Michigan Nurse Aide Skill Test Comprehensive Preparation Guide
Michigan Nurse Aide Skill Test Guidelines and Initial Procedures
These guidelines are intended for candidates preparing for the Michigan nurse aide skill test as of January 1, 2025, through D&SDT-HEADMASTER. It is explicitly noted that these steps are preparation guidelines and may not include every aspect of best-practice care in an actual clinical setting. For most skills, the process begins and ends with proper hand hygiene. Hand hygiene involves covering all surfaces of the hands with hand sanitizer and rubbing the hands together until they are completely dry. Every skill interaction requires maintaining respectful and courteous interpersonal interactions, explaining the procedure to the resident, and ensuring the call light or signaling device is within reach before completion.
Application of Knee-High Anti-Embolic Elastic Stocking
The candidate must perform hand hygiene and explain the procedure. The bed height should be raised for proper ergonomics. The candidate must provide for the resident’s privacy by pulling the privacy curtain and only exposing one leg. The stocking should be rolled, gathered, or turned down inside out to at least the heel. The foot of the stocking is then placed over the toes, foot, and heel. The candidate must roll or pull the top of the stocking over the foot and up the leg, ensuring the stocking is smooth and wrinkle-free. Finally, the candidate checks the toes for pressure, adjusts as needed, lowers the bed, places the call light, and performs hand hygiene.
Ambulating a Resident Using a Gait Belt
After hand hygiene and explanation, the candidate must lock both bed and wheelchair brakes. The resident is brought to a sitting position by raising the head of the bed, and non-skid footwear is applied. The bed height must be adjusted so the resident’s feet are flat on the floor; if necessary, the candidate assists the resident in scooting to the edge of the bed. A gait belt is placed around the waist and tightened. Tightness is verified by slipping fingers between the belt and the resident. Facing the resident, the candidate uses an upward grasp on both sides of the belt to bring the resident to a standing position. After stabilizing, the resident is ambulated at least steps to the wheelchair. The candidate must use proper body mechanics while assisting the resident in pivoting and sitting in a controlled manner. The belt is then removed, and the final safety and hygiene steps are completed.
Bedpan Use, Output Measurement, and Hands-on Washing
This task is a potential mandatory first task. It begins with a knock on the door, hand hygiene, explanation, and privacy. The candidate puts on gloves and positions the resident safely and correctly on the bedpan. The head of the bed is raised to a comfortable level, and tissue and the call light are left within reach. The candidate steps behind the curtain. When signaled to return, the candidate lowers the head of the bed and gently removes the pan. The candidate holds the pan while the RN Test Observer pours an unknown quantity of liquid. To measure, the candidate places the graduate on a level surface and pours the contents. Measurement is taken at eye level. Equipment is emptied, rinsed, and returned to storage. The resident’s hands are washed and dried, and soiled linens are disposed of. Gloves are removed inside out. The candidate must record the output in ml on a recording form, and the measurement must be within of the RN Test Observer's reading. A specific manual hand-washing procedure follows.
Manual Hand-Washing Procedure Requirements
During mandatory tasks, hand washing must be performed precisely. The candidate turns on the water and wets hands and wrists. Soap is applied, and friction is used for at least . Fingers must be interlaced and pointed downward while scrubbing all surfaces and wrists. Fingernails are cleaned by rubbing them against the opposite palm. Rinsing occurs with fingers pointed downward. Drying starts at the fingertips using clean paper towels, which are discarded immediately. The faucet must be turned off using a clean, dry paper towel. Re-contamination—such as touching the sink, crumpling the final towel with both hands, or using a wet towel to touch the faucet—is not permitted.
Catheter Care for Female Resident with Hand Washing
This task is performed on a manikin and is a potential mandatory task. After hygiene and prep, a basin is filled with warm water. The candidate puts on gloves and exposes the resident only between the hip and knee. The candidate holds the catheter at the urethra exit with one hand to prevent tugging. Using a soapy washcloth, the candidate cleans at least down the drainage tube using at least two strokes directed away from the urethra. A clean portion of the cloth is used for each stroke. The tube is سپس rinsed and patted dry using the same downward-stroke technique. The resident is covered, equipment is cleaned and stored, and gloves are removed. The skill concludes with the standard manual hand-washing procedure.
Denture Care for Upper or Lower Plates
The candidate explains the procedure and lines the sink with a protective layer (towel or paper towels) to prevent damage. Gloves are applied, and denture cleanser is applied to a brush. The denture is removed from the cup and handled carefully. Both sides (inner, outer, and chewing surfaces) must be thoroughly brushed and rinsed under cool or tepid running water. The denture cup and lid are rinsed, and the denture is placed back in the cup with clean, cool water. After returning equipment and discarding the sink lining, the candidate completes the task with hygiene and safety checks.
