6.2 Common Missouri Skills and Checkpoints

Learn the Task Families, Not Just the Titles

The Missouri handbook lists the skills you may draw, and the list is more useful when grouped by what the task is really testing. The first assigned task is always one of four mandatory tasks with soap-and-water hand washing embedded at the end: catheter care for a female resident, PPE with emptying a urinary drainage bag and recording output, perineal care for a female resident, or perineal care for a male resident. The handbook states that catheter care and the two perineal-care tasks are performed on a manikin; other tasks use a live resident actor unless the official materials specify otherwise.

After the mandatory task, you receive two or three more tasks from the Missouri list. Those include abbreviated bed bath, ambulation from bed to wheelchair, ambulation from wheelchair to bed, denture care, dressing a dependent resident, feeding a dependent resident, foot care, mouth care for an alert resident, mouth care for a comatose resident, nail care, two pivot-transfer tasks, side positioning, range of motion for hip and knee, range of motion for shoulder, pulse and respirations, and manual blood pressure.

Missouri Skill Families

Mandatory-Task Traps

The mandatory tasks combine infection control with privacy and a detailed cleaning path. For catheter care, keep one hand holding the catheter where it exits the urethra and clean three to four inches down the tube with strokes away from the urethra. Do not tug the tube.

For female perineal care, clean one side of the labia front to back, then the other side, then the vaginal area, using clean portions; after glove removal and hand hygiene, put on new gloves before turning for rectal care. For male perineal care, clean from the urethral opening outward and down the shaft, then clean and rinse the scrotum, then change gloves before rectal care.

The PPE and urinary-drainage task has different traps. It starts before resident contact: hand hygiene before touching the gown, gown opening to the back, neck and waist secured, gloves overlapping sleeves. The output step is technical. Place a barrier under the drainage bag, set the graduate on that barrier, open and close the drain without touching the graduate with the tubing, wipe the drain after emptying, place the graduate on a level surface, read at eye level, and record output on the signed form. The candidate’s output must be within 25 mL of the RN Test Observer’s pre-measured amount.

Mobility, ROM, and Positioning

Missouri mobility skills punish shortcuts because resident falls are preventable. For ambulation and transfers, lock the bed brakes and wheelchair brakes, adjust the bed so feet can be flat, place and tighten the gait belt, and keep hold of the belt during standing and movement. In the bed-to-wheelchair ambulation task, non-skid footwear is required before standing. In wheelchair-to-bed ambulation, the resident is asked to place hands on the wheelchair armrests before standing. In both, sitting must be controlled; dropping the resident into a chair or bed is unsafe even if the destination is reached.

Side positioning requires more than rolling the resident. The scenario tells which side; place the resident on that side, keep the face clear of the pillow, make sure the resident is not lying on the downside arm, align the body, and use pillows or other support devices under the head, arm, behind the back, and between the knees to protect bony prominences. Range-of-motion tasks require at least three repetitions for each listed movement, correct joint support, no forcing beyond free movement, and at least one question about discomfort or pain.

Personal Care and Measurement Accuracy

The smaller care tasks are often where prepared candidates get casual. During the abbreviated bed bath, wash the face without soap, expose only one arm, wash and rinse the arm, hand, and underarm, and put the soiled gown and linen where they belong. For dressing, remove the gown from the unaffected side first, but dress the affected or weak side first for both shirt and pants. For denture care, line the sink, handle the plate carefully, brush all surfaces, use cool clean water, and store it in a rinsed cup with clean water.

Feeding requires the resident upright at least 45 degrees, the resident’s stated name matched to the diet card, resident hand hygiene before feeding, the aide seated at eye level, small amounts at a reasonable rate, fluids offered frequently from each glass, and the head of bed left at least 30 degrees. Record solid intake as a percentage within 25 percentage points and total fluid intake within 60 mL. Pulse must be within four beats, respirations within two breaths, and manual blood pressure within six mmHg for systolic and diastolic readings. Those tolerances mean practice with a real watch, a real form, and someone checking your numbers.