Revised Skills For Revision With Marks and Critical Elements

1.
ELECTROCARDIOGRAM PLACEMENT
Name of the student: ________________________ Student D#: ______________________
S.N Steps Marks Marks Comment

o. Allocated Obtained
1. Check care plan 1
2. *Identify client using two identifiers 2
3. Explain procedure to the client 1
4. Perform hand hygiene 1
5. *Prepare and check ECG Machine: 2
In working order
Recording paper adequate
6. Take requirements to client’s bedside 1
7. Provide privacy 1
8. *Place client in supine/semi-recumbent 2
position
9. *Expose the client’s chest, hands and legs (for 2
placement of electrode
10. Clean skin with alcohol swabs 1
Shave chest hair if necessary
11. Apply gel on placement 1
12. *Attach electrodes to limbs and appropriate 2
position on the client’s chest
13. Take recordings 1
14. Remove electrodes 1
15. Clean client’s skin and electrodes 1
16 *Ensure clients safety and comfort 2
17 Clean and store away equipment 1
19. *Attach sticker and write date and time 2
20. *Document the procedure 2
*critical elements:
Examiner: ……………………………... Signature: ……………………...
Total marks: ______________ X 100 =

28
2. DRUG ADMINISTRATION: NEBULIZATION
Name of the student: ________________________ Student ID#: ______________________
S. Steps Marks Marks Comment

No. Allocated Obtained
1 Check care plan 1
2 *Introduce self and identify client using two identifiers 2
3 Explain procedure to client 1
4 Perform hand hygiene 1
5 Prepare requirements 1
6 *Calculate dose 2
7 Assemble syringe and needle 1
8 *Withdraw the required amount of drug and normal 2
saline
9 Place drug in nebulizer cup 1
10 Take nebulizer and other requirements to client 1
11 Provide privacy 1
12 *Place client in appropriate position (sitting; semi/high 2
fowler’s position)
13 Attach nebulizer to electrical outlet -
14 Switch on the nebulizer button -
15 *Place nebulizer mask to the client and ensure that 2
nose and mouth are well covered
16 *Instruct client to: 2
breath in slowly and deep through the mouth hold it for
few seconds then exhale slowly cough out secretions
after several deep breaths
17 Repeat step 16 until drug is fully consumed 1
18 *Observe client throughout the procedure for any 2
untoward signs and symptoms and report immediately
19 Switch off nebulizer and dispose wastes in appropriate 1
receptacles
20 *Ensure client’s safety and comfort 2
21 Clean and store away nebulizer 1
23 *Document the procedure 2
Characteristics of the secretion
Response of the client to the procedure
24 Report abnormality 1
*critical elements
Total marks: ______________ X 100 =

31
3.AIRWAY MANAGEMENT: ENDOTRACHEAL/TRACHEOSTOMY SUCTION

1 Check care plan 1
2 *Introduce self and identify client using two 2
identifiers
4 *Perform hand hygiene 2
5 Wear face mask(PPE as indicated) 1
6 Provide privacy 1
7 *Auscultate lung sound 2
8 Assess condition of stoma 1
10 Prepare requirements and bring to client’s bedside 1
11 *Adjust the bed to comfortable working position 2
12 *Position client appropriately: 2
Semi-fowlers (Conscious)
Lateral (Unconscious)
13 Place towel/incontinent sheet into client’s chest 1
15 *Open sterile pack 2
16 *Open the sterile gloves 2
17 *Open suction tip and connect to the suction tube 2
18 *Pour normal saline to sterile galipot 2
20 *Wear sterile gloves and place inner cover across 2
client’s chest
21 *With the non-dominant hand: 2
Switch on the suction machine to appropriate pressure
Remove suction catheter from the wrapper
Hyperventilate the client
Disconnect connection (between ET tube and
ventilator/Trach-vent)
22 *Insert suction catheter in to ET tube (until client 2
coughs)
23 *Apply suction (not more than 10seconds) 2
24 *Pull catheter out (rotating slowly) 2
25 Reconnect connection (between ET tube and 1
ventilator/trach-vent) and hyperventilate the client.
26 Rinse the suction catheter with normal saline 1
27 Repeat steps 20 to 24 (if necessary) 1
28 Suction mouth and nose as necessary 1
29 Clear suction tube with normal saline 1
30 Switch suction off 1
31 Discard used suction catheter 1
32 Discard gloves 1
33 Reassess client’s respiratory status: 2
Vital signs (RR, PR, SpO2)
*Auscultate lung sound
35 Clean and store away requirements 1
Characteristics of the secretion
Response of the client to the procedure
38 Report abnormality 1
*critical elements: any time sterility is broken the whole procedure is marked zero
Total marks: ______________ X 100 =

58
4. NASOGASTRIC TUBE INSERTION
S.No Steps Marks Marks Comment

. Allocated Obtained
2. *Introduce self and identify client using two 2
identifiers.
3. Explain procedure to client 1
5. Prepare requirements. 1
6. Take requirements to client. 1
8. *Place client in appropriate position (semi-recumbent 2
or fowler).
9. Place towel/incontinent sheet on client’s chest 1
10. Inspect and clean client’s nostrils with a penlight. 1
12. Wear gloves 1
13. *Measure Nasogastric tube from tip of the nose to ear 2
pinna to two inches below the xiphoid process
14. *Lubricate tip of NG tube with gel/ water soluble 2
lubricant.
15. *Insert NG tube into one nostril (push tube forward 2
and downwards) until tip touches posterior
nasopharynx
16. *Instruct client to swallow tube with water (sip water 2
through a straw or just swallow) or to swallow.
17. *Push tube gently and slowly as client swallows till 2
the desired measurement.
18. Connect 10 ml syringe 1
19. *Ensure tip of NG tube is in the stomach: 2
Aspirate stomach content and test gastric aspirate with
litmus paper. (Litmus paper should turn red). If the
color does not change, proceed with the other tests.
Push 5-10 ml air into tube and listen for “whooshing”
sound using the stethoscope.
20. Cover the opening of NG tube and anchor tube to the 1
nose with plaster
21. Ensure client’s safety and comfort 1
22 Clean and store away used materials 1
23. Discard gloves appropriately 1
25 *Document procedure 2
*critical elements:
Total marks: ______________ X 100

