Certified Nursing Assistant Examination (CNA) Psychosocial, Cognitive, and Mental Health Care Syllabus

Is dementia a normal part of aging?

No. While mild forgetfulness can occur with age, dementia is caused by disease or brain damage and is NOT a normal part of the aging process.

Name common reversible causes of sudden confusion (delirium) a CNA should report.

Infections (especially urinary tract infections), dehydration, medication side effects, low blood sugar, fever, pain, low oxygen, and electrolyte imbalances.

What are the general stages of Alzheimer's disease progression?

Early/mild stage (memory lapses, mild confusion), middle/moderate stage (increasing memory loss, behavior changes, needs more help), and late/severe stage (loss of ability to communicate, total dependence on care).

What is 'sundowning' in residents with dementia?

Sundowning is increased confusion, restlessness, agitation, or anxiety that occurs in the late afternoon and evening. Reducing noise, providing light, and maintaining routine can help.

List effective communication strategies when caring for a resident with dementia.

Approach calmly from the front, make eye contact, use the resident's name, speak slowly in short simple sentences, ask one yes/no question at a time, use gestures, limit distractions, and allow time to respond.

Why should a CNA avoid asking 'why' questions or offering many choices to a dementia resident?

'Why' questions and multiple choices require reasoning and memory that are impaired in dementia, causing frustration. Use simple yes/no questions and limit options to one or two.

What is 'validation therapy' in dementia care?

Validation therapy means acknowledging and accepting the resident's feelings and reality rather than correcting or arguing with them. It reduces distress by respecting their emotional experience.

What is reality orientation, and when is it appropriate vs. not appropriate?

Reality orientation reminds residents of person, place, and time (clocks, calendars, cues). It helps in early confusion/delirium but can increase agitation in advanced dementia, where validation is preferred.

How should a CNA communicate with a dementia resident who is repeating the same question?

Respond calmly and patiently each time, use a gentle tone, avoid saying 'I already told you,' and try redirecting or distracting the resident to another activity.

What is the recommended approach when a resident with dementia becomes agitated or combative?

Stay calm, do not argue or restrain, ensure safety, remove triggers, speak softly and reassuringly, give the resident space, and try redirection or distraction. Report the behavior.

What does 'redirection' mean as a technique for managing difficult behaviors?

Redirection means gently shifting the resident's attention away from a distressing or problematic situation toward a different, calming activity or topic.

What is catastrophic reaction in a resident with dementia?

A catastrophic reaction is an extreme, sudden overreaction (screaming, crying, agitation, aggression) to a minor event or overstimulation. Reduce stimulation and respond calmly to de-escalate.

How should a CNA handle a resident who wanders?

Ensure a safe environment, use alarms/monitoring per facility policy, provide supervised activity and exercise, address unmet needs (toileting, hunger, boredom), and never restrain without an order. Report wandering.

Why are structured routines important for residents with dementia?

Consistent daily routines reduce anxiety, confusion, and agitation by providing predictability and a sense of security, since the resident cannot rely on memory to know what comes next.

What are key features of a safe environment for a confused or dementia resident?

Remove clutter and hazards, ensure good lighting, lock away dangerous items/chemicals, keep call light in reach, use bed/chair alarms as ordered, label rooms, and reduce excess noise and stimulation.

Define stress and distinguish it from a stressor.

A stressor is any event or condition that causes stress. Stress is the body's physical and emotional response to that stressor (the demand or change placed on the person).

What is anxiety?

Anxiety is a feeling of uneasiness, worry, dread, or fear, often about something with an unknown or uncertain outcome. Physical signs can include rapid pulse, sweating, restlessness, and rapid breathing.

What are healthy coping mechanisms a CNA can encourage for stress?

Deep breathing/relaxation, exercise and activity, talking about feelings, adequate rest, hobbies, spiritual support, and a calm environment. Unhealthy coping includes withdrawal, substance use, and aggression.

How can a CNA help reduce a resident's stress and anxiety?

Listen actively, remain calm, explain procedures before doing them, maintain routines, allow choices and control, provide a quiet comfortable environment, and report ongoing anxiety to the nurse.

What are common signs of depression in older adults?

Sadness, withdrawal, loss of interest in activities, fatigue, changes in appetite or sleep, slowed movement, irritability, feelings of worthlessness or hopelessness, poor concentration, and unexplained physical complaints.

Is depression a normal part of aging, and why does this matter for CNAs?

No — depression is NOT a normal part of aging. It is a treatable illness. CNAs must report signs rather than dismiss them, because untreated depression seriously harms health and quality of life.

What warning signs of suicide should a CNA report immediately?

Statements about wanting to die or being a burden, giving away belongings, sudden calmness after depression, withdrawal, hoarding medications, or saying goodbye. Report ANY suicidal statement to the nurse at once.

How can a CNA support a resident showing signs of depression?

Spend time with them, listen without judgment, encourage activity and socialization, ensure they eat and rest, observe and report changes, and never tell them to 'just cheer up.'

Define defense mechanisms.

Defense mechanisms are unconscious behaviors or mental strategies people use to protect themselves from anxiety, stress, guilt, or unacceptable feelings.

What is the defense mechanism of denial?

Denial is refusing to accept or acknowledge a painful or threatening reality, acting as though it does not exist (e.g., a resident insisting they are not ill despite a diagnosis).

What is displacement as a defense mechanism?

Displacement is transferring (redirecting) feelings about one person or situation onto a safer, less threatening target — e.g., a resident angry at illness yells at the CNA instead.

What is projection as a defense mechanism?

Projection is attributing one's own unacceptable feelings, thoughts, or motives to someone else — e.g., an angry resident accusing the CNA of being angry at them.

What is regression as a defense mechanism?

Regression is returning to an earlier, more childlike pattern of behavior to cope with stress — e.g., an adult resident becoming dependent, whining, or having tantrums.

What is rationalization as a defense mechanism?

Rationalization is making excuses or giving logical-sounding but untrue reasons to justify behavior or avoid the real cause — e.g., 'I didn't do my exercises because they were pointless anyway.'

How can a CNA support a resident's overall mental and emotional well-being?

Build trust, treat them with respect and dignity, encourage social interaction and meaningful activity, listen actively, support independence and choices, maintain routine, and promptly report emotional or behavioral changes to the nurse.