Hospitals interview questions

Our only general surgeon is leaving in [a year], and surgery supports imaging, lab and inpatient volume. Walk me through how you'd decide what to do, and who you'd involve.

Situational · Service line decisions

Strong answer

Models the full financial effect with the CFO, including cost-based payment and downstream volume, weighs community need, recruiting odds, locums and network options, brings the medical staff in early, and gives the board options with a timeline.

Red flags

Decides alone, looks only at surgery revenue, or waits until the surgeon leaves.

State surveyors cite us at the condition level for patient rights, tied to restraint use. What do you do in the first week?

Situational · Survey readiness

Strong answer

Owns it, makes sure current patients are safe, pulls in the CNO and medical staff, finds the root cause, writes a plan of correction with owners, dates and audits, and briefs the board.

Red flags

Hands it to the CNO and steps back, argues with the finding, or writes a paper fix with no monitoring.

Tell me about a time you had to tell a board something it didn't want to hear. How did you prepare, and what happened?

Behavioral · Board relations

Strong answer

Told them early, came with data, options and a recommendation, stayed plain about the risk, and describes the decision and follow-through.

Red flags

Delayed the news, softened it until it was misleading, or blamed a predecessor.

Tell me about a physician or nurse practitioner you recruited to a hard-to-fill market. What made the difference?

Behavioral · Provider recruitment

Strong answer

Specific tactics such as loan repayment programs, a fair call schedule, help with housing and a partner's job search, and time with the community. Also says whether the provider stayed.

Red flags

Relied on a recruiting firm and a signing bonus, or can't say whether the provider stayed.

Explain to a new board member how cost-based Medicare payment changes the way we judge adding a service.

Technical · Critical access finances

Strong answer

Medicare pays a critical access hospital based on its reasonable costs, so the cost report and Medicare's share of volume matter. Most commercial plans, and Medicaid in many states, don't pay cost, so payer mix, volume and fixed costs still matter.

Red flags

Treats cost-based payment as guaranteed profit, or can't explain it in plain words.

Tell me about a time staff turnover was hurting a place you led. What did you do, and what changed?

Behavioral · Culture and retention

Strong answer

Listened through rounding or stay interviews, fixed specific causes such as schedules, pay or a weak manager, and tracked turnover until it improved.

Red flags

Blames the labor market and describes no action of their own.

Walk me through how you prepare the Medicare cost report, from the trial balance to filing.

Technical · Medicare cost report

Strong answer

Clean trial balance and reclassifications, accurate statistics such as square footage, patient days by type and time studies, swing bed and observation splits, review of allowable costs with the outside preparer, a settlement estimate, and on-time filing.

Red flags

Hands it all to the consultant and can't explain the statistics or the settlement.

Days cash on hand has fallen for four straight months, and agency nursing is the main cause. What do you bring to the CEO and board?

Situational · Cash and staffing costs

Strong answer

A cash forecast, the cost of agency against recruiting and incentive options, faster collection steps, any covenant risk, and a recommendation with a timeline, built with the CNO.

Red flags

Proposes across-the-board cuts without analysis, or only pushes the business office harder.

The medical staff wants to host a visiting orthopedic clinic. How do you model whether it makes sense for the hospital?

Situational · Service modeling

Strong answer

Volume and payer mix, downstream imaging, therapy and surgery, cost report effects, space and staff costs, a fair market value arrangement reviewed for compliance, a break-even point, and the risks if volume falls short.

Red flags

Looks only at clinic visit revenue, or skips the compliance review.

Tell me about a time an audit or cost report review found a problem on your watch. What did you do?

Behavioral · Audit and controls

Strong answer

Owned the finding, corrected it, fixed the control that let it happen, and told the audit committee or board plainly.

Red flags

Blames staff or the auditor, or describes no change to controls.

Tell me about a time you explained a complicated financial result to physicians or board members who weren't finance people.

Behavioral · Explaining the numbers

Strong answer

Used plain words and one clear takeaway, showed a simple chart, checked that they understood, and a decision followed.

Red flags

Relied on jargon and ratios, or blamed the audience for not getting it.

Denial write-offs rose sharply this quarter. How do you find out why, and how do you hold the right people accountable?

Situational · Revenue cycle oversight

Strong answer

Breaks write-offs down by payer, reason and department with the business office manager, finds root causes, assigns fixes with owners and dates, and tracks them monthly.

Red flags

Blames the business office without data, or accepts the rise as the cost of doing business.

It's Thursday. Two weekend night RN shifts are open, the ED is busy, and agency would put nursing over budget. Walk me through your decision.

Situational · Staffing decisions

Strong answer

Checks the census forecast and acuity, tries incentive shifts, floats and PRN staff first, books agency if safe staffing needs it, tells the CFO why, and addresses the vacancy behind the gap.

Red flags

Leaves the holes open to protect the budget, or books agency without trying anything else.

Surveyors arrive unannounced on Monday morning. What will they look at in nursing, and how will you already know we're ready?

Situational · Survey readiness

Strong answer

Restraint and patient rights documentation, care plans, medication storage, infection control, competency files and current policies. Knows readiness because of regular chart audits and tracer rounds, not a last-minute cleanup.

Red flags

Plans a cleanup sprint once surveyors arrive, or can't name what surveyors review.

Tell me about a nursing quality problem you improved across more than one unit, such as pressure injuries or medication errors. What did you change, and how did you measure it?

Behavioral · Nursing quality

Strong answer

Starts from the data, finds the causes, names specific changes such as turning schedules tied to Braden scores or barcode scanning checks, audits them, reports to leaders, and shows the rate stayed down.

Red flags

Says they educated the staff, with no data before or after.

Tell me about a time you had to hold a well-liked nurse accountable for an unsafe practice.

Behavioral · Accountability

Strong answer

Got the facts, met privately, separated system problems from choices, set clear expectations, followed up, and applied the same standard to everyone.

Red flags

Avoided the conversation, or punished without looking at system causes.

Tell me about a nurse recruiting or retention program you built. What did it cost, and what did it return?

Behavioral · Nurse recruitment

Strong answer

A specific program, such as a CNA to LPN pathway, a school partnership or a new-graduate residency, with hires, retention and agency savings measured against cost.

Red flags

Describes an idea with no results or cost.

Walk me through how you'd build a nurse staffing plan for an ED and inpatient unit that share nurses.

Technical · Staffing plans

Strong answer

Uses ED arrivals by hour and inpatient census, acuity and skill mix, sets a safe minimum, defines float rules and the competencies to float, plans call-back, ties it to budgeted hours, and reviews it on a set schedule.

Red flags

Copies a fixed ratio from another hospital without looking at our data.

This morning Nursys shows a night-shift RN's license as expired, and that nurse is on tonight's schedule. What do you do?

Situational · License verification

Strong answer

Confirms with the state board as the primary source, calls the nurse, takes them off the schedule until the license shows active, tells the CNO and house supervisor so the shift is covered, documents, and fixes the tracking gap.

Red flags

Lets the nurse work on a promise that the renewal is in process.

The monthly OIG exclusion check flags a name that matches one of our housekeepers. What happens next?

Situational · Exclusion screening

Strong answer

Verifies identity with the OIG's verification step before acting, and if it's a true match removes the person from work, brings in compliance or counsel, and reviews any repayment duty.

Red flags

Fires the person on a name match alone, or ignores the hit.

Tell me about a time you filled hard-to-fill frontline jobs, such as aides or housekeepers, in a small or rural market. What worked?

Behavioral · Rural recruiting

Strong answer

Specific sources such as schools, referrals and local events, an offer that addressed housing, drive time or schedule, and results like time to fill and whether the hire stayed.

Red flags

Posted on job boards and waited.

Tell me about a workplace investigation you led. How did you make sure it was fair?

