Wisconsin Certified Nurse Aide Mock Skills Examination Standards

Handbook Guidelines and Standard Procedures

Effective Date: November 1, 2024.
Sponsoring Authority: D&SDT-HEADMASTER.
Purpose: These steps represent discrete skill tasks used exclusively for objective testing. They are not intended as exhaustive care protocols for actual clinical work settings but serve as specific evaluation benchmarks.
Standard Hand Hygiene (Sanitizer Version):
- Apply hand sanitizer to cover every surface of both hands.
- Rub hands together continuously until they are entirely dry.

Apply an Anti-Embolic Stocking to a Resident’s Leg

Perform hand hygiene by covering all surfaces with sanitizer and rubbing until dry.
Explain the full procedure to the resident.
Raise the bed height to a comfortable working level.
Provide for resident privacy by exposing only the single leg being worked on.
Roll, gather, or turn the stocking down inside out, reaching the heel.
Carefully place the stocking over the resident’s toes, foot, and heel.
Roll or pull the stocking up the length of the leg.
Inspect the toes to ensure the stocking is not causing excessive pressure.
Adjust the stocking as required for comfort and fit.
Ensure the final placement is smooth and free of any wrinkles.
Lower the bed back to a safe level.
Maintain respectful and courteous interpersonal interactions at all times.
Place the call light or signaling device within the resident’s easy reach.
Repeat hand hygiene by covering all surfaces with sanitizer and rubbing until dry.

Assist a Resident to Ambulate using a Gait Belt

Perform hand hygiene as described in standard protocols.
Explain the ambulation procedure to the resident.
Obtain the gait belt.
Lock the bed brakes to prevent movement during the transfer.
Lock the wheelchair brakes for safety.
Adjust the bed height so that the resident’s feet will rest flat on the floor when in a sitting position.
Bring the resident to a sitting position with their feet flat on the ground.
Properly position the gait belt around the resident’s waist.
Tighten the belt securely.
Verify the tightness of the belt by slipping fingers between the resident and the belt.
Assist the resident in donning non-skid footwear PRIOR to standing.
Bring the resident to a standing position.
Utilize proper body mechanics throughout the lift.
Maintain a firm grasp on the gait belt and stabilize the resident.
Ambulate the resident for a minimum of ten ( $10$ ) steps.
Assist the resident to pivot or turn.
Sit the resident into the wheelchair using a controlled manner to ensure safety.
Remove the gait belt from the resident’s waist.
Maintain respectful interaction and place the call light within reach.
Perform hand hygiene.

Assist a Resident who is Dependent with a Meal

Perform hand hygiene.
Explain the procedure.
Verify identity: Ask the resident to state their name and confirm it matches the diet card.
Position the resident in an upright position of at least $45^\circ$ .
Protect the resident’s clothing using a protector, napkin, or towel.
Perform hand hygiene for the resident BEFORE feeding. Options include using a wet washcloth followed by a dry towel, or applying hand sanitizer and rubbing until dry.
Ensure the resident’s hands are completely dry before the meal starts.
Sit at eye level, facing the resident directly while assisting.
Provide a description of the food being offered.
Offer fluids frequently throughout the meal.
Offer small, reasonable mouthfuls of food.
Allow sufficient time for the resident to chew and swallow each bite.
Wipe the resident’s face at least one time during the course of the meal.
Scenario Requirement: The actor will indicate satiety by saying "I'm full" before all food/fluids are consumed.
Leave the resident clean at the end of the meal.
Maintain the head of the bed at a minimum of $30^\circ$ after the meal.
Recording Requirements:
- Record solid food intake as a percentage ( $\%$ ). Candidate measurement must be within $25\,\%$ of the RN Test Observer’s calculation.
- Record fluid intake in $ml$ . Candidate measurement must be within $60\,ml$ of the RN Test Observer’s calculation.
Maintain interpersonal courtesy and ensure the call light is within reach.
Perform hand hygiene.

