Behavioural and Situation Questions Flashcards
Explain a time you felt overwhelmed with your workload and its demands and how you handled it.
I was working on a heavy unit with 6 patients assigned to me and I was charge nurse. Our unit clerk was out sick so the phone was almost constantly ringing. One of my patients needed to be prepped for ECT, patients were lining up for lunch medications, and another patient was in the process of having an emotional crisis. In this situation I made sure the patient was where I could see them while I found a staff to answer the phone. Another staff member was able to start my patient’s ECT prep while I took my patient into the treatment room and counselled / assessed them. Once this patient was more calm and comfortable with practising the coping skills independently, I let the patients who were lined up for medications know I would be with them shortly while I finished the ECT preparation. I was able to handle the demands of the unit by asking for help and prioritising.
A patient is supposed to be going on a weekend pass, they tell you they’re suicidal. What are your next steps?
Notify charge nurse
Phone doctor
Check to see if the patient is certified
Suicide risk assessment, plan and intent
Initiate safety planning
Constant observation, no grounds
Room search?
What steps do you take when you see someone is becoming agitated?
De-escalation skills, Move to a more private area, Be empathetic and non judgemental, give undivided attention , Listen carefully (focus on feelings and facts) , Respectful of personal space, keep tone and body language neutral , set limits in a clear, simple and reasonable manner that is enforceable , redirect but using “if” and “then”
Assess the situation, safety, let them know you are listening- active listening and summarizing, appear non-threatening- don’t yell , Provide options
You have a patient who has become increasingly depressed. What kind of questions do you ask them?
Mood, what was happening before you noticed this change in mood, do you feel safe in the hospital, safety plan.
Patient C approaches the nursing station and states they saw patient A go into patient B’s room. What are some reasons a patient would be found in someone’s room?
Drugs, dealings, sexual encounter, confusion/disoriented, violence, dementia.
You are working in a locked unit. A pt is in the common area with his fists clenched, shadow boxing, and threatening to hurt people. There are visitors and patients in the common area. What do you do?
I would clear the area of visitors. This person sounds extremely aggressive and there is potential for violence. I would grab a coworker and use de-escalation skills to defuse the situation. If the patient continues to threaten and is not able to come down from the aggressive state and unable to reason with / accepting of PRN medication, I would call security.
You have a patient who has become unpredictable and angry. You put them in seclusion, what do you do next?
Verbal de-escalation. Explain consequences of negative behaviour. Offer support/listening/prns. Explain why they are being put in seclusion and what is expected from patient behaviour, inform doctor, get order for seclusion and rpns). Make sure patient is provided with fluids / nutrients and is on the correct observation as per policy.
Q: Your patient states that she does not want to live anymore. She has a history of cutting, alcohol abuse, and borderline personality disorder. What do you do?
I would engage in a 1:1 with the patient and find out what happened prior to these thoughts. I would assess if the client is wearing long sleeves and ask about self harm or if they have anything they plan to self harm with. Ask if they have a plan / if they feel safe in the hospital. I would use judgement to determine if this attention seeking behaviour or if the patient is at harm to self.
Your patient has stated that he is anxious for his ECT treatment. What do you do?
I would sit and chat with the patient, ask what they are anxious about exactly. If they are anxious because of a lack of understanding of the treatment, I would provide education with reassurance and comfort. If this is unsuccessful, I would discuss the situation with the doctor and also ask about if PRN ativan would be a good option prior to ECT if the patient is still willing to go forward with the treatment.
A certified 50 year old male has been newly admitted. He is manic, says he has millions in his bank account and can communicate with TVs. He believes there is nothing wrong with him and should not be admitted. How do you provide care for him?
I would not tell the patient that his delusions are false. Provide active listening and validate his feelings. The priority is to build a therapeutic relationship, rapport, and assess / ensure safety. I would explain the stay in simple terms and provide options (food preferences, what his interests are, what resources we can provide to make the stay more comfortable. Gradually provide education about his condition in a non-confrontational manner. Help him understand the importance of treatment and the potential benefits of medication and therapy. Respect his patient rights. Work closely with interdisciplinary team to create a comprehensive treatment plan.
A copatient tells you they found their roommate passed out with a tourniquet around their arm and needle lying next to them. What do you do?
Assess for breathing and pulse, likely an overdose. Code blue, call doctor
Patient approaches the nursing station diaphoretic and high bpm. What do you do?
Vitals, bbgm, call doctor, look at medication, supportive care. May be hypoglycemia, panic attack, heart concerns or even overactive thyroid.
A patient asks to leave the hospital on discharge after hours. What do you do?
See if this patient is voluntary or involuntary. Explain the discharge process and assess what thought process they had prior to wanting to leave, and encourage patient to wait until morning to be assessed by their psychiatrist. If the patient is voluntary and not wanting to wait until the morning, notify on call doctor and AMA form.
Give me an example of a time when you had to interact with a patient who was in great mental distress.
I was charge nurse and a nurse asked me for assistance with a patient who has started to head bang. When I walked into the room she was screaming and crying in the corner and rocking back and forth, hitting her forehead on the wall. I knew this patient well so I placed a pillow between her head and the wall while showing her how to pursed lip breath to help with the hyperventilation. I asked a psych aid to grab an ice pack and with her consent I place this on the back of her neck to help reset her nervous system. I noticed she grabbed the pillow from the wall so I instructed her to squeeze it and she was able to take control of her emotions thereafter and talk about what happened.
Describe a challenging case you’ve managed and how you handled it.
I had a new patient who was involuntary and had been admitted due to substance inducted psychosis. He was quite upset with his admission and very guarded with staff. He would often refuse care / nursing interventions. He did not have money for cigarettes and was very dependant on nicotine as he would constantly come to the nursing station asking for smokes, becoming quite demanding and then yell at staff about his admission. Numerous staff had attempted to offer nicotine gum or the inhaler but he refused each time. One day I decided to try to offer him a nicotine patch as I could see this was a trigger to his exit seeking behaviour. I explained to him how it worked and that it would be a constant supply of nicotine, and he wouldn’t have to interact with staff to get more because it lasts until bedtime. He was reluctant and first but he eventually decided to give it a try. Following this day he would ask for the patch and stay calm throughout the day.
