Telemetry RN Skills Assessment

Congrats on taking the necessary step to applying for a travel nursing position with us! Before we can offer you an amazing nursing assignment, the following skills assessment must be completed. Take your time and review your information before submitting. We look forward to seeing your results!

Instructions:

This checklist is for assessing your experience in specific clinical areas. It will not be a determining factor in accepting your application to become an employee of Trusted Nurse Staffing LLC.

Please rate your experience using the following scale (check the appropriate boxes below):

0 = No Experience / Observed Only
1 = Less than 1 year experience
2 = 1 - 2 years of experience
3 = Over 2 years of experience

Your Information: *This question is required.

Today's Date: This question requires a valid date format of MM/DD/YYYY.

calendar

First Name

Last Name

Email Address

Phone Number

RESPIRATORY, Part 1 *This question is required.

Space Cell	0	1	2	3
Assessment of Breath Sounds	Assessment of Breath Sounds: 0	Assessment of Breath Sounds: 1	Assessment of Breath Sounds: 2	Assessment of Breath Sounds: 3
Administer O2 (NC, Mask)	Administer O2 (NC, Mask): 0	Administer O2 (NC, Mask): 1	Administer O2 (NC, Mask): 2	Administer O2 (NC, Mask): 3
Ventilate with Ambu-bag	Ventilate with Ambu-bag: 0	Ventilate with Ambu-bag: 1	Ventilate with Ambu-bag: 2	Ventilate with Ambu-bag: 3
Assist with Intubation	Assist with Intubation: 0	Assist with Intubation: 1	Assist with Intubation: 2	Assist with Intubation: 3
Care of Intubated Patient	Care of Intubated Patient: 0	Care of Intubated Patient: 1	Care of Intubated Patient: 2	Care of Intubated Patient: 3
Suctioning	Suctioning: 0	Suctioning: 1	Suctioning: 2	Suctioning: 3
Assist with Extubation	Assist with Extubation: 0	Assist with Extubation: 1	Assist with Extubation: 2	Assist with Extubation: 3
Use of Pressure Ventilators	Use of Pressure Ventilators: 0	Use of Pressure Ventilators: 1	Use of Pressure Ventilators: 2	Use of Pressure Ventilators: 3
Use of Volume Ventilators	Use of Volume Ventilators: 0	Use of Volume Ventilators: 1	Use of Volume Ventilators: 2	Use of Volume Ventilators: 3
Weaning Patient from Ventilator	Weaning Patient from Ventilator: 0	Weaning Patient from Ventilator: 1	Weaning Patient from Ventilator: 2	Weaning Patient from Ventilator: 3
Troubleshoot Ventilator Problems	Troubleshoot Ventilator Problems: 0	Troubleshoot Ventilator Problems: 1	Troubleshoot Ventilator Problems: 2	Troubleshoot Ventilator Problems: 3
Establishing an Airway	Establishing an Airway: 0	Establishing an Airway: 1	Establishing an Airway: 2	Establishing an Airway: 3
Pulse Oximetry	Pulse Oximetry: 0	Pulse Oximetry: 1	Pulse Oximetry: 2	Pulse Oximetry: 3
Perform Arterial Puncture	Perform Arterial Puncture: 0	Perform Arterial Puncture: 1	Perform Arterial Puncture: 2	Perform Arterial Puncture: 3
Draw Blood from Arterial Line	Draw Blood from Arterial Line: 0	Draw Blood from Arterial Line: 1	Draw Blood from Arterial Line: 2	Draw Blood from Arterial Line: 3
Interpret Arterial Blood Gases	Interpret Arterial Blood Gases: 0	Interpret Arterial Blood Gases: 1	Interpret Arterial Blood Gases: 2	Interpret Arterial Blood Gases: 3
Assist with Thoracentesis	Assist with Thoracentesis: 0	Assist with Thoracentesis: 1	Assist with Thoracentesis: 2	Assist with Thoracentesis: 3
Assist with Bronchoscopy	Assist with Bronchoscopy: 0	Assist with Bronchoscopy: 1	Assist with Bronchoscopy: 2	Assist with Bronchoscopy: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Chest Injury	Chest Injury: 0	Chest Injury: 1	Chest Injury: 2	Chest Injury: 3
Chest Tubes	Chest Tubes: 0	Chest Tubes: 1	Chest Tubes: 2	Chest Tubes: 3
Tracheostomy	Tracheostomy: 0	Tracheostomy: 1	Tracheostomy: 2	Tracheostomy: 3
Respiratory Complications	Respiratory Complications: 0	Respiratory Complications: 1	Respiratory Complications: 2	Respiratory Complications: 3

NEUROLOGY *This question is required.

Space Cell	0	1	2	3
Neuro Assessment/ Vital Signs	Neuro Assessment/ Vital Signs: 0	Neuro Assessment/ Vital Signs: 1	Neuro Assessment/ Vital Signs: 2	Neuro Assessment/ Vital Signs: 3
Glasgow Coma Scale	Glasgow Coma Scale: 0	Glasgow Coma Scale: 1	Glasgow Coma Scale: 2	Glasgow Coma Scale: 3
Assist with Lumbar Puncture	Assist with Lumbar Puncture: 0	Assist with Lumbar Puncture: 1	Assist with Lumbar Puncture: 2	Assist with Lumbar Puncture: 3
Identify Neuro Complications	Identify Neuro Complications: 0	Identify Neuro Complications: 1	Identify Neuro Complications: 2	Identify Neuro Complications: 3
Seizure Precautions	Seizure Precautions: 0	Seizure Precautions: 1	Seizure Precautions: 2	Seizure Precautions: 3
Aneurysm Precautions	Aneurysm Precautions: 0	Aneurysm Precautions: 1	Aneurysm Precautions: 2	Aneurysm Precautions: 3
Use of Rotating Bed	Use of Rotating Bed: 0	Use of Rotating Bed: 1	Use of Rotating Bed: 2	Use of Rotating Bed: 3
Use of Stryker Frame	Use of Stryker Frame: 0	Use of Stryker Frame: 1	Use of Stryker Frame: 2	Use of Stryker Frame: 3
Epidural Medication Administration	Epidural Medication Administration: 0	Epidural Medication Administration: 1	Epidural Medication Administration: 2	Epidural Medication Administration: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Open/Closed Head Injury	Open/Closed Head Injury: 0	Open/Closed Head Injury: 1	Open/Closed Head Injury: 2	Open/Closed Head Injury: 3
Acute CVA	Acute CVA: 0	Acute CVA: 1	Acute CVA: 2	Acute CVA: 3
Spinal Cord Injury	Spinal Cord Injury: 0	Spinal Cord Injury: 1	Spinal Cord Injury: 2	Spinal Cord Injury: 3
Craniotomy	Craniotomy: 0	Craniotomy: 1	Craniotomy: 2	Craniotomy: 3
Increased ICP	Increased ICP: 0	Increased ICP: 1	Increased ICP: 2	Increased ICP: 3
Cerebral Aneurysm	Cerebral Aneurysm: 0	Cerebral Aneurysm: 1	Cerebral Aneurysm: 2	Cerebral Aneurysm: 3
Halo Traction/Cervical Tongs	Halo Traction/Cervical Tongs: 0	Halo Traction/Cervical Tongs: 1	Halo Traction/Cervical Tongs: 2	Halo Traction/Cervical Tongs: 3
Degenerative Diseases of CNS	Degenerative Diseases of CNS: 0	Degenerative Diseases of CNS: 1	Degenerative Diseases of CNS: 2	Degenerative Diseases of CNS: 3
CNS Infections	CNS Infections: 0	CNS Infections: 1	CNS Infections: 2	CNS Infections: 3
Seizures	Seizures: 0	Seizures: 1	Seizures: 2	Seizures: 3
Drug Overdose / DTs	Drug Overdose / DTs: 0	Drug Overdose / DTs: 1	Drug Overdose / DTs: 2	Drug Overdose / DTs: 3
Multiple Sclerosis	Multiple Sclerosis: 0	Multiple Sclerosis: 1	Multiple Sclerosis: 2	Multiple Sclerosis: 3
Post-Op AV-Shunt	Post-Op AV-Shunt: 0	Post-Op AV-Shunt: 1	Post-Op AV-Shunt: 2	Post-Op AV-Shunt: 3

RENAL, Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Acute Renal Failure	Acute Renal Failure: 0	Acute Renal Failure: 1	Acute Renal Failure: 2	Acute Renal Failure: 3
Chronic Renal Failure	Chronic Renal Failure: 0	Chronic Renal Failure: 1	Chronic Renal Failure: 2	Chronic Renal Failure: 3
Hemodialysis	Hemodialysis: 0	Hemodialysis: 1	Hemodialysis: 2	Hemodialysis: 3
Peritoneal Dialysis	Peritoneal Dialysis: 0	Peritoneal Dialysis: 1	Peritoneal Dialysis: 2	Peritoneal Dialysis: 3
Renal Transplant	Renal Transplant: 0	Renal Transplant: 1	Renal Transplant: 2	Renal Transplant: 3

CARDIAC *This question is required.

