CNA Care Of Cognitively Impaired Residents 4 2 — Questions and Answers
Question 1: A resident with Alzheimer's disease becomes agitated every afternoon around 3 PM. This phenomenon is best described as:
- Morning confusion
- Sundowning (Correct answer)
- Delirium tremens
- Nocturnal wandering
Correct answer: Sundowning
Sundowning refers to increased confusion, agitation, and behavioral changes that occur in the late afternoon or early evening in people with dementia.
Sundowning syndrome is a neurological phenomenon associated with Alzheimer's disease and other forms of dementia. It causes increased confusion, agitation, and behavioral disturbances during late afternoon and evening hours. CNAs can help manage sundowning by maintaining structured routines, ensuring adequate lighting, and minimizing stimulation during these hours.
Question 2: When using validation therapy with a cognitively impaired resident who believes she needs to pick up her children from school, the CNA should:
- Firmly correct the resident and explain her children are adults
- Acknowledge her feelings and redirect gently (Correct answer)
- Ignore the request entirely
- Tell her the children already came home
Correct answer: Acknowledge her feelings and redirect gently
Validation therapy involves acknowledging the resident's feelings and emotional reality rather than correcting factual errors, which reduces distress.
Validation therapy emphasizes empathizing with the feelings and meanings behind a cognitively impaired person's words and behaviors. When a resident expresses a belief tied to their past, the CNA should acknowledge the underlying emotion and gently redirect rather than confront or argue. This approach reduces agitation and preserves dignity.
Question 3: To create a safe environment for a resident with dementia who wanders, the CNA should:
- Lock the resident in their room
- Use physical restraints in the bed
- Ensure the unit has secured exits and visual cues (Correct answer)
- Ignore the wandering behavior
Correct answer: Ensure the unit has secured exits and visual cues
Secured exits with camouflaged doors and visual cues like stop signs or grid patterns on floors help prevent elopement while preserving the resident's freedom to move.
Safe environments for wandering residents include secured exits with coded keypads or camouflaged doors, visual barriers such as floor grids or stop sign decals at exits, enclosed outdoor walking areas, and consistent monitoring. Physical restraints are a last resort and require physician orders, while locking residents in rooms violates their rights.
Question 4: A resident with moderate dementia resists bathing every morning. The most appropriate response is to:
- Force the bath to maintain hygiene standards
- Document the refusal and skip hygiene indefinitely
- Offer choices and try at a different time if needed (Correct answer)
- Report the resident to the charge nurse as non-compliant
Correct answer: Offer choices and try at a different time if needed
Offering choices and flexibility with timing respects the resident's autonomy and often reduces resistance in cognitively impaired individuals.
Resistance to personal care is common in dementia and often stems from fear, discomfort, or loss of understanding. CNAs should approach calmly, explain each step simply, offer choices, use distraction, and try again later if resistance continues. Forcing care can cause trauma and escalate agitation.
Question 5: Reminiscence therapy is most effective for cognitively impaired residents because it:
- Teaches new skills to compensate for memory loss
- Accesses long-term memories that are often preserved (Correct answer)
- Corrects disorientation to time and place
- Prevents further cognitive decline
Correct answer: Accesses long-term memories that are often preserved
Long-term memories are often preserved in Alzheimer's and dementia even when short-term memory is severely impaired, making reminiscence therapy effective.
In Alzheimer's disease and many dementias, long-term memories from the distant past are often retained much longer than recent memories. Reminiscence therapy leverages this by encouraging residents to share memories through photos, music, or familiar objects from their past. This promotes positive engagement, self-esteem, and emotional connection without requiring intact short-term memory.
Question 6: A cognitively impaired resident becomes physically aggressive during personal care. The first action the CNA should take is to:
- Restrain the resident to complete the care task
- Stop the activity, ensure safety, and try again later (Correct answer)
- Call security immediately
- Document the incident and provide no further care that day
Correct answer: Stop the activity, ensure safety, and try again later
Stopping and withdrawing temporarily de-escalates the situation and protects both the resident and CNA from harm.
When a cognitively impaired resident becomes aggressive during care, the CNA should calmly stop the task, step back to give the resident space, speak soothingly, and ensure both parties are safe. Attempting to continue while the resident is agitated can escalate violence and cause injury. The care task should be reattempted when the resident has calmed, and the incident should be reported and documented.
CNA Care Of Cognitively Impaired Residents 4 2
A resident with Alzheimer's disease becomes agitated every afternoon around 3 PM.
This phenomenon is best described as: