PACU RN Skills Assessment

PACU Unit 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
Assess Respiratory Status	Assess Respiratory Status: 0	Assess Respiratory Status: 1	Assess Respiratory Status: 2	Assess Respiratory Status: 3
Assess Lung Sounds	Assess Lung Sounds: 0	Assess Lung Sounds: 1	Assess Lung Sounds: 2	Assess Lung Sounds: 3
Airway Maintenance - Jaw Thrust	Airway Maintenance - Jaw Thrust: 0	Airway Maintenance - Jaw Thrust: 1	Airway Maintenance - Jaw Thrust: 2	Airway Maintenance - Jaw Thrust: 3
Airway Maintenance - Chin Lift	Airway Maintenance - Chin Lift: 0	Airway Maintenance - Chin Lift: 1	Airway Maintenance - Chin Lift: 2	Airway Maintenance - Chin Lift: 3
Insertion of Oral Airway	Insertion of Oral Airway: 0	Insertion of Oral Airway: 1	Insertion of Oral Airway: 2	Insertion of Oral Airway: 3
Insertion of Nasal Airway	Insertion of Nasal Airway: 0	Insertion of Nasal Airway: 1	Insertion of Nasal Airway: 2	Insertion of Nasal Airway: 3
Removal of Nasal & Oral Airway	Removal of Nasal & Oral Airway: 0	Removal of Nasal & Oral Airway: 1	Removal of Nasal & Oral Airway: 2	Removal of Nasal & Oral Airway: 3
Administration of Oxygen: Nasal Cannula	Administration of Oxygen: Nasal Cannula: 0	Administration of Oxygen: Nasal Cannula: 1	Administration of Oxygen: Nasal Cannula: 2	Administration of Oxygen: Nasal Cannula: 3
Administration of Oxygen: Face Masks (With/Without Mist)	Administration of Oxygen: Face Masks (With/Without Mist): 0	Administration of Oxygen: Face Masks (With/Without Mist): 1	Administration of Oxygen: Face Masks (With/Without Mist): 2	Administration of Oxygen: Face Masks (With/Without Mist): 3
Administration of Oxygen: Non-Rebreather Mask	Administration of Oxygen: Non-Rebreather Mask: 0	Administration of Oxygen: Non-Rebreather Mask: 1	Administration of Oxygen: Non-Rebreather Mask: 2	Administration of Oxygen: Non-Rebreather Mask: 3
Administration of Oxygen: Trach Collar	Administration of Oxygen: Trach Collar: 0	Administration of Oxygen: Trach Collar: 1	Administration of Oxygen: Trach Collar: 2	Administration of Oxygen: Trach Collar: 3
Administration of Oxygen: Face Tent	Administration of Oxygen: Face Tent: 0	Administration of Oxygen: Face Tent: 1	Administration of Oxygen: Face Tent: 2	Administration of Oxygen: Face Tent: 3
Incentive Spirometry	Incentive Spirometry: 0	Incentive Spirometry: 1	Incentive Spirometry: 2	Incentive Spirometry: 3
Suctioning - Nasotracheal	Suctioning - Nasotracheal: 0	Suctioning - Nasotracheal: 1	Suctioning - Nasotracheal: 2	Suctioning - Nasotracheal: 3
Suctioning - ETT or Trach	Suctioning - ETT or Trach: 0	Suctioning - ETT or Trach: 1	Suctioning - ETT or Trach: 2	Suctioning - ETT or Trach: 3
Suctioning - Oropharyngeal	Suctioning - Oropharyngeal: 0	Suctioning - Oropharyngeal: 1	Suctioning - Oropharyngeal: 2	Suctioning - Oropharyngeal: 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 (ETT)	Assist with Intubation (ETT): 0	Assist with Intubation (ETT): 1	Assist with Intubation (ETT): 2	Assist with Intubation (ETT): 3

RESPIRATORY, Part 2 *This question is required.

