CNA Promoting Resident Independence and Choice 2 — Questions and Answers
Question 1: A resident with dementia who is otherwise calm insists on wearing a heavy wool sweater on a very hot summer day. Which action by the CNA BEST promotes the resident's choice while ensuring their well-being?
- Acknowledge the choice, find a much lighter sweater of a similar color, and offer it as an alternative. (Correct answer)
- Explain to the resident that it is too hot and they will be uncomfortable, then put a summer shirt on them.
- Allow the resident to wear the sweater but insist they stay indoors in the air conditioning all day.
- Remove the sweater from the resident's closet to prevent the choice from being made again.
Correct answer: Acknowledge the choice, find a much lighter sweater of a similar color, and offer it as an alternative.
This approach respects the resident's initial choice and feelings while gently redirecting them to a safer option. By offering a similar but more appropriate item, the CNA validates the resident's desire while protecting them from overheating. Forcing the resident or removing the item can cause agitation and disregards their autonomy.
Question 2: A resident has a legal guardian who has provided strict instructions for their daily care. The resident, who is alert and can express their preferences, tells you they would prefer to shower at night instead of the morning as the guardian stipulated. What is the CNA's most appropriate action?
- Follow the guardian's instructions exactly as written to avoid legal issues.
- Allow the resident to shower at night and simply don't mention it to the guardian.
- Inform the nurse of the resident's expressed wish so it can be discussed with the resident and guardian. (Correct answer)
- Tell the resident that their guardian makes the decisions and you cannot change the schedule.
Correct answer: Inform the nurse of the resident's expressed wish so it can be discussed with the resident and guardian.
Even with a legal guardian, the resident's preferences should be respected and communicated to the care team. The CNA's role is to observe, report, and advocate for the resident. Informing the nurse allows for a proper assessment and communication through the correct channels to see if the care plan can be adjusted to honor the resident's choice. Ignoring the resident's wish or the guardian's instructions is inappropriate.
Question 3: A resident who had a stroke has expressive aphasia, making it difficult to state their needs. They become visibly frustrated during morning care and begin refusing assistance. What is the CNA's BEST initial response?
- Continue with the care tasks quickly to get them done before the resident becomes more upset.
- Leave the room to give the resident space and return in an hour to try again.
- Stop the task, make eye contact, and use a communication board or simple yes/no questions to determine the cause of their frustration. (Correct answer)
- Inform the resident that the care must be completed and ask a coworker to help you finish.
Correct answer: Stop the task, make eye contact, and use a communication board or simple yes/no questions to determine the cause of their frustration.
Frustration in residents with aphasia often stems from the inability to communicate. The best approach is to pause, reduce pressure, and try alternative communication methods. Using a communication aid or simplifying questions to 'yes' or 'no' respects their struggle and empowers them to express their needs, which could be anything from pain to a desire to do the task differently. Proceeding without addressing the frustration can escalate the situation.
Question 4: Which of the following is an advanced application of promoting independence for a resident who frequently tries to stand from their wheelchair without assistance?
- Applying a lap belt to keep them securely in the chair.
- Placing the resident in a geri-chair with a locked tray table.
- Engaging the resident in a scheduled activity like folding laundry while seated to provide purposeful engagement. (Correct answer)
- Reminding the resident loudly and frequently not to stand up without help.
Correct answer: Engaging the resident in a scheduled activity like folding laundry while seated to provide purposeful engagement.
This is an example of using a restraint alternative that focuses on the root cause of the behavior. Often, residents try to stand out of boredom or a desire to be helpful. Providing a meaningful, seated activity addresses this need, promotes engagement, and reduces the unsafe behavior without using physical restraints. A lap belt or geri-chair are restraints, and simply reminding them does not address the underlying need.
Question 5: In a new 'person-centered' dining program, what is the CNA's MOST impactful role in promoting resident choice and independence?
- Ensuring all residents arrive at the dining room at the exact same time for efficiency.
- Serving pre-plated trays as quickly as possible to all residents.
- Learning and honoring individual resident preferences for seating, meal choices, and the pace of the meal. (Correct answer)
- Completing all feeding assistance before other residents begin to eat.
Correct answer: Learning and honoring individual resident preferences for seating, meal choices, and the pace of the meal.
Person-centered dining moves away from an institutional, task-based model to one that prioritizes individual preferences and a social, home-like experience. The CNA's key role is to know each resident and actively facilitate their choices regarding who they sit with, what they eat (within their dietary plan), and when they are ready for the next course, thus promoting dignity and autonomy.
Question 6: Which of the following CNA actions best demonstrates advanced respect for a resident's right to choose their social interactions?
- Insisting a quiet resident join a large, loud group activity to 'bring them out of their shell'.
- Knocking and waiting for a response before entering a resident's room, even when the door is partially open. (Correct answer)
- Deciding which residents should sit together at lunch based on their medical conditions.
- Turning on the television in the common room to a program the CNA enjoys.
Correct answer: Knocking and waiting for a response before entering a resident's room, even when the door is partially open.
A resident's room is their private space. Knocking and waiting for permission to enter is a fundamental sign of respect for their privacy, personal space, and right to control their social environment. The other options impose the CNA's or facility's choices on the resident, which undermines their independence and right to self-determination in social matters.
CNA Promoting Resident Independence and Choice 2
A resident with dementia who is otherwise calm insists on wearing a heavy wool sweater on a very hot summer day.
Which action by the CNA BEST promotes the resident's choice while ensuring their well-being?