Behavioral · Employee relations

Strong answer

Started promptly, interviewed all sides, documented, kept it confidential, protected against retaliation, made a decision consistent with past cases, and used counsel when needed.

Red flags

Decided before interviewing anyone, or kept no notes.

A nurse asks for a schedule change because of a medical condition. Walk me through your process.

Technical · Accommodation process

Strong answer

Starts the interactive process under the ADA, asks only for documentation of the limits and need, keeps it in a separate confidential file, explores options with the manager, considers FMLA, and documents the decision.

Red flags

Denies it because of staffing, or tells the manager the diagnosis.

Walk me through how you'd cut agency and traveler spend without hurting patient safety.

Technical · Agency spend

Strong answer

Maps where and when gaps happen, checks pay against the market for those shifts, builds an internal float or PRN pool, adds incentive shifts and pipelines, and tracks results with the CNO and CFO.

Red flags

Proposes cancelling agency contracts with no plan to cover the shifts.

Month-end is three days away, and the discharged-not-final-billed report has jumped. Most holds are unsigned provider notes and missing swing bed authorizations. Walk me through your first two days.

Situational · Clearing billing holds

Strong answer

Sorts holds by dollar value and cause, gives each group an owner, escalates unsigned notes through health information and medical staff leaders, works authorizations with case management, and checks the report daily. Plans an upstream fix after close.

Red flags

Works the list alone oldest-first, or releases claims before the missing piece is fixed.

A Medicare Advantage plan has started denying swing bed days as not medically necessary, and several of those patients are still in our beds. What do you do?

Situational · Payer problems

Strong answer

Pulls the denials and the contract terms, works with case management on concurrent review and authorizations, appeals with clinical records, escalates to the plan's provider rep, and briefs the CFO on the pattern and the dollars at risk.

Red flags

Writes the days off or bills the patients without appealing or telling anyone.

Tell me about a denial trend you traced back to its root cause. What did you find, and what changed?

Behavioral · Denial root cause

Strong answer

Names the payer and denial reason, pulled the data by department or registrar, found the upstream cause, fixed the process with that department, and showed denials dropped afterward.

Red flags

Wrote appeals one by one without fixing the source, or blames the payer for everything.

Walk me through what you check before a swing bed claim goes out.

Technical · Critical access hospital billing

Strong answer

The qualifying hospital stay and dates, the swing bed admission order, documented skilled need, payer approval for Medicare Advantage plans, the right swing bed bill type and room charges, and benefit days used.

Red flags

Treats it like any inpatient claim, or can't name what makes swing bed billing different.

Tell me about a time a registrar or biller on your team kept making errors that hurt cash. What did you do?

Behavioral · Coaching staff

Strong answer

Showed the person the error data, found whether it was training, workload or system, retrained, audited their work for several weeks, and documented. Moved to formal steps only when coaching didn't work.

Red flags

Fixed the errors personally and said nothing, or went straight to discipline without data.

A patient complaint reaches the CEO: the patient got a collection letter while their financial assistance application was still being reviewed. How do you handle it?

Situational · Patient billing complaints

Strong answer

Stops collection on the account, apologizes and updates the patient in writing, finds out why the account wasn't on hold, fixes the hold rule with the team, and checks other open applications for the same gap.

Red flags

Fixes this one account only, or blames the collection agency without changing anything.

At [2] a.m., the ED is holding an admission, the inpatient unit is full for its one nurse, and the night LPN just called in. Walk me through your next hour.

Situational · After-hours staffing

Strong answer

Checks acuity, works the call-in list and incentives, floats staff or takes an assignment, considers transfer if the hospital can't staff safely, calls the administrator on call per policy, and documents.

Red flags

Admits without a safe staffing plan and no escalation, or leaves it for the morning.

The provider decides a patient having a heart attack needs transfer. The receiving hospital is slow to call back, and weather has grounded the helicopter. What do you do?

Situational · Transfers

Strong answer

Pushes for a direct physician-to-physician call, tries other receiving hospitals, books critical care ground transport, makes sure treatment continues, completes the transfer paperwork and certification, and logs times.

Red flags

Waits for a callback, or sends the patient without an accepting physician.

A long-term swing bed patient dies during the night. Walk me through what you do and who you call.

Situational · Death and organ donation

Strong answer

Supports the family, makes sure death is pronounced per policy, calls the organ procurement organization as policy requires for every death, notifies the coroner if criteria apply, arranges post-mortem care, and documents.

Red flags

Forgets the organ procurement call, or handles paperwork without supporting the family.

Walk me through what has to be in place when a patient is restrained for violent behavior at night.

Technical · Restraint rules

Strong answer

Tries less restrictive options first, gets a provider order (never as-needed), ensures the face-to-face evaluation happens within the time CMS and policy require, monitors and documents on schedule, and removes restraints as soon as it's safe.

Red flags

Treats restraint as routine, or can't name the order and monitoring rules.

Tell me about a time you had to make a serious call with no manager to ask. What did you decide, and how did it turn out?

Behavioral · Decisions without a manager

Strong answer

A specific situation, the reasoning and policy behind the decision, who they informed after, and what they learned.

Red flags

Avoided deciding and waited for someone else, or acted with no regard for policy.

Tell me about a time a nurse refused an assignment you gave. How did you handle it?

Behavioral · Handling pushback

Strong answer

Listened for a real safety concern, adjusted or explained the reasoning, documented, and followed the chain of command if it stayed unresolved.

Red flags

Pulled rank without listening, or gave in without assessing.

Your night tech calls: chemistry QC failed twice, and the ED is waiting on a stat troponin. What do you tell them?

Situational · Quality control decisions

Strong answer

Don't report patient results on that analyzer. Troubleshoot reagent and calibration, use a validated backup or send-out, tell the ED about the delay, review patient results since the last good QC, and document.

Red flags

Releases the result and plans to fix QC later.

Walk me through what you do after a proficiency testing failure.

Technical · Proficiency testing

Strong answer

Investigates the cause (clerical, method, QC or specimen handling), checks for patient impact, takes and documents corrective action, reviews it with the laboratory director, and knows repeat failures can stop testing under CLIA.

Red flags

Blames the sample and files the result without an investigation.

How do you run CLIA competency assessments for a tech who works in several departments?

Technical · Competency assessment

Strong answer

Uses all six CLIA elements for each test system, twice in the first year and yearly after, done by a qualified assessor and documented so an inspector can follow it.

Red flags

Uses a single quiz or sign-off sheet for everything.

Tell me about a time you kept a lab covered while short-staffed. What tradeoffs did you make?

Behavioral · Coverage tradeoffs

Strong answer

Specific steps such as cross-training, a fair call schedule, sending out low-priority tests, working the bench personally, and watching for burnout.

Red flags

Worked every gap alone with no plan, or let QC slip to keep up.

Tell me about an inspection finding in a lab you ran or worked in. What caused it, and how was it fixed?

Behavioral · Inspection follow-up

Strong answer

Owns the finding, names the root cause, and describes a system fix that held up at the next inspection.

Red flags

Says there were none, or blames the inspector.

An ED nurse calls, frustrated that stat results are slow every night. How do you respond?

Situational · Turnaround complaints

Strong answer

Pulls turnaround data by step (collection, transport, receipt and testing), finds the bottleneck, fixes it with the ED where it's on their side, and reports back.

Red flags

Defends the lab without looking at data.

Falls on your unit doubled this quarter, and two caused injuries. What do you do this week?

Situational · Fall prevention

Strong answer

Reviews each fall (time, risk score, what was in place), holds staff huddles, puts quick fixes in place such as toileting rounds and bed alarms, audits them, and reports to the CNO.

Red flags

Re-educates everyone in general terms without looking at the events.

Tell me about a nurse whose performance you turned around. What did you do?

Behavioral · Coaching staff

Strong answer

Clear expectations, specific feedback, support such as a preceptor or training, a timeline, follow-up, and the result.

Red flags

Avoided the issue until it became a firing, or can't give an example.

Tell me about a time you built a schedule staff felt was fair. How did you do it?

Behavioral · Fair schedules

Strong answer

Clear rules for weekends, holidays and requests, applied the same way to everyone, shared openly, and kept within budget.

Red flags

Favors certain staff, or makes the schedule without explaining the rules.

A family files a written grievance saying their mother waited an hour for help to the bathroom. How do you handle it?

Situational · Grievances

Strong answer

Acknowledges it quickly, investigates with call light data, staffing and interviews, responds in writing within the grievance policy's timeline, and fixes what caused the delay.

Red flags

Offers a verbal apology and closes it.

Walk me through how you audit charts for fall and skin risk, and what you do with the results.

Technical · Chart audits

Strong answer

Pulls a regular sample, checks that Morse and Braden scores are on time and that the precautions match the scores, gives individual and unit feedback, and re-audits.

Red flags

Doesn't audit, or audits without feedback.

You're over your overtime budget, and your best nurses are picking up most of it. What do you do?

Situational · Overtime budget

Strong answer

Finds what's driving the overtime, fills vacancies, builds a PRN or float pool, watches for burnout in those nurses, and gives the CNO a plan.

Red flags

Bans overtime without a plan to cover shifts.

The emergency generator fails its monthly load test. What do you do?

Situational · Generator failure

Strong answer

Tells the CEO and nursing leaders, puts interim safety measures in place, arranges a temporary generator if needed, gets the repair and retest done, and documents for the survey record.

Red flags

Plans to retest later without telling anyone.

Walk me through how you keep the hospital ready for a CMS life safety survey.

Technical · Life safety surveys

Strong answer

Current records for fire drills on every shift, generator, fire alarm, sprinkler, fire door and medical gas testing, regular walk-throughs, a deficiency log with fixes, and interim measures when a system is down.

Red flags

Gets ready only when a survey is expected.

Walk me through how you plan an emergency preparedness exercise.

Technical · Emergency preparedness

Strong answer

Chooses a scenario from the hazard vulnerability assessment, includes community partners, runs it, writes an after-action report, and tracks the fixes, meeting the Conditions of Participation.

Red flags

Runs the same drill every year and files it.

Tell me about a contractor whose work didn't meet your standard. What did you do?

Behavioral · Managing contractors

Strong answer

Documented the problem, held them to the contract, required a fix, and changed how they choose or check contractors.

Red flags

Accepted the work or fixed it in-house without addressing it.

Tell me about a time you made the case for a capital repair to leaders who wanted to spend the money elsewhere.

Behavioral · Capital planning

Strong answer

Showed risk, failure history, survey exposure and cost of waiting, offered options, and describes the outcome.

Red flags

Asked for money without data, or gave up after the first no.

A Legionella test from the water management plan comes back positive on the inpatient unit. What do you do?

Situational · Water safety

Strong answer

Follows the plan's corrective steps, brings in the infection preventionist right away, starts remediation, restricts water use if the plan calls for it, retests, and documents.

Red flags

Retests and waits for the result before doing anything.

One of your three technologists resigns, and the other two are already worn out by call. What do you do?

Situational · Call coverage

Strong answer

Short term: PRN or locum coverage, takes call personally, and shares call fairly. Long term: recruits through schools, reviews call pay and schedules, and cross-trains.

Red flags

Splits the extra call between the two remaining techs with no plan.

What do you keep ready for a state radiation control inspection?

Technical · Regulatory readiness

Strong answer

Equipment registrations, physicist surveys, dosimetry records and reviews, QC logs, technique charts, operator credentials and CT dose protocols.

Red flags

Can't name what inspectors review.

The teleradiology group's overnight read times have slipped, and the ED is waiting on CT reads for possible strokes. What do you do?

Situational · Vendor performance

Strong answer

Pulls turnaround data, holds the vendor to the contract terms, escalates, sets a workaround with the ED, and uses the record when renewing the contract.

Red flags

Complains to the vendor without data or follow-up.

Tell me about an equipment purchase you led. How did you make the case and choose the vendor?

Behavioral · Equipment decisions

Strong answer

Volume and downtime data, total cost of ownership, service terms, input from techs and radiologists, and a clear case to finance.

Red flags

Picked on price alone or on a sales demo.

Tell me about a technologist whose image quality or safety practice you had to correct.

Behavioral · Correcting practice

Strong answer

Used specific examples, retrained, followed up with audits, and documented.

Red flags

Let it slide because the tech was needed on call.

How do you review CT dose and decide when a protocol needs to change?

Technical · CT dose

Strong answer

Tracks CTDIvol and DLP against national reference levels, reviews outliers with the physicist and radiologist, adjusts protocols, and pays special attention to pediatric protocols.

Red flags

Doesn't monitor dose or relies only on the vendor's defaults.

The phone is ringing, a call light is on, a family is at the desk, and the nurse needs a transfer packet copied before the ambulance arrives in [15] minutes. What do you do first?

Situational · Prioritizing at the desk

Strong answer

Routes the call light to a nurse or tech right away, asks the caller and family to hold briefly, and finishes the transfer packet because the ambulance won't wait.

Red flags

Handles everything in the order it arrived, or lets the call light go unanswered.

A caller says they're the patient's son and asks how the patient's procedure went. How do you handle it?

Situational · Privacy on the phone

Strong answer

Follows the privacy policy, such as checking the patient's contact list or passcode, shares nothing clinical, and takes a message for the nurse.

Red flags

Shares details because the caller sounds like family.

Walk me through what goes into a transfer packet and how you make sure nothing is missing.

Technical · Transfer packets

Strong answer

Face sheet, transfer forms, provider notes, medication record, labs, images on disc or image share, advance directive and nursing notes, checked against a list, with what was sent logged and confirmed with the nurse.

Red flags

Copies whatever is in the chart with no checklist or log.

Tell me about a time you found a data entry mistake, yours or someone else's. How did you fix it?

Behavioral · Accuracy

Strong answer

Corrected it the proper way, told the person who needed to know, and changed a habit so it wouldn't repeat.

Red flags

Ignored it, or fixed it quietly in a way that hid the error.

Tell me about a time a busy coworker was short with you. How did you respond?

Behavioral · Working under pressure

Strong answer

Stayed calm, got the task done, and talked with the person later if it needed it.

Red flags

Snapped back or held a grudge.

While scanning, you notice a consent form for a procedure scheduled this morning is missing the patient's signature. What do you do?

Situational · Chart completeness

Strong answer

Tells the nurse right away, before the procedure, and doesn't file the form as complete.

Red flags

Scans it and moves on.

One note says 'pneumonia' and another says 'possible aspiration pneumonia.' Walk me through how you'd write the query.

Technical · Compliant queries

Strong answer

A non-leading query that cites the clinical indicators, offers clinically supported options plus 'other' and 'unable to determine,' and never mentions payment. Knows inpatient and outpatient rules for uncertain diagnoses differ.

Red flags

Picks the higher-paying code, or writes a query that suggests the answer.

How do you assign an ED facility level, and how do you keep levels consistent across coders?

Technical · ED facility levels

Strong answer

Uses the hospital's written facility criteria based on resources and interventions, not the provider's own level, and checks consistency through audits.

Red flags

Copies the provider's level, or goes by gut feel.

A provider hasn't answered your queries for weeks, and the charts are holding claims. What do you do?

Situational · Provider follow-up

Strong answer

Follows the escalation policy to the business office manager and medical staff leaders, talks with the provider about what would make queries easier, and tracks the backlog.

Red flags

Codes the chart by guessing what the provider meant.

A claim edit flags an ED visit level billed on the same day as a laceration repair. How do you work it?