Space Cell	0	1	2	3
Assessment of Heart Sounds	Assessment of Heart Sounds: 0	Assessment of Heart Sounds: 1	Assessment of Heart Sounds: 2	Assessment of Heart Sounds: 3
Place Cardiac Monitor/Telemetry	Place Cardiac Monitor/Telemetry: 0	Place Cardiac Monitor/Telemetry: 1	Place Cardiac Monitor/Telemetry: 2	Place Cardiac Monitor/Telemetry: 3
Troubleshoot Monitor/Telemetry	Troubleshoot Monitor/Telemetry: 0	Troubleshoot Monitor/Telemetry: 1	Troubleshoot Monitor/Telemetry: 2	Troubleshoot Monitor/Telemetry: 3
Identify Lethal Dysrhythmias	Identify Lethal Dysrhythmias: 0	Identify Lethal Dysrhythmias: 1	Identify Lethal Dysrhythmias: 2	Identify Lethal Dysrhythmias: 3
Perform 12-lead EKG	Perform 12-lead EKG: 0	Perform 12-lead EKG: 1	Perform 12-lead EKG: 2	Perform 12-lead EKG: 3
Basic 12-Lead Interpretation	Basic 12-Lead Interpretation: 0	Basic 12-Lead Interpretation: 1	Basic 12-Lead Interpretation: 2	Basic 12-Lead Interpretation: 3
Assist with Code	Assist with Code: 0	Assist with Code: 1	Assist with Code: 2	Assist with Code: 3
Defibrillation/Cardioversion	Defibrillation/Cardioversion: 0	Defibrillation/Cardioversion: 1	Defibrillation/Cardioversion: 2	Defibrillation/Cardioversion: 3
Automatic External Defib (AED)	Automatic External Defib (AED): 0	Automatic External Defib (AED): 1	Automatic External Defib (AED): 2	Automatic External Defib (AED): 3
Cardiac Arrest / CPR	Cardiac Arrest / CPR: 0	Cardiac Arrest / CPR: 1	Cardiac Arrest / CPR: 2	Cardiac Arrest / CPR: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Angina	Angina: 0	Angina: 1	Angina: 2	Angina: 3
Acute MI	Acute MI: 0	Acute MI: 1	Acute MI: 2	Acute MI: 3
Congestive Heart Failure	Congestive Heart Failure: 0	Congestive Heart Failure: 1	Congestive Heart Failure: 2	Congestive Heart Failure: 3
Pre/post Cardiac Cath	Pre/post Cardiac Cath: 0	Pre/post Cardiac Cath: 1	Pre/post Cardiac Cath: 2	Pre/post Cardiac Cath: 3
Pre/post Cardiac Surgery	Pre/post Cardiac Surgery: 0	Pre/post Cardiac Surgery: 1	Pre/post Cardiac Surgery: 2	Pre/post Cardiac Surgery: 3
Femoral-Popliteal Bypass	Femoral-Popliteal Bypass: 0	Femoral-Popliteal Bypass: 1	Femoral-Popliteal Bypass: 2	Femoral-Popliteal Bypass: 3
Aneurysm	Aneurysm: 0	Aneurysm: 1	Aneurysm: 2	Aneurysm: 3
Permanent Pacemaker	Permanent Pacemaker: 0	Permanent Pacemaker: 1	Permanent Pacemaker: 2	Permanent Pacemaker: 3
Temporary Pacemaker	Temporary Pacemaker: 0	Temporary Pacemaker: 1	Temporary Pacemaker: 2	Temporary Pacemaker: 3
Automatic Implanted Defibrillator	Automatic Implanted Defibrillator: 0	Automatic Implanted Defibrillator: 1	Automatic Implanted Defibrillator: 2	Automatic Implanted Defibrillator: 3
Heart Transplant	Heart Transplant: 0	Heart Transplant: 1	Heart Transplant: 2	Heart Transplant: 3

Assist With Insertion and Setup: *This question is required.

