Skills

Question 1

1 Hand Hygiene (Hand Washing)

Answer 1

• Skill to be done at the sink
• Keep hands lower than elbows
1. Address client by name
2. Introduces self to client by name
3. Turns on water at sink
4. Wet hands thoroughly
5. Wet wrists thoroughly
6. Applies soap to hands
Lathers all surfaces of hands producing friction for at least 20 seconds
7. Wrists
8. Hands
9. Fingers
10. Keeps hands lower than elbow, fingertips down
11. Cleans fingertips by rubbing against palms of hands
Rinse - keeping hands lower than elbow, fingertips down
12. Wrists
13. Hands
14. Fingers
Use clean, dry paper towels to dry all surfaces of
15. Wrists
16. Hands
17. Fingers
18. Disposes of paper towels in waste basket
19. Then uses clean, dry paper towel to turn off faucet
20. Disposes of paper towel in waste basket
21. Does not touch inside of sink at any time

Question 2

2 Applies One Knee-High Elastic Stocking

Answer 2

• Skill is done at the Manikin Station
1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen, or door
3. Client is in supine position (lying flat in bed) while stocking is applied
4. Turns stocking inside-out, at least to the heal
5. Places foot of stocking over toes, foot, heel, and leg
6. Pulls top of stocking over foot, heel, leg
7. Moves foot and leg gently and naturally, avoiding force and over-extension of limb and joints
Finishes procedure with:
8. No twists or wrinkles in the stocking
9. With heel of stocking centered over heel of foot
10. With opening of toe area either over or under toe area
11. Signaling device is within reach
12. Bed is in low position
13. After competing skill, washes hands

Question 3

3 Assists to Ambulate Using Transfer Belt

Answer 3

•Evaluator will tell the destination

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

Before assisting to stand the following steps must be done: (*may be done in any order)

2. *“Bed is at a safe level” for client to get up
3. *Checks and/or locks bed wheels
4. *Client is assisted to a sitting position with feel flat on the floor
5. *Client is wearing shoes
6. *Puts on gait belt securely at waist over clothing
7. Provides instructions to enable client to assist in standing including prearranged signal to alert client to standing
8. Stands facing client positioning self to ensure safety of candidate and client during transfer
9. Counts to three (or prearranged signal) to alert client to begin standing
10. On signal, gradually assist client to stand by grasping transfer belt on both sides with an upward grasp (candidates hands are in an upward position)
11. On signal, gradually assist client to stand by maintaining stability of clients legs (your knee touching their knee)
12. Walks slightly behind and to one side of client for a distance of (10) feet while holding onto the belt. (fingers, hand pointing up)

After ambulation:

13. Assists client to bed (okay to leaving sitting)
14. Removes transfer belt
15. Signaling device is within reach
16. Bed is in low position
17. After completing skill, wash his hands

Equipment Needed
Gait Belt

*If your patient is tall you may need to raise the bed. Remember to lower it when the pt is back on bed

Question 4

4 Assists With Use of Bedpan-Standard Bed Pan

Answer 4

• All ‘urine and rinse’ is poured into the toilet

1. Explains procedure, speaking clearly, slowly, maintaining face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen, or door
   Before handling bedpan:
3. Head of bed is flat
4. Put on clean gloves
5. Places bedpan correctly under clients buttocks
6. Avoids over exposure of client
7. Removes gloves without contaminating self
8. Disposes of gloves into waste container without contaminating self
9. Washes hands
10. Raises head of bed after positioning client on bedpan and removing gloves, washes hands
11. Toilet tissue is within reach
12. Hand wipe is within reach
13. Client is instructed to “clean hands with hand wipe when finished”
14. Signal device is within reach
15. Client is asked to “signal when finished”

Before removing bedpan

16. Put on clean gloves
17. Head of bed is lowered
18. Avoids over exposure of client while removing bedpan
19. Empties bedpan in toilet
20. Rinses bedpan
21. Pours rinse in toilet
22. Places bedpan in designated dirty supply area
23. Removes gloves without contaminating self 24. Disposes of gloves into waste container without contaminating self
24. Wash hands
25. Signaling device is within reach
26. Bed is in low position

