22 The Nervous System 1. Define important words in this chapter age-related macular degeneration...

22The Nervous System

1. Define important words in this chapter

age-related macular degeneration (AMD) a condition in which the macula degenerates, gradually causing central vision loss.

agitatedthe state of being excited, restless, or troubled.

Alzheimer’s disease (AD) a progressive, degenerative, and irreversible disease that is a form of dementia; there is no cure.

bipolar disorder a type of depression that causes a person to have mood swings and changes in energy levels and the ability to function; also called manic depression.


1. Define important words in this chapterbrain the part of the nervous system housed in the skull that is responsible for motor activity, memory, thought, speech, and intelligence, along with regulation of vital functions, such as heart rate, blood pressure, and breathing.

burnout mental or physical exhaustion due to a prolonged period of stress and frustration.

cataract a condition in which the lens of the eye becomes cloudy, causing vision loss.

catastrophic reaction reacting to something in an unreasonable, exaggerated way.



central nervous system part of the nervous system made up of the brain and spinal cord.

cerebrovascular accident (CVA) a condition caused when the blood supply to the brain is cut off suddenly by a clot or a ruptured blood vessel; also called a stroke.

cognition the ability to think clearly and logically.

concussion a head injury that occurs from a banging movement of the brain against the skull.



delirium a sudden state of severe confusion due to a change in the body; also called acute confusional state or acute brain syndrome.

delusion a belief in something that is not true or is out of touch with reality.

dementiaa serious, progressive loss of mental abilities such as thinking, remembering, reasoning, and communicating.

disruptive behavior any behavior that disturbs others.



elopement in medicine, when a person with Alzheimer’s disease wanders away from a protected area and does not return on his own.

epilepsy a disorder that causes recurring seizures.

farsightedness the ability to see distant objects more clearly than objects that are near; also called hyperopia.

generalized anxiety disorder (GAD) an anxiety disorder characterized by chronic anxiety, excessive worrying, and tension, even when there is no cause for these feelings.



glaucoma a condition in which the pressure in the eye increases, damaging the optic nerve and causing blindness.

hallucinationsseeing or hearing things that are not really there.

hearing aid a battery-operated device that amplifies sound.

hemianopsia loss of vision on one-half of the visual field, due to CVA, tumor, or trauma.



hoarding collecting and putting things away in a guarded way.

intervention a way to change an action or development.

irreversible unable to be reversed or returned to the original state.

Meniere’s disease a disorder of the inner ear caused by a build-up of fluid, which causes vertigo (dizziness), hearing loss, tinnitus (ringing in the ear), and pain or pressure.


1. Define important words in this chaptermental health refers to the normal function of emotional and intellectual abilities.

mental illness a disease that disrupts a person’s ability to function at a normal level in the family, home, or community.

multiple sclerosis (MS) a progressive disease in which the protective covering of the nerves, spinal cord, and white matter of the brain breaks down over time; without this covering, nerves cannot send clear messages to and from the brain in a normal way.

nearsightedness the ability to see objects that are near more clearly than distant objects; also called myopia.



neuron the basic nerve cell of the nervous system.

obsessive-compulsive disorder (OCD) an anxiety disorder characterized by repetitive thoughts or behaviors.

otitis media an infection in the middle ear that causes pain, pressure, fever, and reduced ability to hear.

pacing walking back and forth in the same area.



panic disorder an anxiety disorder that causes a person to have repeated episodes of intense fear that something bad will occur.

paranoid schizophrenia a form of mental illness characterized by hallucinations and delusions.

paraplegia a loss of function of the lower body and legs.

Parkinson’s disease a progressive disease that causes a portion of the brain to degenerate; causes rigid muscles, shuffling gait, pill-rolling, mask-like face, and tremors.



peripheral nervous system part of the nervous system made up of the nerves that extend throughout the body and connect to the spinal cord.

perseveration the repetition of words, phrases, questions, or actions.

pillaging taking things that belong to someone else; not considered stealing.

post-traumatic stress disorder (PTSD) anxiety-related disorder caused by a traumatic experience.



progressive something that continually gets worse or deteriorates.

psychotherapy a method of treating mental illness that involves talking about one’s problems with mental health professionals.

quadriplegia loss of function of legs, trunk, and arms.

reality orientation type of therapy that uses calendars, clocks, signs, and lists to help people with Alzheimer’s disease remember who and where they are, along with the date and time.



reminiscence therapy type of therapy that encourages people with Alzheimer’s disease to remember and talk about the past.

remotivation therapy type of group therapy that promotes self-esteem, self-awareness, and socialization for people with Alzheimer’s disease.

rummaging going through items that belong to other people.

schizophrenia a form of chronic mental illness that may involve acute episodes; affects a person’s ability to think, communicate, make decisions, and understand reality.



social anxiety disorder a disorder in which a person has excessive anxiety about social situations; also called social phobia.

spinal cord the part of the nervous system inside the vertebral canal that conducts messages between the brain and the body and controls spinal reflexes.

substance abuse the use of legal or illegal substances in a way that is harmful to oneself or others.

sundowning a condition in which a person gets restless and agitated in the late afternoon, evening, or night.



trigger a situation that leads to agitation.

validating giving value to or approving.

validation therapy a type of therapy that lets people with Alzheimer’s disease believe they are living in the past or in imaginary circumstances.

violent word to describe actions that include attacking, hitting, or threatening someone.



wandering walking around a facility without any known goal or purpose.

withdrawal the physical and mental symptoms caused by ceasing to use a particular addictive substance.


2. Explain the structure and function of the nervous systemDefine the following terms:neuron the basic nerve cell of the nervous system.

central nervous system part of the nervous system made up of the brain and spinal cord.

peripheral nervous system part of the nervous system made up of the nerves that extend throughout the body and connect to the spinal cord.


2. Explain the structure and function of the nervous systemDefine the following terms:brain the part of the nervous system housed in the skull that is responsible for motor activity, memory, thought, speech, and intelligence, along with regulation of vital functions, such as heart rate, blood pressure, and breathing.

spinal cord the part of the nervous system inside the vertebral canal that conducts messages between the brain and the body and controls spinal reflexes.

22 The Nervous System

Transparency 22-1: The Nervous System


2. Explain the structure and function of the nervous systemThe nervous system controls and coordinates all body functions. It sends messages throughout the body and senses and interprets information from outside the body.

The neuron, or nerve cell, is the basic working unit of the nervous system. Neurons send and receive nerve impulses from the receptors through the spinal cord to the brain.


2. Explain the structure and function of the nervous systemREMEMBER:The nervous system is divided into two main parts: the central nervous system (CNS) and the peripheral nervous system (PNS).


2. Explain the structure and function of the nervous systemRemember these points about the central nervous system:• Consists of the brain and spinal cord• The brain controls speech, motor and sensory activity, intelligence, reasoning, coordination, reflexes, breathing, emotions, and heart rate.

• The spinal cord conducts messages between the brain and the body within its pathways.


2. Explain the structure and function of the nervous systemRemember these points about the peripheral nervous system:• Consists of the cranial and spinal nerves• Nerves carry messages to and from the brain from the rest of the body.

• The somatic nervous system (SNS) helps with conscious movement of the skeletal system.

• The two parts of the autonomic nervous system (ANS) conserve body’s energy and provide for relaxation of the body and activate the body’s “fight-or-flight” response.


2. Explain the structure and function of the nervous systemKnow these points about the sense organs:• Consist of the skin, tongue, nose, eyes, and ears• Receive impulses from the environment and relay these impulses to the brain


Transparency 22-2: Parts of the Eye


2. Explain the structure and function of the nervous systemThe parts of the eye consist of the following:• Sclera: white of the eye• Cornea: transparent front part of the sclera• Iris: part of the eye that is genetically colored• Pupil: circular opening in the center of the iris, which dilates (opens) and constricts (closes) to adjust the amount of light coming into the eye.

• Retina: located inside the back of the eye; contains cells that respond to light and send messages to the brain.


Transparency 22-3: Parts of the Ear


2. Explain the structure and function of the nervous systemThe parts of the ear consist of the following:• Outer ear: collects sound waves and directs them inward through the external auditory canal toward the middle ear

• Middle ear: amplifies and transfers sound waves to the inner ear.

• Inner ear: contains tiny hair cells which send nerve impulses to the brain.


2. Explain the structure and function of the nervous systemParts of the ear (cont’d.):• Eardrum: separates the outer ear from the middle ear; also known as the tympanic membrane.

• Ossicles: three tiny bones within the middle ear which pick up vibrations and send impulses to the brain.


2. Explain the structure and function of the nervous systemFunctions of the nervous system:• Controls and coordinates mental processes and voluntary movements

• Provides reflex centers of heartbeat and respiration• Senses and responds to changes occurring both inside and outside of the body


3. Discuss changes in the nervous system due to aging

Normal changes of aging in the nervous system:• Responses and reflexes slow.• Some memory loss occurs, especially short-term memory loss.

• Sensitivity of nerve endings in skin decreases, resulting in diminished sense of touch.