Situational · Claim edits

Strong answer

Reviews the record for a significant, separately documented evaluation beyond the repair, adds the modifier only if the documentation supports it, and removes the visit level if it doesn't.

Red flags

Adds a modifier to clear the edit without reading the record.

Tell me about a coding audit finding on your work. What did you learn, and what did you change?

Behavioral · Learning from audits

Strong answer

Names the error, owned it, checked the guideline, and changed a habit or reference to prevent it.

Red flags

Argues the auditor was wrong without checking the guideline.

Tell me about a time you were asked to code something in a way you didn't think the record supported.

Behavioral · Coding integrity

Strong answer

Explained the guideline, documented the disagreement, and escalated to a manager or compliance instead of complying.

Red flags

Went along to avoid conflict.

A patient arrives in the ED doubled over in pain and first asks how much the visit will cost. What do you do?

Situational · EMTALA in registration

Strong answer

Gets the patient to triage first, says care comes before payment, and waits until after the medical screening to register fully and discuss costs.

Red flags

Quotes costs or collects insurance before the patient is seen.

Walk me through how you search for an existing record before creating a new one.

Technical · Preventing duplicate records

Strong answer

Searches by several identifiers such as name spellings, birth date and phone, checks likely matches carefully, and asks a lead before creating a new record when unsure.

Red flags

Creates a new record when the first search comes up empty.

A Medicare patient's outpatient order includes a test that may not be covered for the diagnosis listed. What do you do?

Situational · Medicare notices

Strong answer

Checks the medical necessity tool, gives an Advance Beneficiary Notice before the service, explains the choices in plain words, and gets the signature.

Red flags

Skips the notice, or tells the patient the test is covered.

Tell me about a time you had to ask a stressed person for money or paperwork. How did you handle it?

Behavioral · Collecting with care

Strong answer

Stayed calm and kind, explained why it was needed, offered options, and got it done without arguing.

Red flags

Pushed hard, or skipped the request to avoid discomfort.

Tell me about a time you found an insurance problem, such as an inactive plan or the wrong primary payer, before it turned into a denial.

Behavioral · Insurance accuracy

Strong answer

Explains how they caught it, such as an eligibility check or the Medicare Secondary Payer questions, contacted the patient for updated information, fixed the account, and noted what changed.

Red flags

Registered with the old information and left billing to sort it out.

It's [3] a.m., you're the only registrar, the main phone is ringing, and an ambulance patient just arrived. What do you do?

Situational · Working nights alone

Strong answer

Does a quick registration so care and orders aren't held up, puts the caller on a short hold or answers briefly, and completes the full registration after.

Red flags

Finishes the phone call first while the ambulance patient waits for a record.

You find a batch of claims close to the payer's timely filing limit, and they still have edits. What do you do?

Situational · Timely filing

Strong answer

Ranks them by deadline and dollar value, fixes the edits, submits, keeps proof of timely filing, tells the manager, and finds out why they sat.

Red flags

Works them in random order or lets them lapse.

Walk me through working a denial for missing prior authorization.

Technical · Authorization denials

Strong answer

Checks whether an authorization existed, requests a retro authorization if the payer allows, appeals with records, and sends the root cause to patient access.

Red flags

Writes it off or rebills without changes.

A remittance shows a partial payment with an adjustment code you don't recognize. What do you do?

Technical · Reading remittances

Strong answer

Looks up the CARC and RARC codes, compares the payment with the contract or fee schedule, appeals an underpayment or posts the correct adjustment, and notes the account.

Red flags

Adjusts the balance off without understanding the code.

A patient calls, confused about an ED bill, and says their insurance should have paid it. How do you handle the call?

Situational · Patient billing calls

Strong answer

Listens, reviews the claim and payer response, explains in plain words, fixes and resubmits if we made an error, bills any secondary, and offers financial assistance screening or a payment plan.

Red flags

Tells the patient to call their insurance and ends the call.

Tell me about an appeal you won. What made it work?

Behavioral · Appeals

Strong answer

Specific denial reason, the records and payer policy they cited, and a clear, organized letter.

Red flags

Can't name one or describes resubmitting without changes.

Tell me about a time a payer changed a billing rule and you had to adjust quickly. How did you find out, and what did you change?

Behavioral · Keeping up with payer rules

Strong answer

Found the change in a payer bulletin or portal notice, updated their checklist or claim edits, told teammates, and checked the next claims to make sure they paid.

Red flags

Learned about it only from denials, or kept billing the old way.

The IV start kits the ED uses go on backorder. What do you do?

Situational · Backorders

Strong answer

Checks stock across units, finds a substitute, gets clinical approval before switching, tells nursing what's changing, and tracks the backorder.

Red flags

Swaps products without clinical approval or without telling anyone.

An FDA recall arrives for a lot of urinary catheters. Walk me through your response.

Situational · Recall response

Strong answer

Checks every location, including unit supply rooms and carts, pulls and quarantines the lot, documents what was found and returned, tells nursing, and orders replacements.

Red flags

Checks only the main storeroom.

Walk me through how you set a par level for a supply on a nursing unit.

Technical · Par levels

Strong answer

Uses usage data, delivery frequency, lead time, safety stock and shelf space, then reviews and adjusts it regularly with the unit.

Red flags

Uses whatever amount the unit asks for.

Tell me about a time you saved money on supplies without upsetting the clinical staff who use them.

Behavioral · Cost savings

Strong answer

Brought clinicians into the decision, trialed the product, showed the savings and kept quality.

Red flags

Switched products to save money without asking users.

Tell me about a time you found a price or invoice error. What did you do?

Behavioral · Invoice accuracy

Strong answer

Matched the invoice to the contract price and receipt, got a credit, and fixed the item file so it wouldn't repeat.

Red flags

Paid it to keep things moving.

How do you set up a storeroom so it passes a survey?

Technical · Storage standards

Strong answer

Keeps supplies off the floor and below the sprinkler clearance fire code requires, separates clean and dirty, removes outside shipping boxes from clean areas, rotates stock, and checks dates.

Red flags

Stacks supplies wherever they fit.

A Medicare patient in observation plans to go to a nursing home for rehab and asks why their coverage might be different. What do you explain, and what do you do?

Situational · Observation status and notices

Strong answer

Confirms the status was reviewed against criteria, gives and explains the Medicare observation notice (MOON) in plain words, explains that observation time doesn't count toward the hospital stay Medicare requires for skilled nursing coverage, and lays out options so the patient can choose.

Red flags

Doesn't know how observation affects skilled nursing coverage, or tells the patient it will be covered.

Friday afternoon, a larger hospital refers a patient who needs IV antibiotics and therapy for a swing bed. The patient has a Medicare Advantage plan. How do you decide whether to accept?

Situational · Swing bed referrals

Strong answer

Gets the records, checks skilled need, the qualifying stay and plan authorization, confirms we can staff the IV and therapy needs with nursing, pharmacy and the provider, and answers the referring hospital the same day.

Red flags

Accepts without checking authorization or staffing, or leaves the answer until Monday.

Walk me through how you use [InterQual or MCG] when a patient's inpatient status is unclear.

Technical · Utilization review

Strong answer

Applies criteria to what's documented, treats criteria as a screen rather than the decision, sends unclear cases to the physician advisor, talks with the attending, and documents the review. Knows the status order is the physician's call.

Red flags

Changes status to suit the payer, or treats the criteria result as final without physician review.

Tell me about a discharge plan that fell apart on the day of discharge. What happened, and what did you change afterward?

Behavioral · Discharge planning

Strong answer

A specific case and cause, such as equipment not delivered or a family not ready, how the patient was kept safe that day, and a change that stuck, like earlier family meetings or confirming deliveries the day before.

Red flags

Blames another department, or describes no change in how they plan.

Tell me about a time a patient or family chose a discharge option you thought was risky. How did you handle it?

Behavioral · Patient choice

Strong answer

Explained the risks plainly, respected the patient's decision, gave the choice list, built in safeguards like home health or a follow-up call, and documented the conversation.

Red flags

Steered the family to a favored agency, or overrode the patient's choice.

How do you track which Medicare notices are due, and how do you show they were delivered?

Technical · Medicare notices

Strong answer

Reviews the census daily, delivers the Important Message at admission and again before discharge within Medicare's windows, gives the Medicare observation notice (MOON) to qualifying observation patients, gets signatures, tracks them in a log or EHR flag, and trains weekend backup.

Red flags

Relies on memory or assumes nursing handles notices, with no way to show delivery.

A tray ticket says 'peanut allergy,' and the dessert on the line has a nut topping. The cook is busy. What do you do?

Situational · Allergy safety

Strong answer

Stops the tray, swaps in a safe dessert, tells the lead cook, and rechecks the whole tray against the ticket.

Red flags

Scrapes off the topping, or sends the tray because the cook is busy.

You bring a breakfast tray to a patient whose door has an NPO sign. The patient says they're starving and asks you to leave it. What do you do?

Situational · Following diet orders

Strong answer

Kindly explains they can't leave food yet, takes the tray back, and tells the nurse right away that the patient is asking for food.

Red flags

Leaves the tray because the patient asked.

During your morning log, the walk-in cooler reads warmer than the safe range. What do you do?

Situational · Food temperatures

Strong answer

Tells the lead right away, checks with a second thermometer, keeps the door shut or moves food, logs the real reading, and follows the policy on what to throw out.

Red flags

Writes down a normal number, or ignores it until someone else notices.

Tell me about a time at work, school or volunteering when you worked with a team to get something done on time. What was your part?

Behavioral · Teamwork

Strong answer

Names their own part, how they kept others informed, how they stepped in when someone fell behind, and the result.

Red flags

Talks only about what others did wrong, or finished their own part and left.

Tell me about a rush at work, school or volunteering when you had to move fast. How did you keep from cutting corners?

Behavioral · Speed without shortcuts

Strong answer

Names the rush, the checks they kept doing, and how they asked for help or split the work.

Red flags

Admits skipping steps to keep up and sees no problem with it.

How do you make sure a tray goes to the right patient when you deliver it?

Technical · Patient identification

Strong answer

Checks two identifiers, such as name and birth date, on the wristband against the ticket, confirms the diet matches, and asks the nurse when anything doesn't match.

Red flags

Goes by room number or the name on the door.

You're about to clean a discharge room with a C. diff isolation sign on the door. Walk me through how you clean it.

Situational · Isolation room cleaning

Strong answer

Puts on the PPE the sign calls for, uses the sporicidal product the policy names, keeps surfaces wet for the full contact time, works high to low and clean to dirty, changes the curtain, and washes hands with soap and water after.

Red flags

Uses the regular wipe, wipes surfaces dry right away, or skips PPE.

The ED calls for a stat room turnover while you're halfway through a discharge clean upstairs. What do you do?

Situational · Competing priorities

Strong answer

Tells the supervisor or the unit, leaves the upstairs room marked not ready, goes to the ED, and still uses full contact times there.

Red flags

Leaves without telling anyone, or rushes the ED room and skips steps.

Explain what disinfectant contact time is and how you make sure you meet it.

Technical · Disinfectant use

Strong answer

The surface has to stay wet for the time on the label to kill germs. Reads the label, uses enough product, and rewets a surface that dries early.

Red flags

Hasn't heard of contact time, or thinks wiping is enough.

While collecting trash on a unit, you see a used needle poking through a regular trash bag. What do you do?

Situational · Sharps and waste safety

Strong answer

Doesn't reach in, squeeze the bag or carry it against their body, keeps others away, moves the needle to a sharps container with tongs or calls the supervisor per policy, and tells the charge nurse.

Red flags

Pushes the bag down to make room, or handles it bare-handed and says nothing.

Tell me about a time at work, school or volunteering when you had to do your job in someone's personal space, like their room or home. How did you make them comfortable?

Behavioral · Courtesy in patient rooms

Strong answer

Knocked and introduced themselves, said what they were there to do, asked before moving belongings, worked quietly, and asked if the person needed anything before leaving.

Red flags

Worked around the person without speaking, or moved their things without asking.

Tell me about a job or task where you had to follow the same steps every time, even when no one was watching.

Behavioral · Following procedures

Strong answer

A specific example, why the steps mattered, and how they kept doing them when tired or busy.

Red flags

Admits to shortcuts when unsupervised.

Three inpatients test positive for C. diff in the same week. What do you do?

Situational · Cluster response

Strong answer

Checks whether each case meets the hospital-onset definition, reviews testing practice, confirms contact precautions, sporicidal cleaning and soap-and-water hand hygiene, reviews antibiotic use with the pharmacist, audits cleaning, and reports if it meets outbreak rules.

Red flags

Orders more cleaning and stops there, or doesn't check whether the cases are hospital-onset.

Next month a contractor will tear out a wall to expand the lab, right next to occupied patient rooms. What do you need in place before work starts?

Situational · Construction risk

Strong answer

An ICRA based on the type of work and the patients nearby, with sealed barriers, negative air or HEPA filtration, dust control, routes and timing agreed before work starts, then regular checks on site.

Red flags

Signs off without visiting the site, or treats it as plant operations' problem alone.

Walk me through how you decide whether a urinary infection counts as catheter-associated for surveillance.

Technical · Surveillance definitions

Strong answer

Applies the CDC NHSN criteria exactly: catheter timing, symptoms and culture results, and whether it was present on admission. Applies them the same way even when a clinician calls it something else.

Red flags

Counts any positive urine culture, or goes by the doctor's diagnosis.

Tell me about a time you improved hand hygiene or another practice staff were tired of hearing about.

Behavioral · Changing staff practice

Strong answer

Used observation data by unit, gave quick feedback, recruited peer champions, removed barriers like sanitizer placement, and kept measuring after the push ended.

Red flags

Put up posters and ran an in-service, with no data.

Tell me about a time you told a physician or senior leader they weren't following an infection control rule.

Behavioral · Speaking up to leaders

Strong answer

Spoke directly and respectfully, privately when possible, cited the rule and the risk, and followed up to make sure it changed.

Red flags

Let it go because of the person's rank.

An ED nurse calls you at night after a needlestick from a patient. What do you tell them, and what happens next?

Situational · Staff exposures

Strong answer

Wash the site now and get evaluated right away, since post-exposure treatment is time-sensitive. Arranges source patient testing under state consent rules, documents for the OSHA log, sets follow-up testing, and reviews the sharps device.

Red flags

Tells the nurse to wait for employee health in the morning.

A swing bed patient who was alert at breakfast is now confused and having trouble finding words. What do you do?

Situational · Change in condition

Strong answer

Stays with the patient and calls for help, checks vital signs and blood glucose, recognizes possible stroke signs, and alerts the RN right away with SBAR because time matters.

Red flags

Assumes it's normal confusion, charts it, and waits for the next round.

The RN asks you to do a task you aren't sure is within LPN scope in this state. How do you decide?

Technical · Scope of practice

Strong answer

Checks the state nurse practice act or board guidance and hospital policy, considers their own training, asks the RN or manager, and respectfully declines if it's outside scope.

Red flags

Does it because the RN asked.

Walk me through a shift-change controlled-substance count, and what you do if it's off by one tablet.

Technical · Controlled substances

Strong answer

Counts with another licensed nurse, both verify, doesn't sign until it reconciles, rechecks records and recent wastes, reports to the charge nurse and pharmacist right away, and both stay until it's resolved.

Red flags

Signs the count and plans to sort it out later.

During your med pass, the barcode scanner rejects a medication. The patient says it's the same pill they take at home. What do you do?

Situational · Medication safety

Strong answer

Doesn't override. Checks the order, drug and dose, calls pharmacy, and gives the medication only once the mismatch is resolved.

Red flags

Overrides the scanner because the patient recognizes the pill.

Tell me about a time a patient's family member was unhappy with the care their loved one was getting. What did you do?

Behavioral · Working with families

Strong answer

Listened without getting defensive, fixed what they could right away, brought in the RN or charge nurse for the rest, and checked back with the family before the shift ended.

Red flags

Argued, blamed coworkers, or avoided the family.

Tell me about a patient you cared for over several weeks. How did you help them make progress?

Behavioral · Longer-stay care

Strong answer

Noticed small changes, encouraged the walking and self-care goals therapy set, shared progress with the team, and built trust with the patient and family.

Red flags

Describes only tasks completed, with no sense of the patient's goals.

At night you call a critical result to a nurse, who says they'll pass it on and hangs up before reading it back. What do you do?

Situational · Critical value calls

Strong answer

Calls back, gets the read-back from the responsible nurse or provider, documents the name and time, and follows the escalation policy if no one takes it.

Red flags

Documents the call as complete without a read-back.

A potassium result comes back high, and the specimen looks hemolyzed. Walk me through what you do.

Technical · Specimen quality

Strong answer

Checks the hemolysis index, knows hemolysis falsely raises potassium, doesn't report the value as real, asks for a recollection, notes it on the report and tells the nurse.

Red flags

Reports the value, or calls it as a critical without checking.

The ED needs blood right now for a trauma patient, before a type and screen is done. What do you do?

Situational · Emergency blood release

Strong answer

Follows the emergency release procedure for uncrossmatched units, gets the physician's signed request (policy may allow it after release), asks for a pre-transfusion sample as soon as possible, finishes testing after, and documents.

Red flags

Refuses to release blood until testing is done, or skips the release paperwork.

Walk me through collecting a legal blood alcohol specimen.

Technical · Chain of custody

Strong answer

Uses the chain of custody form, a non-alcohol skin prep, a witnessed collection, sealed and initialed tubes, locked storage, and a signature at every handoff.

Red flags

Treats it like a routine draw.

Tell me about a shift when you were the only tech on and work piled up. How did you prioritize?

Behavioral · Working alone

Strong answer

Ran stat and ED work first, told units about delays, kept QC and documentation intact, and handed off clearly.

Red flags

Skipped QC or documentation to catch up.

Tell me about an error you caught in the lab before a result went out.

Behavioral · Catching errors

Strong answer

A specific catch, such as a delta check, a labeling mismatch or a QC trend, how they fixed it, and who they told.

Red flags

Can't recall one, or fixed it without telling anyone.

It's [2] a.m., you're the only provider in the building, and a patient's ECG shows a STEMI. Walk me through your first [30] minutes.

Situational · Emergency care as sole provider

Strong answer

Starts protocol treatment, calls the receiving PCI center early, weighs fibrinolytics if transfer can't happen within guideline times, calls the on-call physician per bylaws, and completes transfer certification and paperwork.

Red flags

Waits for a consult before starting treatment, or sends the patient without an accepting physician.

Overnight, a swing bed patient develops fever, low blood pressure and new confusion. What do you do?

Situational · Recognizing sepsis

Strong answer

Recognizes possible sepsis, orders cultures, lactate, fluids and early antibiotics per protocol, reassesses, checks goals of care, decides on transfer, and updates the family.

Red flags

Treats the fever and plans to reassess in the morning.

Tell me about a case where you decided a patient needed more than you could safely provide. How did you decide?

Behavioral · Knowing limits

Strong answer

Specific findings that crossed their privileges or the hospital's capability, who they called, how the transfer went, and what they documented.

Red flags

Says they've never needed help, or describes waiting too long.

Walk me through what a medical screening exam has to establish before you discharge or transfer an ED patient.

Technical · EMTALA screening

Strong answer

Whether an emergency medical condition exists. If it does, stabilize within our capability or transfer appropriately with certification, never delay for insurance, and document the reasoning.

Red flags

Confuses triage with the medical screening exam, or doesn't know the transfer rules.

Tell me about a time you disagreed with a collaborating physician or specialist about a patient's plan.

Behavioral · Collaboration

Strong answer

Raised it with findings and evidence, kept the patient at the center, escalated respectfully when needed, and documented.

Red flags

Stayed silent, or turned it into a personal conflict.

A patient you don't know asks for an early opioid refill in the ED, saying their clinic is closed. How do you handle it?

Situational · Controlled substance prescribing

Strong answer

Checks the state prescription monitoring program and records, assesses the pain, offers safe options, follows policy, documents, and connects them with their prescriber, without judging.

Red flags

Refuses without assessing, or prescribes without checking the monitoring program.

During afternoon vital signs, a patient's blood pressure is much lower than this morning, and they say they feel dizzy. What do you do?

Situational · Reporting changes

Strong answer

Keeps the patient seated or in bed, rechecks the reading, tells the RN right away, and stays until the nurse arrives.

Red flags

Charts the number and moves on to the next room.

A confused patient keeps trying to climb out of bed, and the nurse is busy with an admission. What do you do?

Situational · Fall safety

Strong answer

Stays with the patient, lowers the bed, uses the alarm, offers the bathroom, reorients them calmly, calls for help, and tells the RN. Doesn't restrain the patient.

Red flags

Ties the patient down or leaves to finish other tasks.

Walk me through labeling a blood specimen after you draw it.

Technical · Specimen labeling

Strong answer

Checks two identifiers with the patient and wristband, labels at the bedside right after the draw, adds initials and time, and never pre-labels tubes.

Red flags

Labels tubes at the nurses' station or before the draw.

Tell me about a time at work, school or volunteering when you noticed something was wrong and spoke up.

Behavioral · Speaking up

Strong answer

Names a specific problem, such as a safety risk or a change in someone in their care, told the right person right away with clear facts, and followed up.

Red flags

Kept quiet to avoid trouble, or told only coworkers.

Tell me about a time you helped someone with a personal or private task. How did you protect their dignity?

Behavioral · Dignity in personal care

Strong answer

Explained what they were doing, kept the person covered, gave choices, and moved at the person's pace.

Red flags

Focuses on finishing fast with no thought for privacy.

While helping with a bath, you see a new red area on the patient's tailbone that stays red when you press it. What do you do?

Situational · Skin care

Strong answer

Tells the RN, repositions the patient off the area, doesn't rub it, and follows the turning schedule.

Red flags

Rubs lotion into the spot or doesn't mention it.

You arrive to take a patient to X-ray. The name on the request matches the room, but the birth date on the wristband doesn't. What do you do?

Situational · Patient identification

Strong answer

Stops and doesn't move the patient, tells the nurse, and waits until the order and identity are cleared up.

Red flags

Moves the patient because the room and name match.

Halfway to imaging, you notice the patient's oxygen tank is nearly empty. What do you do?

Situational · Oxygen safety

Strong answer

Gets the patient to the nearest wall oxygen or a full tank right away, calls the nurse or respiratory therapist, watches the patient, and checks tanks before every move after that.

Red flags

Keeps going and hopes it lasts.

Walk me through moving a patient from a bed to a stretcher safely.

Technical · Safe transfers

Strong answer

Explains the move to the patient, locks both brakes, matches heights, protects lines and tubes, uses a slide board or sheet, gets enough help, and raises the rails after.

Red flags

Pulls the patient by the arms, or skips the brakes.

Tell me about a time you helped someone who was scared or confused. What did you say or do?

Behavioral · Calming patients

Strong answer

Gives the words they used, explained each next step in simple terms, slowed down, and checked that the person felt safe before moving on.

Red flags

Rushed them, got frustrated, or ignored the fear.

Tell me about a time at work, school or volunteering when you had more requests than you could handle at once. How did you decide what to do first?

Behavioral · Handling many requests

Strong answer

Sorted by urgency, told people when they'd get help, and asked for backup when needed.

Red flags

Took them in random order without telling anyone about delays.

On the way to imaging, the patient says they're in a lot of pain and doesn't want the test. What do you do?

Situational · Patient concerns in transit

Strong answer

Stops somewhere safe, reassures the patient, and calls the nurse so the care team can respond. Doesn't force the trip.

Red flags

Ignores the complaint and finishes the trip.

A new enoxaparin order comes in for a swing bed patient whose kidney function has dropped. What do you do?

Situational · Order verification

Strong answer

Checks current creatinine clearance and weight, knows the dose must be lowered when clearance is severely reduced, reviews bleeding risk and other anticoagulants, calls the prescriber with a recommendation, and documents.

Red flags

Verifies the standard dose without checking kidney function.

Walk me through how you review dispensing cabinet reports for signs of drug diversion.

Technical · Diversion monitoring

Strong answer

Compares each user with peers, looks for frequent overrides, late or unwitnessed wastes, repeat discrepancies and removals for discharged patients, investigates under policy with HR, and reports theft or loss to the DEA and state board as required.

Red flags

Only reviews counts that come up wrong.

How do you keep sterile compounding compliant with USP <797> in a small hospital pharmacy?

Technical · Sterile compounding

Strong answer

Written procedures, garbing and aseptic technique competencies with gloved fingertip and media-fill tests, certified hoods and rooms, environmental monitoring, cleaning logs, and beyond-use dates assigned correctly.

Red flags

Describes technique only, with no testing, monitoring or documentation.

The wholesaler can't supply a key IV antibiotic for weeks. What do you do?

Situational · Drug shortages

Strong answer

Checks stock and use, picks alternatives with the medical staff, tells prescribers and nurses, updates order sets, conserves supply, and watches for errors from unfamiliar substitutes.

Red flags

Waits for the shortage to end, or substitutes without telling anyone.

Tell me about a time you challenged a prescriber's order. How did it go?

Behavioral · Challenging orders

Strong answer

Called with the specific concern and a recommendation, stayed firm on safety, documented, and escalated if needed.

Red flags

Verified it anyway to avoid conflict.

Tell me about an antibiotic stewardship change you led. What data did you use, and how did prescribers respond?

Behavioral · Antibiotic stewardship

Strong answer

Specific change, such as IV-to-oral switches or shorter courses, data like days of therapy, how they brought prescribers along, and the result.

Red flags

Describes stewardship in general terms with no change they made.

While restocking, you notice the same staff member's name on several recent discrepancies for one opioid. What do you do?

Situational · Spotting diversion signs

Strong answer

Resolves today's count by policy, doesn't confront or accuse anyone, reports the pattern to the pharmacist privately the same day, and sticks to facts in what they document.

Red flags

Ignores the pattern, or confronts the staff member or gossips about it.

Walk me through how you get ready to compound a sterile IV bag.

Technical · Aseptic technique

Strong answer

Garbs in the right order, does hand hygiene, cleans the hood, gathers and checks ingredients, keeps first air on critical sites, uses aseptic technique, labels, and holds the bag for the pharmacist's check.

Red flags

Skips garbing or cleaning steps, or can't describe them in order.

While filling a cabinet, you notice hydralazine is stored right next to hydroxyzine. What do you do?

Situational · Look-alike drugs

Strong answer

Scans or double-checks each item, separates the two, tells the pharmacist, and suggests labels or tall-man lettering.

Red flags

Relies on memory and leaves them side by side.

Tell me about a time a pharmacist caught an error in your work. What did you change?

Behavioral · Learning from checks

Strong answer

Names the error, owns it, and describes a specific habit they changed.

Red flags

Downplays it because the pharmacist caught it anyway.

Tell me about a time at work, school or volunteering when you had to keep track of many small details, such as counts, dates or lot numbers. How did you keep them right?

Behavioral · Tracking details

Strong answer

Names the task and a system they used, such as a checklist, log or scan check, and describes a mistake the system caught and how they fixed it.

Red flags

Relies on memory, or can't describe any way they check their own work.

While checking a code tray, you find a medication that will expire before the next scheduled check. What do you do?

Situational · Expiration checks

Strong answer

Replaces it now, updates the expiration log, checks other trays with the same lot, and tells the pharmacist.

Red flags

Leaves it because it hasn't expired yet.

A swing bed patient insists on going home alone next week, but they still need help getting up from the toilet. What do you do?

Situational · Discharge recommendations

Strong answer

Measures function objectively, asks about the home setup, recommends equipment and caregiver training, meets with the patient and family, gives the team an honest recommendation, respects the patient's choice, and documents the risk.

Red flags

Overrides the patient, or signs off without raising the safety risk.

Walk me through how you decide a swing bed patient still needs skilled therapy.

Technical · Skilled need

Strong answer

Looks at progress toward measurable goals and whether the care needs a therapist's skill. Knows Medicare can cover skilled maintenance even without improvement, and documents the skill clearly.

Red flags

Continues as long as the patient is willing, or stops only because progress slowed.

During gait training, your patient's heart rate jumps and they turn pale and sweaty. What do you do?

Situational · Safety during treatment

Strong answer

Stops, gets the patient seated or lying down safely, checks vital signs, calls the nurse or a rapid response, and documents before deciding whether to continue another day.

Red flags

Pushes through to finish the session.

Tell me about a time you taught nurses or aides a safer way to move a patient.

Behavioral · Teaching staff

Strong answer

Showed it at the bedside, had them practice, posted the method, and checked later that it stuck.

Red flags

Told them once and assumed they'd do it.

Tell me about a time a payer or auditor questioned your documentation. What did you learn?

Behavioral · Documentation

Strong answer

Names the gap, fixed it, and changed how they write notes to show skilled need and progress.

Red flags

Blames the payer and changed nothing.

How do you supervise a physical therapist assistant who is treating outpatients while you're on the inpatient unit?

Technical · Supervising assistants

Strong answer

Knows the state's supervision rules and Medicare's outpatient rules, stays reachable, sets the plan of care, reviews progress, and steps in for re-evaluations.

Red flags

Doesn't know the supervision rules.

At night, the medical gas alarm shows low oxygen pressure. What do you do?

Situational · Medical gas alarms

Strong answer

Checks the alarm panel and source, tells the house supervisor and respiratory therapy right away, confirms the reserve supply is working, calls the qualified vendor, and documents. Doesn't silence the alarm and walk away.

Red flags

Silences the alarm or tries repairs outside their qualifications.

Walk me through locking out an air handler before you work on it.

Technical · Lockout/tagout

Strong answer

Notifies affected areas, shuts it down, isolates every energy source, applies their own lock and tag, verifies zero energy by trying to start it, relieves stored energy, and follows the removal steps after.

Red flags

Flips the switch off without a lock or a check.

A nurse asks you to pop a ceiling tile in a patient hallway to check a leak right away. What do you do?

Situational · Infection control during repairs

Strong answer

Checks the ICRA requirements, uses a containment cart or dust control, coordinates with the infection preventionist when required, and keeps the opening short.

Red flags

Pops the tile with no dust control.

How do you check that an isolation room is under negative pressure, and what do you do if it isn't?

Technical · Isolation room pressure

Strong answer

Reads the monitor or does a tissue or smoke test at the closed door, logs it, and if it fails tells nursing and the infection preventionist right away, then checks the exhaust fan and dampers.

Red flags

Doesn't know how to check it.

Tell me about a repair you couldn't finish on your shift. How did you hand it off?

Behavioral · Handoffs

Strong answer

Left the area safe, wrote down what was done and what was left, told the next person directly, and updated the work order.