Equipment Needed
Toilet paper
Hand wipes
Bedpan
Gloves 2 pair

Question 5

5 Cleans Upper or Lower Denture

Answer 5

• Equipment is at Denture Station
• Skill is done at the Denture Station
• Moderate means both faucets on

1. Puts on clean gloves before handling denture
2. Bottom of sink is lined and/or sink is partially filled with water before denture is held over sink
3. Set dentures on paper towel
4. Rinses denture cup inside and out
5. Rinses denture cup lid
6. Fills denture cup with moderate temperature water
7. Applies toothpaste to toothbrush
8. Rinses denture in moderate temperature running water before brushing them (must turn on both faucets)
9. Brushes all surfaces of denture
10. Rinses surfaces of denture under moderate temperature running water
11. Places denture in cup
12. Places lid on cup
13. Rinses toothbrush
14. Places toothbrush and designated toothbrush basin/container
15. Maintains clean technique with placement of toothbrush (do not put on bare counter)
16. Maintains clean technique with placement of denture
17. Sink liner is removed and disposed of appropriately, sink is drained, water off
18. Removes gloves without contaminating self
19. Disposes of gloves into waste container without contaminating self
20. Wash hands

Equipment Needed
Denture set-up (denture cup, dentures, toothpaste, toothbrush)
Paper towels
Gloves

• When you are finished the denture set up is left at the denture station

Question 6

6 Counts and Records Radial Pulse

Answer 6

• Tell the evaluator went to “start” and “stop”
• Count for one full minute
• May restart if needed

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible
2. Signaling devices within reach
3. Places fingertips on thumb side of clients wrist to locate radial pulse. Say “Start”
4. Counts beats for one for minute. Say “Stop”
5. Wash hands
6. Records pulse within plus or minus 4 beats of evaluators reading

Equipment Needed
Pen
Paper
Watch or clock

Question 7

7 Counts and Records Resporations

Answer 7

• Only one chance
• Count for one minute
• Tell evaluater when to “start” and “stop”

1. Explains procedure, “for testing purposes” speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible
2. Signaling devices within reach
3. Count respirations for one full minute
4. Wash hands
5. Records respiration rate within plus or minus 2 breaths of evaluator’s reading

Equipment Needed
Pen
Paper
Watch or clock with a second hand

Question 8

8 Donning and Removing PPE (gown & gloves)

Answer 8

• Supplies at the PPE Station

1. Picks up gown
2. Unfold gown
3. Facing the back opening of the gown places arms through each sleeve
4. Fastens the neck opening
5. Secures gown at waist making sure the back of the clothing is covered by gown (as much as possible)
6. Puts on gloves
7. Cuffs of gloves overlap cuffs of down
8. With one gloved hand, grasps the other glove at the palm
9. Then remove glove (ball up in gloved hand)
10. Slips fingers from ungloved hand
11. Removes glove turning it inside out as it is removed
12. Disposes of gloves into designated waste container without contaminating self
13. Unfastens down at neck
14. Unfastens down at waist
15. Removes gown without touching outside of gown

While removing gown

16. Hold gown away from body without touching floor
17. Turns gown inward
18. Keeps gown inside out
19. Disposes of gown in designated container without contaminating self
20. After completing skill, washes hands

Equipment Needed
PPE gown – yellow
Gloves

Question 9

9 Dresses Client with Affectes (Weak) Right Arm

Answer 9

• Assist means hands on assistance
• Okay to raise head of bed

1. Explains procedure, speaking clearly and slowly, indirectly, maintaining face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen, or door
3. Asks which shirt he/she would like to wear (put that shirt closest to the client)
4. Dress client in shirt of choice
5. Avoids over exposure of client – (sheet no lower than shoulders)
6. Remove gown from unaffected side first
7. Then removes gown from affected side
8. Disposes of gown into the soiled linen container
9. Assists to put the right (affected/weak) arms through the right sleeve of the shirt before placing garment on left (unaffected) arm
10. While putting on shirt, moves body gently and naturally, avoiding force and overextension of limbs and joints
11. Finishes with clothing in place (do not need to button)
12. Signaling device is within reach
13. Bed is in low position
14. After completing skill, washes hands

