20 Situational Nursing Questions (with Answers)

Answer Examples

1.

You are caring for a patient who is three-years-old and the physician has ordered a weight-based medication. When you look at the patient's records, you find the weight is documented in pounds. Explain how you proceed.

Many pediatric medications are weight-based, which means the dosage that the patient will receive depends on their weight. However, for most of these medications, the dosing guidance is listed in kilograms and not pounds, the common unit of weight in the United States. Because of this difference in weight units, medication dosing errors in pediatric patients is very common. The interviewer is asking this question to determine if the candidate is aware of the common issues regarding pediatric weight and medication dosing errors and to determine how they would respond in this situation. To effectively answer this question, the candidate should indicate that they would convert the patient's weight to kilograms in order to determine the correct dosage of the medication for the child. A more successful answer to this question would include an example of when the candidate successfully mitigated such a situation during their nursing career.

Kelly's Answer

"If the child's weight was documented in pounds and I had to administer a weight-based medication, the first thing I would do is convert the weight to kilograms so I could determine the correct dosage of medication. While I have always been aware that pediatric medications were dosed based on kilograms, early in my nursing career, I was busy and distracted and nearly overdosed a child with medication because I had forgotten to convert their weight to kilograms. Luckily, one of my colleagues, who saw me draw up the dose, stopped me, or I would have committed the medical error. Ever since this day, I have always been very cognizant of weight documentation when administering pediatric medication."

2.

You are nearing the end of your 12-hour shift on your inpatient unit and you are exhausted from caring for eight high-acuity patients. As your colleague arrives to relieve you, tell me how you proceed.

When inter-shift information is involved, nurses must ensure that they properly handover information to their colleagues properly, even if this means they stay late to complete handover paperwork on each of their patients. Failing to properly handover information to the next nurse could have dire consequences to patients, making handovers a vital element of a nurse's set of responsibilities. Many facilities have standardized handover templates for nurses to complete before the end of their shifts, and these templates include elements such as: background, assessments, vitals, and recommendations. While many electronic health record systems pre-populate much of this information, it is imperative the remaining information is completed. The interviewer is asking this question to determine if the candidate understands the importance of completing handovers. To effectively answer this question, the candidate should indicate they would ensure handover information for all patients was completed before departing for the day. A more successful answer to this question would include an example from the candidate's nursing career where they ensured their handovers were completed despite being exhausted or dealing with other confounding factors.

Kelly's Answer

"In this situation, even though I am exhausted, I would complete handover templates for all my patients, if I haven't already. This is especially true because you said the eight patients are high-acuity, which means there is a lot the next nurse needs to know about them. I could never leave my patients without completing handovers, because not only could I not leave my coworker in a bad situation, but I also don't want to put my patients at risk. Last week, I was in a similar situation, where I had been so busy that I didn't have time to complete handovers until my coworker arrived to relieve me. So, I stayed late and completed the templates for all my patients, despite the fact that I was tired and ready to go home."

3.

Your patient, who has just returned from surgery, now has multiple tubes and lines that you did not insert. You need to administer a drug into her central line, but are having a hard time finding this tube. As you are in a rush, tell me how you proceed.

When returning from the operating room, intensive care unit, or other units of the hospital, a patient may have many more tubes and lines inserted into their body than normal, and at times, it may be difficult for a nurse to differentiate the lines. This is especially the case if the nurse is in a rush. In this scenario, the nurse, in order to administer medication into the patient's central line, they should take time to ensure they have the correct tube. Administering the medication into the incorrect line or into a drain is a medical error that could have negative consequences for the patient. The interviewer is asking this question to determine if the candidate would take the time to confirm that they are using the correct tube to administer the medication in the patient's central line. To effectively answer this question, the patient should indicate that they would carefully ensure that they had the correct tube for the central line before administering the medication. A more successful answer to this question would include a specific example from the candidate's nursing career where they were in a similar situation, and they took time to ensure they were administering a medication in the appropriate line.

Kelly's Answer

"I was in a very similar situation a couple of weeks ago when one of our patients returned from the ICU with a number of new tubes and lines that were all scattered around. When I received an order to flush one of the patient's lines, I had to take time to ensure I had the correct tube, as I did not one to mistakenly flush a drain or flush the wrong line. So, in the case of the patient you just described, even though I am in a rush, I would take the time needed to ensure I was pushing the medication into the patient's central line and not a different tube."

