of the Clinical Skills Test. When you are registered to test, a computer will decide materials.

The procedure
which skills will be on your test. for any skill may include
more detail about
A Clinical Skills Test consists of five scored skills. All candidates taking this test are important requirements
scored on the than are shown in the
Handwashing and Indirect Care skills. When you take your test, you will be given checkpoints. Your
instructions for the other three skills that are part of your test. Because you may performance may include
learn to perform skills in different ways for different residents’ needs, you are given more detail than is included
instructions that describe how the skill is being tested. For example, if you test on in the checkpoints.
the feeding skill, you will feed a resident positioned in a chair. Remember, you are
still responsible for knowing how to feed residents who are positioned in other ways. A description of the
The Knowledge (Written) Test may also ask questions about feeding residents in instructions given to
other positions. candidates for each skill is
provided below along with
Each skill in the test has checkpoints. The evaluator (nurse) giving your test will use the checkpoints for each
these checkpoints to rate your performance. After you complete your test, the skill. This description
evaluator
Copyright ©
2018will enter Inc.,
Prometric his/her
a observations into a computer. Prometric’s system will includes if a person or
then determine
Delaware your
corporation. All results.
rights Your results will be provided
reserved. 1 to you on the day of mannequin is used for the
20180119
testing, unless a technology issue, such as a printer problem at the test site, resident. Usually another
prevents the evaluator from providing your results. If you are not provided a score candidate will play the role
report on the day of testing, see the candidate bulletin for information on accessing of the resident when a
your results online. Indirect Care Ambulate the resident using a transfer/gait belt person is used. In special
Indirect Care is a skill that is evaluated while 13youRemove transfer/gait belt from resident’s waist situations, the evaluator
perform each skill. This
The checkpoints forskill
each evaluates behaviors
of the skills that are
are listed on the
without pages
harming that follow.
resident (e.g., It is
pulling may need to play the
transfer/gait
common
importantto any resident
that care such as:
you understand infection
that control,
belt) when
the checklists are seated in chair
not written as after ambulation?
procedures. resident.
safety,
Thesecommunication,
checkpoints are andnotresident preferences,
provided to14 needs,
helpMaintain
you learnown
skills,body
but tomechanics
help you when assisting
comfort and rights.
understand what Youtheare not givenwill
evaluator instructions to
look for resident
when you perform
to stand andasit?
skill. While you are waiting to
perform the Indirect Care skill. The evaluator watches for
these behaviors while you perform each skill. 15In the take the test, you will be
Leave resident positioned in chair in proper body
checkpoints provided for each skill below, Indirectalignment
Care and hips against back of seat? given General Instructions
checkpoints are identified with an “(IC)” at the Ask resident about preferences during care? (IC)to read. These are the
16 end.
Indirect Care is one of the five skills scored 17
in every basic rules for the Clinical
Use Standard Precautions and infection control
Clinical Skills Test. The Indirect Care checkpointsmeasures
are: Skills Test. For example,
when providing care? (IC)
these instructions explain
Does the candidate: 18 Ask resident about comfort or needs during carewhat
or you need to do when
1 before care completed? (IC)
Greet resident, address by name, and introduce you want to make a
self? (IC) 19 Promote resident’s rights during care? (IC) correction to a skill you
2 Provide explanations to resident about
20 care beforeresident’s safety during care? (IC)
Promote are performing. These
beginning and during care? (IC) General Instructions are
3 Ask resident about preferences during care? (IC) also available on the
Assist resident needing to use a bedpan website for your state at
4 Use Standard Precautions and infection control
measures when providing care? (IC)
The candidate is asked to help a resident who has asked www.prometric.com/n
for a bedpan. The role of the resident is played by a urseaide. You are
5 Ask resident about comfort or needs person
during who
care will
or be wearing a hospital-style gown over encouraged to review
before care completed? (IC) clothing. For the purposes of testing, the candidate willthem before you arrive at
6 Promote resident’s rights during care?pretend
(IC) that the resident (actor) is not wearing the test site.
7 Promote resident’s safety during care?underpants.
(IC)
Does the candidate:
When you are called into
1 Greet resident, address by name and introduce self?
the testing room to take
Ambulate the resident using a transfer/gait belt
(IC) your test, you will be
The candidate is asked to walk a resident who needs
some assistance to stand. A transfer/gait 2belt is
Provide
used explanations to resident about care before
shown around the testing
beginning
while walking the resident. The role of the resident is and during care? (IC) room so you can see where
played by a person. 3 Place protective pad on bed over bottom sheet, equipment and supplies are
under buttocks/upper thigh area, before placing located. The testing room
Does the candidate:
bedpan, and remove the pad after bedpan is will be set up similar to a
1 Greet resident, address by name and introduce self?
removed? resident’s room. For
(IC) 4 Place and remove bedpan by either having resident example, personal care
2 Provide explanations to resident about care beforeon side to turn on/off back, onto/off supplies such as the
positioned
beginning and during care? (IC) bedpan, or having resident raise hips off bed? resident’s toothbrush,
3 Apply transfer/gait belt before standing
5 resident,
Position bedpan under resident according to toothpaste, basins, and
placing around the resident’s waist and over
form/shape of the selected bedpan? bedpan will be in the
clothing, secure so that only flat fingers/hand fit resident’s bedside cabinet.
6 Position bedpan to allow for collection?
under belt, and the belt does not catch skin or
skin folds (e.g. breast tissue)? 7 Raise the head of the bed after positioning the
resident on the bedpan, and lower the head of the When you are taking your
4 Provide signal or cue to resident before assisting to
bed before removing bedpan? Clinical Skills test,
stand?
8 remember that you are
Ask resident to call when finished or if needs help,
5 Assist resident to stand while holding onto the
required
leaving call light within the resident’s reach before to actually
transfer/gait belt without holding belt only at the
leaving resident to use bedpan? perform the skills. The
front or only at nearest side (if assisting to stand
from the side)? 9 Leave toilet paper within resident's reach before evaluator is not allowed to
leaving resident to use bedpan? answer any questions
6 Ask about how resident feels upon standing?
about how skills are
performed.