Assist a Resident with a Bedpan (Modified) with Hand Washing Required

Knock on the door and introduce yourself to the resident.
Perform hand hygiene.
Explain the procedure.
Provide for privacy.
Put on gloves.
Raise the resident’s hips or turn them to place a waterproof pad/barrier (towel, chux, etc.) under the buttocks.
Correctly position the bedpan or fracture pan (ensure it is centered and not upside down).
Use correct body mechanics during positioning.
Raise the head of the bed to a level comfortable for the resident.
Leave the call light within reach and move to a different area of the room.
Upon indication from the RN Test Observer, return to the bedside.
Gently remove the bedpan/fracture pan while the RN Test Observer adds liquid (simulated urine).
Empty the pan into the designated toilet.
Rinse the equipment and empty the rinse water into the designated toilet.
Remove the waterproof barrier from under the resident.
Remove gloves by turning them inside out and dispose of them appropriately.
Maintain courtesy and place the call light within reach.
Mandatory Hand Washing Procedure:
  - Wet hands under water.
  - Apply soap.
  - Rub hands together using friction for a minimum of $20\,\text{seconds}$ .
  - Interlace fingers with the tips pointed downward.
  - Wash every surface of the hands and include the wrists.
  - Rinse hands thoroughly with fingers pointing downward toward the drain.
  - Dry hands with clean paper towels.
  - Turn off the faucet using a clean, dry paper towel to avoid recontamination.
  - Dispose of all towels in the trash; do not touch the sink or faucet after washing.

Catheter Care for a Female Resident with Hand Washing Required

Knock and introduce yourself to the resident/manikin.
Perform hand hygiene and explain the procedure.
Provide for privacy and put on gloves.
Avoid overexposure throughout the process.
Verify that urine can flow without restriction into the drainage bag.
Use soap and water to wash the catheter at the point where it exits the urethra.
Use a clean washcloth to rinse the catheter at the exit point.
Hold the catheter firmly at the exit point with one hand to prevent pulling.
While holding the tube, use a clean washcloth with soap and water to clean $3-4\,\text{inches}$ down the catheter tube.
Cleaning strokes must be directed AWAY from the urethra only.
Use a minimum of two ( $2$ ) strokes, using a clean portion of the washcloth for every individual stroke.
Rinse the tube using a clean washcloth, again using strokes away from the urethra and using clean portions for each stroke.
Pat the area dry.
Ensure the tube is never pulled during the procedure.
Replace the top covers and leave the resident in a safe, comfortable position.
Place the call light in reach and maintain courtesy.
Perform the full hand washing procedure (as detailed in the Bedpan section, including the $20\,\text{seconds}$ friction and faucet-off technique).

Denture Care – Clean an Upper or Lower Denture

Perform hand hygiene and explain the procedure.
Line the sink floor with a protective barrier (towel, paper towel, or washcloth) to prevent denture damage if dropped.
Put on gloves.
Apply cleanser to a denture brush or toothbrush.
Remove the single denture plate from its cup.
Handle the denture with extreme care to avoid damage or contamination.
Thoroughly brush the inner, outer, and chewing surfaces of the denture.
Rinse the plate using clean, cool water.
Place the denture back into the rinsed cup.
Fill the cup with cool, clean water.
Rinse the brush and return all equipment to storage.
Discard the protective sink lining.
Remove gloves (turning inside out) and dispose of them.
Maintain respectful interaction and ensure the call light is within reach.
Perform hand hygiene.

Donn an Isolation Gown and Gloves; Empty a Urinary Bag; Measure and Record Output and Remove Gown and Gloves with Hand Washing Required

Donning Gown and Gloves:
  - Perform hand hygiene.
  - Face the back opening of the gown and unfold it.
  - Place arms through the sleeves.
  - Secure the neck opening first, then secure the waist.
  - Ensure back flaps cover clothing as completely as possible.
  - Put on gloves, ensuring they overlap the gown sleeves at the wrist.
Emptying the Bag:
  - Knock, introduce yourself, and explain the procedure.
  - Place a barrier on the floor directly under the drainage bag.
  - Place the graduate (measuring container) on the barrier.
  - Open the drain; allow urine to flow into the graduate without the tip touching the container.
  - Close the drain and wipe it with an alcohol wipe after emptying.
  - Return the drain to its holder.
Measurement and Cleanup:
  - Place the graduate on a flat, level surface.
  - Read the output at eye level.
  - Empty urine into the designated toilet, rinse the graduate, and discard rinse water into the toilet.
  - Return equipment to storage and ensure resident safety/comfort with the call light in reach.
Removing Gown and Gloves:
  - Maintain respectful interaction.
  - Remove gloves by turning them inside out BEFORE removing the gown; dispose of them correctly.
  - Unfasten the neck, then the waist.
  - Remove the gown by folding the soiled outer area inward (soiled area to soiled area).
  - Dispose of the gown.
Recording Output:
- Record the sum in $ml$ . Candidate measurement must be within $25\,ml$ of the RN Test Observer.
Hand Washing:
- Perform the full multi-step hand washing procedure (Wet, Soap, Friction for $20\,\text{seconds}$ , Interlace Down, All Surfaces, Wrists, Rinse Down, Dry, Faucet-off with towel).