• Some hearing loss occurs.• Senses of vision, smell, and taste weaken.


4. Discuss common disorders of the nervous system

Define the following terms:cerebrovascular accident (CVA) a condition caused when the blood supply to the brain is cut off suddenly by a clot or a ruptured blood vessel; also called a stroke.

hemianopsia loss of vision on one-half of the visual field, due to CVA, tumor, or trauma.



Know these points about cerebrovascular accident (CVA):• Cause: obstruction inside a blood vessel or the rupture of a blood vessel

• Ischemic stroke is the most common type of stroke. With this type of stroke, the blood supply is blocked, and brain cells begin to die.

• Hemorrhagic stroke, another type of stroke, occurs when there is leaking or a rupture of a blood vessel inside the brain.

• Transient ischemic attack (TIA) is a warning sign.• Symptoms differ depending on which side of the brain is affected.



Know some of the problems that can result from right side or left side brain damage from a CVA:• Hemiparesis• Hemiplegia• One-sided neglect• Loss of ability to identify affected body parts• Expressive aphasia



Problems that can result from right side or left side brain damage from a CVA (cont’d.):• Receptive aphasia• Trouble understanding speech or written words• Emotional lability• Loss of sensations• Loss of bowel or bladder control



Problems that can result from right side or left side brain damage from a CVA (cont’d.):• Cognitive impairments• Changes in personality• Loss of thinking and learning abilities• Dysphagia or total inability to swallow• Vision impairments or blurred vision• Hemianopsia



Know these care guidelines for residents recovering from CVA:• Encourage independence and self-esteem.• Be patient with self-care and communication.• Encourage resting in between self-care tasks.• Assist with ROM exercises.• Carefully assist with shaving, grooming, and bathing.

• Encourage fluids and proper nutrition.



Care guidelines for residents recovering from CVA (cont’d.):• Do not refer to resident’s affected side as “bad.” • Always place food in the unaffected side of the mouth.

• Assist with guidelines from the speech-language pathologist as directed.

• Break instructions into short, simple sentences.• Make sure a clock and calendar are visible.• For one-sided neglect, remind residents about weaker side of body.



Care guidelines for residents recovering from CVA (cont’d.):• Assist with ambulation to prevent falls.• Reposition often.• With emotional lability, redirect resident’s attention.

• Use praise often.• Listen to resident if he or she wants to talk.• Be positive and encouraging with ongoing rehabilitation.



Guidelines for communication with a resident post-CVA:• Speak clearly and face the resident.• Do not rush the resident.• Use signals, such as nodding and pointing.• Keep questions and directions simple.• Use yes or no questions.• Use special methods, such as communication boards.



Define the following terms:Parkinson’s disease a progressive disease that causes a portion of the brain to degenerate; causes rigid muscles, shuffling gait, pill-rolling, mask-like face, and tremors.

progressive something that continually gets worse or deteriorates.



Remember these points about Parkinson’s disease:• Progressive disorder that causes part of brain to degenerate

• Cause: neurons in the brain that produce dopamine begin to break down and die

• Symptoms: tremors or shaking; mask-like face; pill-rolling; rigid muscles; shuffling gait; slurred speech; mood swings; gradual behavior changes

• Treatment: drug therapy, surgery



Know these care guidelines for Parkinson’s disease:• Assist with ambulation to prevent falls.• Encourage residents to stand as straight as possible for ambulation.

• Encourage self-care.• Assist with ADLs.



Care guidelines for Parkinson’s disease (cont’d.):• Assist with ROM exercises• Encourage fluids and proper nutrition.• Listen to residents if they want to talk.• Report severe trembling, severe muscle rigidity/contractures, mood swings, sudden incontinence, constipation, dehydration, weight loss, or signs of depression.



Define the following term:multiple sclerosis (MS) a progressive disease in which the protective covering of the nerves, spinal cord, and white matter of the brain breaks down over time; without this covering, nerves cannot send clear messages to and from the brain in a normal way.



Know these points about multiple sclerosis:• Progressive disorder that affects the way impulses are transmitted to and from the brain

• Cause: loss of myelin• Symptoms: numbness and tingling; muscle weakness; extreme fatigue; tremors; vertigo; reduced sensation; blurred or double vision; poor balance; difficulty walking; incontinence; paralysis

• Treatment: interferon



Remember these care guidelines for multiple sclerosis:• Assist with ambulation to prevent falls.• Be patient with self-care and movement.• Offer rest periods as necessary.• Give frequent skin care.• Assist with ROM exercises.• Do not rush communication.



Care guidelines for multiple sclerosis (cont’d.):• Try to provide a stress-free environment.• Encourage proper nutrition and fluid intake.• Offer support and encouragement as symptoms change.• Listen if resident wants to talk.• Report red skin, pale skin, start of pressure ulcer, start of contracture, UTI symptoms, or signs of depression.



Define the following terms:concussion a head injury that occurs from a banging movement of the brain against the skull.

paraplegia a loss of function of the lower body and legs.

quadriplegia loss of function of legs, trunk, and arms.



Know these points about head and spinal cord injuries:• Causes: accidents, sporting injuries, gunshot wounds, stab wounds, falls

• Symptoms of head injury: confusion or disorientation; coma; death; headaches; drowsiness; loss of consciousness; seizures; fractures; drainage from the ears, nose, or mouth; irritability; poor coordination; slurred speech; blurred vision; vomiting; stiff neck; decreased sense of smell

• Symptoms of spinal cord injury: paralysis, loss of function, paraplegia, quadriplegia



Remember these care guidelines for head or spinal cord injuries:• Give frequent skin care.• Be gentle when turning and repositioning.• Perform ROM exercises as ordered.• Allow as much independence as possible with ADLs.• Offer rest periods as necessary.



Care guidelines for head or spinal cord injuries (cont’d.):• Help with bladder and bowel training.• Encourage fluids and proper diet.• Give careful catheter care and encourage fluids high in vitamin C.

• Protect residents from harm due to lack of sensation.

• Check water temperature carefully.



Care guidelines for head or spinal cord injuries (cont’d.):• Use special stockings to increase circulation as ordered.

• Encourage deep breathing exercises.• Provide privacy and be sensitive if involuntary erections occur.

• Listen to the resident.• Report red skin, pale skin, start of pressure ulcer or contracture, UTI symptoms, shortness of breath, constipation, dehydration, weight loss, or depression.



Define the following term:epilepsy a disorder that causes recurring seizures.



Know these points about seizures: • Involuntary contractions of muscles• Causes: tumors, head injuries, injuries to the brain during birth, high fever, stroke, dementia, genetic factors, and alcohol and drug abuse

• Treatment: medication, surgery, rehabilitation



Define the following terms:nearsightedness the ability to see objects that are near more clearly than distant objects; also called myopia.

farsightedness the ability to see distant objects more clearly than objects that are near; also called hyperopia.



REMEMBER:Vision changes affect people of all ages. Both nearsightedness (myopia) and farsightedness (hyperopia) are usually treated with eyeglasses, contact lenses, or surgery.



Define the following terms:cataract a condition in which the lens of the eye becomes cloudy, causing vision loss.



Know these points about cataracts:• Develops when the lens of the eye becomes cloudy• Causes: diabetes, eye injury, may be inherited or result from normal aging

• Symptoms: blurred vision, glare when driving at night, yellowing of vision

• Treatment: surgery



Define the following terms:glaucoma a condition in which the pressure in the eye increases, damaging the optic nerve and causing blindness.



Remember these points about glaucoma:• Leading cause of blindness in the U.S.• Cause: intraocular pressure increases, damaging the optic nerve

• The majority of people have open-angle, or primary, glaucoma.

• Symptoms of open-angle glaucoma: not always apparent, but over time, there is a decrease in vision, especially in the peripheral vision



Points about glaucoma (cont’d.):• Another form of glaucoma is angle-closure, which can be chronic or acute.

• Symptoms of angle-closure glaucoma: pain, nausea, vomiting, seeing a halo around lights, reddening of the eye, blurred vision

• Treatment: eye drops and other medications, surgery



Define the following terms:age-related macular degeneration (AMD) a condition in which the macula degenerates, gradually causing central vision loss.



Remember these points about age-related macular degeneration (AMD): • Condition in which part of the retina degenerates• Two forms are wet and dry AMD; the dry form is more common.

• Risk factors: aging, smoking, sun exposure, heredity, gender, and race

• Treatment: laser surgery, injections, zinc, antioxidants



Know these care guidelines for vision impairment:• Encourage use of eyeglasses.• Keep eyeglasses clean and safe.• Encourage use of contact lenses.• Always identify yourself as you enter the room.• Keep doors completely open or closed.



Care guidelines for vision impairment (cont’d.):• Leave furniture in place.• Use the face of an imaginary clock to explain the position of objects in a room.

• Make sure there is enough lighting in every room.• Walk a little ahead of the resident as she holds your arm.

• Walk at the resident’s pace.



Care guidelines for vision impairment (cont’d.):• Assist residents to complete menus. Set up meal trays as needed.

• Use large-print books, audio books, and digital books.

• Read to residents if they desire it.• Assist with vision screening.

Caring for eyeglasses

Equipment: emesis basin, special cleaning fluid, 2 lens cloths, towel

1. Identify yourself by name. Identify the resident. Greet the resident by name.

2. Wash your hands.

3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

4. Provide for the resident’s privacy with a curtain, screen, or door.


5. Gently remove eyeglasses and place in emesis basin.

6. Line sink with towel.

7. Clean eyeglasses over lined sink. Wash glass lenses in lukewarm water and rinse. Clean plastic lenses with cleaning fluid and a lens cloth. While cleaning, observe for loose screws or loose or broken lenses.

8. Dry with soft, 100% cotton cloth or special lens cloth. Do not dry with tissues, as they may scratch eyeglasses.


9. Gently assist resident to replace eyeglasses on face. Place over the ears and position comfortably. Observe for proper fit.

10. Make resident comfortable. Remove privacy measures.

11. Leave call light within resident’s reach.

12. Wash your hands.

13. Be courteous and respectful at all times.

14. Report any changes in the resident to the nurse. Document procedure using facility guidelines.



The artificial eye is a type of prosthesis, sometimes called an ocular prosthetic. An artificial eye does not provide vision. It can, however, improve appearance. It may be used when a person has lost an eye due to disease or injury, such as cancer or a gunshot wound.



Know these points about the artificial eye:• Is a type of prosthetic and does not provide vision• Necessary for people who have lost an eye to cancer, other disease, or injury

• Most are made from plastic.• Held in place by suction• Carefully follow care instructions.



Points about the artificial eye (cont’d.):• Do not use alcohol or abrasives to clean the eye.• Act professionally during care.• Keep eye covered completely in solution when stored.



Define the following terms:otitis media an infection in the middle ear that causes pain, pressure, fever, and reduced ability to hear.

Meniere’s disease a disorder of the inner ear caused by a build-up of fluid, which causes vertigo (dizziness), hearing loss, tinnitus (ringing in the ear), and pain or pressure.

hearing aid a battery-operated device that amplifies sound.



Know these points about otitis media:• Cause: infection in the middle ear• Symptoms: pain, pressure, fever, and reduced ability to hear

• Treatment: antibiotics



Remember these points about Meniere’s disease:• Cause: build-up of fluid in the inner ear caused by infections, allergies, or a genetic link

• Symptoms: vertigo, hearing loss, tinnitus, and pain or pressure

• Treatment: medications, salt restriction and other dietary changes, cognitive therapy, antibiotic or corticosteroid injections, and, in extreme cases, surgery



Know these care guidelines for hearing aids:• Be careful when handling a hearing aid.• Turn off when not in use.• Check batteries often.• Do not get batteries wet.



Care guidelines for hearing aids (cont’d.):• Remove hearing aid before bathing, showering, or shampooing hair.

• Do not spray hair care products near hearing aid.• Check for hearing aids before removing bed linen and meal trays.

• Make sure residents wear them and have them turned on.



Define the following term:delirium a sudden state of severe confusion due to a change in the body; also called acute confusional state or acute brain syndrome.



Know these points about delirium:• Causes: dehydration, malnutrition, fever, pain, poisons, alcohol and drug use, prescribed medication, hypoxia, head injury, illness, infections

• Symptoms: disorganized thinking; inability to concentrate; problems with speech, agitation, anger or irritability; drowsiness or sleep disturbance; decrease in short-term memory; lack of attention span; disorientation; changes in consciousness; decrease in ability to move; pulling out tubing; hallucinations

• Treatment: medication, emergency care, hospital stay


5. Discuss dementia and related terms

Define the following terms:cognition the ability to think clearly and logically.

dementiaa serious, progressive loss of mental abilities such as thinking, remembering, reasoning, and communicating.

irreversible unable to be reversed or returned to the original state.



REMEMBER:Dementia is not a normal part of aging.



Know the causes of dementia:• Alzheimer’s disease• Vascular dementia• Lewy body dementia• Parkinson’s disease• AIDS



Causes of dementia (cont’d.):• Huntington’s disease• Excessive alcohol or drug use• Head injuries• Thyroid disorders• Nutritional deficiencies



REMEMBER:Some forms of dementia may be treated. However, many forms of dementia are irreversible.


6. Discuss Alzheimer’s disease and identify its stages

Define the following term:Alzheimer’s disease (AD) a progressive, degenerative, and irreversible disease that is a form of dementia; there is no cure.



Know these points about Alzheimer’s disease (AD):• AD is progressive and irreversible.• Occurs when tangled nerve fibers and protein deposits form in the brain

• Cause is unknown.• Older skills are usually kept longer.


6. Discuss Alzheimer’s disease and identify its stagesThere are seven general stages of Alzheimer’s disease:• Stage 1: No impairment At this stage, the person does not show problems with memory loss or other symptoms. No signs of impairment are found during a medical examination.

• Stage 2: Very mild decline At this stage, the person has mild cognitive loss, which could be due to normal changes of aging or could be the earliest signs of Alzheimer’s disease. There may be some memory loss, and the person forgets some words and the location of familiar objects. However, the person’s medical examination does not show symptoms, and friends and family members do not notice any symptoms.



Seven stages of Alzheimer’s disease (cont’d.):• Stage 3: Mild decline During this stage, people close to the person begin to notice some changes. A medical examination may show problems with memory and concentration. Other problems in this stage include the following: • Difficulty with finding the right word or name • Trouble remembering peoples’ names • Having a harder time functioning in social and

work environments • Forgetting material that one has just read • Losing or misplacing objects • Difficulty with planning or organizing



Seven stages of Alzheimer’s disease (cont’d.):• Stage 4: Moderate decline At this stage, the person’s medical examination shows clear problems, such as • Forgetting recent events • Problems doing more complex arithmetic • Trouble performing more involved tasks, such as managing finances

• Forgetting some of one’s own past experiences and background

• Being moody or withdrawn



Seven stages of Alzheimer’s disease (cont’d.):• Stage 5: Moderately severe decline At this stage, cognitive impairment is noticeable. The person starts to need help with some daily activities. Symptoms include the following: • Inability to recall one’s own address, phone number, and other personal details

• Confusion about time and place • Problems doing less complex arithmetic • Needing help with some ADLs, such as choosing clothing appropriately

• However, the person can often remember many important personal details and usually does not require help with other ADLs, like eating or toileting.



Seven stages of Alzheimer’s disease (cont’d.):• Stage 6: Severe decline During this stage, memory loss and other problems worsen. More help is needed with daily activities. Symptoms include the following: • Forgetting recent events, as well as not being aware of surroundings

• Forgetting one’s own past experiences and background (may be able to remember name)

• Having trouble recalling the name of a family member or close friend or caregiver

• Needing more help with ADLs, such as dressing and toileting

• Trouble controlling bladder or bowels



Seven stages of Alzheimer’s disease (cont’d.):• Stage 6 (cont’d.):

• Having disruptions in sleep patterns • Experiencing significant changes in personality and behavior (having delusions, being suspicious, showing compulsive behavior, wandering or becoming lost)



Seven stages of Alzheimer’s disease (cont’d.):• Stage 7: Very severe decline In the final stage of AD, a person may be unable to communicate with others, control movement, or respond to his or her surroundings. The person needs significant help with ADLs, including eating and toileting. Muscles become rigid, and reflexes are abnormal. The person will have difficulty swallowing.



Think about this question:How different is a resident’s ability for self-care at Stage 2 versus Stage 5 of Alzheimer’s disease?



Think about this question:Which would present a more of a caregiving challenge to you as a nursing assistant: a resident in the fifth stage or seventh stage of Alzheimer’s disease?



REMEMBER:Every victim progresses differently through Alzheimer’s disease, showing different symptoms at different times.



REMEMBER:AD residents should be encouraged to do self-care and keep their minds and bodies active for as long as possible.


6. Discuss Alzheimer’s disease and identify its stagesEarly Identification of Alzheimer’s Disease: In April 2011, the Alzheimer’s Association and the National Institute on Aging (NIA) published new guidelines for early diagnosis of Alzheimer’s disease. There are three phases: 1. Preclinical Alzheimer’s disease2. Mild cognitive impairment due to Alzheimer’s disease3. Dementia due to Alzheimer’s disease

The new guidelines define biomarkers and suggest that they may be a useful tool in the future for identifying or determining a person’s risk of developing Alzheimer’s disease.


7. List strategies for better communication with residents withAlzheimer’s diseaseDefine the following term:perseveration the repetition of words, phrases, questions, or actions.


7. List strategies for better communication with residents withAlzheimer’s diseaseRemember these general guidelines for communication with residents with AD:• Always identify yourself and greet resident by name.• Look at resident while speaking to her.• Speak slowly and quietly.• Reduce background noise.• Use touch and gestures.


7. List strategies for better communication with residents withAlzheimer’s diseaseGeneral guidelines for communication with residents with AD (cont’d.):• Only talk about one subject at a time.• Repeat directions and answers as many times as needed.