Handwashing
Does the candidate:
Handwashing
 CLINICAL SKILLS TEST CHECKLIST

7 Walk resident while standing to the 10

side and
Wearslightly
gloves when removing bedpan and while
behind resident? emptying and cleaning bedpan?
8 Provide support while walking resident
11 with
Empty
an arm
contents of bedpan into toilet, rinse bedpan
around resident’s back holding transfer/gait
pouring
belt? contents into toilet, and dry bedpan?
9 Ask about how resident feels during ambulation?
12 Offer resident damp washcloth or paper towel, or
10 Walk resident at least 10 steps? hand wipe, to cleanse hands after bedpan used,
before end of care?
11 Assist resident to turn and have back of legs
positioned against the seat of chair beforeComplete
13 resident skill storing bedpan and toilet paper,
sits? placing soiled linens in hamper, and disposing of
trash?
12 Provide support to sit resident back into chair?

Assist resident needing to use a bedpan

14 Keep resident positioned a safe distance from the
edge of the bed at all times?
15 Ask resident about preferences during care? (IC)
16 Use Standard Precautions and infection control
measures when providing care? (IC)
17 Ask resident about comfort or needs during care or
before care completed? (IC)
18 Promote resident’s rights during care? (IC)
19 Promote resident’s safety during care? (IC)

Change bed linen while the resident remains in bed

18 Promote resident’s rights during care? (IC)
19 Promote resident’s safety during care? (IC)

Change resident’s position to a

supported side-lying position
The candidate is asked to change the position of a
resident who is lying on his/her back, to a side-lying
position. The resident requires support to remain
positioned on the side. The role of the resident is
played by a person.
Does the candidate:
1 Greet resident, address by name, and introduce
self? (IC)
2 Provide explanations to resident about care before
beginning and during care? (IC)
3 Assist resident with turning onto side before placing
positioning devices?
4 Keep resident positioned a safe distance from the
edge of the bed at all times?
5 Use positioning device/padding or pillow under
or against resident’s back that maintains side-
lying position?
6 Leave resident positioned on side with upper knee
bent in front of the lower leg?
7 Support resident’s top leg by placing device(s)/
padding or pillow(s) between legs?

2
 CLINICAL SKILLS TEST CHECKLIST

8 Position device(s)/padding or pillow(s) placed

between legs so that bony prominences of
the knees and ankles are separated?
9 Leave the resident positioned on side without lying
on the shoulder, arm, and hand?
10 Leave pillow placed under head positioned to also
support the resident’s neck and chin?
11 Place device/padding or pillow positioned to support
the resident’s upper arm, supporting both the
shoulder and arm?
12 Ask resident about preferences during care? (IC)
13 Use Standard Precautions and infection control
measures when providing care? (IC)
14 Ask resident about comfort or needs during care or
before care completed? (IC)
15 Promote resident’s rights during care? (IC)
16 Promote resident’s safety during care? (IC)

Change bed linen while the resident remains in bed

The candidate is asked to change the top and bottom
sheets and pillowcase on the bed while the resident
stays in the bed. The role of the resident is played by a
person.