PPE Management and Urinary Drainage Bag Measurement
This mandatory task begins with donning PPE. The candidate unfolds the gown, secures the neck and waist (ensuring back flaps cover clothing), and puts on gloves so the cuffs overlap the gown. After knocking and explaining, a barrier is placed on the floor under the drainage bag. The graduate is placed on the barrier and the bag is emptied completely into it without let the tubing touch the graduate. The drain is closed and wiped with an alcohol wipe. Output is measured at eye level. To doff PPE, gloves are removed first (one gloved hand grasps the other at the palm; then fingers slip under the remaining cuff). The gown is unfastened at the waist and neck and removed by turning it inward and keeping it inside out without touching the exterior. Standard hand washing is performed. The output must be recorded within of the observer’s reading.
Dressing a Resident with a Weak Side in Bed
The candidate must raise the bed and keep the resident covered. The gown is removed from the unaffected side first. When dressing in a button-up shirt, the candidate must dress the affected (weak) side first by inserting their hand through the sleeve to grasp the resident’s hand. For pants, the candidate assists the resident in raising their buttocks or turning side-to-side, dressing the affected leg first. Socks must be drawn up smoothly. The resident should be left comfortably dressed with the shirt fully buttoned and pants at the waist.
Assisting a Dependent Resident with a Meal in Bed
The candidate must verify the resident’s identity against the diet card. The resident is positioned upright between before the meal. The candidate provides hand hygiene for the resident (using wipes, sanitizer, or soap/water) and ensures hands are dry. The candidate sits in a chair facing the resident, describes the food/fluids, offers fluids frequently, and provides small amounts of food. After the resident chews and swallows, their hands and mouth are wiped. The candidate records solid food intake as a percentage (within accuracy) and fluid intake in ml (within accuracy). The resident is left at a minimum of a angle.
Foot Care for a Resident
The candidate specifies the right or left foot as specicified in the scenario. The foot is immersed in warm water; the candidate may verbalize a soak time of . The entire foot and between the toes are washed with a soapy washcloth, rinsed, and dried thoroughly. Lotion is applied to the top and bottom of the foot but never between the toes. Excess lotion is wiped off before replacing the sock and cleaning the equipment.
Modified Bed Bath: Face, Arm, Hand, and Armpit
A bath blanket is used to cover the resident, and the gown is removed without exposure. The eyes are washed first from the inner to the outer aspect using a clean portion of a washcloth and NO SOAP. The whole face is washed without soap and patted dry. A towel is placed under the arm, and the arm, hand, and armpit are washed with soap, rinsed, and patted dry. The candidate assists the resident into a clean gown and cleans the workspace.
Mouth Care: Brushing Resident’s Teeth
The candidate drapes the chest with a towel and puts on gloves. After wetting the toothbrush and applying toothpaste, the candidate gently brushes the inner, outer, and chewing surfaces of all teeth, as well as the tongue. The resident is assisted in rinsing and wiping their mouth. Equipment, including the emesis basin and toothbrush, is rinsed and returned to storage.
Passive Range of Motion (PROM) for Hip, Knee, and Shoulder
For both sets of PROM exercises, the bed must be flat (supine) and raised for the candidate. Joints must be supported correctly at all times (e.g., one hand under the knee and one under the ankle). In each exercise, the candidate must complete at least three repetitions. For the hip and knee, the movements include abduction/adduction (away from and toward the body) and simultaneous flexion/extension of the hip and knee. For the shoulder, the movements include flexion/extension (up to ear level) and abduction/adduction (to shoulder level). The candidate must never force a joint and must ask the resident at least once during the exercise if they are experiencing pain or discomfort.
Perineal Care for a Female Resident with Hand Washing
This mandatory manikin task involves placing a waterproof pad under the buttocks and exposing only the perineal area. The labia are separated (verbalization is helpful). Using only soap and water (no-rinse soaps are prohibited), the candidate cleans one side of the labia, the other side, and the vaginal area, all using a front-to-back motion with clean portions of the cloth. The same pattern is used for rinsing. After patting dry, the manikin is turned (the Observer may help hold the manikin). The candidate washes and rinses from the vagina to the rectal area. The pad is removed, the resident is repositioned, and the task ends with equipment care and the mandatory hand-washing protocol.
Positioning a Dependent Resident on Their Side
The bed is positioned flat and raised. The RN Test Observer is directed to stand on the side opposite the candidate for safety. From the working side, the candidate moves the resident's upper body, hips, and then legs toward themselves. The resident is rolled onto the side specified in the scenario. The candidate adjusts the head pillow and ensures the resident is not lying on their own arm. Support devices are placed under the upside arm, behind the back, and between the knees.
Vital Signs: Radial Pulse and Respirations
The candidate locates the radial pulse on the thumb side of the wrist. The pulse must be counted for one full minute, with the candidate telling the Observer when they start and stop counting. The same one-minute count is required for respirations. The results are recorded; the pulse must be within and respirations must be within of the RN Test Observer's measurements.