34
5. NASOGASTRIC TUBE FEEDING

2. *Introduce self and identify client using two identifiers 2
6. Take requirements to the bedside. 1
8. *Place client in semi or high fowler’s position. 2
9. Place towel/incontinent pad on the chest and kidney dish 1
on the side of the client
11. Wear gloves 1
12. *Pinch tube, open cover/remove spigot and place it in the 2
kidney dish
13. *Connect 60 ml syringe and aspirate gastric content 2
(gastric residual volume), note amount and color
Withhold feeding if more than 100 ml or according to
hospital protocol
14. *Check tube placement: 2
Aspirate stomach content and test gastric aspirate with
litmus paper. (Litmus paper should turn red). If the color
does not change, proceed with the other tests.
Push 5-10 ml of air into tube and listen for “whooshing”

sound using the stethoscope ( if no sound, withhold feeding
and refer)
15. *Kink the tube and remove syringe from the NG tube and 2
close.
16 Remove plunger of the 60 ml syringe, kink the tube, open 1
the cover/remove spigot and connect barrel to the tip of NG
tube
17. Fill syringe barrel initially with 10 ml of water and release 1
the tube to allow flow of water by gravity
18. Pour liquid food into the syringe barrel and hold barrel at a 1
level where liquid food flow gently into client’s stomach.
19. Refill barrel before it gets empty 1
20. Repeat steps 17-18 until the required amount of liquid food 1
has been given
21. Flush tube with water 1
Adult: 30-50 ml
Child: 15-30 ml
(Follow hospital protocol)
22. *Kink the tube when empty, disconnect barrel and close 2
the NG tube.
23. *Maintain client’s position for 30 minutes 2
24. *Ensure client’s safety and comfort 2
25. Clean and store away used utensils 1
26. Discard gloves 1
28. *Document procedure 2
*critical elements:
Total marks: ______________ X 100 =

38
6. INSERTION OF FEMALE URINARY CATHETER (INDWELLING FOLEY’S
CATHETER)

1 Check care plan 1
2 *Identify client using two identifiers 2
4 Perform hand hygiene. Put on PPE as indicated 1
5 Prepare requirements and take to client’s bedside 1
6 *Lock and adjust the height of the bed 2
7 *Provide privacy 2
8 *Place client in appropriate position (Dorsal recumbent 2
or Sim’s position).
9 Place incontinent sheet under client’s buttocks 1
10 Place cheatle forceps at bed side table, kidney dish at 1
client side
12 *Open the sterile catheterization set and prepare the 2
following
(Arrange the equipment with cheatle forceps)
sterile gloves
catheter pack
20 ml of syringe
Pour normal saline/sterile water into kidney dish
Pour antiseptic solution into galipot
Prepare lubricant in another galipot
(Place additional gauze / cotton balls if necessary)
14 *Wear sterile gloves 2
15 *Check catheter balloon with air using a sterile syringe 2
16 *Prepare syringe with required amount of normal 2
saline/sterile water
17 *Lubricate the catheter 1-2 inches from the tip and place 2
in kidney dish
18 *Perform perineal care 2
With the dominant hand clean labia majora using
forceps with antiseptic soaked gauze swabs.
With the non-dominant hand part labia majora (using
thumb and index finger) and clean labia minora with
dominant hand
With dominant hand, Clean the vestibule (from above
the meatus down towards the rectum)
Note: Clean from top to bottom using single stroke

19 Place fenestrated drape around perineum 1
20 Place kidney dish with catheter between client’s thighs 1
on fenestrated drape
21 *With the non-dominant hand part the labia to expose 2
the urethral meatus
22 *Hold catheter 2-3 inches from the tip, instruct client to 2
breathe deeply through mouth while inserting the
catheter gently into urethral meatus until urine flows out
into the kidney dish
23 Once urine flows advance the catheter for another 2-3 1
inches
24 Slowly inflate the catheter balloon with the prefilled 1
syringe
25 Pull catheter gently until resistance is felt then advance 1
again
26 Remove fenestrated drape and connect the urine bag 1
27 Secure catheter with the plaster into client’s inner thigh 1
then hang the urine bag properly
28 Dry perineal area 1
29 Remove and discard incontinent sheet 1
30 Measure amount of urine as ordered/ clinically required 1
31 Remove and discard gloves and other PPEs 1
appropriately
Total marks: ______________ X 100 =

50
7. INSERTION OF MALE URINARY CATHETER: INDWELLING FOLEYS CATHETER

No Allocated Obtained
.
1 Check care plan 1
3. Explain procedure to client 1
4 Perform hand hygiene. Put on PPE as indicated 1
5 Prepare requirements and take to client’s bedside 1
6 *Lock and adjust the height of the bed 2
7 *Provide privacy 2
8 *Place client in supine position with legs slightly apart 2
9 Place incontinent sheet under client’s buttocks 1
10 Place cheatle forceps at bed side table, kidney dish at 1
client side
12 *Open the sterile catheterization set and prepare the 2
following
(Arrange the equipment with cheatle forceps)
sterile gloves
catheter pack
20 ml of syringe
Pour normal saline/sterile water into kidney dish
Pour antiseptic solution into galipot
Prepare lubricant in another galipot
(Place additional gauze/ cotton balls if necessary)
14 *Wear sterile gloves 2
15 *Check catheter balloon with air using a sterile syringe 1
16 Prepare syringe with required amount of normal 1
saline/sterile water
17 *Lubricate the catheter 1-2 inches from the tip and place 2
in kidney dish
18 *Clean the penis using the following technique: 2
With the non-dominant hand gently hold the penis at the
shaft and hold it at the right angle
Using dominant hand, pick up forceps and clean penis in
circular motion with antiseptic soaked gauze swabs
from penis tip downwards.
(For uncircumcised client -retract the foreskin and
clean beneath)
Note: Use one (1) gauze swab per stroke and repeat as
necessary
19 Place fenestrated drape around the penis 1

20 Place kidney dish with catheter between client’s thighs 1
on fenestrated drape
21 *When inserting catheter: 2
With the non-dominant hand hold penis perpendicular to
body and pull up slightly on shaft
Ask the patient to bear down gently and slowly insert
the catheter to urethral meatus
Advance catheter 7-9 inches or until urine flows from
catheter
22 Once urine flows advance the catheter for another 2-3 1
inches
23 *Slowly inflate the catheter balloon with the prefilled 2
syringe accordingly
24 *Pull catheter gently until resistance is felt then advance 2
again
25 Remove fenestrated drape and connect the urine bag 1
26 Secure catheter with the plaster into client’s upper thigh 1
with penis directed downward then hang the urine bag
properly
27 Dry the penis 1
28 Remove and discard incontinent sheet 1
29 Measure amount of urine as ordered/ clinically required 1
30 Remove and discard gloves and other PPEs 1
appropriately
Total marks: ______________ X 100 =

48
8. INTRAVENOUS FLUID (IVF) PREPARATION, ADMINISTRATION AND REGULATION

PREPARATION OF IVF SOLUTION
1 *Check prescription chart: 2
Name of client
Registration number
Name and type of IV fluid
Amount of the IV fluid
Frequency and time of administration
Doctor’s signature
Date and time of prescription
2 *Check available prescribed intravenous fluid. 2
Check for the color or presence of leakage in the IV
bottle and read the expiration date.
3 *Check manufacturer’s drip rate calibration on the 2
administration set.
4 *Calculate the intravenous fluid flow rate. 2
5 Perform hand hygiene. 1
6 Remove the protective cap of the IV solution by 1
pulling it up
7 *Open and remove the sterile IV administration set 2
by applying principles of asepsis
8 *Adjust the height of the roller clamp near the IV 2
bottle and close the roller clamp.
9 *Remove the cap of the spike of the IV tubing 2
(Careful not to touch the spike)
10 *Using a twisting and pushing motions, insert the 2
administration set spike into the entry port of the
intravenous container following aseptic technique.
11 Hang the IV bottle on the IV pole/stand 1
12 Squeeze the drip chamber and fill at least halfway 1
13 *Remove the cap of the tip of the IV tubing (Careful 2
not to touch it)
14 *Prime the IV tubing by opening the clamp to allow 2
fluid to flow.
15 *Check IV tubing for presence of air bubbles and 2
remove until air bubbles have disappeared.
16 Close the clamp and recap the tip of the IV tubing. 1
17 Tape the tip of the tubing to the body of the tube. 1
(Let the tube hang and not to touch any surface)
18 *Apply the sticker into the IV bottle (as per agency 2
protocol)
Name of IV fluid
Date and time
Flow Rate
Signature
19 Bring requirements to the bedside. 1
ADMINISTRATION OF IVF
20 *Identify client by using 2 identifiers. 2
21 Explain the procedure to the client 1
22 Provide privacy 1
23 Position the client appropriately 1
25 *Remove the cap of the IV cannula and connect the 2
tip of the IV tubing following aseptic technique.
26 Anchor the IV tubing properly. 1
REGULATION OF IVF
27 Take the watch with the second hand and place it 1
beside the drip chamber.
28 *Adjust the roller clamp and count the drip for 15 2
seconds (to determine if the flow rate is close to the
desired rate) if not, adjust it.
29 If the desired flow rate for 15 seconds is already 1
met, continue counting for 1 full minute.
30 *Ensure client safety and comfort 2
*critical elements:
Total marks: ______________ X 100 =

51
9. DRUG ADMINISTRATION: PREPARATION OF INJECTION FROM AN AMPULE

1. *Check prescription chart: 2
Name of client
Registration number
Name of drug/medication
Dose
Frequency of administration
Route of administration
2. *Check available medication/drug (name, stock dose, 2
expiration date)
3. *Calculate amount of drug to be administered 2
4. *Check accuracy of calculation. 2
6. Prepare requirements 1
7. *Ensure drug is below the ‘neck’ of ampoule. 2
flick the upper stem of the ampule with finger nail or
tap the stem of the ampule or twist your wrist quickly
while holding the ampule vertically
8. *Cover the ‘neck’ of ampoule with gauze or use 2
ampule opener if ampule is not scored, use the file first
9. Break the ampule away from you. 1
10. *Dispose the top of ampule in sharp container. 2
11. Assemble syringe. 1
12. *Withdraw medication in the amount ordered. 2
13. *Pull the plunger and change the needle and discard 2
used needle in the sharp container.
14. *Tap syringe barrel and expel the air carefully. 2
15. *Check amount of drug in syringe and discard any 2
surplus.
16. *Label syringe: 2
Client’s name
Registration number
Name and dose of drug
Date
17. Place syringe, ampule and an alcohol wipe/cotton ball 1
and a dry cotton ball on injection tray
18. Place waste materials in waste receptacle 1
19. Perform hand hygiene. 1
*critical elements:
Examiner: ……………………………. Signature: …………………….

Total marks: ______________ X 100 =
28
10. DRUG ADMINISTRATION: PREPARATION OF INJECTION FROM A VIAL
CONTAINING POWDER
Name of the student: ________________________ Student ID#_______________________

Name of client
Registration number
Dose
2. *Check available medication/drug (name, stock dose, 2
expiration date)
3. *Calculate amount of drug to be administered. 2
4. *Check accuracy of calculation. 2
7. *Rotate the vial between the palms to disperse the 2
drug.
8. Remove the protective cap of the vial. 1
Swab the rubber cap if it is previously opened vial &
let it dry
9. Prepare the diluent following the steps from 1
preparation of ampule/vial
10. *Assemble syringe and withdraw the amount of 2
sterile water or saline.
11. *Inject diluent into the vial. Remove the needle and 2
recap it using the scoop method while maintaining
sterility.
12. *Mix the solution by rotating the vial between the 2
palms and not by shaking
13. *Draw up into the syringe the amount of air equal to 2
the volume of the medication to be withdrawn.
14. Inject the air keeping the bevel of the needle above 1
the surface of the solution.
15. Invert the vial and withdraw the needle tip slightly so 1
that it is below the fluid level.
16. *Draw up the prescribed amount of medication at eye 2
level.
If air bubbles accumulate in the syringe, tap the barrel
of syringe sharply and move the needle past the fluid
into the air space to re-inject the solution and continue
withdrawal of medication.
17. *When correct volume of medication plus a little 2
more (eg.0.25 ml) is obtained, withdraw the needle
and recap the needle using the scoop method (thus
maintaining sterility).
18. Change needle if required. 1
19. *Tap the syringe barrel and expel the air. 2
20. *Check amount of drug in syringe and discard any 2
surplus.
21. *Label syringe: 2
Client’s name
Registration number
Name and dose of drug
Date
22. Place syringe, vial and an alcohol wipe/cotton ball 1
and a dry cotton ball on injection tray.
23. Place waste materials in waste receptacle. 1
Total
*critical elements:
Total marks: ______________ X 100 =

38
11. DRUG ADMINISTRATION: INTRAMUSCULAR INJECTION

Name of client
Registration number
Dose
2. *Identify client with two identifiers. 2
3. Explain the purpose and action of medication and 1
complete necessary assessment before administering
the medication.
7. *Provide privacy. 2
8. *Place client in appropriate position. 2
9. *Identify and expose injection site (upper arm, 2
buttock, thigh – anterior, lateral).
10. Clean site with alcohol wipe/cotton ball 1
11. Remove needle cap. 1
12. Hold injection site between thumb and index finger. 1
13. *Hold syringe and insert at 90 into the muscle 2
14. *Withdraw plunger slightly (to ensure needle is not in 2
a blood vessel).
15. Administer drug by pushing plunger slowly. 1
16. Withdraw needle gently but quickly at the same angle 1
used for insertion
17. Clean/wipe skin with dry cotton ball. Massage the site 2
18. *Ensure client’s comfort. 2
19. *Dispose wastes in appropriate receptacles. 2
21. *Document each medication given. 2
22. *Evaluate the client when the medication is expected 2
to take effect (usually 30 minutes or depending on the
medication) and report abnormalities
*critical elements:
Total marks: ______________ X 100 =

34
12. DRUG ADMINISTRATION: SUBCUTANEOUS INJECTION
Name of the student: ________________________ Student ID#: -______________________

Name of client
Registration number
Dose
2. *Identify client using two identifiers. 2
3. Explain the purpose and action of medication and 1
complete necessary assessment before administering
the medication.
8. Place client in appropriate position. 1
9. *Identify and expose injection site 2
10. Clean site with alcohol swab/cotton with spirit 1
12. Hold injection site between thumb and index finger. 1
13. *Hold syringe and insert needle at 45 or 90 into the 2
subcutaneous.
14. *Withdraw plunger slightly (to ensure needle is not in 2
a blood vessel, except for heparin)
15. Administer drug by pushing plunger slowly. 1
16. Withdraw needle gently but quickly at the same angle 1
used for insertion
17. Clean/wipe skin with dry cotton ball. 1
18. *Ensure client’s comfort. 2
19. *Dispose wastes in appropriate receptacles. 2
21. *Document each medication given. 2
22. *Evaluate the client when the medication is expected 2
to take effect (usually 30 minutes or depending on the
medication) and report abnormalities.
*critical elements
Total marks: ______________ X 100 =

32
13. DRUG ADMINISTRATION: INTRADERMAL INJECTION

Name of client
Registration number
Dose
3. Explain the purpose and action of medication and complete 1
necessary assessment before administering the medication.
7. Provide privacy. 1
8. Place client in appropriate position. 1
9. *Identify and expose injection site 2
10. Clean site with alcohol swab/cotton with spirit 1
12. *Grasp arm to stretch skin using thumb and index finger 2
with the non-dominant hand.
o
13. *Hold syringe parallel (10-15 angle) to skin with needle 2
bevel pointing upwards.
14. *Insert needle horizontally until the bevel is under the 2
epidermis.
15. *Push plunger slowly until a wheal appears. 2
16. Withdraw needle gently but quickly at the same angle used 1
for insertion
17 Pat/dry skin with cotton ball. 1
18 *Encircle the edges of the wheal with a blue or black pen. 2
19 *Write the name of the medication, date and time of 2
administration near the wheal.
20 Ensure client’s comfort. 1
21 *Dispose wastes in appropriate receptacles 2
23 *Document each medication given 2
24 *Evaluate the client when the medication is expected to 2
take effect :For antibiotic test dose: ½ hour after injection.
For Mantoux Test: 72 hours after injection
*critical elements

Total marks: ______________ X 100 =
36
14. OXYGEN THERAPY ADMINISTRATION (Nasal Prongs)
Name of the student: ________________________ Student ID#: _______________________

*Check the prescription chart 2
Name of the client
1. ID #
Oxygen concentration and method to be
administered
2. Explain procedure to the client 1
Assemble and prepare requirements 1
4.
fill puritan bottle with distilled water
5. Take requirements to the client bedside 1
*Place client in semi fowler’s / fowler’s 2
6.
position
7. Close regulator meter 1
8. Connect oxygen to the wall outlet 1
9. Connect vinyl tube to oxygen outlet 1
10. Turn on the oxygen on (10 to 15 L/min) 1
11. *Adjust flow rate as prescribed 2
12. Clean client’s nostril 1
13. Insert oxygen nasal prongs into the nostrils 1
14. Adjust strap 1
15. *Assess client’s response to oxygen therapy 2
16. Ensure client’s comfort 1
*Record the procedure and observations in 2
18.
nursing notes
*critical elements:
Total marks: ______________ X 100 =

23
15.OXYGEN THERAPY ADMINISTRATION (Mask)

*Check the prescription chart 2
Name of the client
1.
ID #
Oxygen concentration and method to be administered
2 Explain procedure to the client 1
Assemble and prepare requirements 1
4
Fill puritan bottle with distilled water
5 Take requirements to the client bedside 1
6 *Place client in semi fowler’s / fowler’s position 2
7 *Close regulator meter 2
8 Connect oxygen to the wall outlet 1
9 Connect Vinyl tube to oxygen outlet 1
10 *Turn on the oxygen on (10 to 15 L/min) 2
11 *Adjust flow rate as prescribed 2
12 Clean client’s nostril 1
13 *Apply the mask to client ( cover nose and mouth) 2
14 Adjust strap 1
15 *Assess client’s response to oxygen therapy 2
16 Ensure client’s comfort 1
*Record the procedure and observations in nursing 2
18
notes
*critical elements:
Total marks: ______________ X 100 =

26
16. ANTENATAL ASSESSMENT: PERFORMING LEOPOLD’S MANEUVER

1 *Identify client using two identifiers. 2
2 Explain the procedure to the client. 1
3 *Ensure that the client emptied the bladder. 2
5 Prepare requirements needed and take it to the bedside. 1
6 *Provide privacy. 2
7 *Position client appropriately (dorsal recumbent and 2
putting small pillow or rolled towel under one side).
9 Warm hands 1
10 Stand on the side of the client and expose the abdomen 1
with drapes on both thighs.
11 Inspect the abdomen of the client 1
12 *Perform the first maneuver 2
Stand facing the mother and place both hands and
palpate superior surface of fundus. Determine shape,
consistency and mobility
13 *Perform the second maneuver 2
Still facing the patient, palpate the sides of the uterus.
Hold the left hand stationary while the right hand
palpates the opposite side from top to bottom. Repeat
on the other side
14 *Perform the third maneuver 2
Still facing the patient, gently grasp the lower portion
of the abdomen just above the symphysis pubis
between the thumb and index finger and try to press
the thumb and finger together. Determine any
movement and whether the part is firm or
soft.
15 *Perform the fourth maneuver 2
Facing the feet of the patient, place 3 fingers on both
sides of the uterus using the finger pads palpate in a
downward motion towards the symphysis pubis.
16 *Ensure client’s safety and comfort. 2
17 Clean and store away the equipment properly. 1
19 *Document and report any abnormal findings 2
Observation of the abdomen
Presentation
Position
Attitude
Engagement
*critical elements:
Total marks: ______________ X 100 =

30
17. ANTENATAL ASSESSMENT: MEASURING FUNDAL HEIGHT
S.No. Steps Marks Marks Comment

Allocated Obtained
1. Check care plan. 1
3. Explain the procedure to the client. 1
4. *Ensure that the client emptied the bladder. 2
6. Prepare requirements needed and take it to the bedside. 1
8. *Position client appropriately (Semi-recumbent with knee 2
slightly flexed and putting small pillow or rolled towel
under one side).
9. *Perform hand hygiene. 2
10. Warm hands. 1
11. Stand on the side of the client and expose the abdomen 1
with drapes on both thighs.
12. *Place one hand (medial side) and palpate for the top 2
boarder of the fundus.
13. *Palpate the superior border of the symphysis pubis with 2
the other hand and place the “0” line of the tape measure
on it. Note that the measurement must be by “cm”.
14. *Stretch the tape measure across the contour of the 2
abdomen to the top of the fundus and take note of the
measurement.
15. *Ensure client’s safety and comfort. 2
16. Clean and store away the equipment properly. 1
18. *Document measurement and report any abnormality. 2
*critical elements:
Total marks: ______________ X 100 =

28
18. ANTHROPOMETRIC MEASUREMENT OF NEWBORN
Name of the student: ________________________ Student ID#: _____________________

3. Wear gloves. 1
4. *Cover the scale with a blanket/paper cover. Balance 2
or adjust the scale to zero after the cover is placed.
5. *Remove newborn’s clothing/blanket. Place gently on 2
the scale and ensure safety throughout procedure
6. *Note the newborn’s weight. 2
7. *Place the newborn in supine position on a flat 2
surface.
8. *Measure around the fullest part of the head, with the 2
tape placed around the occiput and just above the
eyebrows and take note of the measurement (use cm
as unit of measurement).
9. *Move tape down to measure the chest at the level of 2
the nipples (move tape by gently lifting or rolling the
infant instead of pulling the tape). Note measurement.
10. *Straighten newborn’s body and gently press knees 2
11. *Place measuring tape beside the newborn with the 2
upper end at the top of the head (crown of the head).
12. *Tuck it beneath the shoulder and extend it down to 2
the feet.
13. *Hold the measuring tape straight alongside the 2
newborn’s body while extending one of the legs to its
full length. Note measurement.
14. *Provide safety and comfort. 2
16. *Document measurement of newborn in observation 2
chart.
*critical elements:
Total marks: ______________ X 100 =

30
19. NEUROLOGICAL ASSESSMENT – Glasgow Coma Scale
S.N Steps Marks Marks Comments

1 Check Care plan 1
5 Provide privacy 1
6 *Elevate head of bed at 30 degree 2
7 Assess client’s general condition 1
Eye opening Response
8 * Spontaneous (4) 2
If the client's eyes open spontaneously it is recorded as 4.
To sound (3)
If spontaneous opening is not demonstrated, a verbal
stimulus is used by
introducing yourself clearly
requesting ‘eye opening’
If necessary by shouting.
If the client opens his eyes‘to sound’ it is recorded as 3.
To pressure(2)
If the Client does not open his eyes to sound, a
peripheral stimulus is then applied.
Stimulation starts at a low level by pressing on the nail tip
and is applied with increasing intensity, for up to 10
seconds until the client demonstrates a response or until
maximum stimulus has been applied.
If the client opens his eyes ‘to pressure,’ it is recorded as
2.
None (1)
If the client does not open his eyes, it is recorded as 1.
Not testable (NT)
If the eyes are not testable, it is recorded as NT
Verbal Response
9 *Orientated (5) 2
Assess the client’s orientation to
Person- what is his name?
Place - where he is?
Time - what month it is?
If he answers correctly, it is recorded as 5.
Confused (4)
If any one of the three items of information is not
provided correctly, it is recorded as 4.
Words (3)
If, the client does not talk sensibly but utters single
word, it is recorded as 3.
Sounds (2)
If the client moans and groans with no recognizable
words, it is recorded as 2.
None (1)
If the client makes no sounds at all, it is recorded as 1.
Not testable (NT)
If the verbal response is not testable, it is recorded as NT
Best Motor Response
10 *Obeys commands (6) 2
Ask the client to perform a two-step action;
grasp and release your fingers with his hand
raise and lower his arms;
put out and put back his tongue.
If the client does this, it is recorded as 6.
Localizing (5)
In a patient who does not obey commands, a central
stimulus is needed for additional information about motor
response.
Central stimulus
Trapezius pinch
Apply pressure by pinching the trapezius muscle with
increasing intensity for up to 10 seconds.
To perform this, place your hand over the client's
shoulder and press your fingers into the muscle above the
shoulder blade.
b. Pressure to the supraorbital notch
If there has been no localizing response to the trapezius
pinch, apply pressure to the supraorbital notch with
increasing intensity for up to 10 seconds.
This is located by feeling along the lower edge of the
upper rim of the orbit until a groove is felt.
If the client moves his hand above the clavicle, or
collarbone it is recorded as 5. After applying central
stimulation and his upper limb does not reach above the
clavicle, then they are either normally or abnormally
flexing.
The assessment of these non-localizing responses is based
on a combination of both peripheral and central stimuli.
After applying peripheral stimulation and the client bends
his elbow and moves the arms rapidly away from the
body, it is recorded as 4.
Abnormal flexion (3)
After applying peripheral stimulation and the client bends
his elbow slowly and the arms comes across the body,
thumb clenched and leg extends, it is recorded as 3.
Extension (2)
If the client extends his elbows rather than flexing them, it
is recorded as 2.
Straightening the elbow constitutes an “extension”
response.
NONE (1)
A patient who makes no response, it is recorded as 1.
Not testable (NT)
If the best motor response is not testable, it is recorded as
NT.
11 *Ensure client’s safety (put side rails up) 2
13 *Document the results and refer if necessary 2
*critical elements:
Total marks: ______________ X 100 =

20
20. DRUG ADMINISTRATION: INSTILLATION OF EYE DROPS
S.No. Steps Marks Marks Comments

Allocated Obtained
Name of client
Registration number
Dose
2 *Identify client with two identifiers 2
3 Explain the purpose and action of medication 1
5 *Check available medication/drug (name, expiry date) 2
6 Prepare and take requirements to client. 1
7 Provide privacy. 1
8 *Place client in appropriate position 2
Lying supine
Sitting back in a chair
10 Put on gloves and clean client’s eyes if necessary. 1
11 Remove cap from bottle. 1
12 *Tilt clients head backwards 2
13 *Pull lower lid of one eye 2
14 *Instruct client to look upwards 2
15 *Hold dropper 1-2 cm (1/2 – ¾ inch) above conjunctival sac 2
16 *Instill prescribed number of medication drops into the 2
conjunctival sac
17 *Instruct client to close eyes gently for 1 minute 2
18 Wipe excess eye drop (if any) with gauze 1
20 Remove gloves and dispose wastes in appropriate 1
receptacles
22 *Document each medication given. 2
23 *Evaluate the client when the medication is expected to take 2
effect (usually 30 minutes or depending on the medication)
and report abnormalities
*critical elements:
Total marks: ______________ X 100 =

35
21. DRUG ADMINISTRATION: INSTILLATION OF EAR DROP

No Allocated Obtained
.
Name of client
Registration number
Dose
8 *Place client in appropriate position 2
Lie on the unaffected ear
10 Put on gloves and clean client’s ears if necessary 1
11 Remove cap of ear drop. 1
12 *Gently pull the auricle 2
Adult – upward and backward
Child – downward and backward
13 *Instill prescribed drops holding dropper 1 cm (1/2 inch) 2
above ear canal
14 *Instruct client to stay in position for 5- 10 minutes. 2
15 Wipe excess ear drop (if any) with gauze. 1
16 *Repeat the procedure in the other ear after 5-10 minutes 2
if ordered.
receptacles
21 *Evaluate the client when the medication is expected to
take effect (usually 30 minutes or depending on the
medication) and report abnormalities
*critical elements:
Total marks: ______________ X 100 =