(not tested in Wyoming)

Does the candidate:
1 Greet resident, address by name and introduce self?
(IC)
2 Provide explanations to resident about care before
beginning and during care? (IC)
3 Keep resident positioned a safe distance from the
edge of the bed at all times?
4 Remove and replace bottom sheet on one side of
the bed, before turning resident to remove and
replace sheet on the other side of the bed?
5 Keep resident positioned on a bottom sheet
throughout procedure?
6 Secure bottom sheet to mattress (e.g., for fitted
sheet secure over all four corners of the mattress;
for flat sheet, tuck at head of bed and on sides and
extend toward bottom of mattress so that resident’s
heels are not against any exposed mattress)?
7 Leave bottom sheet free of creases or folds?
8 Turn or position resident to remove or replace
sheet(s) without pulling sheets in a manner
that creates friction and risks skin shearing?
9 Replace the top sheet over resident with a clean
sheet?
10 Tuck top sheet under foot of mattress leaving sheet
placed loosely, avoiding pressure against toes and
allowing for foot movement?
11 Leave top sheet placed on top of resident to cover
body up to shoulder level, without tucking in along
sides?
12 Keep pillow positioned under resident’s head
throughout and at the end of the procedure, except
when removed briefly to replace pillowcase?
3
 CLINICAL SKILLS TEST CHECKLIST

13 Complete procedure with resident positioned

between the top and bottom sheet?
14 Complete skill placing soiled linens in hamper and
disposing of trash?
15 Ask resident about preferences during care? (IC)
16 Use Standard Precautions and infection control
measures when providing care? (IC)
17 Ask resident about comfort or needs during care or
before care completed? (IC)

Dress a resident who has a weak arm

Empty contents of resident’s urinary drainage bag,

The candidate is asked to put a long-sleeved button-front shirt, pants, and socks on a resident who is lying in bed. The resident is
not able to help with the dressing and has a weak arm. A mannequin is used for the role of the resident

and measure and record urine output on an Intake and Output (I&O) form

4
Set graduate or bedpan on barrier placed on floor and empty full contents of drainage bag into the graduate or bedpan?

Does the candidate:

5
Empty contents of urinary drainage bag without contaminating drainage tube (e.g., touching container) and close and protect
drain (e.g., clamp and tuck drain into pocket) after emptying drainage bag?

1
Greet resident, address by name, and introduce self? (IC)

4
 CLINICAL SKILLS TEST CHECKLIST

2
Provide explanations to resident about care before beginning and during care? (IC)

6
Set graduate on flat surface protected with barrier to read, obtaining measurement by reading graduate at eye level, and if urine
poured into graduate from a bedpan, complete task over toilet pouring the full amount of urine into the graduate?

3
Include resident in decision-making about clothing to wear?

4
Collect all garments before removing hospital gown?

5
Support affected arm while undressing and dressing?

5
 CLINICAL SKILLS TEST CHECKLIST

6
Remove hospital gown?

7
Empty urine in graduate into toilet after measuring, rinse and dry container, pouring rinse water into toilet?

7
Dress affected arm first?

8
Gather up sleeve to ease pulling over affected arm?

8
Record output with clean hands?

9
Dress resident by putting on pants, shirt with sleeves, and socks?

6
 CLINICAL SKILLS TEST CHECKLIST

9
Record output within +/- 50 mL/cc's of nurse’s measurement?

10
Move resident’s extremities gently without over- extension or force when undressing and dressing?

10
Record output as urine and indicate the correct time on the I&O form?

11
Apply clothing correctly (e.g. front of shirt in front), adjust clothing for comfort, neatness, alignment, and close fasteners?

11
7
 CLINICAL SKILLS TEST CHECKLIST

Leave bag hanging from bed frame (not side rail), and drainage bag and tubing off (not touching) the floor?

12
Place dirty gown in hamper?

12
Keep urinary drainage bag positioned lower than bladder throughout care?

13
Keep resident positioned a safe distance from the edge of the bed at all times?

13
Complete skill having stored equipment, placing soiled linens in hamper, and disposing of trash?

14
Ask resident about preferences during care? (IC)

8
 CLINICAL SKILLS TEST CHECKLIST

15
Use Standard Precautions and infection control measures when providing care? (IC)

14
Ask resident about preferences during care? (IC)

15
Use Standard Precautions and infection control measures when providing care? (IC)

16
Ask resident about comfort or needs during care or before care completed? (IC)

16
Ask resident about comfort or needs during care or before care completed? (IC)

17
Promote resident’s rights during care? (IC)

9
 CLINICAL SKILLS TEST CHECKLIST

18
Promote resident’s safety during care? (IC)

17
Promote resident’s rights during care? (IC)

18
Promote resident’s safety during care? (IC)

Empty contents of resident’s urinary drainage bag,

and measure and record urine output on an Intake
and Output (I&O) form
The candidate is asked to empty the resident’s urinary
drainage bag into a graduate container and to measure
the amount of urine. An Intake and Output (I&O) Form
(see sample on website) is provided to record the
measurement. The output should be recorded as urine
and the correct time recorded for the measurement. The
role of the resident is played by either a person or
mannequin.
(not tested in Wyoming)
Does the candidate:
1 Greet resident, address by name, and introduce
self? (IC)
2 Provide explanations to resident about care
before beginning and during care? (IC)
3 Wear gloves while handling the urinary drainage
bag, graduate, or any urine-filled container, and
remove gloves before documenting I&O?

