Mental Health and Social Services Needs

Mrs. Lee is showing signs of anxiety by repeatedly using the call signal and is sharp with you when you respond. What is your best course of action? A. Give Mrs. Lee some choices and control over her care. B. Tell Mrs. Lee that you have sick people to take care of. C. Take Mrs. Lee's call signal away or unplug it. D. Tell the nurse that Mrs. Lee doesn't like you and request to be reassigned.

A: Anxiety can cause a client to seem demanding and rude. Don't get angry or impatient, and pay attention to your body language. Don't ignore an anxious client; work directly with the person. In this case, offering choices can help Mrs. Lee feel less dependent. Ask her opinion of her schedule. You can even address her behavior: "Mrs. Lee, you seem anxious. What can we do to make you feel better?"

A resident with dementia needs A. a structured environment. B. increased activity to stay alert. C. to be isolated from others. D. freedom from rules and regulations.

A: Daily routines can keep clients with dementia calm and focused. These clients require as much familiarity as possible in their environment. Try to include their favorite activities: Did they like to wake up early? Did they watch the evening news? Did they enjoy playing cards? Keep the daily schedule consistent: mealtimes, grooming, naps, toileting, and medications are small ways to help the clients stay anchored.

Mrs. Branden is a resident at your long-term care (LTC) facility. She has been diagnosed with depression. The best way for you to help Mrs. Branden is to A. spend time with her, listening or sitting quietly. B. listen to her troubles and concerns, being very sympathetic and agreeable with her perceptions. C. remind her of all the things she should be thankful for. D. avoid spending much time with her because it doesn't seem to help her.

A: Depression is not a normal part of aging. It occurs more in females and in people who are single or lack a social network. Elderly people can struggle with loss, because they don't feel hopeful about the future. Medications can be useful, but support by the staff can help Mrs. Branden feel less isolated.

A client looks forward to playing Bingo each morning. The best action for the nurse aide is to A. plan the client's schedule so the client will be bathed and dressed in time for Bingo. B. tell the client that the nurse aide forgot about Bingo, but they will go the next day. C. encourage the client to bathe and dress himself or herself to be ready for Bingo. D. tell the client that the nurse aide may not have time to get the client ready for Bingo.

A: Helping clients maintain their interests is important to their self-esteem. Clients who can make decisions about their activities have a greater sense of independence and social connection. This can help prevent depression and withdrawal. Arrange the client's schedule to accommodate the person's interests.

If an alert and oriented client touches a nurse aide inappropriately, the nurse aide's BEST response is to A. step back and ask the client not to do it again. B. warn the client that the behavior may be punished. C. refuse to care for the client. D. slap the client's hand.

A: Intimacy is a lifelong need for humans, and clients can be sexually active into their 80s and 90s. However, inappropriate sexual behavior is never acceptable. It can include suggestive comments, deliberate touching, or exposure of the genitals. Do not ignore the behavior. The nurse aide should immediately step back and give the patient immediate and firm feedback about the inappropriate behavior. Say to the patient, "If you do that again, I will not be able to continue to care for you."

Nurse aides can provide a client with a sense of security by A. turning on the television when giving care. B. explaining all routines and procedures. C. talking to another nurse aide while providing care. D. leaving the room without speaking.

B: An important standard of client care is to always explain what you are going to do before proceeding. Ask the client if he or she has any questions. Rushing a client or doing something without warning creates anxiety. If the client refuses, he or she may be fearful. Don't argue or use force. Tell the person that you will return again in a few minutes.

A confused and disoriented client is begging to go home. The nurse aide's BEST response is to A. tell the client, " We will take you home later." B. ask the client to talk about his or her home. C. tell the client, "This is your home." D. take the client to the activity room.

B: Clients with dementia may have times when they remember places or events. Rather than discourage or destroy their memories, validate them by asking the clients to tell you what they recall. Don't worry if it doesn't make sense to you. Support them with comments like, "That sounds lovely," or "I can understand why you miss your home." Often the client is not really asking to go home but to have his or her memories and life recognized.

When you empathize with residents, you are A. feeling pity for them. B. putting yourself in their place. C. helping them cheer up. D. letting them stay in bed.

B: Empathy is the ability to understand what another person is feeling or experiencing. Once you can imagine the person's situation, you'll know how to help the person. Empathy also requires that we look at others without labels or biases. Active listening is an important skill for being empathetic. It helps us "hear" the emotions behind the words.

A good listening approach to use when communicating with residents is to A. stand about 6 feet away from the resident. B. sit beside the resident. C. always offer some advice. D. avoid direct eye contact.

B: For the best communication, place yourself at the resident's eye level. This helps the resident feel reassured and engaged in the interaction. Studies show that when staff members sit next to clients, the clients perceive a higher quality of care. They also feel more connected to the staff.

When caring for a client from another country, the nurse aide SHOULD A. promote group activity participation. B. be sensitive to the client's cultural needs. C. decline to care for the client. D. orient the client to the cultural practices of the facility.

B: Providing excellent care means treating each person as a unique individual. This includes respecting the client's beliefs, values, and religious practices. All health care professionals should learn about the ethnic groups in their service area. As a direct care provider, the CNA may be the first person that a client meets. Understanding how to communicate will increase the likelihood of successful treatment and successful outcomes.

If a nurse aide finds a client who is sad and crying, the nurse aide should A. tell the client to cheer up. B. ask the client if something is wrong. C. tell the client to stop crying. D. call the client's family to come

B: Regardless of a client's age or mental status, sadness can occur. While crying can make some people uncomfortable, the nurse aide is in the best position to ask the client about his or her feelings and offer comfort. Do not leave the client alone or try to distract the client. Instead, sit with the client and ask gentle questions. Listen and do not offer solutions. During sadness, people seek comfort and a kind presence. They may not be asking for a solution but just someone to listen. If you can help, do so.

Mrs. Melvin is a demanding patient who is difficult to please. Which of the following would be appropriate for you to do when caring for Mrs. Melvin? A. Tell Mrs. Melvin you have other residents who need your help more than she does. B. Before leaving the room, ask Mrs. Melvin if you have done everything she needs. C. Avoid Mrs. Melvin's room once you have finished her care, so she won't keep asking for things. D. Require Mrs. Melvin to bathe and dress when you are available, not when she wishes to

B: Show a demanding client that you care by asking the client what the person needs or what will make the person feel better. The client's behavior is not directed at you but can be a sign of anxiety, loneliness, or fear. Take the time to learn more about the client; this may help you understand what is behind the behavior. Stay positive and focus on giving excellent care.

If a client is confused, the nurse aide should A. ignore the client until he or she starts to make sense. B. help the client recognize familiar things and people. C. keep the client away from other clients. D. restrain the client to prevent self-harm.

B: When a client becomes confused, try to figure out the cause. It can often be a change of routine, a change of caregiver, or a sudden memory. Start with basic reasons for the confusion. Has the client's schedule been changed? Has there been a change in staff? Is the client wearing his or her glasses or hearing aids? Perhaps the client saw an object or someone that reminded the client of the past. A good technique is to spend time with the client, reviewing familiar things and people. Look at objects and photos to reassure the client and help the person calm down.

Mrs. Lee is an alert, demanding resident who uses the call signal often. If you don't answer it immediately, she yells, "Help! Help!" When you answer the call signal, her requests are never urgent. She also speaks sharply to you when you are in the room. Mrs. Lee is demonstrating A. that she doesn't like you. B. anxiety or fear. C. being spoiled and pampered. D. psychotic behavior.

B: When a client is overusing the call light and making frequent demands, try to understand the reasons behind the behavior. Anxiety is a common cause. Make frequent rounds so the client will feel reassured and not have to rely on the call light. It is important to note that abuse and neglect charges can be filed if a client does not receive necessary physical or mental care. This includes failure to respond to a call light.

The normal aging process is BEST defined as the time when A. Alzheimer's disease begins. B. people are over 65 years of age. C. normal body functions and senses decline. D. people become dependent and childlike.

C: After about 30 years, the adult human body begins to change gradually. Each person ages at a different rate, depending on his or her medical history, lifestyle, and genetics. Over time, vision and hearing decline, and organ systems become less efficient. Muscle tissue is lost, resulting in less strength and flexibility. Remaining active, eating well, and keeping social ties can help slow the aging process.

If a resident refuses to eat a certain food because of a religious preference, the CNA should A. tell the resident that all meals are the same. B. make a meal from other clients' food trays. C. notify the dietitian of the dietary restriction. D. ask the family to bring in special foods.

C: Cultural diversity includes diets for religious reasons. There may be foods that are not allowed, strict rules for preparation, or fasting on certain days. For these clients, appropriate diets may be important in the healing process. Not getting what they need can feel like a sin or a violation of their faith. Health care professionals must make sure their client's dietary needs are met and their religious beliefs are supported.

Which of the following statements might strongly indicate that a client is considering suicide? A. "I think I need to see a psychiatrist." B. "We all have to go sometime." C. "It would be better if I were dead." D. "I don't really care what you think."

C: If someone is thinking about suicide, warning signs include the following: talking about death, losing interest in favorite things, expressing a sense of hopelessness or worthlessness, putting one's affairs in order, or calling others to say good-bye. Another sign is when someone has been very depressed and suddenly becomes happy and calm. If someone says, "I'd be better off dead," get help for the person immediately.

A client with Alzheimer's disease wanders from room to room, moving the belongings of other clients to different locations. Alert and oriented clients are angry that their things have been moved. The nurse aide SHOULD A. return the client to the client's room and close the door. B. walk with the client to keep the person from wandering. C. find the missing articles and return them. D. assure the other clients that the client with Alzheimer's disease will not harm them.

C: It is not unusual for clients with Alzheimer's or dementia to take objects and misplace or hide them. The clients are not stealing but are attracted by the look or feel of an object. An object may also remind them of a similar object they may have owned. Clients with Alzheimer's or dementia may also "collect" things like pencils or coins. Do not scold the clients or become angry. Return the items to their owners. Make a box of the client's favorite objects and talk about their meaning.

A patient who has been depressed and complaining of feeling hopeless suddenly appears happier one morning and says that everything is OK now. What should the nurse aide do? A. Call the family with the good news. B. Tell the nurse that the patient is fine. C. Notify the nurse and other staff members of the sudden change. D. Congratulate the patient on getting better.

C: One of the warning signs that someone has been planning to commit suicide is a sudden or unexpected change in mood from being sad to being happy or calm. It can indicate that the person has decided to end his or her life. Similar signs are giving away favorite possessions and putting affairs in order. Never assume that a suicidal patient has given up suicidal thinking. Let others know so that everyone can monitor the client

A nurse aide who is active in her church is assigned to care for a client who is not a member of any religious group. The nurse aide SHOULD A. explain how religion has helped her during difficult times. B. arrange to have his or her clergyman visit the client. C. respect the client's beliefs and not try to change them. D. tell the client that it is important to have some type of spiritual belief.

C: Respecting a client's spiritual beliefs can be a challenge if they are not understood or are different from yours. Compassionate care means having an open mind and not promoting any religion or spiritual practice. A client may be deeply spiritual but not part of a formal religion. Ask if the client has any spiritual needs, then comply with the person's wishes.

A patient who is on suicide watch should be allowed to have A. a glass container of flowers in the person's room. B. a mirror at the bedside table. C. pictures of the person's family in an album. D. his or her favorite leather belt.

C: Suicide watch is an ongoing monitoring process meant to prevent clients from hurting or killing themselves. A client on suicide watch is placed in a special room with nothing on the walls or ceiling. There may only be a mattress on the floor. Any object that could be used to commit suicide is removed. This includes glass, razors, belts, shoelaces, and bedsheets. The room may have a video monitor. The client is checked at least every 15 minutes by a qualified staff member

All behavior has meaning to the A. facility psychologist. B. person observing the behavior. C. person doing the behavior. D. person who is talking.

C: When a client's behavior seems puzzling or challenging, try to understand what the person is trying to achieve. Is the client afraid? Hungry? Cold? Ill? Clients with dementia or other brain conditions may only be aware that they are uncomfortable. Ask the client's family if the behavior makes sense or if there are any triggers for the behavior. As you become more familiar with the client, you will learn how to interpret the behavior and assist the client.

