CNA Care of Cognitively Impaired Residents 1 — Questions and Answers

Question 1: A resident with Alzheimer’s disease tells the nurse aide that she smells smoke. The nurse aide should

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.
tell her that no one is allowed to smoke in the building.

Correct answer: look around for a fire.

Even if a resident with Alzheimer's disease is confused, their perception of smelling smoke should always be taken seriously as a potential safety concern. The nurse aide must prioritize safety by investigating the environment for any actual signs of fire or smoke, as ignoring such a complaint could have serious consequences.

Question 2: The primary reason for combative behavior in a resident is

hunger
stubbornness
resentment
confusion (Correct answer)

Correct answer: confusion

Confusion is the primary reason for combative behavior in residents, especially those with dementia or cognitive impairments. When residents are confused, they may misinterpret their environment, feel threatened, or be unable to communicate their needs effectively, leading to frustration and aggressive outbursts.

Question 3: When getting dressed, a client always wants to wear her favorite outfit. What is a good solution?

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

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

For a client who always wants to wear their favorite outfit, providing several identical outfits respects their preference and promotes their comfort and sense of control. This solution avoids conflict, maintains their routine, and ensures they always have a clean version of their preferred clothing available.

Question 4: All of the following are clues to aggressive behavior EXCEPT

depressed mood (Correct answer)
clenched jaw
rocking
pacing

Correct answer: depressed mood

Depressed mood is typically associated with sadness, withdrawal, and lack of energy, not with aggressive behavior. Clenched jaw, rocking, and pacing are all physical indicators that can signal increasing anxiety, agitation, or frustration, which often precede or accompany aggressive outbursts.

Question 5: Reality orientation should include

Calling the resident by his name (Correct answer)
Telling imaginative stories to the resident
Using nicknames like "Granny"
Talking about your interests

Correct answer: Calling the resident by his name

Reality orientation aims to help residents stay connected to their current environment and identity. Calling a resident by their name is a fundamental aspect of person-centered care that reinforces their identity and shows respect, helping to ground them in reality.

Question 6: A way to make sure a resident with dementia gets adequate nutrition is to

turn on the television so they will be distracted and eat more.
give the resident 10 minutes to eat, then feed them the rest of the meal.
offer small meals and snacks that match their limited attention span. (Correct answer)
only provide their favorite foods to ensure the resident will eat.

Correct answer: offer small meals and snacks that match their limited attention span.

Residents with dementia often have a limited attention span and may become easily distracted or overwhelmed by large meals. Offering small, frequent meals and snacks caters to their cognitive abilities, making it easier for them to consume adequate nutrition without becoming fatigued or agitated.

Question 7: Communication with a resident who has late-stage dementia or Alzheimer's includes

encouraging them to be more expressive.
speaking one- or two-word sentences. (Correct answer)
hiring a speech therapist.
eliminating all conversation.

Correct answer: speaking one- or two-word sentences.

In late-stage dementia or Alzheimer's, residents have significantly impaired communication abilities. Using short, simple one- or two-word sentences makes it easier for them to process and understand information, reducing confusion and facilitating more effective interaction.

Question 8: A resident who has not been discharged insists she is going home. What should the nurse aide do?

Tell her she cannot leave without a doctor’s order.
Notify the charge nurse immediately. (Correct answer)
Put her in physical restraints until she calms down.
Advice her that she can leave if she wants to.

Correct answer: Notify the charge nurse immediately.

If a resident who has not been discharged insists on leaving, it is considered an elopement risk or an 'Against Medical Advice' (AMA) situation. The nurse aide's responsibility is to ensure the resident's safety and notify the charge nurse immediately, as this requires professional assessment and intervention from licensed personnel.

Question 9: A resident has difficulty remembering what day it is and where they are. How can you best help the resident?

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

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

For a resident experiencing confusion about time and place, consistent and gentle reorientation is crucial. Regularly reminding them of the day and their location helps to ground them in reality and can reduce anxiety and disorientation, promoting a sense of security.