Feed a resident who is sitting in a chair

The candidate is asked to feed a snack to a resident who
is not able to feed him/herself. The resident is sitting in a
chair in an inappropriate position for feeding. A Food and
Fluid Intake Form (sample provided on the website) is
provided to record the resident’s estimated food and fluid
intake. The role of the resident is played by a person.
Does the candidate:
1 Greet resident, address by name, and introduce
self? (IC)
2 Provide explanations to resident about care before
beginning and during care? (IC)

10
 CLINICAL SKILLS TEST CHECKLIST

3 Assist or cue resident to sit upright in chair before

feeding?
4 Offer or assist resident to wash hands before
feeding using a damp washcloth, paper towel, or
hand wipe?

Feed a resident who is sitting in a chair

Measure and record a resident’s radial pulse
5 Sit while feeding the resident? 11 Promote resident’s rights during care? (IC)
6 Offer to protect resident’s clothing with
12 a Promote
barrier resident’s safety during care? (IC)
before feeding, and if used, remove barrier at
end of feeding?
Measure and record a resident’s respirations
7 Use spoon to feed?
The candidate is asked to count the resident’s
8 Offer fluids to drink throughout feeding; at least
respirations. The respirations should be counted for one
every 2-3 bites of food?
full minute. During the test, since this skill is tested
9 Allow resident the opportunity to swallow before from the measure and record pulse skill,
separately
feeding the next bite? candidates are allowed to tell the resident that his/her
10 Converse with resident during meal pulse is being counted or vital signs taken, instead of
(e.g., encourage intake)? stating that respirations are being counted. A
Measurement
11 Leave area around resident’s mouth clean and dry Form (sample provided on the website) is
provided to record the resident’s respiration rate. The
when care completed?
role of the resident is played by a person.
12 Complete skill placing any used linen in hamper,
disposing of trash, and leaving overbedDoes thedry?
table candidate:
13 1 intake
Record the amount of the resident’s food Greetonresident, address by name, and introduce
the Food and Fluid Intake Form within 25%self? (IC)
of the
nurse’s measurement? 2 Provide explanations to resident about care before
14 beginning
Record the amount of the resident’s fluid intake on and during care? (IC)
the Food and Fluid Intake Form within325%Measure
of the rate of respirations without providing
nurse’s measurement? instructions to resident about how to breathe?
15 Ask resident about preferences during4care?
Count
(IC) respirations for one full minute?
16 5
Use Standard Precautions and infection Record resident’s respiration rate on Measurement
control
measures when providing care? (IC) Form within +/- 2 breaths per minute of nurse’s
17 measurement?
Ask resident about comfort or needs during care or
before care completed? (IC) 6 Ask resident about preferences during care? (IC)
18 Promote resident’s rights during care?7(IC) Use Standard Precautions and infection control
19 Promote resident’s safety during care? (IC)measures when providing care? (IC)
8 Ask resident about comfort or needs during care or
before care completed? (IC)
Measure and record a resident’s radial pulse
9 Promote resident’s rights during care? (IC)
The candidate is asked to take the resident’s radial pulse,
10
measured at the wrist. The pulse should be counted Promote
for resident’s safety during care? (IC)
one full minute. A Measurement Form (sample provided
on the website) is provided to record the resident’s pulse
rate. The role of the resident is played by a Provide
person. catheter care to a female resident who has
an indwelling urinary catheter
Does the candidate:
The candidate is asked to provide catheter care to a
1 Greet resident, address by name, andfemale
introduce
resident who has an indwelling urinary catheter.
self? (IC) Soap and water should be used for the catheter care. For
2 Provide explanations to resident about carepurposes,
testing before only the cleansing of the front perineal
beginning and during care? (IC) area and catheter are evaluated; cleansing of the rectal
3 area and
Support resident’s arm in manner to avoid buttocks is not tested in this skill. A mannequin
dangling
while pulse is taken? is used for the role of the resident.
4 Does the candidate:
Use fingers (not thumb) to take pulse?
5 1 toGreet
Places fingers on wrist at radial pulse resident, address by name, and introduce
measure
pulse rate? self? (IC)
6 Count pulse for one full minute? 2 Provide explanations to resident about care before
beginning and during care? (IC)

11
 CLINICAL SKILLS TEST CHECKLIST

7 3 Wear
Record resident’s pulse rate on Measurement Formgloves while providing catheter care, cleaning
within +/- 4 beats per minute of nurse’s equipment, and handling soiled underpads,
measurement? washcloths, and towels?
8 Ask resident about preferences during4care?
Position
(IC) towel or underpad under buttocks/thigh
area before cleansing, and when care completed
9 Use Standard Precautions and infection control
measures when providing care? (IC) remove towel or underpad, or leave resident on a
dry underpad?
10 Ask resident about comfort or needs during care or
before care completed? (IC)