• Use pictures.• Praise often.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf resident is frightened or anxious:• Move and speak slowly.• Speak in a quiet area with few distractions.• Try and see yourself as they might.• Use simple language and short sentences.• Check your body language.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf resident forgets or shows memory loss:• Repeat yourself in the same words.• Do not try to stop a resident who is perseverating.• Keep messages simple.• Break complex tasks into smaller, simpler steps.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf resident has trouble finding words or names:• Suggest a word that sounds correct.• Use touch, if it is welcome.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf the resident seems not to understand basic instructions or questions:• Ask resident to repeat your statements.• Pay attention to communication methods that are useful.

• Watch for nonverbal cues.• Use signs, pictures, gestures, or written messages.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf the resident wants to say something but cannot:• Encourage resident to point, gesture, or act it out.• Offer comfort or try to distract resident.

If the resident is disoriented to time and place:• Post reminders in early stages of disease.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf the resident does not remember how to perform basic tasks:• Break each activity into simple steps.

If the resident insists on doing something that is unsafe or not allowed:• Try to limit saying, “don’t.”• Redirect activities.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf the resident hallucinates, is paranoid, or accusing:• Do not take it personally.• Try to redirect or ignore behavior.

If the resident is depressed or lonely:• Take time to ask how the resident feels, and listen closely.

• Try to involve resident in activities.


7. List strategies for better communication with residents withAlzheimer’s diseaseIf the resident is verbally abusive or uses bad language:• Remember it is the dementia speaking and not the resident.

• Try to ignore the language and redirect attention.

If the resident has lost most verbal skills:• Use nonverbal communication.• Assume that resident is aware of losses in abilities.


8. Identify personal attitudes helpful in caring for residents with Alzheimer’s disease

Define the following term:burnout mental or physical exhaustion due to a prolonged period of stress and frustration.



These attitudes are helpful when caring for residents with AD. • Do not take it personally.• Put yourself in their shoes.• Work with the symptoms and behaviors you see.• Work as a team.• Take care of yourself.• Work with family members.• Remember the goals of the care plan.



Think about this question:Can you think of a situation in which each attitude listed on the previous slide might be helpful on the job?


9. Describe guidelines for problems with common activities of daily living (ADLs)

Remember these guidelines for bathing:• Schedule bathing when resident is least agitated.• Prepare resident before bathing.• Be organized.• Make sure bathroom is well-lit.• Provide privacy.• Check temperature.



Guidelines for bathing (cont’d.):• Calmly explain procedure the same way every time.• Offer the resident a washcloth to hold.• Ensure safety.• Do not try to force the resident to bathe.• Allow resident to enjoy the bath.• Be encouraging and positive.• Observe the skin.



Remember these guidelines for grooming and dressing:• Assist with grooming to help resident feel attractive and dignified.

• Choose clothing ahead of time.• Lay out clothes in the order to be put on.• Provide privacy.• Do not rush the resident.• Praise and encourage resident often.



Know these guidelines for toileting:• Encourage fluids.• Mark the restroom with a sign.• Check for episodes of incontinence.• Take resident to bathroom after drinking fluids.• Follow toileting schedule.• Take resident to bathroom before meals and bedtime.



Guidelines for toileting (cont’d.):• Take resident to bathroom at his preferred time.• Take resident to bathroom near bedtime.• Check skin for irritation.• Cover garbage cans or waste baskets.• Document bowel movements.• Support family and friends.



Know these guidelines for nutrition:• Schedule meals at the same time each day with familiar foods.

• Remind resident when it is mealtime.• Encourage independence.• Make dining area pleasant and calm.• Encourage socialization.• Foods should look and smell appealing.• Food and drink should not be too hot.



Guidelines for nutrition (cont’d.):• Use plain plates without patterns or colors.• Use a variety of foods the resident prefers.• Ask resident which food she would like to eat first.• Serve finger foods.• Offer one bite at a time.• Offer fluids often.• Obtain assistive devices, if needed.



Guidelines for nutrition (cont’d.):• Give simple instructions.• Use the hand-over-hand method to help resident eat.• Allow plenty of time to eat and drink.• If resident needs to be fed, do so slowly, offering small pieces of food.

• Sit directly in front of resident.• Try smaller, more frequent meals to prevent restlessness or wandering.

• Observe and report changes or problems in eating habits.

• Promptly report changes in intake or output.



Remember these guidelines for physical health:• Prevent infections and follow Standard Precautions.• Help residents wash hands.• Report potential problems.• Reduce risk of falls.• Provide excellent skin care.• Take action to manage pain.