Dress a Bedridden Resident with an Affected (Weak) Side

Perform hand hygiene and explain the procedure.
Provide for privacy and raise the bed height.
Keep the resident covered during the removal of the old gown.
Removal: Always remove the gown from the resident’s UNAFFECTED side first.
Place the soiled gown in the laundry hamper.
Dressing (Shirt): Insert your hand through the shirt sleeve and grasp the resident’s hand.
Rule: When dressing in a button-up shirt, always dress the resident’s WEAK side first.
Dressing (Pants): Turn the resident or raise their buttocks to draw pants up to the waist.
Rule: When dressing in pants, always dress the resident’s WEAK side leg first.
Put on non-skid socks, drawing them up until smooth.
Ensure the resident is comfortably dressed and in a safe position.
Lower the bed and maintain interpersonal courtesy.
Place the call light within reach and perform hand hygiene.

Foot Care for One Foot

Perform hand hygiene and explain the procedure.
Fill a basin with warm water and put on gloves.
Remove the sock from the specified foot (left or right as per scenario).
Immerse the foot in water. Verbalize a soaking time of $5$ to $20\,\text{minutes}$ .
Use a soapy washcloth to wash the entire foot and between the individual toes.
Rinse the entire foot and between the toes (a wrung-out soapy washcloth dipped in the basin is acceptable).
Dry the foot and between the toes thoroughly.
Warm lotion by rubbing it between your hands.
Massage lotion over the entire foot, specifically AVOIDING the area between the toes.
Wipe any excess lotion with a towel.
Replace the sock.
Empty, rinse, and dry the basin before returning it to storage.
Place soiled linens in the hamper.
Remove gloves (turning inside out) and dispose of them.
Ensure resident safety and body alignment in the chair.
Maintain courtesy, place the call light, and perform hand hygiene.

Modified Bed Bath for Resident – Whole Face and One Arm, Hand and Underarm

Perform hand hygiene and explain the procedure.
Provide privacy, fill a basin with warm water, and raise the bed.
Cover the resident with a bath blanket.
Fanfold linens to the waist or move them to the opposite side.
Remove the resident's gown while maintaining coverage; place it in the hamper.
Face: Wash the face WITHOUT SOAP and pat dry.
Upper Body: Place a towel under the resident’s arm, exposing only that arm.
Wash the arm, hand, and underarm using soap.
Rinse the arm, hand, and underarm.
Pat dry the arm, hand, and underarm.
Assist the resident into a clean gown.
Empty, rinse, and dry the basin; return equipment to storage.
Place soiled linens in the hamper and lower the bed.
Maintain courtesy, place the call light, and perform hand hygiene.

Mouth Care – Brush a Resident’s Teeth

Perform hand hygiene and explain the procedure.
Provide privacy and gather supplies. Put on gloves ONLY AFTER gathering supplies.
Drape the resident’s chest with a cloth or paper towel to prevent soiling.
Wet the toothbrush and apply toothpaste.
Brush the inner, outer, and chewing surfaces of all upper and lower teeth.
Requirement: Must verbalize which surfaces are being cleaned during the process.
Clean the resident's tongue.
Assist with rinsing the mouth and wipe the mouth area.
Remove the chest barrier and place it in the appropriate container.
Empty, rinse, and dry the emesis basin; rinse the toothbrush.
Return equipment to storage.
Remove gloves (turning inside out) and dispose of them.
Ensure resident comfort, place the call light, and maintain courtesy.
Perform hand hygiene.

Perineal Care for a Female with Hand Washing Required

Intro/Knock, Hand hygiene, and Explanation.
Provide for privacy, raise the bed, and fill a basin with warm water.
Put on gloves.
Safety: Direct the RN Test Observer to stand on the opposite side of the bed or raise the opposite side rail.
Place a waterproof pad under the buttocks (by turning or raising hips).
Expose the perineum ONLY.
Frontal Cleaning:
  - Separate the labia.
  - Use a clean, soapy washcloth.
  - Clean one side of the labia from TOP to BOTTOM.
  - Use a clean portion of the cloth for the other side (TOP to BOTTOM).
  - Use a clean portion to clean the vaginal area (TOP to BOTTOM).
Frontal Rinsing: Repeat the process with a clean washcloth, rinsing in the same top-to-bottom order using clean portions for each side and the vagina.
Pat dry and avoid overexposure.
Back Cleaning:
  - Assist the resident to turn onto their side away from you (RN Test Observer may help hold the manikin ONLY after the turn).
  - Use a soapy washcloth to clean from the VAGINA to the RECTAL area.
  - Use a clean portion of the cloth for strokes.
Back Rinsing: Rinse from the VAGINA to the RECTAL area using a clean washcloth and clean portions.
Pat dry and remove the waterproof barrier.
Reposition the resident onto their back.
Store linens in the hamper; empty, rinse, dry, and store equipment.
Remove gloves (turning inside out) and lower the bed.
Maintain courtesy and place the call light.
Perform the full multi-step hand washing procedure with $20\,\text{seconds}$ friction and faucet technique.