Provide catheter care to a female resident who Provide

has foot care to a resident who is
an indwelling urinary catheter sitting in a chair
5 Use water of safe temperature for washing and
rinsing? 9 Dry entire top and bottom of foot including between
toes?
6 Use soapy washcloth to clean inside labia?
10 Warm lotion before applying to foot (e.g., warming
7 Change spot on soapy washcloth for ineach hands, placing bottle in warm water)?
washing stroke, wiping from front to back when
cleansing inside labia? 11 Apply lotion to top and bottom of foot, excluding
between toes?
8 Cleanse catheter using clean area of washcloth,
washing away from body and down the 12catheter
Removeat visible excess lotion from foot if present
least 3-4 inches? after applying?
9 13 Apply
Use clean soap-free wet washcloth to remove sock to foot leaving sock smooth, and replace
soap?
shoe; leaving any fasteners, such as ties, secured?
10 Change spot on washcloth for each rinsing stroke,
14 from
wiping front to back inside labia, and away Provide support to lower extremity throughout
body when rinsing catheter? procedure as needed to avoid strain?
11 Dry perineal area, from front to back after Avoid placing resident’s barefoot directly on floor
15
completing cleansing and rinsing? before, during or after foot care?
12 16 and
Leave tubing free of kinks or obstructions, Complete
keep skill having rinsed, dried and stored
tubing and urinary drainage bag off floor? basin, placing soiled linens in hamper, and
disposing of trash?
13 Keep urinary drainage bag positioned lower than
bladder throughout procedure? 17 Ask resident about preferences during care? (IC)
14 18 Use Standard Precautions and infection control
Complete skill having rinsed, dried and stored
measures
basin, placing soiled linens in hamper, disposing of when providing care? (IC)
trash, and leaving overbed table dry? 19 Ask resident about comfort or needs during care or
15 Keep resident positioned a safe distance before care completed? (IC)
from the
edge of the bed at all times? 20 Promote resident’s rights during care? (IC)
16 Ask resident about preferences during21
care?Promote
(IC) resident’s safety during care? (IC)
17 Use Standard Precautions and infection control
measures when providing care? (IC)
Provide mouth care to a resident
18 Ask resident about comfort or needs during care or who has a denture
before care completed? (IC) A resident is sitting at an overbed table and the
19 Promote resident’s rights during care?resident’s
(IC) denture is in a denture cup. The resident is not
20 Promote resident’s safety during care?able (IC)to provide own mouth or denture care. The
resident’s denture needs to be cleaned and the resident
needs mouth care. The denture is stored in a denture cup
after cleaning. The role of the resident is played by a
Provide foot care to a resident person.
who is
sitting in a chair
Does the candidate:
The candidate is asked to provide foot care to a resident.
1
Soap and water is used and foot care is provided Greet resident, address by name and introduce self?
to only
(IC)
one foot. The resident is sitting in a chair. The resident’s
sock and shoe are replaced at the end of the 2 skill. The explanations to resident about care before
Provide
resident role is played by a person. beginning and during care? (IC)
Does the candidate: 3 Wear gloves when handling denture, providing
1 mouthself?
Greet resident, address by name and introduce care, and rinsing equipment?
(IC) 4 Protect denture from damage while cleaning
2 by before
Provide explanations to resident about care lining sink, filling sink with water, or
beginning and during care? (IC) holding denture directly over basin?

12
 CLINICAL SKILLS TEST CHECKLIST

3 Place water filled basin on protective 5barrier

Protect denture from contamination (e.g., use a
on floor
to prepare for foot care? barrier when setting denture on surfaces, avoid
4 Use water of safe temperature for soaking placing
foot? or rinsing denture in sink water)?
6 Use cool or tepid running water to clean and rinse
5 Soak resident’s foot in basin of water?
denture?
6 Use soapy washcloth to wash foot without adding
7 Brush all surfaces of the denture using a toothbrush
soap directly to basin of water?
or denture brush with toothpaste?
7 Wash top and bottom of foot and between toes?
8 Rinse denture to remove toothpaste?
8 Remove soap from foot including between toes?

