CDP Behavioral Symptom Management 3 — Questions and Answers
Question 1: A resident with dementia repeatedly removes their clothing in common areas. After ruling out medical causes, the BEST intervention is to:
- Apply mittens to prevent hand use
- Use adaptive clothing with back closures and address comfort or sensory needs (Correct answer)
- Restrict the resident to their room during the day
- Immediately administer a PRN sedative
Correct answer: Use adaptive clothing with back closures and address comfort or sensory needs
Adaptive clothing that is difficult to self-remove, combined with assessment of sensory discomfort or heat, addresses the behavior while preserving dignity.
Question 2: The DICE approach to behavioral symptoms in dementia stands for:
- Diagnose, Intervene, Care, Evaluate
- Describe, Investigate, Create, Evaluate (Correct answer)
- Define, Identify, Communicate, Execute
- Detect, Interpret, Consult, Engage
Correct answer: Describe, Investigate, Create, Evaluate
The DICE framework — Describe, Investigate, Create, Evaluate — is a structured clinical process for assessing and managing behavioral and psychological symptoms of dementia.
Question 3: Which statement about psychotropic medications for behavioral symptoms in dementia is most accurate?
- They are the first-line treatment recommended by major guidelines
- Nonpharmacological strategies should be tried first; medications used only when necessary (Correct answer)
- Antipsychotics are FDA-approved for use in dementia-related psychosis
- Benzodiazepines are the safest long-term option for agitation
Correct answer: Nonpharmacological strategies should be tried first; medications used only when necessary
Major clinical guidelines (APA, AGS) consistently recommend nonpharmacological interventions as first-line treatment, reserving medications for cases where there is significant risk of harm.
Question 4: A person with Lewy body dementia experiences vivid, frightening visual hallucinations. The caregiver's SAFEST response is to:
- Administer a typical antipsychotic as ordered
- Remain calm, acknowledge the experience, and offer reassurance (Correct answer)
- Argue that the hallucination is not real to ground the person
- Increase room lighting and leave the person alone to self-settle
Correct answer: Remain calm, acknowledge the experience, and offer reassurance
Remaining calm and validating the person's fear without agreeing the hallucination is real is the safest approach; typical antipsychotics are contraindicated in Lewy body dementia due to severe sensitivity reactions.
Question 5: Which pain assessment tool is most appropriate for a nonverbal person with advanced dementia who displays agitated behaviors?
- Numeric Rating Scale (NRS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Visual Analog Scale (VAS)
- McGill Pain Questionnaire
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
PAINAD is validated specifically for nonverbal individuals with advanced dementia, assessing behavioral and physiological indicators of pain that may present as agitation.
Question 6: Therapeutic fibbing in dementia care refers to:
- Withholding information about a diagnosis to prevent distress
- Using compassionate untruths to avoid causing unnecessary distress (Correct answer)
- Providing false reassurance about medical prognosis
- Documenting inaccurate behavioral observations
Correct answer: Using compassionate untruths to avoid causing unnecessary distress
Therapeutic fibbing involves using compassionate, benign untruths — such as agreeing that a deceased loved one will visit — to prevent unnecessary emotional pain while maintaining the person's wellbeing.
Question 7: A person with frontotemporal dementia (FTD) makes sexually inappropriate comments to staff. The MOST likely explanation is:
- Intentional harassment stemming from preserved insight
- Disinhibition due to frontal lobe degeneration affecting impulse control (Correct answer)
- A side effect of cholinesterase inhibitor medication
- Depression manifesting as attention-seeking behavior
Correct answer: Disinhibition due to frontal lobe degeneration affecting impulse control
FTD preferentially damages the frontal lobes, which govern impulse control and social judgment, causing disinhibition that results in inappropriate social behaviors.
CDP Behavioral Symptom Management 3
A resident with dementia repeatedly removes their clothing in common areas.
After ruling out medical causes, the BEST intervention is to: