CNA Care for Residents with Cognitive Impairment 2 — Questions and Answers
Question 1: A resident with dementia becomes increasingly agitated in the late afternoon, a behavior known as sundowning. Which of the following is a less obvious environmental trigger that a CNA should assess and attempt to modify?
- The resident's hunger or thirst level.
- The need for the resident to use the toilet.
- Increased shadows and decreased natural light as the sun sets. (Correct answer)
- The resident reporting feelings of pain or discomfort.
Correct answer: Increased shadows and decreased natural light as the sun sets.
While physical needs like hunger, toileting, and pain are common triggers for agitation, a key environmental factor in sundowning is the change in lighting. As natural light fades, shadows can become distorted and frightening to a person with cognitive impairment, increasing confusion and anxiety. Modifying the environment by turning on lights before dusk can help minimize this effect.
Question 2: A resident with severe dementia is crying and repeatedly asking to 'go home' to see her mother, who has been deceased for many years. What is the MOST therapeutic response for the CNA?
- "Your mother passed away a long time ago. This is your home now."
- "You must miss your mother very much. Tell me a favorite memory you have of her." (Correct answer)
- "Let's not talk about that. It's time to get ready for dinner."
- "If you stop crying, I will take you to see your mother tomorrow."
Correct answer: "You must miss your mother very much. Tell me a favorite memory you have of her."
This response uses validation therapy, which focuses on the emotion behind the resident's words rather than the factual inaccuracy. Acknowledging the resident's feelings of loss and encouraging reminiscence provides comfort without causing the repeated grief that would come from reality orientation (Choice A). Choice C is dismissive, and Choice D is a non-therapeutic lie that will lead to future distress.
Question 3: A CNA observes a resident with cognitive impairment frequently rummaging through other residents' drawers, causing distress and conflict. Which of the following is the most effective and person-centered intervention?
- Strictly forbid the resident from entering other residents' rooms.
- Create a 'rummage box' or drawer for the resident filled with safe, interesting items. (Correct answer)
- Inform the resident's family that they need to control this behavior during visits.
- Tell the other residents to lock their drawers to prevent theft.
Correct answer: Create a 'rummage box' or drawer for the resident filled with safe, interesting items.
Rummaging behavior often stems from a need to feel busy, useful, or to be searching for something familiar. Providing a safe and acceptable outlet for this behavior, such as a designated rummage box with items like folded towels, old wallets, or soft objects, redirects the energy positively and reduces conflict. This approach addresses the underlying need rather than simply punishing the behavior.
Question 4: You are assisting a resident with expressive aphasia who is trying to tell you something but is becoming visibly frustrated and unable to find the words. After ensuring a calm environment, what is the BEST next step?
- Speak louder and repeat your last question multiple times.
- Finish their sentences for them to speed up communication.
- Offer a picture board or ask simple 'yes' or 'no' questions. (Correct answer)
- Leave the room and come back in 10 minutes when they have calmed down.
Correct answer: Offer a picture board or ask simple 'yes' or 'no' questions.
For a resident with expressive aphasia, who knows what they want to say but can't produce the words, providing alternative communication methods is key. Offering a picture board or simplifying the question to a 'yes' or 'no' format reduces the pressure to find words and empowers the resident to communicate their needs. Speaking louder is not helpful unless there is a hearing impairment, and finishing sentences can increase frustration.
Question 5: A resident is discovered to be hoarding perishable food items, such as sandwiches and fruit, in their bedside table. What is the CNA's priority action?
- Immediately discard all the hoarded food to eliminate the health risk.
- Document the finding and wait for the nurse's instructions at the end of the shift.
- Involve the resident, gently explaining the safety risk, and ask for permission to remove the spoiled items. (Correct answer)
- Place a lock on the bedside table to prevent future hoarding.
Correct answer: Involve the resident, gently explaining the safety risk, and ask for permission to remove the spoiled items.
The priority is to address the immediate safety risk (spoiled food) while respecting the resident's dignity and property. Involving the resident in the process, explaining the reason for removal (safety, pests, odor) in simple terms, and asking for permission is a collaborative and therapeutic approach. Discarding items without their involvement can be traumatic and may increase the behavior. While safety is the goal, this approach balances safety with person-centered care.
Question 6: During morning care, a resident with dementia suddenly becomes extremely agitated, shouting and striking out in response to the CNA trying to brush their teeth. This is an example of a catastrophic reaction. The CNA's first response should be to:
- Firmly hold the resident's hands and finish the task quickly.
- Call for assistance to restrain the resident for safety.
- Stop the task immediately, step back, and speak in a calm, reassuring voice.
- Explain to the resident why dental hygiene is important for their health. (Correct answer)
Correct answer: Explain to the resident why dental hygiene is important for their health.
A catastrophic reaction is an overwhelming emotional outburst, often triggered by a task that is too stimulating or confusing. The immediate priority is to de-escalate the situation by removing the trigger. The CNA should stop the task, give the resident space, and use a calm tone to provide reassurance. Trying to power through the task or restrain the resident will likely escalate the reaction. Reasoning or explaining is ineffective when the resident is in a state of high emotional distress.
CNA Care for Residents with Cognitive Impairment 2
A resident with dementia becomes increasingly agitated in the late afternoon, a behavior known as sundowning.
Which of the following is a less obvious environmental trigger that a CNA should assess and attempt to modify?