Provide mouth care to a resident Provide mouth care to a resident who has teeth
who has a denture 8 Offer resident cup of water to rinse mouth after
brushing?
9 Handle clean denture maintaining cleanliness after
9 Provide
brushed, placing denture in denture cup filled withresident an emesis basin or disposable cup
clean cool or tepid water? to use for spitting as needed, such as after rinsing
mouth?
10 Leave denture cup on resident’s bedside cabinet or
10 Leave area around resident’s mouth clean and dry
overbed table unless following resident’s preference
about where denture cup should be stored? when care completed?
11 11 mouth
Protect resident’s clothing before providing Complete skill having rinsed, dried and stored
care and remove protective cover when carebasin,
is placing soiled linens in hamper, disposing of
completed? trash, and leaving overbed table dry?
12 Provide mouth care cleaning upper12andAsklower resident about preferences during care? (IC)
gums, using moistened foam-tipped 13 applicator or
Use Standard Precautions and infection control
toothbrush with toothpaste? measures when providing care? (IC)
13 Offer resident cup of water to rinse mouth
14 after
Ask resident about comfort or needs during care or
mouth care? before care completed? (IC)
14 Provide emesis basin or disposable cup15 toPromote
residentresident’s rights during care? (IC)
to use for spitting as needed? 16 Promote resident’s safety during care? (IC)
15 Leave area around resident’s mouth clean and dry
when care is completed?
Provide perineal care to a female resident
16 Complete skill having rinsed, dried and stored basin
who is incontinent of urine
(if used), emptying sink of water and removing
The candidate
barrier from sink (if used), placing soiled linens in is asked to provide perineal care to a
hamper, disposing of trash, and leaving resident who is incontinent of urine. The resident is lying
overbed
table dry? in bed on an underpad and is wearing a hospital-style
gown that is dry. A mannequin is used for the role of the
17 Ask resident about preferences duringresident.
care? (IC)
18 Use Standard Precautions and infection Does thecontrol
candidate:
measures when providing care? (IC)
1 Greet resident, address by name and introduce self?
19 Ask resident about comfort or needs during care or
(IC)
before care completed? (IC)
2 Provide explanations to resident about care before
20 Promote resident’s rights during care? (IC) beginning and during care? (IC)
21 Promote resident’s safety during care?3(IC) Wear gloves while providing perineal care,
cleaning equipment, and handling soiled
underpads, washcloths and towels?
Provide mouth care to a resident who has teeth
A resident who has his/her natural teeth is4lyingRemove
in bed soiled underpad and replace with dry
and needs mouth care. The resident is not able to underpad before beginning cleansing?
5
provide own mouth care. The role of the resident Use
is water of safe temperature for washing and
played by a person. rinsing?
Does the candidate: 6 Use soapy washcloth to wash front perineum to
include genital and skin fold areas of groin?
1 Greet resident, address by name, and introduce
self? (IC) 7 Change spot on washcloth for washing and rinsing
strokes when cleansing inside the vulva?
2 Provide explanations to resident about care before
beginning and during care? (IC) 8 Wipe from front to back with all washing and rinsing
strokes when cleansing the front perineum, to
3 Assist resident to sitting position in bed by raising
include the genital and skin fold areas of groin?
HOB and using pillows as needed to position
9 Usefluid
resident upright at 60° to 90° before offering clean, soap-free, wet washcloth to remove soap
or brushing teeth? from resident’s skin on front perineum?

13
 CLINICAL SKILLS TEST CHECKLIST

4 10 Dry
Protect resident’s clothing before providing front perineum after washed and rinsed, using
mouth
care and remove protective cover when care towel to pat dry, moving from front to back?
completed? 11 Replace water in basin during care if it becomes
5 cold or soapy?
Moisten toothbrush with water and apply toothpaste
before brushing teeth? 12 Position resident on side to prepare for cleansing of
6 Wear gloves when brushing resident’s teeth buttocks
and and rectal area?
wear throughout mouth care including 13 Wash, whenrinse, and dry buttocks and rectal area?
rinsing basin and toothbrush?
14 Wipe from front to back with all washing and rinsing
7 Brush sides and biting surfaces of teethstrokes
and the
when cleansing the rectal area?
gum line with a gentle motion?

Provide perineal care to a female resident Provide resident hand and nail care
who is incontinent of urine16 Ask resident about comfort or needs during care or
15 before
Leave resident on dry underpad at completion of care completed? (IC)
procedure? 17 Promote resident’s rights during care? (IC)
16 Complete skill having rinsed, dried and18 Promote resident’s safety during care? (IC)
stored
basin, placing soiled linens in hamper, disposing of
trash, and leaving overbed table dry?
Provide resident a partial bed bath and back rub
17 Keep resident positioned a safe distance from the
edge of the bed at all times? The candidate is asked to bathe a resident who is in bed
and who is not able to help with his/her bathing. For
18 Ask resident about preferences duringtesting
care? (IC)
purposes only, the candidate is asked to wash
19 Use Standard Precautions and infection just partcontrol
of the body so that technique can be evaluated.
measures when providing care? (IC) Instructions ask the candidate to wash the resident’s
20 Ask resident about comfort or needs face,
duringneck,
careback,
or one hand and arm, and the chest and
before care completed? (IC) abdomen. Soap and water should be used for the
bathing. The resident also needs a back rub. When
21 Promote resident’s rights during care? (IC)
completing the skill, the mannequin is dressed in a clean
22 Promote resident’s safety during care?hospital-style
(IC) gown. A mannequin is used for the role of
the resident.
Provide resident hand and nailDoes carethe candidate:
The candidate is asked to provide hand and 1 nailGreet resident, address by name and introduce self?
care to
one hand. The role of the resident is played by a(IC)
person.
(not tested in Wyoming) 2 Provide explanations to resident about care before
beginning and during care? (IC)
Does the candidate: 3 Use water of safe temperature for washing and
1 Greet resident, address by name, and introduce
rinsing?
self? (IC) 4 Cleanse eyes by using soap-free washcloth wiping
2 Provide explanations to resident about care before
eye from the inside corner to the outside corner,
beginning and during care? (IC) changing to clean area of washcloth before
3 Use water of safe temperature for soaking returning
fingers to inner corner and before cleansing the
or hand? other eye?
4 5 water
Place fingers or full hand into basin of Wash resident’s face using a soap-free wet
to soak
before removing residue from under nails?washcloth, unless ascertains resident’s preference
to use soap before washing face?
5 Clean hand surfaces using wet washcloth, cleaning
6
between fingers, and if soap used, rinse or Leave face dry after washing?
remove
soap using a clean, soap-free, wet washcloth?
7 Contain corners of washcloth while washing and
6 Use flat edge of orangewood stick to remove rinsing (e.g., forming mitt)?
residue under tips of each fingernail,8and remove
Protect bed linen from becoming wet during
residue from edge of orangewood stick, if washing
present, and rinsing of body (non-face)?
before using again to clean under another
9 Wash resident’s body (non-face) using a wet
fingernail? washcloth with small amount of soap?
7 Rest resident’s hand on barrier such 10 as
Usea clean,
dry soap-free, wet washcloth to remove soap
towel once removed from basin while providing
from resident’s skin?
nail and hand care?
11 Wash and rinse resident’s neck, hand, arm, chest,
8 Dry hand before completing care? and abdomen?
9 Leave nails smooth (e.g., free of jagged
12 edges)?
Dry neck, hand, arm, chest, and abdomen?
10 Apply lotion to cleaned hand after nail
13careSupport arm if raised off bed to wash, rinse, and
finished? dry the back side of arm?
14
 CLINICAL SKILLS TEST CHECKLIST

