CLINICAL NURSING SKILLS EXAM
QUESTIONS WITH VERIFIED
ANSWERS
Standard Precautions - Answer-used for all patients, regardless of risk or infection
status. What you need to wear for dealing with blood, body fluids, non intact skin,
mucous membranes. If chance for spraying, wear mask, goggles, etc. Dirty linen
goes in a leak proof bag. Needles go in a special holder.
Airborne - Answer-mask + standard precautions
Droplet - Answer-mask if closer than 3ft + standard precautions
Contact - Answer-gloves and gown + standard precautions
Isolation PPE - Answer-Donning: gown - mask - eyewear - gloves;
Removing: gloves - eyewear - gown - mask
Things that can be delegated: - Answer-Isolation care can be delegated to NAP,
Hand Hygiene can be delegated,
Safe environment - Answer-patient's needs are met, physical hazards are
reduced/eliminated, transmission of microorganisms is reduced, sanitary measures
are carried out.
If there's a fire: - Answer-RACE. Rescue patient. Active fire alarm. Contain fire.
Extinguish.
To Extinguish: - Answer-PASS. Pull pin. Aim. Squeeze handle. Sweep.
Radiation Safety - Answer-wear a radiation dosimeter (to measure how much
radiation) and goggles
Chemical spill - Answer-take care of patient, notify the authorities
Most common in patient accident: - Answer-falling. Over 1/3 of patients 65 and older
fall annually.
Fall assessment: - Answer-Unsteady gait/dizziness/imbalance, Impaired memory or
judgment, Weakness, History of falls, Use of a wheelchair; Medications: Diuretics or
diuretic effects, Hypotensive or central nervous system suppressants (e.g., narcotic,
sedative, psychotropic, hypnotic, tranquilizer, antihypertensive, antidepressant),
Medication that increases gastrointestinal motility (e.g., laxative, enema)
Be familiar with different ways to keep patients in bed/ know when they're escaping: -
Answer-Make sure anything they would need is close by, Ask often to see if they
need anything/need to go to the bathroom, Electronic bed/chair alarm that goes off
, when they are getting up, Posey Bed Canopy System - encloses the bed, Safe room
- non skid mat, side rails up (not 4), free of hazards and clutter, bedside commode if
needed, call light close, bed at a low position, etc
What cannot be delegated? - Answer-Fall Assessment cannot be delegated to NAP
Ambulating - Answer-non skid shoes, gait belt, make sure they aren't dizzy. Know
who the patient is, what their condition is, what they are sick with, etc***If you start to
fall, wide stance, bend knees, fall with patient. Notify physician and report the fall.
When getting in Wheelchair - Answer-on strong side of body, lock wheels. Back in
and out of elevators/doors.
Kids: - Answer-no side rails or anything else that would provoke climbing.
1st goal of care - Answer-restraint-free environment; Do everything possible to avoid
using restraints. Position tubes out of sight, use stress reduction techniques (back
rubs, music, etc) and diversional activities. For wanderers, remove cane, shoes, etc
from sight.
Know rules of restraints: - Answer-MD order, last resort, know how to put them on,
*Restraint application and care can be delegated, Never tie to movable part of bed,
Remove every 2 hours and inspect skin, Check every 15 minutes, Before new order
from physician after 24 hours, he has to assess patient face to face, Continue to
assess skin, etc
General seizure rules: - Answer-1st priority - patient's safety, A clear airway is a
priority - but don't stuff anything in their mouth*, Stay with patient, note time and
duration, call for help, Lay them on their side once back in bed, etc
Procedure giving a bedbath: - Answer-1. Place bath blanket over patient.
2. Remove patients gown or pajamas.
3. Raise siderail and fill wash basin 2/3 full. Have patient test water with finger.
4. Place basin and and supplies on over bed table. Lower side rail. Place head at 30
degrees. Place bath towel under head, and over patient's chest.
5. Wash face: Form mitten washcloth. Wash patient's eyes from inner to outer. Ask if
patient wants soap. Proceed to wash forehead, cheeks, nose, neck, and ears.
Provide eyecare for unconscious patient.
6. Wash upper extremities and trunk.
7. Wash hands and nails.
8. Wash lower extremities.
9. Wash back: Assist patient in assuming prone or side-lying position. Keep patient
draped.Wash rinse and dry back from neck to buttocks using long firm strokes.