Equipment Needed
2 shirts

Question 10

10 Feeds Client Who Can Not Feed Self

Answer 10

• Have clients it on side of bed
• The food tray has 2 pieces of fruit and water
• The meal card will have the clients name on it

1. Explains procedure, speaking clearly and slowly, and directly, maintaining face-to-face contact whenever possible
2. Looks at name card on tray
3. Ask client to state name “Tell me your name”
4. Client is in an upright sitting position (75-90) degrees (can sit on side of bed)
5. places tray where the food can be easily seen by client
6. Candidate sits facing client during feeding
7. Candidate cleans clients hands with hand wipe before feeding
8. Tells client what foods are on tray
9. Asks what client would like to eat first
10. Using spoon, offers client one bite of each type of food on tray – feed client what they chose first
11. Tell client the content of each spoonful
12. Offers beverage at least once during meal
13. Candidate ask client if they are ready for “The next bite of food or sip of beverage?”

At end of meal

14. Candidate cleans clients mouth (with napkin)
15. Candidate cleans clients hands with wipes
16. Removes food tray
17. Places tray and designated dirty supply area
18. Signaling device is within clients reach
19. After completing skill, washes hands

Equipment Needed
Food tray
Hand wipes
Napkin – from tray

Question 11

#11 Gives Modifies Bed Bath
(face & one arm, hand and underarm)

Answer 11

• “Air Washing” is an automatic fail

1. Explains procedure, speaking clearly, maintaining face-to-face contact whenever possible (Place Call Light)
2. Privacy is provided with a curtain, screen, or door

Before washing client (* can be done in any order)

3. • Checks water temperature for safety and comfort
4. • Asks client to verify comfort of water (bring basin to pt)
5. • Puts on clean gloves before washing client
6. • Removes gown, while avoiding overexposure of the client
7. Places gown in soiled linen container
8. Begin with eyes, using a wet washcloth (no soap) wash inner to outer aspect
9. Uses a different area of the washcloth for each stroke
10. Proceed to wash entire face & nose
11. Dries entire face with towel
12. Exposes one arm
13. Places towel underneath arm keeping rest of body covered
14. Moves by gently and actually avoiding force and over extension of limbs and joints
15. Applies soap to wet washcloth
16. Washes arm
17. Washes hand
18. Washes underarm (armpit)
19. Rinses arm
20. Rinses hand
21. Rinses underarm (armpit)
22. Dries arm
23. Dries hand
24. Dries underarm (armpit)
25. Disposes of linen into soiled linen container
26. Avoids contact between candidate clothing and used linens
27. Puts clean gown on client
28. Empty basin
29. Rinse basin
30. Dry basin
31. Place basin in designated dirty supply area
32. Remove gloves without contaminating self
33. Dispose of gloves
34. Washes hands
35. Signaling device within reach
36. Bed is in low position

Equipment Needed
Gloves
Bath basin 
Soap
Clean pt gown
1 hand towel
1 bath towel
3 wash cloths

Question 12

12 Measures and Records Blood Pressure

Answer 12

• The candidates can try B/P two times on each arm

1. Explains procedure, speaking clearly and slowly, indirectly, maintaining face-to-face contact whenever possible
2. Wipe bell/diagram of stethoscope with alcohol wipes
3. Wipe your pieces of stethoscope with alcohol wipes
4. Positions clients arm palm up
5. Expose his clients upper arm
6. Feels for brachial artery on inner aspect of arm, at bend of elbow
7. Places blood pressure cuff snugly on clients upper arm, with sensor/arrow over break your artery site
8. Earpieces of stethoscope or in ears
9. Bell/diagram is over brachial artery site (hold firmly)
10. Candidate inflates cuff between 160mm Hg to 180mm Hg
11. Deflates cuff slowly and notes the first sound (systolic reading) and last sound (diastolic reading)(If rounding needed, measurements are rounded up to the nearest 2mm Hg)
12. Removes cuff
13. Washes hands
14. Records both systolic and diastolic pressures each within plus or minus 8mm of evaluators reading
15. Signaling device is within reach