4.

You are currently in a patient's room during hourly rounds and although she is not due for another dose of pain medication for two more hours, she is complaining of increased pain. Tell me how you proceed.

The interviewer is asking this question for two reasons - first, to ensure the candidate will not give the patient a dose of pain medication before it is due; and second, to see if the candidate will attempt to lower the patient's pain using other comfort measures. While the administration of pain medication will relieve a patient's pain, it is important that pain medication is administered as directed by the physician, in order to avoid patient overdose or other negative side effects. Although patients may ask for pain medication in advance of their scheduled dose, nurses can help reduce their pain using other comfort measures, such as repositioning, offering heated blankets or warm compresses, helping them stretch, or getting them up for a walk. To effectively answer this question, the candidate should indicate that they would avoid giving the patient their pain medication early and instead use alternative comfort measures to help reduce the patient's pain. A more successful answer to this question would include an example from the candidate's nursing career where they helped a patient manage their pain using comfort measures rather than pain medication.

Kelly's Answer

"Unfortunately, since the patient is not due for their medication for a couple of more hours, I would not be able to administer it to them. But, I would be able to help reduce their pain using other comfort measures. So, instead of simply telling the patient that they could not have any medication, I would work with them to see what I could do to make them comfortable in the meantime. Having many years of experience as a nurse in the emergency department, I have a lot of experience helping patients manage their pain when they do not get the desired relief from pain medications that were administered, and I would be able to draw from this experience to help this patient get relief until their next dose of medication."

5.

You are caring for a young patient who is being discharged with a prescription for an inhaler. Upon asking the patient if he knows how to use the inhaler, he says, "Yes, I do." Tell me how you proceed.

Although most medications are dispensed with administration instructions at the pharmacy, many patients do not understand how to administer to themselves which results in their misuse. For medications such as beta agonists or corticosteroids which are administered via inhaler, misusing the inhalant device could mean the patient is not getting enough medication to help manage their condition. This is common for all medications which is why it is important for nurses to ensure patients understand how to properly take their medications before discharge. The interviewer is asking this question to determine if the candidate would ensure the understands how to use the inhaler before discharging him, rather than simply taking the patient's word for it. To effectively answer this question, the candidate should describe, in detail, how they would verify that the patient understands how to use the inhaler. A more successful answer to this question would include a specific example from the candidate's nursing career where they helped educate a patient on their medication regimen before discharge or how they developed patient education protocols or materials for their unit or organization.

Kelly's Answer

"Even if the patient was adamant that he knew how to use the inhaler, I would get him to demonstrate how he uses an inhaler, either by using a teaching tool or by simply using an unrelated object to mock up the situation. Inhalers are more difficult to use than most people realize, and so many patients make mistakes when administering their inhaled medications to themselves. But this isn't only limited to inhaled medications, I always make sure my patients understand their medication regimen, and after I go over it with them, I have them demonstrate it to me or repeat it back to me, to ensure they understand. This is something I have always done in my nursing career and will continue to do so before I discharge my patients."

6.

You are caring for a patient on your inpatient unit who is taking a turn for the worse. You decide you need to call the hospitalist physician. Tell me how you will proceed.

Before calling for the assistance of a physician, therapist, or nursing colleague, unless it is a dire emergency, nurses should gather as much pertinent information on the patient as they can so they can effectively and succinctly explain the situation and the needs of the patient. If the nurse does not collect this information in advance of making the call to the physician, the call will likely take additional time as they will have to look the information up and take more of the physician's time. While patients are not typically put at risk in these situations, having the information ready to report during the call assists nurses with building professional relationships with the many professionals the must consult with on a daily basis. The interviewer is asking this question to determine how important the candidate feels it is to collect information before calling the physician. To effectively answer this question, the candidate should indicate that they would collect all pertinent information on the patient, including diagnosis, condition, impression, test results, and vital signs. A more successful answer to this question can include experience from the candidate's nursing career, information the candidate typically relays during such a call, or how the candidate assisted a colleague with such a call.

