Currently holding pressure at site. BP 170/96 (121). Complaining of new 10/10 abd. pain. Please come to bedside to assess. Would you like CBC? Coags? Blood? Fluids? Thank you!”

The more comfortable you get with the formula, the less anxious these questions will make you. As long as when you hear this question, you don’t let it intimidate you, and you just walk through the formula, you’ll show hiring managers what need to hear from you.

It’s not expected that you will go in the room and know exactly what is wrong with the patient and exactly what to do. It’s just expected that you get help, stay with the patient, assess and see what extra info and context you can gather, intervene how you can, and page the docs to let them advise you from there.

Post a comment if there are any other scenarios you’d like to see in another video!

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