CNA Care of Cognitively Impaired Residents 1 2 — Questions and Answers

Question 1: When communicating with a resident who has moderate Alzheimer's disease, the CNA should:

Speak quickly using complex sentences to keep their attention
Use short, simple sentences, maintain eye contact, and speak in a calm tone (Correct answer)
Raise the voice to ensure the resident hears and understands
Avoid talking to the resident since communication is impossible

Correct answer: Use short, simple sentences, maintain eye contact, and speak in a calm tone

Short, simple sentences spoken calmly and with eye contact are most effective for residents with dementia who have difficulty processing complex language.

Residents with Alzheimer's disease or other dementias have progressive difficulty understanding and processing language. Effective communication strategies include: using the resident's name, maintaining eye contact at eye level, speaking slowly and clearly in short sentences, using simple yes/no questions rather than open-ended questions, allowing extra time for response, using gestures and touch when appropriate, and avoiding arguing or correcting the resident. Raising the voice or speaking too quickly increases confusion and agitation. A calm, reassuring tone helps the resident feel safe and understood.

Question 2: A resident with dementia is experiencing 'sundowning.' What does this term describe?

Increased confusion, agitation, and behavioral changes that worsen in the late afternoon and evening (Correct answer)
A resident falling asleep during meals
Improved memory function after exposure to sunlight
A medication side effect causing sleepiness

Correct answer: Increased confusion, agitation, and behavioral changes that worsen in the late afternoon and evening

Sundowning refers to increased confusion, restlessness, agitation, and disorientation that occurs in people with dementia as daylight decreases in the late afternoon and evening.

Sundowning (or sundown syndrome) is a pattern of increased behavioral and psychological symptoms of dementia that appear or worsen in the late afternoon and early evening hours. Symptoms include increased confusion, agitation, wandering, anxiety, pacing, and combativeness. The exact cause is not fully understood but may relate to disruption of the internal body clock, fatigue from the day's activities, or changes in light levels. CNA strategies to manage sundowning include maintaining a consistent daily routine, providing a calm environment with adequate lighting, redirecting the resident, and reporting the behavior to the nurse.

Question 3: What is 'validation therapy' in the context of dementia care?

Correcting the resident's false beliefs with factual information
Acknowledging and respecting the resident's feelings and reality, even if it differs from actual facts (Correct answer)
Administering medications to validate the diagnosis
Isolating the resident to prevent harm to others

Correct answer: Acknowledging and respecting the resident's feelings and reality, even if it differs from actual facts

Validation therapy involves acknowledging and empathizing with the feelings and subjective reality of a person with dementia, rather than correcting them.

Validation therapy, developed by Naomi Feil, is a communication approach based on empathy and respect. Rather than correcting or arguing with a confused resident — for example, one who believes a deceased spouse is still alive — the caregiver acknowledges the emotional content of what the resident is expressing. If a resident says, 'I need to go pick up my children from school,' a validating response might be, 'You sound worried about your children. Tell me about them.' This approach reduces agitation, preserves dignity, and builds trust. Reality orientation (correcting the resident) can cause distress and is generally not recommended for advanced dementia.

Question 4: A resident with dementia attempts to leave the facility through an exit door. This behavior is called:

Sundowing
Elopement (Correct answer)
Perseveration
Confabulation

Correct answer: Elopement

Elopement refers to a cognitively impaired resident attempting to leave a secured area unsupervised, which poses a significant safety risk.

Elopement is when a cognitively impaired resident attempts to leave the facility or a secured unit without authorization, putting themselves at serious risk of injury, exposure to weather, getting lost, or death. Facilities are required to have elopement prevention programs that include door alarms, secured unit locks, monitoring, and staff training. If a CNA witnesses an elopement attempt, they must immediately alert staff, activate any alarm systems, and attempt to safely redirect the resident. After any elopement incident or near-miss, it must be documented and reported per facility policy. Residents at risk for elopement are identified in their care plan.

Question 5: Which of the following best describes 'person-centered care' for residents with cognitive impairment?

Providing the same routine for all dementia residents regardless of their history
Tailoring care based on the resident's life history, preferences, and remaining abilities (Correct answer)
Focusing solely on physical safety and ignoring emotional needs
Having family members make all decisions without consulting the resident

Correct answer: Tailoring care based on the resident's life history, preferences, and remaining abilities

Person-centered care individualizes care based on who the resident is — their life story, values, preferences, and capabilities — not just their diagnosis.

Person-centered care for residents with cognitive impairment means seeing and responding to the resident as a whole person with a unique history, preferences, relationships, and remaining abilities rather than focusing primarily on symptoms and deficits. CNAs gather and use information from the resident's life story — favorite foods, hobbies, career, family — to personalize interactions. For example, playing music a resident loved in their youth can reduce agitation, and involving a former teacher in simple educational activities can provide purpose. This approach maintains dignity, reduces behavioral symptoms, and improves quality of life.

Question 6: When providing personal care to a resident with dementia who becomes agitated, the CNA's first action should be to:

Continue the care task quickly to get it done before the agitation escalates
Stop the care, calmly reassure the resident, and allow time to calm down before continuing (Correct answer)
Physically restrain the resident to prevent injury
Leave the resident alone without completing the care

Correct answer: Stop the care, calmly reassure the resident, and allow time to calm down before continuing

Stopping the activity and providing calm reassurance gives the resident time to de-escalate before care is resumed, which is safer and more effective than forcing continuation.

When a resident with dementia becomes agitated during personal care, the most therapeutic and safe response is to stop the activity, remain calm, speak soothingly, and give the resident time to settle. The CNA should not physically restrain the resident (which escalates fear and agitation), nor rush through the care (which can cause injury or trauma). After the resident calms, the CNA can try again using a different approach — perhaps breaking the task into smaller steps, offering a distraction, or trying again later. The agitation episode should be documented and reported to the nurse to identify triggers and update the care plan.

CNA Care of Cognitively Impaired Residents 1 2

When communicating with a resident who has moderate Alzheimer's disease, the CNA should: