CNA Care for Residents with Cognitive Impairment 2

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?

Accepted Answer

Increased shadows and decreased natural light as the sun sets.

Answer

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?

Accepted Answer

"You must miss your mother very much. Tell me a favorite memory you have of her."

Answer

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?

Accepted Answer

Create a 'rummage box' or drawer for the resident filled with safe, interesting items.

Answer

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?

Accepted Answer

Offer a picture board or ask simple 'yes' or 'no' questions.

Answer

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?

Accepted Answer

Involve the resident, gently explaining the safety risk, and ask for permission to remove the spoiled items.

Answer

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.

CNA Practice Test

CNA Practice Test

CNA Care for Residents with Cognitive Impairment 2