Red flags

Left it for someone to find.

Tell me about a time you found a problem on rounds before it caused a failure.

Behavioral · Preventive maintenance

Strong answer

A specific reading, sound or leak they noticed, what they did, and what it prevented.

Red flags

Only reacts to breakdowns.

An outpatient is scheduled for a lumbar spine X-ray and says they might be pregnant. What do you do?

Situational · Pregnancy screening

Strong answer

Follows the pregnancy policy, which may include a test, talks with the radiologist or ordering provider before going ahead, and documents.

Red flags

Does the exam anyway, or sends the patient home without telling the provider.

The ED calls you to a trauma patient on a backboard in a cervical collar. How do you get the images you need?

Situational · Trauma imaging

Strong answer

Keeps the collar on and the spine in line, uses portable and cross-table views per protocol, coordinates any move with the team, confirms identity, and protects staff with distance and aprons.

Red flags

Removes the collar or moves the neck for positioning.

Walk me through how you keep dose as low as reasonably achievable on a portable exam.

Technical · Radiation safety

Strong answer

Uses the right technique, tight collimation and distance, gives staff aprons or has them step away, announces the exposure, and avoids repeats by checking positioning first.

Red flags

Can't explain what drives dose, or repeats exams casually.

Tell me about an exam you had to repeat. What went wrong, and what did you change?

Behavioral · Image quality

Strong answer

Names the cause, such as rotation or motion, and a specific change in technique.

Red flags

Blames the patient or says they never repeat.

Tell me about a time you saw something on an image that worried you before the radiologist read it.

Behavioral · Urgent findings

Strong answer

Knew not to diagnose, but told the provider or radiologist right away per policy.

Red flags

Said nothing, or told the patient what they thought it was.

Walk me through sending images for a teleradiology read and making sure an urgent result reaches the provider.

Technical · Teleradiology

Strong answer

Checks the study is complete and matched to the right patient and order, adds clinical history, flags priority, confirms it was received, and follows up when the read is slow.

Red flags

Sends it and assumes someone will call.

You're the only RN in the ED at night. A patient walks in with chest pain while you're with a child who has a high fever. What do you do in the first few minutes?

Situational · ED triage

Strong answer

Triages the chest pain right away using ESI, starts the ECG and standing orders, alerts the provider, asks an LPN or tech to take vital signs on the child, and reassesses the child soon.

Red flags

Finishes with the first patient before seeing the chest pain patient.

A few hours after admission, a pneumonia patient is breathing faster, their oxygen level has dropped, and they seem more confused. Walk me through what you do.

Situational · Change in condition

Strong answer

Assesses at the bedside, applies oxygen per orders, gets full vital signs, screens for sepsis, calls the provider with SBAR, calls a rapid response if criteria are met, rechecks, and documents.

Red flags

Charts the change and waits for the next scheduled check.

Walk me through getting a patient ready for transfer to a tertiary center.

Technical · Transfers

Strong answer

Confirms the accepting physician and bed, checks the transfer certification and consent, gives nurse-to-nurse SBAR report, sends records and images, secures lines and medications, documents condition and time at departure, and updates the family.

Red flags

Hands the ambulance crew a stack of paper without a report or checklist.

Walk me through giving a unit of blood, from picking it up to finishing the transfusion.

Technical · Blood transfusion safety

Strong answer

Order and consent, baseline vitals, two-person bedside check of patient and unit, saline-only line with a filter, starts slowly and stays with the patient, watches for reaction signs, and stops and calls the provider and blood bank if one appears.

Red flags

Skips the two-person check, or keeps the transfusion running when a reaction appears.

Tell me about a time you went up the chain of command because you were worried about a patient.

Behavioral · Escalation

Strong answer

A specific case, the facts they gave in SBAR, how they escalated when the first call didn't resolve it, and the outcome.

Red flags

Has never escalated, or waited for someone else to act.

Tell me about a time you delegated care to an LPN or tech and had to follow up on how it went.

Behavioral · Delegation

Strong answer

Matched the task to the person's role and state rules, gave clear instructions and what to report back, checked the result, and kept the assessment and judgment as the RN's job.

Red flags

Delegated an assessment, or never delegates and falls behind.

A ventilated patient waiting for transfer suddenly triggers high-pressure alarms, and their oxygen level is falling. What do you do?

Situational · Ventilator emergencies

Strong answer

Takes the patient off the vent and bags with oxygen, works through displacement, obstruction, pneumothorax and equipment, checks tube position, suctions, and calls the provider right away.

Red flags

Silences the alarm or changes settings before checking the patient.

A COPD patient on BiPAP is getting drowsier, and the blood gas shows rising carbon dioxide. What do you do?

Situational · Noninvasive ventilation

Strong answer

Checks mask fit, leaks and synchrony, adjusts within protocol, tells the provider, gets ready for intubation and transfer, and repeats the gas.

Red flags

Turns up the oxygen and leaves.

Walk me through drawing and running an arterial blood gas.

Technical · Arterial blood gases

Strong answer

Verifies order and patient, checks collateral circulation per policy, uses a heparinized syringe, removes air bubbles, holds pressure on the site, runs the sample promptly with QC in range, and calls critical results.

Red flags

Skips the circulation check, leaves air bubbles, or lets the sample sit.

Tell me about a code or difficult airway you were part of. What was your role, and what would you do differently?

Behavioral · Codes and airways

Strong answer

Names their role, such as bagging, suction or setting up the vent, describes closed-loop talk with the team leader, and gives one concrete thing they'd do differently.

Red flags

Vague, or takes credit for everything with no lesson.

Tell me about a time you recommended a change in a patient's breathing treatment and the provider disagreed.

Behavioral · Recommending changes

Strong answer

Brought assessment data, explained the reasoning, listened, escalated if the patient was at risk, and documented.

Red flags

Dropped it, or argued without data.

How do you teach a patient going home on oxygen to use it safely?

Technical · Patient teaching

Strong answer

The prescribed flow, no smoking or open flames nearby, tubing trip hazards, safe tank storage, who to call with problems, and teach-back to confirm understanding.

Red flags

Hands over a pamphlet.

An intoxicated visitor in the ED waiting room starts yelling at the triage nurse. What do you do?

Situational · De-escalation

Strong answer

Approaches calmly, gives space, speaks low, listens, offers choices, keeps other people safe, calls for backup or police per policy if it escalates, and writes a report.

Red flags

Goes hands-on first, or argues back.

A behavioral health patient on a hold heads for the ED doors. What do you do?

Situational · Patient holds

Strong answer

Uses calm words to slow the patient, alerts the nurse and provider, positions to protect people, and uses physical holds only as trained and directed by policy. Calls the missing-patient code if the patient leaves.

Red flags

Tackles the patient, or lets them go without calling anyone.

Walk me through how you handle evidence or a patient's belongings when police are involved.

Technical · Chain of custody

Strong answer

Inventories items with a witness, bags, seals and labels them, logs every handoff with signatures, and stores them locked.

Red flags

Hands items over without a record.

Tell me about a time you calmed down someone who was angry or upset.

Behavioral · Calming people

Strong answer

Gives the words they used, such as naming the person's concern and offering a choice, kept a calm voice and a safe distance, and ended it without force or threats.

Red flags

Describes using force or threats first.

Tell me about an incident report you wrote. How did you make sure it was accurate?

Behavioral · Report writing

Strong answer

Wrote it the same shift, stuck to facts, quotes and times, and left out opinions.

Red flags

Wrote it days later from memory, or included guesses.

At night, someone knocks on a locked side door and says they're a nurse who forgot their badge. What do you do?

Situational · Access control

Strong answer

Doesn't open the side door, directs them to the monitored entrance, and verifies identity with the house supervisor or staff list before letting them in.

Red flags

Opens the door because they look like staff.