CNA Care Of Cognitively Impaired Residents 3 — Questions and Answers
Question 1: What is an important way to help the resident feel comfortable in a long-term facility?
- Discourage visitors until the resident has settled in.
- Provide space for personal possessions. (Correct answer)
- Bring the resident to all activities.
- Allow the resident to establish their own schedule.
Correct answer: Provide space for personal possessions.
Providing space for personal possessions helps residents personalize their environment and maintain a sense of identity and familiarity. This contributes significantly to their comfort and emotional well-being in a long-term facility. It helps them feel more at home and eases the transition into a new living situation.
Question 2: When caring for a confused resident what should a nursing assistant do?
- Give simple directions (Correct answer)
- Allow the resident to plan daily activities
- Say nothing to avoid more confusion
- Give the resident activities
Correct answer: Give simple directions
When caring for a confused resident, giving simple, clear, and concise directions is most effective. Complex instructions can overwhelm and further confuse them, leading to frustration and non-compliance. Simple directions help the resident understand and cooperate with care tasks, promoting their safety and dignity.
Question 3: As dementia progresses, incontinence can become an issue. How can the nurse aide assist?
- Watch for signs of discomfort so you can take the resident to the bathroom. (Correct answer)
- Remind the resident to let you know when they need to use the bathroom.
- Start to use an adult diaper to keep clothing and linens clean.
- Avoid outings to minimize accidents and possible embarrassment.
Correct answer: Watch for signs of discomfort so you can take the resident to the bathroom.
For residents with dementia and incontinence, proactively watching for non-verbal signs of discomfort or the need to use the bathroom can help prevent accidents. This approach maintains the resident's dignity and comfort by addressing their needs before an accident occurs, rather than solely relying on verbal reminders or immediate use of adult diapers.
Question 4: Residents with cognitive impairments often have difficulty sleeping. What can be helpful?
- Keep residents up as late as possible, so they will fall asleep more quickly.
- Turn on the television and allow the residents to watch until they fall asleep on their own.
- Establish a bedtime schedule and make sure the residents go to bed within 15 minutes of that time. (Correct answer)
- Avoid physical activity during the day because it can overstimulate the residents.
Correct answer: Establish a bedtime schedule and make sure the residents go to bed within 15 minutes of that time.
Establishing a consistent bedtime schedule and routine is crucial for residents with cognitive impairments. Predictability helps regulate their sleep-wake cycle, reduces anxiety, and can significantly improve sleep quality. Disrupting routines or overstimulating them can worsen sleep difficulties.
Question 5: A confused resident tells you there is a monster in the closet. The nurse aide should
- pretend to kill the monster in the closet
- open the closet and show the resident nothing is there (Correct answer)
- tell the resident there are no such things as monsters
- tell the resident you will take the monster home with you
Correct answer: open the closet and show the resident nothing is there
When a confused resident expresses a delusion, it's important not to argue or dismiss their feelings, but also not to reinforce the delusion. Gently opening the closet and showing them nothing is there acknowledges their fear while providing a simple, factual reassurance. This approach validates their emotions without validating the false belief.
Question 6: While the nurse aide is giving care to Mr. T., he calls the nurse aide by the name of his son who died several years ago. The nurse aide’s BEST response is to
- pretend to be Mr. T’s son
- quickly finish the care and leave Mr. T alone
- ask Mr. T about his favorite memories of his son (Correct answer)
- ignore Mr. T. because he is confused
Correct answer: ask Mr. T about his favorite memories of his son
When a confused resident misidentifies the CNA, it's best to engage with their emotions and memories rather than correcting them harshly. Asking about their son validates their feelings and shows empathy, fostering a connection and reducing potential distress. This approach focuses on the emotional content of their communication.
Question 7: If a resident displays paranoid behavior, what is important for the nurse aide to know?
- Delusions are a normal part of the progression of the dementia process. (Correct answer)
- The family must be involved, so they can reason with the resident.
- The nurse should be immediately notified, so a medication can be ordered.
- If the behavior is ignored, it will diminish. The resident will forget about it.
Correct answer: Delusions are a normal part of the progression of the dementia process.
Paranoid behaviors and delusions are common symptoms of dementia, resulting from the progressive changes in the brain. Understanding this helps CNAs respond with empathy and appropriate strategies, recognizing that these behaviors are not intentional but rather a manifestation of the disease. While the nurse should be informed, it's important to know this is part of the disease process.
Question 8: A resident is standing in the hallway holding a bag, and asks the nurse aide when the train is due. The aide should tell her
- that it should be here any time now.
- to go back to her room.
- where she is, in a matter-of-fact tone of voice (Correct answer)
- that she is being ridiculous.
Correct answer: where she is, in a matter-of-fact tone of voice
When a resident with dementia is disoriented, the best approach is to gently reorient them to reality in a calm, matter-of-fact tone. Stating where she is provides factual information without arguing or dismissing her feelings, which can help reduce confusion and anxiety. Dismissing her or lying would be inappropriate.