Space Cell	0	1	2	3
ETT - Measure Cuff Pressures	ETT - Measure Cuff Pressures: 0	ETT - Measure Cuff Pressures: 1	ETT - Measure Cuff Pressures: 2	ETT - Measure Cuff Pressures: 3
ETT - Determine Air Leaks	ETT - Determine Air Leaks: 0	ETT - Determine Air Leaks: 1	ETT - Determine Air Leaks: 2	ETT - Determine Air Leaks: 3
Pulse Oximetry	Pulse Oximetry: 0	Pulse Oximetry: 1	Pulse Oximetry: 2	Pulse Oximetry: 3
Draw ABGs - Arterial Puncture and Line	Draw ABGs - Arterial Puncture and Line: 0	Draw ABGs - Arterial Puncture and Line: 1	Draw ABGs - Arterial Puncture and Line: 2	Draw ABGs - Arterial Puncture and Line: 3
Interpret ABGs	Interpret ABGs: 0	Interpret ABGs: 1	Interpret ABGs: 2	Interpret ABGs: 3
Pressure Ventilators	Pressure Ventilators: 0	Pressure Ventilators: 1	Pressure Ventilators: 2	Pressure Ventilators: 3
Volume Ventilators	Volume Ventilators: 0	Volume Ventilators: 1	Volume Ventilators: 2	Volume Ventilators: 3
End Tidal CO2 Monitor	End Tidal CO2 Monitor: 0	End Tidal CO2 Monitor: 1	End Tidal CO2 Monitor: 2	End Tidal CO2 Monitor: 3
Troubleshoot Ventilator Alarms	Troubleshoot Ventilator Alarms: 0	Troubleshoot Ventilator Alarms: 1	Troubleshoot Ventilator Alarms: 2	Troubleshoot Ventilator Alarms: 3
Charting Respirations w/ Ventilator	Charting Respirations w/ Ventilator: 0	Charting Respirations w/ Ventilator: 1	Charting Respirations w/ Ventilator: 2	Charting Respirations w/ Ventilator: 3
Weaning From Ventilator	Weaning From Ventilator: 0	Weaning From Ventilator: 1	Weaning From Ventilator: 2	Weaning From Ventilator: 3
ETT Extubation	ETT Extubation: 0	ETT Extubation: 1	ETT Extubation: 2	ETT Extubation: 3
Chest Percussion	Chest Percussion: 0	Chest Percussion: 1	Chest Percussion: 2	Chest Percussion: 3
Chest Tubes	Chest Tubes: 0	Chest Tubes: 1	Chest Tubes: 2	Chest Tubes: 3
Identify & Troubleshoot Airway Problems:	Identify & Troubleshoot Airway Problems:: 0	Identify & Troubleshoot Airway Problems:: 1	Identify & Troubleshoot Airway Problems:: 2	Identify & Troubleshoot Airway Problems:: 3
Displaced ETT	Displaced ETT: 0	Displaced ETT: 1	Displaced ETT: 2	Displaced ETT: 3
Upper Airway Obstruction	Upper Airway Obstruction: 0	Upper Airway Obstruction: 1	Upper Airway Obstruction: 2	Upper Airway Obstruction: 3
Bronchospasm	Bronchospasm: 0	Bronchospasm: 1	Bronchospasm: 2	Bronchospasm: 3
Aspiration	Aspiration: 0	Aspiration: 1	Aspiration: 2	Aspiration: 3
Pneumothorax	Pneumothorax: 0	Pneumothorax: 1	Pneumothorax: 2	Pneumothorax: 3
Hemothorax	Hemothorax: 0	Hemothorax: 1	Hemothorax: 2	Hemothorax: 3
Care of Post-Op Thoracic Surgery	Care of Post-Op Thoracic Surgery: 0	Care of Post-Op Thoracic Surgery: 1	Care of Post-Op Thoracic Surgery: 2	Care of Post-Op Thoracic Surgery: 3
Care of Post-op ENT Surgery	Care of Post-op ENT Surgery: 0	Care of Post-op ENT Surgery: 1	Care of Post-op ENT Surgery: 2	Care of Post-op ENT Surgery: 3

GENITOURINARY *This question is required.

Space Cell	0	1	2	3
Straight/Foley Cath Female	Straight/Foley Cath Female: 0	Straight/Foley Cath Female: 1	Straight/Foley Cath Female: 2	Straight/Foley Cath Female: 3
Straight/Foley Cath Male	Straight/Foley Cath Male: 0	Straight/Foley Cath Male: 1	Straight/Foley Cath Male: 2	Straight/Foley Cath Male: 3
GU irrigations	GU irrigations: 0	GU irrigations: 1	GU irrigations: 2	GU irrigations: 3
Suprapubic tube	Suprapubic tube: 0	Suprapubic tube: 1	Suprapubic tube: 2	Suprapubic tube: 3
Nephrostomy tube	Nephrostomy tube: 0	Nephrostomy tube: 1	Nephrostomy tube: 2	Nephrostomy tube: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Shunts & fistulas	Shunts & fistulas: 0	Shunts & fistulas: 1	Shunts & fistulas: 2	Shunts & fistulas: 3
Nephrectomy	Nephrectomy: 0	Nephrectomy: 1	Nephrectomy: 2	Nephrectomy: 3
Renal Transplant	Renal Transplant: 0	Renal Transplant: 1	Renal Transplant: 2	Renal Transplant: 3
Mastectomy	Mastectomy: 0	Mastectomy: 1	Mastectomy: 2	Mastectomy: 3
Hysterectomy	Hysterectomy: 0	Hysterectomy: 1	Hysterectomy: 2	Hysterectomy: 3
Prostate surgery	Prostate surgery: 0	Prostate surgery: 1	Prostate surgery: 2	Prostate surgery: 3

MEDS/IV THERAPY *This question is required.

Space Cell	0	1	2	3
Administer PO Medications	Administer PO Medications: 0	Administer PO Medications: 1	Administer PO Medications: 2	Administer PO Medications: 3
Administer NG/GT Medications	Administer NG/GT Medications: 0	Administer NG/GT Medications: 1	Administer NG/GT Medications: 2	Administer NG/GT Medications: 3
Administer IM & SQ Meds	Administer IM & SQ Meds: 0	Administer IM & SQ Meds: 1	Administer IM & SQ Meds: 2	Administer IM & SQ Meds: 3
Peripheral IV Insertion	Peripheral IV Insertion: 0	Peripheral IV Insertion: 1	Peripheral IV Insertion: 2	Peripheral IV Insertion: 3
Mix IV Infusion w/ Additives	Mix IV Infusion w/ Additives: 0	Mix IV Infusion w/ Additives: 1	Mix IV Infusion w/ Additives: 2	Mix IV Infusion w/ Additives: 3
Administer IV Medications	Administer IV Medications: 0	Administer IV Medications: 1	Administer IV Medications: 2	Administer IV Medications: 3
Use of Heparin/Saline Locks	Use of Heparin/Saline Locks: 0	Use of Heparin/Saline Locks: 1	Use of Heparin/Saline Locks: 2	Use of Heparin/Saline Locks: 3
Needle-less Systems	Needle-less Systems: 0	Needle-less Systems: 1	Needle-less Systems: 2	Needle-less Systems: 3
Infusion Pumps	Infusion Pumps: 0	Infusion Pumps: 1	Infusion Pumps: 2	Infusion Pumps: 3
Discontinue Peripheral IVs	Discontinue Peripheral IVs: 0	Discontinue Peripheral IVs: 1	Discontinue Peripheral IVs: 2	Discontinue Peripheral IVs: 3
Know Anesthetic Agents, Complications & Treatment	Know Anesthetic Agents, Complications & Treatment: 0	Know Anesthetic Agents, Complications & Treatment: 1	Know Anesthetic Agents, Complications & Treatment: 2	Know Anesthetic Agents, Complications & Treatment: 3
Knowledge of Inhalants	Knowledge of Inhalants: 0	Knowledge of Inhalants: 1	Knowledge of Inhalants: 2	Knowledge of Inhalants: 3
Knowledge of Injectables	Knowledge of Injectables: 0	Knowledge of Injectables: 1	Knowledge of Injectables: 2	Knowledge of Injectables: 3
Knowledge of Narcotics	Knowledge of Narcotics: 0	Knowledge of Narcotics: 1	Knowledge of Narcotics: 2	Knowledge of Narcotics: 3
Knowledge of Reversal Agents	Knowledge of Reversal Agents: 0	Knowledge of Reversal Agents: 1	Knowledge of Reversal Agents: 2	Knowledge of Reversal Agents: 3
Knowledge of Muscle Relaxants	Knowledge of Muscle Relaxants: 0	Knowledge of Muscle Relaxants: 1	Knowledge of Muscle Relaxants: 2	Knowledge of Muscle Relaxants: 3
Knowledge of Local Anesthesia	Knowledge of Local Anesthesia: 0	Knowledge of Local Anesthesia: 1	Knowledge of Local Anesthesia: 2	Knowledge of Local Anesthesia: 3
Knowledge of Regional Anesthesia	Knowledge of Regional Anesthesia: 0	Knowledge of Regional Anesthesia: 1	Knowledge of Regional Anesthesia: 2	Knowledge of Regional Anesthesia: 3
Knowledge of Epidural Anesthesia	Knowledge of Epidural Anesthesia: 0	Knowledge of Epidural Anesthesia: 1	Knowledge of Epidural Anesthesia: 2	Knowledge of Epidural Anesthesia: 3
Knowledge of Spinal Anesthesia	Knowledge of Spinal Anesthesia: 0	Knowledge of Spinal Anesthesia: 1	Knowledge of Spinal Anesthesia: 2	Knowledge of Spinal Anesthesia: 3
Knowledge of Intrathecal Anesthesia	Knowledge of Intrathecal Anesthesia: 0	Knowledge of Intrathecal Anesthesia: 1	Knowledge of Intrathecal Anesthesia: 2	Knowledge of Intrathecal Anesthesia: 3
Knowledge of AntiEmetic Drugs	Knowledge of AntiEmetic Drugs: 0	Knowledge of AntiEmetic Drugs: 1	Knowledge of AntiEmetic Drugs: 2	Knowledge of AntiEmetic Drugs: 3

VASCULAR *This question is required.

Space Cell	0	1	2	3
Draw Venous Blood (Peripheral)	Draw Venous Blood (Peripheral): 0	Draw Venous Blood (Peripheral): 1	Draw Venous Blood (Peripheral): 2	Draw Venous Blood (Peripheral): 3
Draw Blood from Central Line	Draw Blood from Central Line: 0	Draw Blood from Central Line: 1	Draw Blood from Central Line: 2	Draw Blood from Central Line: 3
Interpretation of Lab Results	Interpretation of Lab Results: 0	Interpretation of Lab Results: 1	Interpretation of Lab Results: 2	Interpretation of Lab Results: 3
Intake and Output	Intake and Output: 0	Intake and Output: 1	Intake and Output: 2	Intake and Output: 3
Peripheral Pulses	Peripheral Pulses: 0	Peripheral Pulses: 1	Peripheral Pulses: 2	Peripheral Pulses: 3
Ultrasonic Doppler	Ultrasonic Doppler: 0	Ultrasonic Doppler: 1	Ultrasonic Doppler: 2	Ultrasonic Doppler: 3
Identify & Troubleshoot Edema/Fluid Overload	Identify & Troubleshoot Edema/Fluid Overload: 0	Identify & Troubleshoot Edema/Fluid Overload: 1	Identify & Troubleshoot Edema/Fluid Overload: 2	Identify & Troubleshoot Edema/Fluid Overload: 3
Identify & Troubleshoot Hypovolemia	Identify & Troubleshoot Hypovolemia: 0	Identify & Troubleshoot Hypovolemia: 1	Identify & Troubleshoot Hypovolemia: 2	Identify & Troubleshoot Hypovolemia: 3
Administer Packed RBCs	Administer Packed RBCs: 0	Administer Packed RBCs: 1	Administer Packed RBCs: 2	Administer Packed RBCs: 3
Administer Whole Blood	Administer Whole Blood: 0	Administer Whole Blood: 1	Administer Whole Blood: 2	Administer Whole Blood: 3
Plasma/Albumin	Plasma/Albumin: 0	Plasma/Albumin: 1	Plasma/Albumin: 2	Plasma/Albumin: 3
Cryoprecipitate	Cryoprecipitate: 0	Cryoprecipitate: 1	Cryoprecipitate: 2	Cryoprecipitate: 3
Fluid Resuscitation (Crystalloids)	Fluid Resuscitation (Crystalloids): 0	Fluid Resuscitation (Crystalloids): 1	Fluid Resuscitation (Crystalloids): 2	Fluid Resuscitation (Crystalloids): 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Central Venous Catheter (CVL)	Central Venous Catheter (CVL): 0	Central Venous Catheter (CVL): 1	Central Venous Catheter (CVL): 2	Central Venous Catheter (CVL): 3
Arterial Line	Arterial Line: 0	Arterial Line: 1	Arterial Line: 2	Arterial Line: 3
Hickman/Broviac Catheters	Hickman/Broviac Catheters: 0	Hickman/Broviac Catheters: 1	Hickman/Broviac Catheters: 2	Hickman/Broviac Catheters: 3
Implantable Venous Port	Implantable Venous Port: 0	Implantable Venous Port: 1	Implantable Venous Port: 2	Implantable Venous Port: 3
PICC Line	PICC Line: 0	PICC Line: 1	PICC Line: 2	PICC Line: 3
SwanGanz / Pul Art. Catheter	SwanGanz / Pul Art. Catheter: 0	SwanGanz / Pul Art. Catheter: 1	SwanGanz / Pul Art. Catheter: 2	SwanGanz / Pul Art. Catheter: 3
Auto Infusion Pump	Auto Infusion Pump: 0	Auto Infusion Pump: 1	Auto Infusion Pump: 2	Auto Infusion Pump: 3
Assist CVL Insertion	Assist CVL Insertion: 0	Assist CVL Insertion: 1	Assist CVL Insertion: 2	Assist CVL Insertion: 3
Assist Arterial Line Insertion	Assist Arterial Line Insertion: 0	Assist Arterial Line Insertion: 1	Assist Arterial Line Insertion: 2	Assist Arterial Line Insertion: 3
Arterial Line D/C	Arterial Line D/C: 0	Arterial Line D/C: 1	Arterial Line D/C: 2	Arterial Line D/C: 3