Question 10: The following are all indicators of aggressive behavior. EXCEPT

depressed mood (Correct answer)
pacing
clenched jaw
rocking

Correct answer: depressed mood

Depressed mood is characterized by feelings of sadness, hopelessness, and lack of interest, which are generally not indicators of aggressive behavior. Pacing, clenched jaw, and rocking are physical signs of agitation, anxiety, or frustration that can often precede or accompany aggressive outbursts.

Question 11: You are told there is a monster in the closet by a perplexed resident. The nursing assistant must

tell the resident you will take the monster home with you
tell the resident there are no such things as monsters
open the closet and show the resident nothing is there (Correct answer)
pretend to kill the monster in the closet

Correct answer: open the closet and show the resident nothing is there

When a perplexed resident expresses a fear, such as a monster in the closet, validating their feelings while gently reorienting them to reality is best. Opening the closet and showing them it's empty addresses their fear directly and provides concrete evidence that there is no threat, without dismissing their feelings.

Question 12: Making sure a dementia patient receives enough nutrition is one way to

turn on the television so they will be distracted and eat more.
offer small meals and snacks that match their limited attention span. (Correct answer)
only provide their favorite foods to ensure the resident will eat.
give the resident 10 minutes to eat, then feed them the rest of the meal.

Correct answer: offer small meals and snacks that match their limited attention span.

Residents with dementia often have a reduced attention span and can be easily distracted or overwhelmed by large meals. Providing small, frequent meals and snacks is an effective strategy to ensure they consume adequate nutrition, as it accommodates their cognitive limitations and prevents mealtime fatigue.

Question 13: Continually rising from his wheelchair, Mr. Gordon. If you want to avoid using restraints, you should .

he wants to sit alone in his room.
he needs to go to the toilet. (Correct answer)
he is just being difficult.
he would rather go home.

Correct answer: he needs to go to the toilet.

When a resident continually tries to rise from their wheelchair, especially if they are confused or have communication difficulties, it often indicates an unmet need. The most common and urgent unmet need in this scenario is the need to use the toilet, and addressing this can prevent falls and the need for restraints.

Question 14: What should a nursing assistant do when looking after a person who is confused?

Give simple directions. (Correct answer)
Give the resident activities.
Say nothing to avoid more confusion.
Allow the resident to plan daily activities.

Correct answer: Give simple directions.

For a confused person, complex instructions can be overwhelming and increase agitation. Giving simple, clear, and concise directions helps them understand and follow requests more easily, promoting cooperation and reducing confusion.

Question 15: The Global Deterioration Scale (GDS) aids caregivers in comprehending how dementia patients deteriorate over time. Which of the seven stages is devoid of dementia symptoms?

Stage 6
Stage 4
Stage 2 (Correct answer)
Stage 7

Correct answer: Stage 2

The Global Deterioration Scale (GDS) outlines seven stages of dementia progression. Stage 2 is characterized by very mild cognitive decline, where individuals may notice some memory lapses, but these are typically not detectable by others or during a medical examination, meaning they are essentially devoid of clear dementia symptoms.

Question 16: A person with Alzheimer's illness cares for and carries about a baby doll. She tears up when she can't find the doll. What ought to the nurse assistant do?

Allow the resident to cry until she stops.
Comfort the resident as if the doll were real. (Correct answer)
Quickly find a new doll to replace the lost one.
Tell the resident that it was only a doll.

Correct answer: Comfort the resident as if the doll were real.

For a resident with Alzheimer's, their reality may involve a baby doll being a real child. It is crucial to enter their reality and provide comfort and reassurance as if the doll were real, rather than correcting them, which can cause distress and agitation. This approach validates their feelings and maintains their dignity.

CNA Care of Cognitively Impaired Residents 1

A resident with Alzheimer’s disease tells the nurse aide that she smells smoke.
The nurse aide should