29
22. DRUG ADMINISTRATION: INSTILLATION OF NOSE DROPS

Name of client
Registration number
Dose
8 *Place client in appropriate position Supine position 2
10 Put on gloves and clean client’s nose if necessary. 1
11 Remove cap of nose drop. 1
12 *Tilt the client’s head gently. 2
13 *Support the head with the non- dominant hand and 2
push up the tip of the client’s nose slightly.
14 *Hold dropper 1 cm (1/2 inch) above the nares and 2
instill prescribed drops towards the midline.
15 *Instruct client to stay in position for 5 minutes and 2
breath through his/her mouth.
16 Wipe excess nose drop (if any) with gauze. 1
receptacles
21 *Evaluate the client when the medication is expected to 2
take effect (usually 30 minutes or depending on the
medication) and
report abnormalities
*critical elements:
Total marks: ______________ X 100 =

31
23. MENTAL STATUS EXAMINATION
Marks Marks
S# Steps Allocate Comments
d Obtained
*Assess the general condition

Behavior
1 Clothing 2
Facial Expression
Level of consciousness
*Assess the psychomotor activity (Retardation,
2 2
Agitation, Unusual movements, Gait, Catatonia)
*Assess the speech pattern (Rate, Rhythm, Volume,
3 2
Amount, Articulation, Spontaneity
*Assess the thought process (Coherence, Logic, Stream,

4 2
Perseveration, Neologism, Blocking, Attention)
*Assess the mood and affect (Stability, Range,
Appropriateness, Intensity, depressed, sad, happy,
5 2
euphoric, irritable, anxious, neutral, fearful, angry,
pleasant)
*Sensory Perception
6 Hallucinations 2
Illusions
*Assess orientation to:
Time
7 2
Place
Person
*Assess the insight (Awareness of illness)
What brings you here today? What seems to be the
problem?
8 2
What do you think is causing your problems?
How do you understand your problems?
How would you describe your role in this situation?”
*Judgement
How do you plan to get help for this problem?
What will you do when ____________occurs?
How will you manage if __________happens?
9 2
If you found a stamped, addressed envelope on the
street, what would you do with it?
If you were in a movie theater and smelled smoke, what
would you do?
10 *Report abnormal findings 2
Total 20
*critical elements:
Total marks: ______________ X 100 =

20
24. INTERVIEWING TECHNIQUE: COUNSELLING

1 Check Care plan 1
3 Ensure quit and well lighted environment 1
4 *Ensure privacy 2
5 Sit facing client with an open posture 1
6 Listen to the content that is being expressed by client 1
7 *Allow adequate time for counseling 2
8 *Focus on the issue/s being expressed 2
9 *Avoid interruptions 2
10 Listen actively and with an open mind 1
11 *Observe client’s nonverbal expressions 2
12 *Ensure eye contact with client 2
13 *Avoid making premature interpretations. Wait until 2
client has finished talking.
14 Nod and smile as necessary 1
15 *Avoid judgmental and embarrassing remarks 2
16 *Ask open-ended questions 2
17 *Avoid making decision for client 2
18 *Encourage client to make decision based on 2
available choices
19 Express confidence in client’s ability to solve his 1
/her problems
*critical elements:
Total marks: ______________ X 100 =

31
25. OBSERVATION: TEMPERATURE (Axillary)

1 Check care plan. 1
2 *Introduce self and identify the client using two 2
identifiers.
5 Prepare requirements and take to the bedside 1
6 Provide privacy 1
7 *Position the client appropriately. 2
8 Take the thermometer out of its protective cover. 1
9 *Clean thermometer with alcohol swab / place 2
thermometer sheath or cover
10 Press the button on the thermometer (for centigrade 1
reading).
11 *Dry axilla 2
12 *Place thermometer under axilla. 2
13 *Instruct client to hold thermometer under axilla until 2
it beeps.
14 *Remove thermometer and clean the thermometer with 2
alcohol swab.
15 Read the temperature 1
16 Place the digital thermometer in its protective cover. 1
19 *Record temperature in client’s chart and report any 2
abnormal reading
*critical elements:
Total marks: ______________ X 100 =

27
26. OBSERVATION: PULSE RATE (Radial)

Allocated Obtained

identifiers.
4 *Ensure that the client has not done any activity (at 2
least 5 to 10 minutes)
7 Provide privacy 1
8 *Position client appropriately. 2
9 *Identify site of radial artery and palpate using three 2
finger pads (index, middle, ring fingers)
10 *Count pulse for one full minute 2
11 *Assess characteristic of pulse for rate, rhythm and 2
volume/strength.
14 * PR in client’s chart and report any abnormal 2
reading
*critical elements:
Total marks: ______________ X 100 =

21
27. OBSERVATION: RESPIRATORY RATE

identifiers.
4 *Ensure that the client has not done any activity 2
(at least 5 to 10 minutes)
7 Provide privacy 1
9 *Hold client’s hand and place it on his/her chest 2
10 *Observe movement (rise and fall) of client’s 2
chest and count respiration for 1 full minute
11 *Assess characteristic of respiration for rate, 2
rhythm and depth.
14 *Record RR in client’s chart and report any 2
abnormal reading
*critical elements
Total marks: ______________ X 100 =

21
28. BLOOD PRESSURE TAKING (Aneroid)

identifiers.
4 *Ensure that the client has not done any activity (at 2
least 5 to 10)
6 Prepare requirements needed and take to the bedside 1
7 Provide client privacy. 1
9 *Clean ear pieces and diaphragm of the stethoscope. 2
10 *Apply cuff firmly on client’s arm (2.5 cm above 2
antecubital fossa) and attach the gauge clip of the
manometer to the cuff.
11 *Identify radial pulse. 2
12 *Inflate the cuff until radial pulse disappears and note 2
the systolic pressure.
13 Release air from cuff until the gauge needle reaches 1
zero.
14 Place stethoscope earpieces into the ears. 1
15 *Identify brachial pulse. 2
16 *Place diaphragm of stethoscope on brachial artery 2
and inflate the cuff until gauge needle reaches the
approximate systolic pressure (initial systolic pressure
plus 30 mmHg).
17 Release air from cuff slowly. 1
18 *Read systolic pressure at eye level (first sound 2
heard).
19 *Read diastolic pressure (last sound heard). 2
20 Release air completely from cuff. 1
21 Remove cuff. 1
23 Clean and store the equipment used. 1
25 *Record BP in client’s chart and report abnormality. 2
*critical elements:
Total marks: ______________ X 100 =