Note: * If beat heard immediately upon cuff deflation, completely deflated cuff. Reinflate cuff to 200mm Hg, they will use this as their systolic number and continue to listen for the diastolic number and a record. If they go over 200 on any attempt they will be given a SAFETY STOP and FAIL

Equipment Needed
B/P cuff
Stethoscope
Alcohol wipes
Pen
Paper

Question 13

13 Measures &a Records Urinary Output

Answer 13

• Equipment at the ‘Urinary Station’
• Measuring container will be on counter
• All ‘urine and rinse’ is poured into toilet

1. Puts on clean gloves before handling bedpan
2. Pours the contents of bedpan into measuring container without spilling or splashing urine outside of container
3. Rinses bedpan
4. Pours rinse into toilet and put bedpan back where you got it
5. Measures the amount of urine at eye level with container on a flat surface
6. Empties contents of measuring container into toilet
7. Rinses measuring container (hat or graduate)
8. Pours rinse into toilet-return container to counter
9. Removes gloves without contaminating self
10. Disposes of gloves into waste container without contaminating self
11. Before recording washes hands
12. Records contents of container within plus or minus 25 ml/cc of evaluators reading

Equipment Needed
Gloves
Pen
Paper
Graduate or hat (at station)

(Bedpans and measuring containers are not usually dried, but it will not be an error if you do so)

Question 14

14 Measures and Records Weight of Ambulatory Client

Answer 14

• No gait belt
• Assist means ‘hands on assistance’
• Weigh client with shoes on

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible
2. Client has shoes on before walking to scale
3. Sets scale to zero – before client steps on
4. Assist client onto center of scale
5. After assisting client on scale obtain weight
6. Assist client off of scale (tell them to go back to bed)
7. Wash his hands before recording
8. Records weight based on indicator on scale. Weight is within plus or minus 2 lb of evaluators reading

Equipment Needed
Pen
Paper
Scale -stand up or floor

Question 15

15 Performs Modified Passive Range of Motion (PROM) for One Knee & One Ankle

Answer 15

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen, or door
3. Instructs client to inform candidate if pain is experienced during exercise
4. PROM KNEE – Support leg at the knee
5. Supports under the ankle while performing PROM for knee (At least 3 times or unless pain is verbalized)
6. Bends the knee
7. Then returns leg to clients normal position (extension/flexion)
8. PROM ANKLE Supports the foot (hand below the toes)
9. Support under the ankle keep foot close to the bed
10. Pushes/polls foot forward toward the head of bed (dorsiflexion)
11. Pushes and pulls foot down, toes point down (plantar flexion) At least 3 times or unless pain is verbalized
12. While supporting the limb, moves joints gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain
13. Bed is in low position, signal device
14. After completing skill, washes hands

Question 16

16 Performs Modified Passive Range of Motion (PROM) for One Shoulder

Answer 16

• Do not hold onto the client’s hand

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen, or door
3. Instructs client to inform candidate if pain is experienced during exercise
4. Supports clients upper arm during PROM
5. Supports clients lower arm during PROM
6. Racist clients straightened arm from one side position upward toward head to ear level
7. Returns farm down to side of body (flexion/extension) At least 3 times unless pain is verbalized
8. Supporting the limb, moves joint gently, slowly, and smoothly through the range of motion, discontinuing if client verbalizes pain
9. Moves clients straightened arm away from the side of body to shoulder level (abduction)
10. moves clients straightened arm from the shoulder level and returns to side of body. (abduction/addduction) At least 3 times, discontinuing exercise if client verbalizes pain
11. Supporting the limb, moves joint gently, slowly, and smoothly through the range of motion, discontinuing if client verbalizes pain
12. Signaling device is within reach
13. Bed is in low position
14. After completing skill, washes hands

Question 17

17 Positions on Side

Answer 17

• Assist means hands on

1. Explains procedure, speaking clearly, slowly, and directly, maintain face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen or door
3. Lowers head of bed, (Evaluators mark “Yes” If head of bed is already lowered)
4. racist side rail on side to which client will be turned
5. Uncover client – (fanfold sheet)
6. Assist client to turn toward real
7. Slowly assist to roll onto side as one unit toward raised side rail
8. Places or adjusts pillow under head for support
9. Places supportive device behind clients back
10. Places supportive device between legs with top knee flexed, knee and ankle supported
11. Supports top arm with supportive device
12. Candidate positions client so that client is not lying on arm (untuck lower shoulder)
13. Cover client with sheet
14. Signaling device is within reach, bed is low
15. Washes hands

Equipment Needed
4 pillows total

Question 18

18 Provides Catheter Care for Female

Answer 18

• Manikin will have catheter inserted

1. Explains procedure, speaking clearly, slowly, and directly, maintain face-to-face contact whenever possible
2. Signaling device is within reach
3. Privacy is provided with a curtain, screen or door

Before washing

4. Checks water temperature for safety and comfort
5. Ask client to verify comfort of water - bring basin to clients
6. Put on clean gloves
7. Places linen protector under perineal area
8. Exposes area surrounding catheter while avoiding over exposure of client
9. Applies soap to wet washcloth
10. While holding catheter at meatus (rest hand on pubic bone)
11. Without tugging
12. Moving in only one direction (away from the meatus)
13. Using a clean area of the cloth for each stroke (only 1 stroke needed)
14. Clean catheter at least 4 inches moving away from meatus
15. While holding catheter at meatus (rest hand on pubic bone)
16. Without tugging
17. Moving in only one direction (away from the meatus) using a clean area of the cloth for each stroke (only 1 stroke needed)
18. rinse catheter at least 4 inches moving away from the meatus
19. While holding catheter at meatus (rest hand on pubic bone)
20. Without tugging
21. Moving in only one direction (away from the meatus)
22. dry catheter at least 4 inches moving away from meatus (only 1 stroke needed)
23. Disposes of linen into soiled linen container
24. Disposes of bed protector appropriately
25. Avoid contact between candidate clothing and used linen
26. Empties basin
27. Rinses basin
28. Dries basin
29. Places basin in designated dirty supply area
30. Remove gloves without contaminating self
31. Dispose of gloves
32. Washes hands
33. Signaling device within reach/bed low

Equipment Needed
Gloves
3 Bath basin of water
1 Hand towel

Question 19

19 Provides Foot Care on One Foot

Answer 19

• Client can sit at bed or stay in the bed

1. Explains procedure, speaking clearly, slowly, and directly, maintain face-to-face contact whenever possible
2. Privacy is provided with curtain, screen, or door
3. Checks temperature of water for safety and comfort
4. Asked client to verify comfort of water
5. Puts on clean gloves
6. Basin is on a protective barrier
7. Basin is in a comfortable position for client (bend knee)
8. Clients bare foot is placed into the water
9. Applies soap to wet washcloth
10. Lifts foot from water
11. Washes foot (not above ankle)
12. Washes between toes
13. Rinse foot – can put back into basin
14. Rinse in between the toes

Put foot back on towel and put basin on over bed table

15. Dries foot
16. Dries between toes
17. Applies lotion to top of foot – do not ask
18. Apply lotion on bottom of foot – NOT in between the toes, remove excess with towel
19. Disposes of used linen in soiled linen container
20. Empties basin
21. Rinses basin
22. Dries basin
23. Places basin in designated dirty supply area
24. Removes gloves without contaminating self
25. Disposes of gloves into waste container
26. Wash hands
27. Signaling device is within reach/bed low

Equipment Needed
Gloves
Bath basin
Soap
Lotion
2 wash cloths 
1 hand towel
1 bath towel

Question 20

20 Provides Mouth Care

Answer 20

• Screened for dental procedures/surgery
• No tongue rings
• Client can sit on side of bed
• Must actually provide mouth care

1. Explains procedure, speaking clearly, slowly, and directly, maintain face-to-face contact whenever possible
2. Privacy is provided with curtain, screen, or door

Before providing mouth care (*can be done in any order)

3. • Client is in upright sitting position
4. • Puts on clean gloves
5. • Places clothing protector across chest
6. • Secures (get) cup of water
7. • Moistens toothbrush
8. Applies toothpaste to moistened toothbrush
9. Cleans mouth and surface of teeth, using gentle motions
10. Cleans tongue
11. Maintains clean technique with placement of toothbrush (put on paper towel not bare table)
12. candidate offers water and holds emesis basin to chin while client rinses mouth
13. Candidate wipes mouth
14. Candidate removes clothing protector
15. Disposes of used linen in soil linen container
16. At sink, first rinse toothbrush, put on paper towel
17. After rinsing toothbrush, empty basin
18. Rinses basin
19. Dries basin
20. Put toothbrush in dried basin
21. Places basin and toothbrush in designated dirty supply area
22. Removes gloves without contaminating self
23. Disposes of gloves into waste container
24. Wash hands
25. Signaling device is within reach
26. Bed is in low position

Equipment Needed
Gloves
Emesis Basin
Toothpaste
Tooth brush (wrapped)
Cup of water
Paper towel
1 hand towel

Question 21

21 Perineal Care (PeriCare) for Female

Answer 21

•Care provided on Manikin

1. Explains procedure, speaking clearly, slowly, and directly, maintain face-to-face contact whenever possible
2. Privacy is provided with a curtain, screen, or door (signal devices within reach)

Before washing client (*can be done in any order)

3. • Checks water temperature for safety and comfort
4. • Ask client to verify comfort of water (bring basin to pt)
5. • Puts on clean gloves before washing client
6. • Places pad/linen protector under perineal area
7. Exposes perineal area while avoiding over exposure
8. Applies soap to wet washcloth
9. Washes genital area, moving from front to back
10. While using a clean area of the washcloth for each stroke (1 stroke okay)
11. Using clean washcloth, rinses soap from genital area, (1 stroke okay)
12. Moving from front to back
13. While using a clean area of the washcloth for each stroke (1 stroke okay)
14. Dries genital area from front to back with towel

After washing genital area

15. Turns manikin to side
16. Washes rectal area
17. Moving from front to back
18. Using a clean area of washcloth for each stroke (1 stroke okay)
19. Rinses rectal area
20. Moving from front to back
21. Using a clean area of washcloth for each stroke (1 stroke okay)
22. Dries with a towel (front to back)
23. Dispose of dirty linen and bed protector – repositions client on to back
24. Empty basin
25. Rinse basin
26. Dry basin
27. Place basin in designated dirty supply area
28. Remove gloves without contaminating self
29. Dispose of gloves
30. Washes hands
31. Signaling device within reach
32. Bed is in low position

Equipment Needed
Gloves
Bath basin
Soap
4 wash clothes
2 hand towel 
1 bath towel

Question 22

22 Transfers from Bed to Wheelchair Using Transfer Belt

Answer 22

1. Explains procedure, speaking clearly, slowly, and directly, maintain face-to-face contact
2. Privacy is provided with a curtain, screen, or door

Before assisting to stand (*all must be done before client is standing)

3. • Wheelchair is positioned a long side of bed, at head of bed, facing foot of bed or at foot of bed facing the head of bed
4. • Footrests are folded up or removed
5. • Locks wheels on wheelchair
6. • “Bed is at safe level” for client to stand
7. • Locks bed wheels (push on bed)
8. • Client is assisted (hands-on) to sitting position with feet flat on floor
9. • Client is wearing shoes
10. • Applies transfer belt securely at waist over clothing/down
11. • Provides instruction to enable client to assist in transfer including prearranged signal to alert when to begin standing
12. Stands facing client positioning self to ensure safety of candidate and client during transfer
13. Knee to knee, counts 1, 2, 3 to alert client to begin standing
14. Gradually assist client to stand, grasping transfer belt on both sides with an upward grasp
15. Maintaining stability of clients legs (knee touching)
16. Assists client to turn to stand in front of wheelchair
17. The back of the clients legs are touching the seat of the wheelchair
18. Lowers client into wheelchair
19. Positions client with “hips touching back of wheelchair”
20. Transfer belt is removed
21. Positions feet on foot rests
22. Signaling device is within reach
23. After completing skill, washes hands

Equipment Needed
Gait Belt
Wheelchair