ORTHOPEDIC *This question is required.

Space Cell	0	1	2	3
Cast Care	Cast Care: 0	Cast Care: 1	Cast Care: 2	Cast Care: 3
Circulation Assessment	Circulation Assessment: 0	Circulation Assessment: 1	Circulation Assessment: 2	Circulation Assessment: 3
Cold Systems	Cold Systems: 0	Cold Systems: 1	Cold Systems: 2	Cold Systems: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	3
Continuous Passive Motion (CPM)	Continuous Passive Motion (CPM): 0	Continuous Passive Motion (CPM): 1	Continuous Passive Motion (CPM): 2	Continuous Passive Motion (CPM): 3
Skeletal traction	Skeletal traction: 0	Skeletal traction: 1	Skeletal traction: 2	Skeletal traction: 3
Amputation	Amputation: 0	Amputation: 1	Amputation: 2	Amputation: 3
Arthroscopy/Arthrotomy	Arthroscopy/Arthrotomy: 0	Arthroscopy/Arthrotomy: 1	Arthroscopy/Arthrotomy: 2	Arthroscopy/Arthrotomy: 3
Total Hip Replacement	Total Hip Replacement: 0	Total Hip Replacement: 1	Total Hip Replacement: 2	Total Hip Replacement: 3
Total Knee Replacement	Total Knee Replacement: 0	Total Knee Replacement: 1	Total Knee Replacement: 2	Total Knee Replacement: 3

NEUROLOGICAL *This question is required.

Space Cell	0	1	2	3
Neurological assessment	Neurological assessment: 0	Neurological assessment: 1	Neurological assessment: 2	Neurological assessment: 3
Glascow Coma Scale	Glascow Coma Scale: 0	Glascow Coma Scale: 1	Glascow Coma Scale: 2	Glascow Coma Scale: 3
Seizure Precautions	Seizure Precautions: 0	Seizure Precautions: 1	Seizure Precautions: 2	Seizure Precautions: 3
Intracranial Pressure Monitoring	Intracranial Pressure Monitoring: 0	Intracranial Pressure Monitoring: 1	Intracranial Pressure Monitoring: 2	Intracranial Pressure Monitoring: 3
Knowledge of Anticonvulsants	Knowledge of Anticonvulsants: 0	Knowledge of Anticonvulsants: 1	Knowledge of Anticonvulsants: 2	Knowledge of Anticonvulsants: 3
Care of Post-Op Craniotomy	Care of Post-Op Craniotomy: 0	Care of Post-Op Craniotomy: 1	Care of Post-Op Craniotomy: 2	Care of Post-Op Craniotomy: 3
Care of Post-Op Ophth. Patient	Care of Post-Op Ophth. Patient: 0	Care of Post-Op Ophth. Patient: 1	Care of Post-Op Ophth. Patient: 2	Care of Post-Op Ophth. Patient: 3
Care of Spinal Cord Injury	Care of Spinal Cord Injury: 0	Care of Spinal Cord Injury: 1	Care of Spinal Cord Injury: 2	Care of Spinal Cord Injury: 3
Care of Ventriculostomy	Care of Ventriculostomy: 0	Care of Ventriculostomy: 1	Care of Ventriculostomy: 2	Care of Ventriculostomy: 3
ICP Monitoring	ICP Monitoring: 0	ICP Monitoring: 1	ICP Monitoring: 2	ICP Monitoring: 3
Care of Spinal Fusion	Care of Spinal Fusion: 0	Care of Spinal Fusion: 1	Care of Spinal Fusion: 2	Care of Spinal Fusion: 3

