CNA Care of Cognitively Impaired Residents 2 — Questions and Answers

Question 1: A good way to reduce confusion or agitation for residents with dementia is

follow a familiar schedule every day. (Correct answer)
include a variety of activities for stimulation.
ask them what they want to do.
trade assignments so they get to know all staff.

Correct answer: follow a familiar schedule every day.

A consistent and predictable daily schedule provides structure and reduces anxiety for residents with dementia. Familiar routines help them anticipate events, minimize confusion, and create a sense of security, which can significantly reduce agitation and promote a calmer environment.

Question 2: A nurse aide finds a resident looking in the refrigerator at the nurses’ station at 5 a.m. The resident, who is confused, explains that he needs breakfast before he leaves for work. The best response by the nurse aide is to __________.

remind him that he is retired from his job and in a nursing home
tell him that residents are not allowed in the nurses’ station
help the resident back to his room and into bed
ask the resident about his job and if he is hungry (Correct answer)

Correct answer: ask the resident about his job and if he is hungry

When a confused resident expresses a desire related to their past life, such as going to work, it's best to validate their feelings and gently redirect them. Asking about their job and if they are hungry acknowledges their current state of mind and opens an opportunity to address an immediate need (hunger) in a compassionate way, rather than confronting their confusion directly.

Question 3: When you approach a resident with dementia, how should you behave?

With an "I'm busy, let's get this done" behavior.
With a meek, submissive demeanor.
With a cold, professional attitude.
With a relaxed and cheerful manner. (Correct answer)

Correct answer: With a relaxed and cheerful manner.

Approaching a resident with dementia in a relaxed and cheerful manner helps create a calm and positive environment. This demeanor can reduce anxiety and confusion in the resident, making them more receptive to care and interaction. A positive attitude fosters trust and cooperation, which is essential when caring for individuals with cognitive impairments.

Question 4: When preparing to give peri-care to an incontinent female resident with dementia, the CNA knows

the resident may become combative.
the resident may become tearful.
the resident may feel sexually assaulted.
all of the above (Correct answer)

Correct answer: all of the above

When providing peri-care to a resident with dementia, it's crucial to anticipate a range of reactions due to their confusion, fear, or perceived invasion of privacy. They may become combative, tearful from embarrassment, or feel sexually assaulted if they don't understand the procedure. Therefore, CNAs must be prepared for any of these responses and approach care with sensitivity and caution.

Question 5: If a resident's behavior becomes combative, the nurse aide should

Tell him to calm down or restraints may be necessary.
Ask a co-worker to witness the situation.
Show him that the nurse aide is in control.
Communicate calmly while stepping out of the way. (Correct answer)

Correct answer: Communicate calmly while stepping out of the way.

If a resident becomes combative, the nurse aide's priority is safety for both the resident and themselves. Communicating calmly can help de-escalate the situation, while stepping out of the way prevents injury and gives the resident space. This approach avoids confrontation, which can worsen combative behavior, and allows the CNA to assess the situation safely before seeking further assistance.

Question 6: A 90 year-old resident tells you that his mother is coming to visit on Sunday. What is your most appropriate response?

"Okay, let's figure out how old your mother could be."
"That is impossible! Your mother is dead."
"How nice! What are you going to do when she gets here?"
"Are you wishing you could see your mother?" (Correct answer)

Correct answer: "Are you wishing you could see your mother?"

When a resident with dementia expresses a belief not rooted in reality, like their deceased mother visiting, it's important to validate their feelings rather than correct them. Asking 'Are you wishing you could see your mother?' acknowledges their emotional need and allows them to express feelings of longing or sadness. This therapeutic communication technique, known as validation therapy, avoids causing distress or confusion by directly contradicting their reality.

Question 7: Which of the following can be a cause of intellectual disability?

Childhood illness
Down syndrome
Birth complications
All of the above (Correct answer)

Correct answer: All of the above

Intellectual disability can stem from a variety of factors, including genetic conditions like Down syndrome, complications during birth such as oxygen deprivation, and severe childhood illnesses like meningitis or lead poisoning. These diverse causes highlight that intellectual disability is not a single condition but rather a broad term encompassing various etiologies that affect brain development and function. Therefore, all listed options are potential causes.

Question 8: If a resident becomes confused, you should

Put him in restraints so he won’t fall.
Sit him down until you have time to assist him.
Place him in his room so he won't wander.
Help the resident recognize familiar items. (Correct answer)

Correct answer: Help the resident recognize familiar items.

When a resident becomes confused, helping them recognize familiar items can provide comfort and reorientation. This technique, known as reality orientation, uses tangible cues to ground the resident in their environment and reduce anxiety. It's a gentle way to bring them back to the present without causing distress, unlike restraints or isolation which can worsen confusion and agitation.