Kelly's Answer

"This is a very common situation that I find myself in, as I work in the inpatient environment, so I understand that it is important to gather as much information about the patient and the patient's current situation before making the call to the physician. Early in my nursing career, I sometimes would call before I had gathered the necessary information, and when I did so, it was very difficult to communicate the situation to the physician, and sometimes they would become frustrated. Now that I have more experience, I understand the importance of gathering information such as current impression, vital signs, test results, and other pertinent information, so the conversation can be efficient and brief."

7.

You just finished preparing IV medications for a patient, and you thoroughly washed your hands before doing so. As you enter the patient's room with the medication, describe the first thing you do to prevent patient infection.

While hospitalized or receiving outpatient medical treatment, patients are at significant risk of picking up an infection as a consequence of the care they are receiving. Although infection prevention measures in the healthcare industry have greatly improved over the years, the risk still exists and healthcare professionals must be vigilant in order to prevent healthcare-acquired infections. Although it may seem obvious, the simple task of handwashing is the first step in infection prevention. The interviewer is asking this question to determine if the candidate understands the importance of handwashing and is in the habit of washing their hands upon entering a patient's room and/or before administering IV medication. To effectively answer this question, the candidate should explain that the first step they would take to prevent infection would be to wash their hands thoroughly. A more successful answer to this question would include an example of how the candidate has helped train colleagues on handwashing in such situations and/or assisted in the development and implementation of handwashing policies for their nursing unit.

Kelly's Answer

"The first thing I would do to prevent the patient from getting an infection is to wash my hands. There are other actions I would need to take in preventing infection, but handwashing is primary. I have always been an advocate of handwashing, even when many of my colleagues were not. When I found out that my nursing and care partner colleagues on my unit were not following handwashing protocols last year, I worked with my supervisor to develop a training on the importance of proper handwashing, handwashing technique, and infection prevention. After this training, handwashing compliance on my unit improved greatly, and the infection control nurse attributed it to a reduction in secondary infections."

8.

You are conducting intake on a patient who was just seen at your facility earlier in the week. After you enter the patient's vital signs, you see their medication list, which was updated earlier in the week. Tell me how you proceed.

Because patient medications can change very quickly, even over a few days, it is important that nurses verify current medications for every patient at the beginning of every patient visit. If a patient's medication list is not verified and accurately updated, they are at risk of being prescribed a new medication that could interfere with one they are taking. If the nurse does not verify and update the patient medication list, the prescribing provider will not be aware of undocumented medications and will not be able to avoid prescribing errors. The interviewer is asking this question to assess whether or not the candidate understands that medication must be reviewed and verified with the patient or a caregiver during each encounter. To effectively answer this question, the candidate should indicate that they would review and verify the medications with the patient. A more successful answer to this question could include an example of how the candidate has dealt with a similar situation in the past, learned from a mistake that was made because they did not verify the medication, or spearheaded a policy change at their facility to ensure medications are verified during each patient visit.

Kelly's Answer

"I would review and verify the patient's medication with them again, even though they were just seen in the facility a few days prior. It is too risky to assume that the patient's medications have not changed, as the provider may prescribe a medication that interferes with something the patient is taking that is not documented. Unfortunately, I had to learn this lesson the hard way early in my career. It was a similar situation, where a patient had just been seen a few days earlier, and I assumed their medication list was the same, so I did not ask about it. The next day, I learned that the patient had a bad reaction due to a medication interaction from something they were taking that wasn't documented and a new medication that was prescribed by the doctor during the appointment the previous day. Luckily, the patient was okay, but after this happened, failing to verify medications was a mistake I only had to make once."

9.

You are caring for a patient on your unit who is now resting well but has tried to get up and fallen multiple times over the past couple of days. As you prepare to leave the patient's room, do you restrain her to prevent her from falling again?

While it may seem like the most rationale step to take in this situation would be to restrain the patient, only current behavior should determine whether a patient should be restrained. The use of restraints can have physical and psychological consequences for the patient, so it is important that nurses and other medical professionals be very careful with their use. In this situation, since the patient is resting well and not agitated, the nurse should avoid using restraints. The interviewer is asking this question to determine if the candidate understands that restraints should be used judiciously, and to effectively answer this question, the candidate should indicate they would not restrain the patient in this situation. A more successful answer this question would include an example from the candidate's nursing career where they chose not to restrain a patient based on current behavior, despite previous history of falls, violence, and/or intentional or unintentional self-harm.

