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.
"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."
"When working phone triage, if a patient calls with chest pain, I would instruct him to go to the emergency department immediately. I would request verbal confirmation that the patient understands my instruction and will go to the emergency department immediately. Chest pain can indicate myocardial infarction, and delay in treatment can lead to heart failure or death. This isn't a time to take a chance that the chest pain might be caused by something else."
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Anonymous Answer
Immediately call 911.
Chad's Feedback
Good start! It is clear you understand the clinical significance of chest pains and the fact that the patient needs to be evaluated in the emergency department. However, the interviewer will be anticipating a more complete answer with additional details. To strengthen your response, consider citing a specific example from your career where you directed a patient with chest pains to the emergency department.
Anonymous Answer
Ok, this patient might be having an MI so it is important for them to be seen right away to rule this out, get an ECG done, and a cardiac workup. Can ask if he has ever experienced this pain before? Does he have any cardiac history? Prescribed nitro for instance if so to take a spray of the nitro. Also should advise patient to take ASA if hasn't already done so. Patients having chest pain ask them to describe the pain LOTARP where is it, when did it start is it constant or intermittent what were you doing when it started, has it resolved gotten better or worse. Type is it sharp dull, tearing ripping, pressure, worse with deep inspiration or palpating, any associated symptoms SOB, diaphoretic, dizzy, does it radiate down their arm to their back up into the jaw. Any history of similar events did they see a doctor then. Any changes in medication, exercise, stress level. Advise going straight to emerg call EHS if no one to drive them do not drive yourself if you have chest pain.
Cindy's Feedback
Good! Your answer reflects the urgency of the situation, but I'd recommend slowing down a bit and explaining the "why" behind your actions. This is a great opportunity to show that you understand the underlying reasons for the way you're handling the issue.
Anonymous Answer
I would instruct them to sit down and call 911. One time I had a patient start complaining of chest pain 6/10 during shift change after a long night. I called an RRT, got vitals, input all the emergency orders, and kept the client and her daughter calm. Thankfully it wasn't an MI!
Stephanie's Feedback
You do a great job of incorporating a specific experience that you've had into your response, and it sounds like that situation worked itself out easily. Given that the scenario presented in this question is a new patient, I suggest providing a bit more detail on what you would do. (You'd have them call 911, but what then? What would your follow-up be? What other steps would you take?) A few more details will help to round out your response.
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