The Mock Code Interview Question: How to Talk Through a Clinical Scenario Without Freezing

"Walk me through how you'd manage a patient who just went into V-fib."

Your heart rate spikes. Your mind goes blank. You've run dozens of codes, but suddenly you can't remember what comes first.

This is the mock code interview question—and it trips up even experienced ICU APPs. Here's how to handle it like a pro.

Why Interviewers Ask Clinical Scenarios

They're not trying to trick you. They want to assess:

1. Clinical knowledge: Do you know ACLS/resuscitation protocols?
2. Critical thinking: Can you prioritize and adapt?
3. Communication: Can you articulate your thought process?
4. Composure: How do you handle pressure?
5. Team leadership: Do you understand code team dynamics?

The Structured Approach: Think Out Loud

The biggest mistake candidates make is trying to give a "perfect" answer. Instead, verbalize your thought process using this structure:

1. Confirm the Situation (5 seconds)

"First, I'd confirm pulselessness and unresponsiveness while calling for help and the crash cart."

2. Immediate Actions (10 seconds)

"I'd initiate high-quality CPR, get the patient on the monitor, and call a code."

3. Rhythm Identification (5 seconds)

"Once on the monitor, I'd identify the rhythm. You said V-fib, which is a shockable rhythm."

4. Protocol Execution (30 seconds)

Walk through ACLS systematically:

• "Charge the defibrillator to 200J biphasic"
• "Ensure everyone is clear, deliver shock"
• "Immediately resume CPR for 2 minutes"
• "Establish IV/IO access if not present"
• "First dose of epinephrine 1mg IV"
• "Consider reversible causes—the H's and T's"

5. Reassessment and Next Steps

"After 2 minutes, pause CPR briefly to reassess rhythm..."

The H's and T's: Your Interview Safety Net

If you blank on anything, fall back on the H's and T's. It shows systematic thinking:

H's:

• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo/hyperkalemia
• Hypothermia

T's:

• Tension pneumothorax
• Tamponade (cardiac)
• Toxins
• Thrombosis (pulmonary/coronary)

Say something like: "While continuing resuscitation, I'd be considering reversible causes. Given the clinical context, I'd particularly think about..."

Sample Mock Code Scenario With Model Answer

Interviewer: "You're called to a room where a post-op cardiac surgery patient is found unresponsive. The nurse says he was just talking five minutes ago. Walk me through your approach."

Strong Answer:

"I'd approach the bedside assessing responsiveness and checking for a pulse while calling for help and the crash cart. Given he was just talking, this is a sudden change.

[Pause] No pulse, unresponsive—I'm starting CPR immediately and asking the nurse to put him on the monitor.

Looking at the monitor—what rhythm do you want me to see?

[Interviewer: V-fib]

V-fib in a post-op cardiac patient—my immediate thought is coronary graft occlusion, but I'm not delaying defibrillation. I'd charge to 200J biphasic, ensure everyone is clear, and shock.

Right back into CPR. I'm asking someone to get IV access if we don't have it, drawing up epi, and getting a focused history. When did we last see a rhythm? What was the last set of vitals? Any chest tube output changes?

After 2 minutes, I'd pause CPR to check rhythm. If still V-fib, I'd shock again and give epinephrine 1mg IV. Next cycle, I'm adding amiodarone 300mg.

Given the post-cardiac surgery context, I'm keeping tamponade high on my differential. I'd ask about Beck's triad signs—JVD, muffled heart sounds—and check for chest tube patency. If there's any concern for tamponade, I'd want the CT surgery team at the bedside for emergent re-exploration.

I'm also thinking about mechanical causes—did the wire break, is there bleeding? But I'm not stopping quality CPR for diagnostics."

Common Follow-Up Questions

Be prepared for these curveballs:

"What if you can't get IV access?" "I'd go for IO access—proximal tibia or humeral head. Epi and amiodarone can both be given IO with similar efficacy."

"The patient has a DNR. What do you do?" "I'd verify the code status and what specific limitations exist. If it's truly a full DNR, I'd stop resuscitation and focus on comfort. If there's any ambiguity, I'd continue while clarifying."

"You're alone. No one else is coming. What do you do?" "I'd prioritize getting to a phone or pull cord to call for help, then start CPR. If there's an AED nearby, I'd use that. But in reality, I'd emphasize that codes require a team."

"After 30 minutes of resuscitation, the family asks to stop. The attending wants to continue. How do you handle this?" "This is a values and goals of care conversation. I'd want to understand the clinical context—is there a reversible cause we haven't addressed? What was the patient's stated wishes? I'd facilitate communication between the family and attending, but ultimately, the family's voice matters greatly here."

Body Language and Delivery Tips

How you say it matters as much as what you say:

• Maintain eye contact (not staring, but engaged)
• Speak at a measured pace (rushing = anxiety)
• Use hand gestures naturally (demonstrates leadership presence)
• Pause before answering (shows thoughtfulness, not hesitation)
• It's okay to say "Let me think for a moment"

What NOT to Do

• Don't freeze silently: Say "I'm thinking through this" rather than going quiet
• Don't skip ahead: Follow ACLS sequentially
• Don't be a cowboy: Acknowledge team-based care
• Don't argue about minutiae: If they correct you, adapt and continue
• Don't apologize excessively: Confidence matters

Practice Makes Competent

Before your interview:

1. Review ACLS algorithms (not just read—say them out loud)
2. Practice with a colleague or spouse
3. Record yourself and review
4. Do at least 3-5 practice scenarios
5. Review your institution's specific protocols

The Bottom Line

Clinical scenario questions aren't about perfection—they're about demonstrating you can think systematically under pressure, communicate clearly, and lead a team. Verbalize your reasoning, follow established algorithms, and show you can adapt.

You've run codes before. This is just talking through one—and you've got this.