Space Cell	0	1	2	3
Arterial Lines	Arterial Lines: 0	Arterial Lines: 1	Arterial Lines: 2	Arterial Lines: 3
Central Venous Catheter	Central Venous Catheter: 0	Central Venous Catheter: 1	Central Venous Catheter: 2	Central Venous Catheter: 3
Placement of External Pacemaker	Placement of External Pacemaker: 0	Placement of External Pacemaker: 1	Placement of External Pacemaker: 2	Placement of External Pacemaker: 3
Obtain ABG	Obtain ABG: 0	Obtain ABG: 1	Obtain ABG: 2	Obtain ABG: 3
Obtain Mixed Venous Gases	Obtain Mixed Venous Gases: 0	Obtain Mixed Venous Gases: 1	Obtain Mixed Venous Gases: 2	Obtain Mixed Venous Gases: 3

Emergency Medication Administration *This question is required.

Space Cell	0	1	2	3
Epinephrine	Epinephrine: 0	Epinephrine: 1	Epinephrine: 2	Epinephrine: 3
Atropine	Atropine: 0	Atropine: 1	Atropine: 2	Atropine: 3
Bicarbonate	Bicarbonate: 0	Bicarbonate: 1	Bicarbonate: 2	Bicarbonate: 3
Lidocaine	Lidocaine: 0	Lidocaine: 1	Lidocaine: 2	Lidocaine: 3

Infusion Medication Administration *This question is required.

Space Cell	0	1	2	3
Bretylium	Bretylium: 0	Bretylium: 1	Bretylium: 2	Bretylium: 3
Dopamine	Dopamine: 0	Dopamine: 1	Dopamine: 2	Dopamine: 3
Insulin	Insulin: 0	Insulin: 1	Insulin: 2	Insulin: 3
Pronestyl	Pronestyl: 0	Pronestyl: 1	Pronestyl: 2	Pronestyl: 3

INFUSION THERAPY *This question is required.

Space Cell	0	1	2	3
Infusion Pump	Infusion Pump: 0	Infusion Pump: 1	Infusion Pump: 2	Infusion Pump: 3
Syringe Pump	Syringe Pump: 0	Syringe Pump: 1	Syringe Pump: 2	Syringe Pump: 3
Hyperalimentation Admin (Perip/Central)	Hyperalimentation Admin (Perip/Central): 0	Hyperalimentation Admin (Perip/Central): 1	Hyperalimentation Admin (Perip/Central): 2	Hyperalimentation Admin (Perip/Central): 3
Blood/Blood Products Admin.	Blood/Blood Products Admin.: 0	Blood/Blood Products Admin.: 1	Blood/Blood Products Admin.: 2	Blood/Blood Products Admin.: 3
Insert Peripheral IV/Heplock	Insert Peripheral IV/Heplock: 0	Insert Peripheral IV/Heplock: 1	Insert Peripheral IV/Heplock: 2	Insert Peripheral IV/Heplock: 3
Insert PICC/Midline Catheter	Insert PICC/Midline Catheter: 0	Insert PICC/Midline Catheter: 1	Insert PICC/Midline Catheter: 2	Insert PICC/Midline Catheter: 3
Discontinue Peripheral IV/Heplock	Discontinue Peripheral IV/Heplock: 0	Discontinue Peripheral IV/Heplock: 1	Discontinue Peripheral IV/Heplock: 2	Discontinue Peripheral IV/Heplock: 3
Discontinue PICC/Midline Catheter	Discontinue PICC/Midline Catheter: 0	Discontinue PICC/Midline Catheter: 1	Discontinue PICC/Midline Catheter: 2	Discontinue PICC/Midline Catheter: 3
Titration of drips	Titration of drips: 0	Titration of drips: 1	Titration of drips: 2	Titration of drips: 3
PCA/Epidural pumps	PCA/Epidural pumps: 0	PCA/Epidural pumps: 1	PCA/Epidural pumps: 2	PCA/Epidural pumps: 3

Access & Care of: *This question is required.

Space Cell	0	1	2	3
Hickman/Broviac	Hickman/Broviac: 0	Hickman/Broviac: 1	Hickman/Broviac: 2	Hickman/Broviac: 3
Groshong	Groshong: 0	Groshong: 1	Groshong: 2	Groshong: 3
Implanted Ports	Implanted Ports: 0	Implanted Ports: 1	Implanted Ports: 2	Implanted Ports: 3
PICC/Midline	PICC/Midline: 0	PICC/Midline: 1	PICC/Midline: 2	PICC/Midline: 3

GASTROINTESTINAL *This question is required.

Space Cell	0	1	2	3
Assessment of Bowel Sounds	Assessment of Bowel Sounds: 0	Assessment of Bowel Sounds: 1	Assessment of Bowel Sounds: 2	Assessment of Bowel Sounds: 3
Identification of Abnormalities	Identification of Abnormalities: 0	Identification of Abnormalities: 1	Identification of Abnormalities: 2	Identification of Abnormalities: 3
Insert / Maintain Feeding Tubes	Insert / Maintain Feeding Tubes: 0	Insert / Maintain Feeding Tubes: 1	Insert / Maintain Feeding Tubes: 2	Insert / Maintain Feeding Tubes: 3
Insert/Maintain NG tubes	Insert/Maintain NG tubes: 0	Insert/Maintain NG tubes: 1	Insert/Maintain NG tubes: 2	Insert/Maintain NG tubes: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
GI Bleed	GI Bleed: 0	GI Bleed: 1	GI Bleed: 2	GI Bleed: 3
Acute Pancreatitis	Acute Pancreatitis: 0	Acute Pancreatitis: 1	Acute Pancreatitis: 2	Acute Pancreatitis: 3
Open Abd Wound/Incision	Open Abd Wound/Incision: 0	Open Abd Wound/Incision: 1	Open Abd Wound/Incision: 2	Open Abd Wound/Incision: 3
Abdominal Aortic Aneurysm	Abdominal Aortic Aneurysm: 0	Abdominal Aortic Aneurysm: 1	Abdominal Aortic Aneurysm: 2	Abdominal Aortic Aneurysm: 3

OTHER, Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Multiple Trauma	Multiple Trauma: 0	Multiple Trauma: 1	Multiple Trauma: 2	Multiple Trauma: 3
Burns	Burns: 0	Burns: 1	Burns: 2	Burns: 3
Oncology	Oncology: 0	Oncology: 1	Oncology: 2	Oncology: 3
Chemotherapy	Chemotherapy: 0	Chemotherapy: 1	Chemotherapy: 2	Chemotherapy: 3
AIDS	AIDS: 0	AIDS: 1	AIDS: 2	AIDS: 3
Ketoacidosis	Ketoacidosis: 0	Ketoacidosis: 1	Ketoacidosis: 2	Ketoacidosis: 3
Bone Marrow Transplant	Bone Marrow Transplant: 0	Bone Marrow Transplant: 1	Bone Marrow Transplant: 2	Bone Marrow Transplant: 3
Liver Transplant	Liver Transplant: 0	Liver Transplant: 1	Liver Transplant: 2	Liver Transplant: 3
Suicide Precautions	Suicide Precautions: 0	Suicide Precautions: 1	Suicide Precautions: 2	Suicide Precautions: 3
Hyperbaric Oxygenation	Hyperbaric Oxygenation: 0	Hyperbaric Oxygenation: 1	Hyperbaric Oxygenation: 2	Hyperbaric Oxygenation: 3

AGE OF PATIENTS CARED FOR *This question is required.

Space Cell	0	1	2	3
Newborn (birth-30 days)	Newborn (birth-30 days): 0	Newborn (birth-30 days): 1	Newborn (birth-30 days): 2	Newborn (birth-30 days): 3
Infant (30 days - 1 year)	Infant (30 days - 1 year): 0	Infant (30 days - 1 year): 1	Infant (30 days - 1 year): 2	Infant (30 days - 1 year): 3
Toddler (1 - 3 years)	Toddler (1 - 3 years): 0	Toddler (1 - 3 years): 1	Toddler (1 - 3 years): 2	Toddler (1 - 3 years): 3
Preschooler (3 - 5 years)	Preschooler (3 - 5 years): 0	Preschooler (3 - 5 years): 1	Preschooler (3 - 5 years): 2	Preschooler (3 - 5 years): 3
School Age (5 - 12 years)	School Age (5 - 12 years): 0	School Age (5 - 12 years): 1	School Age (5 - 12 years): 2	School Age (5 - 12 years): 3
Adolescents (12 - 18 years)	Adolescents (12 - 18 years): 0	Adolescents (12 - 18 years): 1	Adolescents (12 - 18 years): 2	Adolescents (12 - 18 years): 3
Young Adults (18 - 39 years)	Young Adults (18 - 39 years): 0	Young Adults (18 - 39 years): 1	Young Adults (18 - 39 years): 2	Young Adults (18 - 39 years): 3
Middle Adults (39 - 64 years)	Middle Adults (39 - 64 years): 0	Middle Adults (39 - 64 years): 1	Middle Adults (39 - 64 years): 2	Middle Adults (39 - 64 years): 3
Older Adults (64+ years)	Older Adults (64+ years): 0	Older Adults (64+ years): 1	Older Adults (64+ years): 2	Older Adults (64+ years): 3

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