Position Resident in Bed on Their Side

Perform hand hygiene and explain the procedure.
Provide privacy and flatten the bed.
Raise the bed height.
Raise the side rail or direct the RN Test Observer to stand on the opposite side for safety.
Move the resident’s body toward yourself from the working side.
Turn the resident onto the specified side (Left or Right as instructed by the Observer).
Ensure the face is never obstructed by the pillow.
Verify the resident is not lying on their own downside arm.
Position the resident in the center of the bed in correct alignment.
Support Devices (Pillows): Place supports under the head, under the upside arm, behind the back, and between the knees.
Ensure comfort and safety; lower the bed.
Maintain courtesy, place the call light, and perform hand hygiene.

Range of Motion (ROM) for a Resident’s Hip and Knee

Perform hand hygiene and explain the procedure.
Safety Rule: Never cause pain or discomfort; do not force joints beyond free movement.
Raise the bed and provide privacy.
Position the resident supine (flat on back) in good alignment.
Support joints by placing one hand under the knee and one under the ankle.
Hip Abduction/Adduction:
  - Abduction: Move the entire leg AWAY from the body.
  - Adduction: Move the entire leg TOWARD the body.
  - Complete this cycle at least three ( $3$ ) times.
Hip and Knee Flexion/Extension:
  - Flexion: Bend the knee and hip toward the resident’s trunk simultaneously.
  - Extension: Straighten the knee and hip simultaneously.
  - Complete this cycle at least three ( $3$ ) times.
Communication: Ask the resident at least once during the exercise if they are experiencing any pain.
Ensure comfort, lower the bed, and maintain courtesy.
Place the call light and perform hand hygiene.

Range of Motion (ROM) for a Resident’s Shoulder

Perform hand hygiene and explain procedure.
Provide privacy and raise the bed.
Position the resident supine (flat) in good alignment.
Support joints by placing one hand under the elbow and the other under the wrist.
Flexion/Extension:
  - Flexion: Raise the arm up and over the resident’s head.
  - Extension: Bring the arm back down to the side.
  - Complete this cycle at least three ( $3$ ) times.
Abduction/Adduction:
  - Abduction: Move the entire arm out away from the body.
  - Adduction: Return the arm to the side.
  - Complete this cycle at least three ( $3$ ) times.
Requirement: Do not force movement; ask the resident about pain/discomfort at least once.
Ensure comfort, lower the bed, and maintain courtesy.
Place call light and perform hand hygiene.

Stand and Pivot Transfer a Weight-Bearing Resident

Perform hand hygiene and explain the procedure.
Obtain the gait belt.
Lock the bed brakes.
Assist the resident in putting on non-skid footwear.
Position the bed so feet are flat on the floor when sitting.
Assist the resident to a sitting position.
Position the wheelchair so the arm or wheel is touching the side of the bed.
Lock the wheelchair brakes.
Apply the gait belt around the waist, tighten, and check for fit with fingers.
Face the resident and grasp the gait belt with both hands.
Bring the resident to a standing position using proper body mechanics.
Assist the resident to pivot in a safe, controlled manner.
Sit the resident in the wheelchair safely.
Remove the gait belt, maintain courtesy, and place the call light.
Perform hand hygiene.

Vital Signs: Count and Record a Resident’s Radial Pulse and Respirations

Perform hand hygiene and explain the procedure.
Radial Pulse:
  - Locate the pulse on the thumb side of the resident’s wrist using fingertips.
  - Count for exactly sixty ( $60$ ) seconds.
  - Verbalize the "Start" and "Stop" of the count to the RN Test Observer.
  - Record the reading on the form.
  - Accuracy standard: Within six ( $6$ ) beats of the Observer’s rate.
Respirations:
  - Count respirations for exactly sixty ( $60$ ) seconds.
  - Verbalize the "Start" and "Stop" of the count to the RN Test Observer.
  - Record the reading on the form.
  - Accuracy standard: Within two ( $2$ ) breaths of the Observer’s rate.
Maintain courtesy, place the call light, and perform hand hygiene.