Question 9: Which of the following is NOT true of dementia?
- People with dementia are often frightened and anxious.
- People with dementia act uncooperative in order to be spiteful. (Correct answer)
- Patients can have vivid hallucinations.
- Grooming is difficult for patients with dementia.
Correct answer: People with dementia act uncooperative in order to be spiteful.
People with dementia do not act uncooperative out of spite or malice. Their behaviors are a direct result of the brain changes caused by the disease, affecting their cognitive abilities, memory, and emotional regulation. Understanding this helps caregivers respond with patience and empathy, recognizing that the behavior is not intentional.
Question 10: The nurse assistant should intervene if a resident starts acting aggressively.
- Communicate calmly while stepping out of the way. (Correct answer)
- Tell him to calm down or restraints may be necessary.
- Show him that the nurse aide is in control.
- Ask a co-worker to witness the situation.
Correct answer: Communicate calmly while stepping out of the way.
When a resident becomes aggressive, the CNA's primary concern is safety for both the resident and themselves. Communicating calmly can help de-escalate the situation, while stepping out of the way creates a safe distance and reduces the risk of physical harm. Confrontation or threats can escalate aggression.
Question 11: Which of these actions DOES NOT indicate a potential for combativeness?
- Saying "I am angry." (Correct answer)
- Fists in a ball.
- Rapid eye movement.
- Clenched mouth and teeth.
Correct answer: Saying "I am angry."
Saying 'I am angry' is a verbal expression of emotion, indicating the resident is communicating their feelings. While it signals distress, it is not a non-verbal cue of *potential* physical combativeness. Non-verbal cues like clenched fists, rapid eye movement, or a clenched mouth often precede physical aggression and indicate a higher risk.
Question 12: A dementia patient has grown afraid of taking a shower. What tasks can a nurse's assistant perform?
- Offer a reward if the client takes a shower.
- Remind the client of the importance of being clean.
- Ask the client's family to convince the client.
- Give a bed bath and try a shower on another day. (Correct answer)
Correct answer: Give a bed bath and try a shower on another day.
If a dementia patient is afraid of showering, forcing the issue can increase their anxiety and resistance. A more compassionate approach is to provide an alternative form of hygiene, like a bed bath, to ensure cleanliness, and then attempt the shower again on a different day or with a modified approach to reduce fear and distress.
Question 13: The day can come to a conclusion with a typical behavior for dementia patients termed
- Depressive Disorder
- Sundown Syndrome (Correct answer)
- Evening Paranoia
- Overstimulation Fatigue
Correct answer: Sundown Syndrome
Sundown Syndrome is a common phenomenon in individuals with dementia, characterized by increased confusion, agitation, anxiety, and other behavioral changes that occur in the late afternoon or evening as daylight fades. It is a specific term for this typical pattern of behavior, often leading to increased restlessness and difficulty sleeping.
Question 14: Unreleased inhabitant insists she is leaving to go home. What ought to the nurse assistant do?
- Put her in physical restraints until she calms down.
- Tell her she cannot leave without a doctor’s order.
- Advise her that she can leave if she wants to.
- Notify the charge nurse immediately. (Correct answer)
Correct answer: Notify the charge nurse immediately.
A CNA's primary responsibility in this situation is to ensure resident safety and report significant changes or concerns to the charge nurse. An unreleased resident attempting to leave poses a safety risk and requires professional assessment and intervention from a licensed nurse. CNAs do not have the authority to make decisions regarding a resident's discharge or to physically restrain them without proper orders.
Question 15: The nursing assistant receives a report from an Alzheimer's patient that she smells smoke. The nursing assistant must
- tell her that no one is allowed to smoke in the building.
- reassure the patient that there is no fire.
- look around for a fire. (Correct answer)
- put the patient to bed because she is clearly tired.
Correct answer: look around for a fire.
While Alzheimer's patients may experience hallucinations, a report of smelling smoke must always be taken seriously as a potential fire hazard. The nursing assistant's immediate priority is to ensure the safety of all residents and staff by investigating the claim thoroughly. Dismissing the report without checking could lead to catastrophic consequences if there were an actual fire.
Question 16: When speaking with a person who has Alzheimer's or late-stage dementia,
- eliminating all conversation.
- hiring a speech therapist.
- encouraging them to be more expressive.
- speaking one- or two-word sentences. (Correct answer)
Correct answer: speaking one- or two-word sentences.
Individuals with Alzheimer's or late-stage dementia often have significant cognitive impairment, making it difficult to process complex information. Using short, simple one- or two-word sentences helps to reduce confusion and allows the resident to better understand and respond to communication. This approach minimizes frustration for both the resident and the caregiver.
CNA Care Of Cognitively Impaired Residents 3
What is an important way to help the resident feel comfortable in a long-term facility?