Question 9: Reality orientation therapy should include

Addressing the resident by their proper name (Correct answer)
Creating imaginative stories to amuse the resident
Calling the resident by a name such as "Gramps."
Telling the resident that they will be going home soon.

Correct answer: Addressing the resident by their proper name

Reality orientation therapy aims to help residents stay connected to their current environment and identity. Addressing a resident by their proper name reinforces their personal identity and shows respect, which is a fundamental aspect of this therapy. It helps to ground them in reality and reduces confusion, unlike using informal names or creating imaginative stories that can further disorient them.

Question 10: What of the following can lead to intellectual disability?

Birth complications
Down syndrome
Childhood illness
All of the above (Correct answer)

Correct answer: All of the above

Intellectual disability can result from a range of factors that impact brain development. Birth complications, such as prematurity or oxygen deprivation, can cause brain damage. Genetic conditions like Down syndrome directly affect cognitive development. Additionally, severe childhood illnesses, including infections or injuries, can lead to intellectual impairments. Therefore, all the listed options are recognized causes.

Question 11: A client always wants to wear her favorite clothes when getting dressed. What makes a good solution?

Tell the resident that the outfit is dirty and she will have to choose another.
Ask the family to get several identical outfits. (Correct answer)
Explain the benefits of variety and offer several other outfits.
Hide the favorite outfit for a few days so she forgets.

Correct answer: Ask the family to get several identical outfits.

Residents with dementia often find comfort and security in routines and familiar items, like a favorite outfit. Rather than forcing them to change or hiding their clothes, asking the family to provide several identical outfits allows the resident to maintain their preference while ensuring hygiene and variety. This approach respects their autonomy and reduces potential agitation or distress associated with change.

Question 12: A resident has trouble recalling the date and their location. How best can you assist the resident?

Tell the resident often what day it is and where the resident is. (Correct answer)
Agree with whatever the resident says.
Joke with the resident about their forgetfulness.
Keep the resident from talking about the past.

Correct answer: Tell the resident often what day it is and where the resident is.

For residents experiencing memory loss or confusion about time and place, consistent and gentle reorientation is beneficial. Regularly stating the date and location helps reinforce reality and can reduce anxiety. This approach provides clear, factual information without overwhelming the resident, supporting their cognitive function and sense of security.

Question 13: The main cause of a resident's belligerent behavior is

resentment
hunger
confusion (Correct answer)
stubbornness

Correct answer: confusion

Belligerent behavior in residents, especially those with dementia, is most often a manifestation of confusion, fear, or an inability to communicate their needs. They may be disoriented, misinterpret their environment, or feel threatened, leading to aggressive outbursts. Attributing such behavior to stubbornness or resentment overlooks the underlying cognitive impairment and can lead to inappropriate responses.

Question 14: What crucial information must the nurse's assistant know if a resident exhibits paranoid behavior?

The nurse should be immediately notified, so a medication can be ordered.
Delusions are a normal part of the progression of the dementia process. (Correct answer)
If the behavior is ignored, it will diminish. The resident will forget about it.
The family must be involved, so they can reason with the resident.

Correct answer: Delusions are a normal part of the progression of the dementia process.

It is crucial for a nurse's assistant to understand that delusions and paranoid behaviors are common symptoms in the progression of the dementia process. These are not intentional acts but rather a result of brain changes affecting perception and cognition. Recognizing this helps the CNA respond with empathy and appropriate de-escalation techniques, rather than trying to reason with the resident or dismiss their feelings.

Question 15: You learn from a 90-year-old resident that his mother will be dropping by on Sunday. What is the best course of action?

"How nice! What are you going to do when she gets here?".
"That is impossible! Your mother is dead."
"Are you wishing you could see your mother?" (Correct answer)
"Okay, let's figure out how old your mother could be."

Correct answer: "Are you wishing you could see your mother?"

When a resident with dementia expresses a belief not based in reality, such as their deceased mother visiting, the best approach is to validate their feelings rather than correct them. Asking 'Are you wishing you could see your mother?' acknowledges their emotional state and allows them to express their longing or sadness without being contradicted. This therapeutic communication technique, known as validation therapy, helps maintain trust and reduces distress.

Question 16: Which of the following statements about dementia is FALSE?

Grooming is difficult for patients with dementia.
Patients can have vivid hallucinations.
People with dementia are often frightened and anxious.
People with dementia act uncooperative in order to be spiteful. (Correct answer)

Correct answer: People with dementia act uncooperative in order to be spiteful.

The statement that people with dementia act uncooperative to be spiteful is false. Uncooperative behaviors in individuals with dementia are typically a result of their cognitive impairment, confusion, fear, or an inability to communicate their needs or understand instructions. They are not intentionally trying to be difficult, but rather are struggling with the effects of their disease.

CNA Care of Cognitively Impaired Residents 2

A good way to reduce confusion or agitation for residents with dementia is