11 Support resident’s arm if raised 14 Assistwhen

off table resident to turn onto side before cleansing
providing nail and hand care? back?
12 Remove visible excess lotion from hand
15 if Wash,
present
rinse,
at and dry back?
completion of hand care? 16 Replace basin of water during task if it becomes
13 Complete skill having rinsed, dried and stored
cold or soapy?
basin, placing soiled linens in hamper,
17disposing
Warm oflotion before applying to resident’s back
trash, disposing of or storing emery board(e.g.,
and warming in hands, placing bottle in
orangewood stick, and leaving overbed table dry?
warm water)?
14 Ask resident about preferences during
18care?
Use(IC)
lotion to provide back rub with long gliding and
15 circular motions?
Use Standard Precautions and infection control
measures when providing care? (IC)

Provide resident a partial bed bath and Provide

back rubresident with passive range of motion
19 Place clean hospital gown on resident and secure (ROM) exercises to one shoulder
gown in back? The candidate is asked to provide range of motion
exercise to a resident who is not able to help with the
20 Complete skill having rinsed, dried and stored
exercises. The resident needs his/her shoulder flexed and
basin, placing soiled linens in hamper, disposing of
extended, and abducted and adducted. For testing
trash, and leaving overbed table dry?
purposes, the resident needs three repetitions of both
21 Keep resident positioned a safe distance from
exercises. Thethe
instructions provided at the test site will
edge of the bed at all times? indicate whether the exercise is to the left or right side.
22 Ask resident about preferences during The role (IC)
care? of the resident is played by a person.
23 Use Standard Precautions and infection
Does the candidate:
control
measures when providing care? (IC) 1 Greet resident, address by name, and introduce
24 Ask resident about comfort or needs during self?care
(IC)or
before care completed? (IC) 2 Provide explanations to resident about care before
25 Promote resident’s rights during care? (IC)beginning and during care? (IC)
26 Promote resident’s safety during care?
3 (IC)
Exercise only correct joints and only correct
side when performing range of motion (ROM)?

Provide resident with passive range4of motion Support extremity to protect the working joint
(ROM) exercises to one elbow and wrist throughout ROM exercises?
5
The candidate is asked to provide range of motion Move shoulder through ROM, raising and lowering
exercise to a resident who is not able to help witharm
thealongside, toward head of bed (HOB) and back
exercises. The resident needs his/her elbow flexed to and
mattress (flexion/extension)?
6
extended, and the wrist flexed and hyperextended. MoveForresident’s shoulder through ROM taking arm
testing purposes, the resident needs three repetitions
away offrom side and back to side (abduction/
adduction)?
both exercises. The instructions provided at the test site
will indicate whether the exercise is to the left
7 orAsk
right
resident to report discomfort during ROM or
side. The role of the resident is played by a person.
ask if resident has discomfort during ROM
Does the candidate: exercises?
1 Greet resident, address by name, and8introduce
Control extremity throughout ROM exercises
self? (IC) providing smooth, slow, non-forceful movement?
2 9 Askbefore
Provide explanations to resident about care resident about preferences during care? (IC)
beginning and during care? (IC) 10 Use Standard Precautions and infection control
3 Exercise only correct joints and measures when providing care? (IC)
side when performing range of motion11(ROM)?
Ask resident about comfort or needs during care or
4 Support extremity to protect the working before care completed? (IC)
joint
throughout ROM exercises? 12 Promote resident’s rights during care? (IC)
5 Bend and straighten arm at elbow through
13 ROM
Promote resident’s safety during care? (IC)
(flexion/extension)?
6 Move wrist through ROM by bending wrist to move
Provide resident with passive range of motion
hand down and back (flexion and hyperextension)?
(ROM) exercises to one hip, knee and ankle
7 Ask resident to report discomfort during ROM or ask
if resident has discomfort during ROM exercises?
8 Control extremity throughout ROM exercises
providing smooth, slow, non-forceful movement?
9 Ask resident about preferences during care? (IC)