A nurse aide is caring for a client who is agitated. The nurse aide SHOULD A. ask another nurse aide to take care of the client. B. speak loudly so the client can hear the instructions. C. try to convince the client to be quiet. D. talk in a slow, calm, reassuring manner.

D: Causes of agitation include noise, sudden changes in location or caregiver, perceived fears or threats, or fatigue. Stay with the client and offer reassurances, such as "You are safe here," or "I'll stay with you." Eliminate distractions and check for physical needs: hunger, thirst, need to use the toilet, fatigue, or pain. The client's favorite music can be soothing, as well as exercise or a new activity.

Mrs. Patton's husband died several months ago. She continues to talk about him and expects him to come visit daily. She is experiencing A. acceptance. B. displacement. C. schizophrenia. D. denial.

D: Denial is the first and natural response to loss. It serves as a temporary defense mechanism that prevents the person from being overwhelmed by what has happened. During the denial phase, people may ignore facts that are too painful to face. In this case, do not confront Mrs. Patton or try to convince her that her husband has died. Ask her what he was like and what her favorite memories are. Encourage her to do her favorite activities.

A nurse aide is caring for a client whose religious beliefs do not allow the person to eat certain foods. The nurse aide should report this information to the A. other nurse aides. B. dietitian. C. client's family. D. charge nurse.

D: Notify the nurse if you learn that a client requires a special diet. The diet should have been specified on admission, but if not, the nurse can obtain an order and contact the dietitian. Reasons for special diets include religion, medical conditions, and food allergies.

Which of the following actions by the nursing assistant can help meet a male resident's social needs? A. Keep his room clean and neat, with personal items put away. B. Serve his meal tray promptly while the food is hot. C. Keep his bed's side rails up and use postural supports as necessary. D. Praise him for his accomplishments and for trying new things.

D: Social rewards such as praise and attention are meaningful to everyone. When using praise to reinforce positive behavior and accomplishments, be specific and sincere. Tell the client what you liked: "I'm glad you went to the woodworking class this morning." "Thank you for trying the zucchini at lunch today." Use praise for behaviors and skills that the client is able to change.

You can assist clients with their spiritual needs by A. talking about your own spiritual beliefs. B. avoiding any religious discussions. C. telling them to focus on their physical health. D. encouraging them to talk about their beliefs.

D: Spiritual beliefs are part of the whole person and can affect how clients approach their medical care. While discussing religion is not part of most conversations, it is important to find out the client's preferences. Ask, "How do you handle stressful times?" or "Is there anything we can do to help you practice your beliefs?" Many clients are relieved to be able to discuss their needs and how their faith matters during illness and difficult times.

Which of the following stages of dying is usually the final stage? A. Depression B. Bargaining C. Anger D. Acceptance

D: The five stages of grief and dying are a model that explains the emotional response to death. Both the client and the client's loved ones can experience these emotions. The stages are denial, anger, bargaining, depression, and acceptance. The stages are not linear; most people move back and forth. Acceptance is the final stage, in which the client reflects on his or her life and understands that it is ending.

A resident who is disoriented A. will probably become violent. B. is over 70 years old. C. likely has developmental delays. D. is confused as to time and place.

D: When a client seems disoriented, start by offering basic information: "Hello, Mr. Roberts. I'm Sally, your nurse aide. Do you remember me?" From there, offer other ways to help the person regain his or her sense of time and place: "It's Tuesday, August 26. You had chicken for lunch and watched the movie." Returning the client to his room to look at familiar objects and photos can also be helpful. Always remain calm and friendly.

A resident's daughter expresses concern because her father, who has Parkinson's disease, appears "stuck" at times and stands still, unable to walk. The nurse aide should tell the daughter that A. her father has likely had a stroke. B. when he is confused, he doesn't move. C. he might not feel like walking. D. this is a common sign of Parkinson's disease.

When a client or family member expresses concern about the client's condition, education can be useful. Provide basic information. If you aren't certain about the client's illness, ask the nurse to speak with the concerned person. Encourage the concerned person to check resources from reliable organizations. The Parkinson's Disease Foundation website has educational materials, online seminars, and a national helpline. Most diseases and chronic conditions have similar websites and resources.