Kelly's Answer

"Since I have been an inpatient nurse for many years, I have dealt with these types of situations many times, and in this situation, I would not restrain the patient. Even though the patient has fallen since she has been admitted, if she is currently resting well and isn't agitated, I would not restrain her. Restraints are very difficult for patients, and I will not use them unless it is absolutely necessary. This reminds me of a patient who I was caring for recently who had been violent and restrained while in the ICU, but when he was transferred to my unit, he was much calmer. The nurse who cared for him the shift prior to mine had kept him restrained, as she was fearful of him, but the patient was now much more lucid and the restraints were stressful to him. Once I took the handoff, I immediately removed the restraints from the patient, and from then on, he was able to relax."

10.

You are talking with a patient during rounds, and the patient tells you she does not understand what the doctors tell her and she is unsure of what is going on with her health. Tell me how you respond to the patient.

Unfortunately, these types of situations are very common in the healthcare system, as patients are often confused or misinformed about their health. This is particularly true for elderly patients and/or patients without someone present to advocate for them. In this situation, the nurse should take time to help the patient understand what is going on with her health. The interviewer is asking this question to determine if the candidate would take initiative to help the patient; and to effectively answer this question, the candidate should indicate they would explain the medical situation to the patient in layman's terms. A more successful answer to this question would include a specific example from the nurse's career where they helped clarify a diagnosis, procedure, or other medical-related situation when a patient was confused.

Kelly's Answer

"This type of situation has to be so frightening for a patient, and unfortunately, it happens so often. I would take time to explain the patient's medical condition to them at a level in which they could understand, and I would not leave until I was sure they understood. I have dealt with this many times in my nursing career, but one time in particular sticks out to me. I was caring for a patient who had been admitted after a car accident, and after she had a CT scan on her head, a mass was found on her pituitary gland. The doctors did not think the mass was cancerous, and the patient was told it was likely benign; but unfortunately, she didn't know the meaning of benign. Later, when I went to check on the patient, she was devastated and thought she had brain cancer. Luckily, I was able to help explain the situation to her, just like I would do in the situation with the patient you described to me."

11.

A patient on your unit you are caring for has had his peripheral venous catheter in place for approximately 100 hours. The catheter looks normal and the vein is open. Tell me how you proceed with administering more IV medications.

In order to help prevent nosocomial infection, which is an infection a patient acquires while receiving care in a hospital, peripheral catheters should be replaced every 72-96 hours. If not changed, the IV catheter may become infected and cause the patient's hospital length of stay to increase or could even cause death in extreme cases. Although a peripheral catheter may look normal and the vein may be open, it is imperative the catheter be changed. The interviewer is asking this question to determine if the candidate understands the importance of changing peripheral catheters on time in order to prevent infections. To successfully answer this question, the candidate should indicate they would change the catheter, specifically noting that the catheter should have been changed at a maximum of 96 hours.

Kelly's Answer

"This patient's peripheral venous catheter needs to be changed, no matter how good it may look. Unfortunately, you can't see bacteria, and these types of catheters are prone to infection, so they must be changed often. In fact, this patient's IV catheter should have been changed prior, as they shouldn't be inserted more than 96 hours. I typically change my patients' IV catheters every 72 hours, which is at the low-end of the suggested range for changing, just as a precautionary measure. So in this case, I would change this patient's IV catheter before administering anymore medication and change it every 72 hours after that."

12.

You are working phone triage for your physician practice when a patient calls asking for advice as he is having chest pains. Tell me what you direct the patient to do.

In this situation there are multiple directions the nurse could give the patient, but in a situation when a patient is having chest pains, the patient should be directed to go to the emergency department. While care can be given at a physician office or urgent care center, a patient with chest pains could be in the midst of a medical crisis which requires the service of an emergency department. The interviewer is asking this question to determine if the candidate understands the clinical significance of chest pains and the fact that the patient needs to be evaluated in the emergency department. To effectively answer this question, the candidate should indicate that they would direct the patient to hang up and immediately go to the emergency department. A more successful answer to this question would include a specific example from the nurse's career where they directed a patient with chest pains to the emergency department.

Kelly's Answer

"If a patient called with complaints of chest pains, I would tell them to go to the emergency department immediately after hanging up. Even though the patient's chest pains may not be from a heart condition, there is a chance that they could be, and an evaluation in an emergency department is necessary. In these situations, it is easy to assume the patient's symptoms or conditions may be caused by an ancillary condition, such as anxiety, but until they are properly evaluated, it is too risky to assume."

13.

Everyone on your unit is busy and you requested that your unit's nursing assistants bathe one of your patients earlier today. The patient has yet to be bathed and she is upset about it. Tell me how you proceed.

Inpatient nursing is very much a team effort, and while nursing assistants and care partners are typically available to assist with tasks such as bathing patients, they are sometimes at capacity and are unable to take on all the requests. In these situations, it is a requirement of all members of the care team, including nurses, to care for the patient, and this includes changing, bathing, or otherwise cleaning them. To effectively answer this question, the candidate should indicate that they would take initiative and bathe the patient rather than allowing the patient to wait even longer and become even more upset. A more successful answer to this question would include a specific example from the candidate's nursing career where they provided similar care for a patient when nursing assistants were unavailable.

Kelly's Answer

"In this situation, it sounds like the nursing assistants are very busy and are unable to get to the request put in for the patient. So, I would cancel the request I previously sent to the nursing assistants and bathe the patient myself. Not only would this help my patient feel more comfortable, it would help my nursing assistant team members out as well because it would be one less thing they would need to do. I know I am a nurse, but I do not feel I am above doing things like changing and bathing patients. To me, these tasks are part of providing adequate care to my patients, and I will always do what is needed."

14.

You are assisting a physician perform a procedure, when you are asked to retrieve a bottle of acetic acid that can be used on the patient. After retrieving the bottle from its normal location, what do you do you do before passing it to the physician?

The interviewer is asking this question to determine if the candidate would verify that they retrieved the correct chemical before passing it to the physician. This confirmation is important, as the nurse may have accidentally retrieved the incorrect bottle or a bottle containing a different chemical may have been in the place where the requested chemical was typically kept. If either of these were the case, and the incorrect chemical was passed to the physician and used on the patient, significant consequences could occur. Simply verifying that the correct chemical is being passed to the physician could help avoid a serious medical error. To effectively answer this question, the candidate should indicate that they would verify that they have the correct chemical by checking the label on the bottle. A more successful answer to this question would include a specific example from the candidate's nursing career where they avoided a medical error by verifying the name of a chemical or drug that was to be administered to a patient.

Kelly's Answer

"I know exactly what I would do in this situation, as I have been in a situation almost identical to this. Before handing the bottle to the physician, I would read details on the label to verify that I am handing them what they requested. This is similar to a situation I was in a few years ago, while I was working in an oncology office and was assisting a physician with a colposcopy, which requires acetic acid. During the procedure, I went and grabbed the bottle, which I assumed was acetic acid, from where it was normally stored on the shelf; but when I checked the label, I found that it was sulfuric acid, which would have burned the patient if applied. Someone had placed the sulfuric acid in the incorrect location, but since I verified I had the correct chemical, I avoided a medical error."

15.

You are preparing medication in your unit's med room when you are paged to the nurse's station. You plan to immediately return to the med room, which you can see from the nurse's station. Do you lock the door upon leaving the med room?

While most medication rooms in hospitals and clinical facilities automatically lock when closed with current technology, some do not, and in these cases, it is important that nurses and other clinical professionals keep the medication room secured at all times. Not only does leaving medications unsecured place the facility at significant financial risk, it also places patients and the public at risk as well. If an unauthorized individual enters an unlocked medication room and takes medications, these drugs will not be available to patients who need them and may end up being misused by those who end up receiving them. The interviewer is asking this question to ensure the candidate understands the importance of securing the unit's medications. To effectively answer this question, the candidate should indicate that they would ensure the medication room was secured. A more successful answer to this question would include a specific example from the candidate's nursing career where they were in a similar situation or when they helped develop or implement a new policy for securing medications for their unit.

Kelly's Answer

"Even though I would only going to the nursing station and could see the medication room, I would lock the door behind me. You can't take chances with the medication room, and there is no guarantee that you are only being called away for only a moment. In my nursing career, I've learned that a quick page to the nursing station could mean I am away for a 15-minute period, or even longer. The environment on the nursing unit is too volatile to assume you can visually monitor an unlocked medication room, so it is best to ensure the room is secured at all times. Each time I leave the medication room on my unit, I ensure it is locked, and I will continue to do so no matter where I am working."

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