Certified Nursing Assistant Examination (CNA) Restorative Care, Rehabilitation, and End-of-Life Care Syllabus

What are common normal age-related sensory changes?

Decreased vision (including presbyopia and reduced night vision), hearing loss (especially high pitches), and reduced senses of taste, smell, and touch.

Is confusion or dementia a normal part of aging?

No. Some mild slowing of memory/recall can occur, but confusion and dementia are NOT normal aging and should be reported.

What is the difference between a normal age change and a disease/disability?

Normal age changes happen gradually to everyone and don't necessarily impair function; diseases/disabilities are abnormal, cause illness or loss of function, and require treatment.

List three ways to promote safety for an elderly resident at risk of falls.

Keep the call light and personal items within reach, ensure non-skid footwear and clear walkways, and keep the bed in the lowest locked position.

Why are older adults more prone to dehydration, and how can it be prevented?

Their sense of thirst decreases with age; prevent it by offering fluids frequently throughout the day and keeping water within reach.

How does promoting independence relate to resident safety?

Encourage residents to do what they safely can, while supervising and assisting as needed so independence does not come at the cost of injury.

List four common complications of immobility.

Pressure injuries (bedsores), blood clots (DVT), pneumonia, muscle atrophy/contractures, constipation, and urinary tract infections.

What is a contracture and how is it prevented?

A permanent shortening/tightening of a muscle or joint causing deformity; prevented with regular range-of-motion exercises and proper positioning.

How often should an immobile/bedbound resident be repositioned, and why?

At least every 2 hours, to relieve pressure and prevent pressure injuries (bedsores).

What is a pressure injury (decubitus ulcer) and where do they commonly form?

Skin/tissue breakdown caused by unrelieved pressure over a bony area; common sites include the sacrum/tailbone, hips, heels, elbows, and back of the head.

How can the complication of pneumonia from immobility be reduced?

Encourage deep breathing and coughing, reposition frequently, and keep the resident upright when possible to keep lungs clear.

How is DVT (deep vein thrombosis) prevented in immobile residents?

Promote movement and ROM, use prescribed anti-embolism stockings, encourage leg exercises, and avoid pressure behind the knees.

What is hospice care and who is it for?

Comfort-focused (palliative) care for people who are terminally ill, typically with a prognosis of 6 months or less, when curative treatment has stopped.

What is the core philosophy of hospice?

To provide comfort, dignity, and quality of life—not to cure—by managing pain and symptoms and supporting the patient and family physically, emotionally, and spiritually.

What is palliative care?

Care focused on relieving symptoms, pain, and stress of a serious illness to improve quality of life; it can be given at any stage, with or without curative treatment.

What are the five stages of grief described by Kubler-Ross?

Denial, Anger, Bargaining, Depression, and Acceptance.

Do dying people always go through the grief stages in order?

No; people may experience the stages in any order, skip stages, or revisit them—everyone grieves differently.

List common physical signs that death is approaching.

Decreased blood pressure, slow/weak/irregular pulse, changed (often rapid or irregular) breathing, cold/mottled extremities, decreased consciousness, and loss of bladder/bowel control.

What is usually the last sense to be lost in a dying person, and why does it matter?

Hearing is believed to be the last sense lost; always speak normally and reassuringly, assuming the resident can hear you.

How should a nursing assistant provide emotional support to a dying resident?

Use active listening, offer presence and touch, allow expression of feelings without judgment, and avoid clichés or false reassurance.

How does a nursing assistant support a resident's spiritual needs?

Respect their religious/cultural beliefs and practices, provide privacy for prayer or clergy visits, and never impose your own beliefs.

What are advance directives?

Legal documents stating a person's wishes for medical care if they become unable to communicate or make decisions themselves.

What is a living will?

An advance directive that states which life-sustaining treatments a person does or does not want at the end of life.

What is a durable power of attorney for health care?

A document naming a person (health care proxy) to make medical decisions on the resident's behalf if they become unable to do so.

What does a DNR (Do Not Resuscitate) order mean?

A medical order directing staff NOT to perform CPR if the resident's heart or breathing stops; basic comfort and care still continue.

What should a nursing assistant do regarding a resident's advance directives and wishes?

Know and follow the care plan, respect the resident's documented wishes, and report any change in the resident's expressed wishes to the nurse.

What is postmortem care?

The respectful physical care of the body after death, preparing it for viewing by family and transfer, while maintaining dignity and privacy.

When is postmortem care begun, and why is it done promptly?

After death is pronounced; it is done promptly before rigor mortis (stiffening of the body) sets in so the body can be positioned naturally.

What is rigor mortis?

The temporary stiffening of muscles and joints of the body that occurs after death.

List key steps a nursing assistant performs in postmortem care.

Provide privacy and respect, position the body in good alignment with eyes/mouth closed, bathe and remove soiled items, place dentures, follow facility policy on tubes/IDs, and handle the body gently.

How should the body be positioned during postmortem care before rigor mortis?

Lying supine in normal alignment with the head slightly elevated on a pillow, arms at the sides, and eyes and mouth gently closed.