10. Remove gloves. Give backrub
11. Apply body lotion.
12. Assist patient in grooming.
13. Check external devices such as catheters.
14. Remove soiled linens.
QUESTIONS WITH VERIFIED
ANSWERS
Standard Precautions - Answer-used for all patients, regardless of risk or infection
status. What you need to wear for dealing with blood, body fluids, non intact skin,
mucous membranes. If chance for spraying, wear mask, goggles, etc. Dirty linen
goes in a leak proof bag. Needles go in a special holder.
Airborne - Answer-mask + standard precautions
Droplet - Answer-mask if closer than 3ft + standard precautions
Contact - Answer-gloves and gown + standard precautions
Isolation PPE - Answer-Donning: gown - mask - eyewear - gloves;
Removing: gloves - eyewear - gown - mask
Things that can be delegated: - Answer-Isolation care can be delegated to NAP,
Hand Hygiene can be delegated,
Safe environment - Answer-patient's needs are met, physical hazards are
reduced/eliminated, transmission of microorganisms is reduced, sanitary measures
are carried out.
If there's a fire: - Answer-RACE. Rescue patient. Active fire alarm. Contain fire.
Extinguish.
To Extinguish: - Answer-PASS. Pull pin. Aim. Squeeze handle. Sweep.
Radiation Safety - Answer-wear a radiation dosimeter (to measure how much
radiation) and goggles
Chemical spill - Answer-take care of patient, notify the authorities
Most common in patient accident: - Answer-falling. Over 1/3 of patients 65 and older
fall annually.
Fall assessment: - Answer-Unsteady gait/dizziness/imbalance, Impaired memory or
judgment, Weakness, History of falls, Use of a wheelchair; Medications: Diuretics or
diuretic effects, Hypotensive or central nervous system suppressants (e.g., narcotic,
sedative, psychotropic, hypnotic, tranquilizer, antihypertensive, antidepressant),
Medication that increases gastrointestinal motility (e.g., laxative, enema)
Be familiar with different ways to keep patients in bed/ know when they're escaping: -
Answer-Make sure anything they would need is close by, Ask often to see if they
need anything/need to go to the bathroom, Electronic bed/chair alarm that goes off
, when they are getting up, Posey Bed Canopy System - encloses the bed, Safe room
- non skid mat, side rails up (not 4), free of hazards and clutter, bedside commode if
needed, call light close, bed at a low position, etc
What cannot be delegated? - Answer-Fall Assessment cannot be delegated to NAP
Ambulating - Answer-non skid shoes, gait belt, make sure they aren't dizzy. Know
who the patient is, what their condition is, what they are sick with, etc***If you start to
fall, wide stance, bend knees, fall with patient. Notify physician and report the fall.
When getting in Wheelchair - Answer-on strong side of body, lock wheels. Back in
and out of elevators/doors.
Kids: - Answer-no side rails or anything else that would provoke climbing.
1st goal of care - Answer-restraint-free environment; Do everything possible to avoid
using restraints. Position tubes out of sight, use stress reduction techniques (back
rubs, music, etc) and diversional activities. For wanderers, remove cane, shoes, etc
from sight.
Know rules of restraints: - Answer-MD order, last resort, know how to put them on,
*Restraint application and care can be delegated, Never tie to movable part of bed,
Remove every 2 hours and inspect skin, Check every 15 minutes, Before new order
from physician after 24 hours, he has to assess patient face to face, Continue to
assess skin, etc
General seizure rules: - Answer-1st priority - patient's safety, A clear airway is a
priority - but don't stuff anything in their mouth*, Stay with patient, note time and
duration, call for help, Lay them on their side once back in bed, etc
Procedure giving a bedbath: - Answer-1. Place bath blanket over patient.
2. Remove patients gown or pajamas.
3. Raise siderail and fill wash basin 2/3 full. Have patient test water with finger.
4. Place basin and and supplies on over bed table. Lower side rail. Place head at 30
degrees. Place bath towel under head, and over patient's chest.
5. Wash face: Form mitten washcloth. Wash patient's eyes from inner to outer. Ask if
patient wants soap. Proceed to wash forehead, cheeks, nose, neck, and ears.
Provide eyecare for unconscious patient.
6. Wash upper extremities and trunk.
7. Wash hands and nails.
8. Wash lower extremities.
9. Wash back: Assist patient in assuming prone or side-lying position. Keep patient
draped.Wash rinse and dry back from neck to buttocks using long firm strokes.
10. Remove gloves. Give backrub
11. Apply body lotion.
12. Assist patient in grooming.
13. Check external devices such as catheters.
14. Remove soiled linens.