37
29. Handwashing technique: Medical Asepsis
Name of the student: _______________________ Student ID#: _______________________

Allocated Obtained
1 Prepare requirements 1
2 Turn on tap water with the elbow 1
3 Wet hands with water 1
4 Pump soap (using elbow) on to the palms of the hands 2
5 Rub hands palm to palm 1
6 Right palm over left dorsum with interlaced fingers and 1
vice versa
7 Palm to palm with fingers interlaced 1
8 Back of fingers to opposing palms with fingers 1
interlocked and vice versa
9 Rotational rubbing of left thumb clasped in right palm 2
and vice versa. Continue these motions for about 30
seconds
10 Rotational rubbing, backward and forward with clasped 2
fingers of right hand in left palm and vice versa
11 Rinse the hands 2
12 Keep the fingers above elbow level 2
13 Turn off the tap of the faucet with the elbow or use a new 2
paper towel to grasp a hand-operated control.
14 Dry hand and arms thoroughly with a towel or paper 1

towel without scrubbing and dry thoroughly by pat
drying the hands and arms
15 Discard the paper towel in the appropriate container. 1
*critical elements:
Total marks: ______________ X 100 =

21
30. HYGIENE CARE: MOUTH CARE
Name of the student: ________________________Student ID#: _______________________

2 *Introduce self and identify client using two 2
identifiers
3 Explain procedure to client. 1
5 Prepare requirements needed and take to the bed side. 1
6 Provide privacy 1
7 *Position client (semi-fowlers). 2
8 Place towel/incontinent sheet on client’s chest. 1
9 Put the kidney dish near the client. 1
10 *Open mouth care set. 2
11 Dilute antiseptic mouth wash with water into the 1
galipot and place cotton buds (as required).
13 Wear clean gloves. 1
14 Moisten the cotton buds with the diluted solution. 1
15 *Clean upper teeth using cotton buds in downward 2
stroke. Repeat if necessary.
Expose teeth using tongue depressor
Farthest to nearest
Outer to inner side
16 *Clean the lower teeth using cotton buds in upward 2
stroke. Repeat if necessary.
Expose teeth using tongue depressor
Farthest to nearest
Outer to inner side
17 Clamp and moisten gauze with the diluted solution 1
18 *Clean oral cavity (cheek) using up to down stroke. 2
Repeat if necessary.
Retract the cheek using the tongue depressor
Farthest to nearest
One gauze per stroke
19 *Depress the tongue using the tongue depressor and 2
clean the upper palate (posterior to anterior) using
moistened gauze. Repeat if necessary.
20 *Open the mouth using the tongue depressor and 2
clean tongue from posterior to anterior using
moistened gauze in a single stroke. Repeat if
necessary.
21 *Lift tip of the tongue using the tongue depressor and 2
clean under the tongue with moistened gauze in a
single stroke.
22 Dry lips and apply lip moisturizer. 1
23 Remove the towel/incontinent sheet. 1
24 Ensure client’s comfort and safety. 1
25 Clean and store away used utensils. 1
26 Remove gloves. 1
28 *Document the procedure. 2
*critical elements:
Total marks: ______________ X 100 =

38
31. POSITIONING: RECUMBENT TO LATERAL (2 Nurses)

identifiers.
6 *Adjust the height of the bed and lock. 2
7 Remove pillow/s under client’s head. 1
8 Decide on which position the client is to be placed. 1
9 *Cross client’s hands on his/her chest. 2
10 Loosen the draw sheet on both sides of the bed and 1
roll towards the client.
11 *Hold draw sheet firmly and on the count of three, 2
lift the client towards the side of the bed.
12 *Keep the arms crossed and then cross the legs 2
13 Push and pull the client to the desired position. 1
14 *Support client’s head and back with pillow/s. 2
15 *Flex client’s elbow and knee (left or right) and 2
support with pillow
16 *Ensure client’s comfort and safety. 2
*critical elements:
Total marks: ______________ X 100 =

27
32. POSITIONING: RECUMBENT TO SEMI-PRONE (2 Nurses)

Allocated Obtained
identifiers.
6 *Adjust the height of the bed and lock. 2
7 Remove pillow/s under client’s head. 1
8 Decide on which position the client is to be placed. 1
9 *Cross client’s hands on his/her chest 2

10 Loosen the draw sheet on both sides of the bed and roll 1
towards the client.
11 *Hold draw sheet firmly and on the count of three, lift the 2
client towards the side of the bed.
12 *Put client’s hand (inferior) alongside the body. 2
13 *Cross client’s legs. 2
14 Stand opposite each other. 1
15 Hold client’s shoulder and hips. 1
16 Push or pull client to a semi-prone position. 1
17 Place client’s face to the desired side (left or right). 1
18 Straighten client’s (inferior) hand. 1
19 *Flex client’s (superior) elbow and place hand in front of 2
his/her face
20 *Flex client’s (superior) knee 2
21 Place the small pillow under client’s chest. 1
23 *Perform hand hygiene. 2

*critical elements:
Total marks: ______________ X 100 =

35
33. LIFTING CLIENT: IN BED

Allocated Obtained
2 *Introduce self and verify the client’s identity and explain 2
the procedure.
4 *Keep the bed flat, adjust the height and lock. 2
5 Remove pillow/s, then place against the head of the bed. 1
6 Stand on either side of bed. 1
7 *Place client’s hands on his/her chest crosswise. 2
8 Loosen the draw sheet on both sides of the bed and roll 1
towards the client.
9 *Hold draw sheet firmly and on the count of three, lift the 2
client towards the head of the bed.
10 Place pillow/s under client’s head (if necessary). 2
*critical elements
Total marks: ______________ X 100 =

20
34. LIFTING CLIENT: FROM BED TO CHAIR

2 *Introduce self and verify the client’s identity and explain 2
the procedure.
4 *Place chair/wheel chair at the side of the bed and as close 2
as possible.
5 *Lower bed to its lowest position and lock. 2
6 Assist the client to a sitting position on the side of the bed. 1
7 *Support client’s back. 2
8 *Stand facing the client (one foot forward). Lean the trunk 2
forward from the hips. Flex the hips, knees and ankles.
9 *Place client’s hands on your (nurse) shoulders. 2
10 *Place your (nurse) hands around client’s back. 2
11 *On the count of three, assist client into standing position 2
and then move together toward the chair/wheelchair.
12 *Position client until his/her back faces the chair and allow 2
him/her to sit comfortably and safely.
13 Tidy the bed. 1
*critical elements:
Total marks: ______________ X 100 =

25
35. WOUND CARE(DRESSING)

Allocated Obtained
1 Check care plan 1
5 Prepare requirements needed 1
6 Provide privacy 1
7 *Position client appropriately 2
8 Place a plastic sheet/ incontinence sheet appropriately and 1
kidney dish near the wound site
9 Put on clean gloves 1
10 *Open sterile dressing set (through the edges) 2
11 * sterile gloves in a separate table 2
12 *Pour antiseptic solution in the galipot and add sterile 2
gauze as needed
13 Remove and dispose old/dirty dressing appropriately 1
(moisten the tape if necessary to lessen discomfort of
removal )
14 Remove clean gloves and dispose properly (yellow bag ) 1
15 Perform hand rub 1
16 *Put on sterile gloves and arrange equipment according to 2
use
17 *Squeeze the gauze and transfer to the empty galipot 2
using the dominant hand only
18 *Clean the wound with moistened gauze using forceps. 2
Use a separate swab for each stroke and discard each
swab after use
19 *Dry wound with dry gauze swabs 2
nd
20 *Drop the forceps on the dominant and transfer the 2 2
forceps from non-dominant to dominant hand.
21 *Apply new dressing to the incision site/ wound 2
22 Remove and dispose gloves properly (yellow bag) 1
23 Secure dressing with adhesive tape 1
24 Remove plastic/incontinence sheet 1
26 Clean and store away used utensils 1
28 *Document and record observations 2
Total marks: ______________ X 100 =

41
36. SUTURE REMOVAL

No. Allocated Obtained
1 Check Care plan 1
5 Prepare requirements needed 1
6 Provide privacy 1
7 Position client appropriately 1
8 Place a plastic sheet/ incontinence sheet appropriately 1
and kidney dish near the wound site
9 *Put on clean gloves 2
10 *Open sterile suture removal set (through the edges) 2
11 *Prepare sterile gloves in a separate table 2
12 *Pour antiseptic solution in the galipot and add sterile 2
gauze as needed; add sterile suture removal scissor
13 Remove and dispose old/dirty dressing appropriately 1
(moisten the tape if necessary to lessen discomfort of
removal )
14 Remove clean gloves and dispose properly (yellow bag ) 1
15 Perform hand rub 1
16 *Put on sterile gloves and arrange equipment according 2
to use
17 *Squeeze the gauze and transfer to the empty galipot 2
using the dominant hand only
18 *Clean the wound with moistened gauze using forceps. 2
Use a separate swab for each stroke and discard each
swab after use
19 *Place sterile gauze near the wound 2
20 *Cut suture at skin level (below knot). 2
21 Pull suture out slowly and place on gauze. 1
22 *Check wound union (before proceeding to remove the 2
remaining sutures).
23 *Repeat steps 20 – 22 (remove alternate sutures) until all 2
sutures have been removed.
24 Dry wound with dry gauze swabs 1
25 Discard sutures in yellow bag. 1
26 Remove and dispose gloves properly (yellow bag ) 1
27 Spray wound with plastic dressing 1
28 Remove plastic/incontinence sheet 1
30 Clean and store away used utensils 1
32 *Document and record observations 2
Examiner: ……………………………... Signature: …………………….

Total marks: ______________ X 100 =
47
37. PUTTING AND REMOVING ON FACE MASK (with strings)
S.No Steps Marks Marks Commen

. Allocate Obtaine t
d d
To put on a facemask
1 Assemble requirement. 1

3 Remove mask from box (holding the strings). 1
4 *Hold mask by the top strings. 2
5 *Place mask on face covering nose and mouth. 2
6 *Tie top strings of mask at the back of the head. 2

7 *Tie bottom strings of mask at the back of neck. 2
8 Pull the top and middle of mask to ensure mask covers 1
nose and mouth completely.
To remove facemask
9. *Undo (pull string) tie at the back of neck. 2
10. *Undo (pull string) tie at the back of head. 2

11. Remove facemask (holding the string). 1
12. Discard facemask in waste disposal container. 1

*critical elements:
Total marks: ______________ X 100 =

20
38. PUTTING ON AND REMOVING A GOWN

Allocated Obtained
To put on a gown
2 Place on a clean surface/table. 1
3 Open wrapping of gown. 1
4 *Hold gown at the collar. 2
5 *Place hands into sleeves (one at a time). 2
6 *Tie strings at the neck. 2
7 *Tie strings at the waist. 2
To remove a gown
8 *Undo (pull string) tie at the back of waist. 2
9 *Undo (pull string) tie at the back of the neck. 2
10 *Place right hand under the sleeve of left hand. 2
11 Pull sleeve until the left hand is covered. 1
12 *Hold the sleeve of right hand with the (covered) left hand. 2
13 *Pull the sleeve downwards. 2
14 Hold the sleeves together. 1
15 Remove gown and discard into receptacle. 1
*critical elements
Total marks: ______________ X 100 =

25
39. PUTTING ON AND REMOVING GLOVES

To put on gloves
2 Place on a clean surface/table. 1
3 Open the external wrapping of gloves. 1
4 Place on the table. 1
5 *Open internal wrapping of gloves. 2
7 *Lift glove (hold edge of cuff) from wrapper. 2
8 *Place (opposite) hand into glove 2
9 *Lift (gloved hand) the other glove by holding under the 2
cuff.
10 *Place (ungloved) hand into glove. 2
11 Ensure tips of fingers fit snugly into each glove. 1
12 Unfold cuffs of gloves. 1
To remove gloves
13 *Hold glove at the cuff (external). 2
14 *Pull glove off. 2
15 Leave removed glove in the gloved hand. 1
16 *Insert index finger of ungloved hand into cuff of the other 2
glove.
17 *Pull glove off. 2
18 Hold glove at the cuff and discard into waste disposal 1
container.
*critical elements:
Total marks: ______________ X 100 =

29

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1.

Name of the student: ________________________ Student D#: ______________________

S.N Steps Marks Marks Comment

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S. Steps Marks Marks Comment

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.N Steps Marks Marks Comment

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100

Name of the student: ________________________ Student ID#: ______________________

S.N Steps Marks Marks Comment

Push 5-10 ml of air into tube and listen for “whooshing”

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.N Steps Marks Marks Comment

Note: Clean from top to bottom using single stroke

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S. Steps Marks Marks Comment

19 Place fenestrated drape around the penis 1

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.N Steps Marks Marks Comment

Examiner: ……………………………. Signature: …………………….

Name of the student: ________________________ Student ID#_______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………. Signature: …………………….

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………. Signature: …………………….

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: -______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………. Signature: …………………….

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.N Steps Marks Marks Comment

Examiner: ……………………………. Signature: …………………….

Name of the student: ________________________ Student ID#: _______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………... Signature: ……………………...

Total marks: ______________ X 100 =

Name of the student: ________________________ Student ID#: ______________________

S.No Steps Marks Marks Comment

Examiner: ……………………………. Signature: …………………….

Total marks: ______________ X 100 =

Name of the student: __ Student D#:

Name of the student: __ Student ID#:

Name of the student: __ Student ID#:

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