PAIN MANAGEMENT *This question is required.

Space Cell	0	1	2	3
Pain Assessment & Pain Scale	Pain Assessment & Pain Scale: 0	Pain Assessment & Pain Scale: 1	Pain Assessment & Pain Scale: 2	Pain Assessment & Pain Scale: 3
Admin of IV Sedation	Admin of IV Sedation: 0	Admin of IV Sedation: 1	Admin of IV Sedation: 2	Admin of IV Sedation: 3
Admin of Narcotic Analgesia	Admin of Narcotic Analgesia: 0	Admin of Narcotic Analgesia: 1	Admin of Narcotic Analgesia: 2	Admin of Narcotic Analgesia: 3
PCA Pump	PCA Pump: 0	PCA Pump: 1	PCA Pump: 2	PCA Pump: 3
Assist w/ Epidural Cath Insertion	Assist w/ Epidural Cath Insertion: 0	Assist w/ Epidural Cath Insertion: 1	Assist w/ Epidural Cath Insertion: 2	Assist w/ Epidural Cath Insertion: 3
Assess Epidural Anesthesia Level	Assess Epidural Anesthesia Level: 0	Assess Epidural Anesthesia Level: 1	Assess Epidural Anesthesia Level: 2	Assess Epidural Anesthesia Level: 3
Assess Spinal Anesthesia Level	Assess Spinal Anesthesia Level: 0	Assess Spinal Anesthesia Level: 1	Assess Spinal Anesthesia Level: 2	Assess Spinal Anesthesia Level: 3
Auto Med Dispense (Pyxis,SureMed)	Auto Med Dispense (Pyxis,SureMed): 0	Auto Med Dispense (Pyxis,SureMed): 1	Auto Med Dispense (Pyxis,SureMed): 2	Auto Med Dispense (Pyxis,SureMed): 3

CARDIAC *This question is required.

Space Cell	0	1	2	3
Auto BP Monitor (NIBP)	Auto BP Monitor (NIBP): 0	Auto BP Monitor (NIBP): 1	Auto BP Monitor (NIBP): 2	Auto BP Monitor (NIBP): 3
Use of Cardiac Monitors	Use of Cardiac Monitors: 0	Use of Cardiac Monitors: 1	Use of Cardiac Monitors: 2	Use of Cardiac Monitors: 3
Interpretation of Arrhythmias	Interpretation of Arrhythmias: 0	Interpretation of Arrhythmias: 1	Interpretation of Arrhythmias: 2	Interpretation of Arrhythmias: 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
Use of Warming Blankets	Use of Warming Blankets: 0	Use of Warming Blankets: 1	Use of Warming Blankets: 2	Use of Warming Blankets: 3
Care of Post-Op Cardiac Surgery	Care of Post-Op Cardiac Surgery: 0	Care of Post-Op Cardiac Surgery: 1	Care of Post-Op Cardiac Surgery: 2	Care of Post-Op Cardiac Surgery: 3

Care of Patient With: *This question is required.

Space Cell	0	1	2	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
Cardiogenic Shock	Cardiogenic Shock: 0	Cardiogenic Shock: 1	Cardiogenic Shock: 2	Cardiogenic Shock: 3
Hypothermia	Hypothermia: 0	Hypothermia: 1	Hypothermia: 2	Hypothermia: 3
Malignant Hyperthermic Crisis	Malignant Hyperthermic Crisis: 0	Malignant Hyperthermic Crisis: 1	Malignant Hyperthermic Crisis: 2	Malignant Hyperthermic Crisis: 3

GASTROINTESTINAL *This question is required.

Space Cell	0	1	2	3
Assess Bowel Sounds	Assess Bowel Sounds: 0	Assess Bowel Sounds: 1	Assess Bowel Sounds: 2	Assess Bowel Sounds: 3
Assess GI Distress/Bleeding	Assess GI Distress/Bleeding: 0	Assess GI Distress/Bleeding: 1	Assess GI Distress/Bleeding: 2	Assess GI Distress/Bleeding: 3
Insertion/Monitoring NG Tube	Insertion/Monitoring NG Tube: 0	Insertion/Monitoring NG Tube: 1	Insertion/Monitoring NG Tube: 2	Insertion/Monitoring NG Tube: 3
Abdominal Wounds	Abdominal Wounds: 0	Abdominal Wounds: 1	Abdominal Wounds: 2	Abdominal Wounds: 3
Wound Drains	Wound Drains: 0	Wound Drains: 1	Wound Drains: 2	Wound Drains: 3
Enterostomy Care	Enterostomy Care: 0	Enterostomy Care: 1	Enterostomy Care: 2	Enterostomy Care: 3
Care of Post-Op Abd Surgery	Care of Post-Op Abd Surgery: 0	Care of Post-Op Abd Surgery: 1	Care of Post-Op Abd Surgery: 2	Care of Post-Op Abd Surgery: 3
Care of Liver Transplant	Care of Liver Transplant: 0	Care of Liver Transplant: 1	Care of Liver Transplant: 2	Care of Liver Transplant: 3

GENERAL NURSING *This question is required.

Space Cell	0	1	2	3
Admit & Orient patients	Admit & Orient patients: 0	Admit & Orient patients: 1	Admit & Orient patients: 2	Admit & Orient patients: 3
Discharge/Transfer patients	Discharge/Transfer patients: 0	Discharge/Transfer patients: 1	Discharge/Transfer patients: 2	Discharge/Transfer patients: 3
Supervise Unlicensed Personnel	Supervise Unlicensed Personnel: 0	Supervise Unlicensed Personnel: 1	Supervise Unlicensed Personnel: 2	Supervise Unlicensed Personnel: 3
Pre-operative Care/Preparation	Pre-operative Care/Preparation: 0	Pre-operative Care/Preparation: 1	Pre-operative Care/Preparation: 2	Pre-operative Care/Preparation: 3
Urine dipstick	Urine dipstick: 0	Urine dipstick: 1	Urine dipstick: 2	Urine dipstick: 3
Blood Glucose Monitoring	Blood Glucose Monitoring: 0	Blood Glucose Monitoring: 1	Blood Glucose Monitoring: 2	Blood Glucose Monitoring: 3
Positioning / Transferring	Positioning / Transferring: 0	Positioning / Transferring: 1	Positioning / Transferring: 2	Positioning / Transferring: 3
Restraints	Restraints: 0	Restraints: 1	Restraints: 2	Restraints: 3
Advance Directives	Advance Directives: 0	Advance Directives: 1	Advance Directives: 2	Advance Directives: 3
Postmortem Care	Postmortem Care: 0	Postmortem Care: 1	Postmortem Care: 2	Postmortem Care: 3
Care of Patient w/ Latex Allergy	Care of Patient w/ Latex Allergy: 0	Care of Patient w/ Latex Allergy: 1	Care of Patient w/ Latex Allergy: 2	Care of Patient w/ Latex Allergy: 3
Isolation Techniques	Isolation Techniques: 0	Isolation Techniques: 1	Isolation Techniques: 2	Isolation Techniques: 3
Care of HIV Patient	Care of HIV Patient: 0	Care of HIV Patient: 1	Care of HIV Patient: 2	Care of HIV Patient: 3
Care of Multiple Trauma Patient	Care of Multiple Trauma Patient: 0	Care of Multiple Trauma Patient: 1	Care of Multiple Trauma Patient: 2	Care of Multiple Trauma Patient: 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

1. CANDIDATE SIGNATURE

Clear

Signature of