15
 CLINICAL SKILLS TEST CHECKLIST

10 Use Standard Precautions and infectionThe candidate

controlis asked to provide range of motion
measures when providing care? (IC) exercise to a resident who is not able to help with the
11 Ask resident about comfort or needs exercises.
during care Theorresident needs his/her hip and knee flexed
before care completed? (IC) and extended, and dorsiflexion and plantar flexion to the
ankle. For testing purposes, the resident needs three
12 Promote resident’s rights during care?repetitions
(IC) of both exercises. The instructions provided at
13 Promote resident’s safety during care?the
(IC)
test site will indicate whether the exercise is to the
left or right side. The role of the resident is played by a
person.
Does the candidate:
1 Greet resident, address by name, and introduce
self? (IC)
2 Provide explanations to resident about care before
beginning and during care? (IC)
3 Exercise only correct joints and only correct
side when performing range of motion (ROM)?

Provide resident with passive range of motion Transfer the resident from the bed into a
(ROM) exercises to one hip, knee and ankle wheelchair using a pivot technique and a
4 Support extremity to protect the working joint transfer/gait belt
throughout ROM exercises?
10 Lock wheelchair before standing resident to begin
5 Move resident’s hip and knee throughtransfer?ROM,
flexing knee and hip, raising toward 11torso andtransfer/gait belt before standing resident,
Apply
returning back to mattress (flexion/extension)?
placing around the resident’s waist and over
6 Support extremity to prevent heel friction against
clothing, secured so that only flat fingers/hand fit
mattress during ROM exercises? under belt, and the belt does not catch skin or
7 Move resident’s foot up toward head and skin folds (e.g. breast tissue)?
point down toward the mattress through12 ROMProvide cue or signal to resident before assisting to
(dorsiflexion/plantar flexion)? stand?
8 Ask resident to report discomfort during
13 ROM
Stand in front of resident reaching under
ask if resident has discomfort during ROM resident’s arms to hold transfer/gait belt at sides
exercises? or around back throughout transfer?
9 Control extremity throughout ROM exercises
14 Brace one or both of resident’s legs during transfer
providing smooth, slow, non-forceful movement?
while assisting to stand, turn, and sit?
10 Ask resident about preferences during15
care?Maintain
(IC) own body mechanics when assisting
11 Use Standard Precautions and infection resident to stand, turn, and sit?
control
measures when providing care? (IC) 16 Transfer resident as a pivot completed without
12 Ask resident about comfort or needs during having
care resident
or take step(s) to reach wheelchair,
before care completed? (IC) and before assisting resident to sit in wheelchair,
positions with the back of resident’s legs against
13 Promote resident’s rights during care? (IC)
the seat of wheelchair?
14 Promote resident’s safety during care? (IC)
17 Support resident to provide for controlled gentle
lowering into seat of wheelchair?
Transfer the resident from the bed 18 into
Leave
a resident positioned in wheelchair in proper
wheelchair using a pivot technique and body
a alignment, hips against back of seat, and feet
transfer/gait belt on footrests?
The candidate is asked to transfer a resident
19 who is lyingtransfer/gait belt from resident’s waist
Remove
in bed, into a wheelchair. A pivot transfer technique is harming resident (e.g., pulling transfer/gait
without
required and a transfer/gait belt is required. Thebelt)
resident
when transfer is complete?
is able to stand but cannot take steps. The20role Ask
of the
resident about preferences during care? (IC)
resident is played by a person.
21 Use Standard Precautions and infection control
Does the candidate: measures when providing care? (IC)
1 Greet resident, address by name and22 introduce self?
Ask resident about comfort or needs during care or
(IC) before care completed? (IC)
2 Provide explanations to resident about 23 care before
Promote resident’s rights during care? (IC)
beginning and during care? (IC)
24 Promote resident’s safety during care? (IC)
3 Place wheelchair near resident’s bed before
assisting resident to sit at edge of bed?

16
 CLINICAL SKILLS TEST CHECKLIST

4 Move wheelchair footrests out of the way before

standing resident for transfer (e.g., lift, swing, or
remove)?
5 Place nonskid footwear (e.g., shoes) on resident
before standing resident for transfer?
6 Provide support to assist resident to sitting position
on side of bed, without pulling resident by lower
arms or hands?
7 Provide resident opportunity to sit on side of bed to
adjust to change in position before beginning
transfer?
8 Position resident’s feet flat on the floor before
standing to begin transfer?
9 Prepare for transfer by positioning wheelchair with
front interior wheel close enough to bed so that
transfer can be completed as a pivot?

17