Certified Nursing Assistant (CNA) Exam: Emotional and Mental Health Needs Concepts
Importance ★★★★☆ · 80% (estimate)
Overview
This chapter covers residents' emotional needs, dementia care, difficult behavior, and care at the end of life. Questions often ask for the most respectful and calming response.
Basic physical needs such as air, water, and food come first in Maslow's hierarchy, followed by safety, love and belonging, and self-esteem. Moving into a facility is a big loss, so help new residents with personal items, listening, and contact with others. Report signs of depression, such as withdrawal and loss of interest, and report any talk of not wanting to live right away while staying with the resident.
Alzheimer's disease is the most common cause of dementia and gets worse over time. Use short, simple sentences, one step at a time, and approach from the front. When a resident with dementia is upset, stay calm, speak softly, and redirect or try again later. Respond to the feelings behind confused statements instead of arguing about facts. Sundowning is increased confusion late in the day.
Anger often comes from fear or loss of control, so stay calm and listen. Dying residents may pass through denial, anger, bargaining, depression, and acceptance, in any order. Hearing is thought to be one of the last senses lost, so keep talking to a resident who no longer responds.
Key concepts
Maslow's hierarchy
A model of human needs: physical needs first, then safety, love and belonging, self-esteem, and self-actualization.
Memory tipBody needs before feelings needs.
Dementia
A loss of memory, thinking, and daily skills that is more than normal aging; Alzheimer's disease is the most common cause.
Memory tipShort sentences, one step at a time.
Redirection
Gently moving a confused or upset resident's attention to another topic or activity instead of arguing.
Memory tipDon't argue, redirect.
Sundowning
Increased confusion, restlessness, or agitation in the late afternoon or evening in people with dementia.
Memory tipSun goes down, confusion goes up.
Stages of grief
Five stages described by Kübler-Ross: denial, anger, bargaining, depression, and acceptance; people may move between them in any order.
Memory tipBargaining = making a deal for time.
Signs of depression
Withdrawal, loss of interest in activities, sadness, and changes in appetite or sleep, which should be reported.
Memory tipStopped joining in? Report it.
Often tested
- Talk of self-harm: stay with the resident and report immediately.
- Never lock a resident in a room; that is involuntary seclusion.
- Respond to the feeling behind a confused statement.
- Keep talking to a dying resident, because hearing may remain.
3 sample questions
Verified practice questions from this unit.
Question 1. Which is the best way to talk with a resident who has dementia?
- ① Give several instructions at once to save time
- ② Speak quickly so the resident keeps up
- ③ Use long explanations so nothing is missed
- ④ Use short, simple sentences and give one step at a time
▼ Show answer and explanation▲ Hide answer and explanation
Answer: ④ Use short, simple sentences and give one step at a time
Key point: Dementia: short sentences, one step at a time
Dementia makes it hard to follow and remember information. Approach from the front, use the resident's name, speak calmly, and use short, simple sentences with one step at a time. Give the resident time to respond.
Wrong choices
- Give several instructions at once to save time: Several steps at once are confusing for a person with dementia.
- Speak quickly so the resident keeps up: Fast speech is harder to follow.
- Use long explanations so nothing is missed: Long explanations are hard to follow and remember.
Question 2. A resident with dementia becomes upset and starts shouting during bath time. What should the aide do?
- ① Argue with the resident until she agrees to the bath
- ② Stay calm, speak softly, and try again later or redirect to something else
- ③ Finish the bath quickly while holding her arms
- ④ Leave her alone in a locked room to calm down
▼ Show answer and explanation▲ Hide answer and explanation
Answer: ② Stay calm, speak softly, and try again later or redirect to something else
Key point: Dementia agitation: stay calm, redirect, report
Upset behavior in dementia often comes from fear, pain, or confusion. Stay calm, speak softly, make sure she is safe, and redirect her or try again later. Report the behavior to the nurse. Never argue, force care, or isolate her.
Wrong choices
- Argue with the resident until she agrees to the bath: Arguing makes the resident more upset.
- Finish the bath quickly while holding her arms: Holding a resident down for care can be abuse.
- Leave her alone in a locked room to calm down: Locking a resident in a room is involuntary seclusion.
Question 3. A resident tells the aide, "I don't want to live anymore." What should the aide do?
- ① Change the subject to something cheerful
- ② Tell the resident he does not really mean it
- ③ Stay with the resident and report the statement to the nurse right away
- ④ Promise to keep it a secret
▼ Show answer and explanation▲ Hide answer and explanation
Answer: ③ Stay with the resident and report the statement to the nurse right away
Key point: Talk of self-harm: stay and report immediately
Any talk about not wanting to live or harming oneself must be taken seriously. Do not leave the resident alone, listen calmly, and report to the nurse immediately.
Wrong choices
- Change the subject to something cheerful: Changing the subject ignores a serious warning sign.
- Tell the resident he does not really mean it: This dismisses his feelings and may stop him from talking.
- Promise to keep it a secret: A statement about not wanting to live must be reported; it cannot be kept secret.
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