Elimination, Nutrition, and Measurement Skill Tasks

Assist a Resident with a Bedpan + Measure and Record Output (Mandatory Task)

This is one of the four possible mandatory first tasks, and its official title ends with 'with Hand Washing' because the full soap-and-water wash is embedded at the end.

Knock on the door and introduce yourself — this task is one of the few that scores both — then hand hygiene, explain, privacy, and adjust the bed to a comfortable working height. Position the resident on the bedpan correctly, and after the pan is placed, raise the head of the bed to a comfortable level. Leave tissue within reach and the call light within easy reach.

Here is the step candidates get wrong: Montana scores moving to an area of the room away from the resident to provide privacy — you stay in the room, you simply step away. You do not leave. When the RN Test Observer indicates, return, put on gloves, lower the head of the bed, and gently remove the pan. The observer will pour simulated urine into the bedpan for you to hold, and you pour it from the bedpan into a graduate.

Place the graduate on a flat surface and measure the output with the graduate at eye level. Lower the bed; empty, rinse, dry, and return the equipment; remove gloves and discard them; then perform hand hygiene for the resident or assist the resident in performing their own. Record the output on the recording form you signed before the test. Your number must land within 30 mL of the observer's pre-measured amount. Then the embedded hand wash, and the call light in reach.

On the job, output is not just urine — emesis, wound drainage, and liquid stool also go on an intake and output (I&O) record, and dark, bloody, cloudy, or foul-smelling urine is reported to the nurse rather than simply charted.

Don Gown and Gloves → Empty Urinary Drainage Bag → Measure and Record → Doff (Mandatory Task)

This task tests infection-control sequencing as much as measurement, and it carries the tightest tolerance on the whole skill test.

Begin with hand hygiene, then don before you ever meet the resident. Face the back opening of the gown, unfold it, put your arms through the sleeves, secure the neck, and secure the waist so the back flaps cover your back as completely as possible. Put on gloves and overlap the gown sleeves at the wrist with the gloves. Only then knock, introduce yourself, explain, and provide privacy.

Setting up: place a barrier on the floor under the drainage bag and set the graduate on that barrier. Ensure the bag is below the bladder and ensure the drainage tube is not kinked — Montana's own handbook suggests verbalizing while you inspect for kinks so the observer can see that you checked.

Emptying: open the drain and let the urine flow into the graduate until the bag is empty, avoiding letting the tip of the tubing touch the graduate. Clamp the tubing, wipe the drain with an antiseptic wipe, and insert the plug or protective cap into the tubing or holder. Those last two steps are easy to skip and are individually scored.

Measuring: place the graduate on a flat surface and measure at eye level. Record the reading — within 10 mL of the observer's pre-measured amount.

Doffing: Montana accepts two methods. Either remove the gloves first, turning them inside out and folding one inside the other without touching the outside of a glove with a bare hand, then unfasten the gown at the neck and waist with bare hands; or pull/pop the gown from the neck keeping gloved hands on the contaminated outside, working the gown down the arms and rolling it inside out with the gloves peeled off inside it. Either way, fold soiled area to soiled area, dispose of the gown appropriately, and finish with the embedded soap-and-water hand wash.

Assist a Dependent Resident with Eating

Montana's feeding checklist is about dignity and pacing, and it scores two steps candidates routinely skip.

After hand hygiene and explaining, look at the diet card to be sure the resident is getting the correct tray. Protect the resident's clothing with a napkin, clothing protector, or towel. Now the commonly missed pair: wash the resident's hands before feeding, and dry the resident's hands before feeding — two separate scored steps.

Sit down facing the resident (or otherwise get yourself to eye level), describe the foods being offered, offer fluid frequently, and offer small amounts of food at a reasonable rate, allowing time to chew and swallow between offerings. Wipe the resident's hands and face during the meal as needed, leave them clean and comfortable, and place the soiled linen in the hamper.

The recording is doubled on this task:

• Solid food is recorded as a percentage of the total eaten, and your figure must be within 25 percentage points of the observer's.
• Fluid consumed is recorded in mL, and your figure must be within 40 mL.

Good clinical practice — sitting the resident upright, keeping them upright after the meal, never rushing a swallow — is also correct and is tested on the knowledge exam; just be aware that the scored Montana steps are the ones listed above.

Measure and Record the Resident's Oral Fluid Intake

This is a calculation task, not a hands-on care task. After hand hygiene and explaining, you observe the dinner tray and calculate the grand total of mL consumed from three different glasses. Montana explicitly allows paper, pencil, mental computation, or a basic calculator supplied by the RN Test Observer — take the calculator. Record the sum total in mL on your signed recording form; the score depends on your total landing within the required range of the observer's.

The conversion to have ready is 1 ounce = 30 mL, so a 4-ounce juice cup is 120 mL and an 8-ounce carton is 240 mL. For each glass: intake = amount served − amount left. Half of a 240 mL milk is 120 mL. On the job, ice chips count as half their volume, and everything liquid at room temperature counts — water, milk, juice, coffee, tea, soup, gelatin, ice cream.

Pass Fresh Water to a Resident

On the Montana skill test, marbles stand in for ice. Assemble the ice (marbles) and the scoop, explain the procedure, and obtain the water pitcher from the resident's room. Empty the pitcher and verbalize cleaning it — the verbalization is the scored step. Scoop the ice into the pitcher using the scoop or dispenser without contaminating the water or the pitcher: do not let the ice touch your hand and fall back into the pitcher, and do not let the scoop touch the pitcher. Store the scoop properly in its receptacle after use. Add water, return the pitcher to the bedside stand or table, and pour the resident a fresh glass of water. Call light in reach, hand hygiene.

In real practice you would also check the care plan first: residents who are NPO (nothing by mouth), on a fluid restriction, or on thickened-liquid orders do not get plain water. That judgment is knowledge-exam material rather than a scored step on this task.

Weigh an Ambulatory Resident

Hand hygiene, explain, and then a safety step: lock the wheelchair brakes (a gait belt is optional here, but the transfer must be safe). Balance or zero the scale before the resident steps on — never after. Check that the resident is balanced and centered on the scale with arms at the side, and check that the resident is not holding on to anything that would alter the reading. Adjust the weights until the scale balances, read it, and record it: within 1 lb of the observer's reading. Then assist the resident to sit in the wheelchair and unlock the wheelchair brakes — an ending step candidates forget after concentrating on the number.

On the unit, comparability is what makes a weight useful: same scale, same time of day, similar clothing, after voiding. A sudden gain or loss of several pounds in a day or two can signal fluid retention or dehydration and is reported to the nurse.

The Universal Recording Rule

Every task in this family ends the same way: hand hygiene, then record accurately, immediately, and in the correct units on the form you signed before the test started. Report anything abnormal — dark or bloody urine, poor intake, a sudden weight change — to the nurse rather than simply charting it.