Know these guidelines for mental and emotional health:• Maintain self-esteem.• Provide a daily calendar to encourage activities.• Share in enjoyable activities.• Reward positive and independent behavior with smiles, hugs, and warm touches.



Remember these guidelines for the residents’ environment:• Use pictures or photos to identify each room.• Mark stairs and windows with brightly colored tape or signs.

• Use handrails and non-skid mats in the bathroom.• Do not keep shampoos, cleaning agents, plants, or other potentially dangerous items within reach of confused or disoriented residents.

• Provide a safe area for pacing and wandering.


10. Describe interventions for common difficult behaviors related to Alzheimer’s disease

Define the following terms:intervention a way to change an action or development.

agitatedthe state of being excited, restless, or troubled.

trigger a situation that leads to agitation.



Agitation:• Causes: feeling insecure or frustrated, encountering new people and places, changes in routine

• Interventions: recognize and eliminate triggers, keep a regular routine, avoid frustration, use slow and soothing tone, reduce noise and distractions, focus on familiar activities, listen carefully, reassure resident



Define the following term:catastrophic reaction reacting to something in an unreasonable, exaggerated way.



Catastrophic reaction:• Causes: fatigue; change of routine, environment, or caregiver; overstimulation; physical pain or discomfort

• Interventions: respond as you would to agitation, remove triggers, help resident focus on soothing activity



Define the following term:violent word to describe actions that include attacking, hitting, or threatening someone.



Violent behavior:• Causes: frustration, overstimulation, change in roommate, caregiver, or routine

• Interventions: notify nurse, block blows but never hit back, remove triggers, remove others from the area, do not try to restrain resident, care conference may be needed



Define the following terms:hallucinationsseeing or hearing things that are not really there.

delusion a belief in something that is not true or is out of touch with reality.



Hallucinations or delusions:• Interventions: ignore the behavior, reassure resident, do not argue with resident, redirect resident to other activities



Depression:• Causes: losing independence, facing incurable disease, feelings of failure, fear, chemical imbalance

• Interventions: report to nurse, medications may help, try to note triggers, encourage independence and self-care, reward activities that improve mood, foster social relationships, listen to resident, offer comfort and concern, be as pleasant as possible, use touch if it does not bother the person



Define the following term:disruptive behavior any behavior that disturbs others.



Disruptiveness:• Causes: pain, constipation, frustration, wish for attention

• Interventions: get resident’s attention, stay calm, be friendly, try to direct resident to quiet area, try to find out why behavior is occurring



Inappropriate sexual behavior:• Causes: rash, tight clothing, need to urinate• Interventions: direct resident to private area, distract resident, report to nurse, consider appropriate ways to provide physical stimulation



Inappropriate social behavior:• Interventions: do not take it personally, try to remove resident from area, try to find out what caused the behavior, stay calm



Perseveration or repetitive phrasing:• Interventions: be patient, respond to questions with the same words each time, do not try to silence or stop resident



Define the following terms:pillaging taking things that belong to someone else; not considered stealing.

hoarding collecting and putting things away in a guarded way.

rummaging going through items that belong to other people.



Pillaging, rummaging, and hoarding:• Interventions: remember that behaviors are not within resident’s control, label resident’s belongings, remember hiding places, notify family and friends and enlist help, create a drawer for rummaging



Define the following term:sundowning a condition in which a person gets restless and agitated in the late afternoon, evening, or night.



Sundowning:• Causes: hunger, fatigue, change in routine or caregiver

• Interventions: provide adequate lighting; avoid stressful situations during this time; play soft music; discourage naps; set a bedtime routine; plan calming activities; serve evening meal long before bedtime; eliminate caffeine; give back rubs; redirect behavior; maintain exercise routine



Suspicion:• Interventions: do not argue, offer calm reassurance, be understanding and supportive



Define the following terms:pacing walking back and forth in the same area.

wandering walking around a facility without any known goal or purpose.

elopement in medicine, when a person with Alzheimer’s disease wanders away from a protected area and does not return on his own.



Pacing and wandering:• Causes: restlessness, hunger, disorientation, the need to use the bathroom, constipation, pain, forgetting how or where to sit down, too much daytime napping

• Interventions: encourage exercise, minimize napping, let residents pace in safe area, redirect attention, place stop signs on doors



Think about this question:Why can caring for someone with Alzheimer’s disease be very difficult?



REMEMBER:Residents with AD may exhibit frustrating behaviors. You can never abuse residents in any way. If you feel you cannot respond professionally to a resident, talk to your supervisor.


11. Discuss ways to provide activities for residents with Alzheimer’s disease

Activities are very important for residents with Alzheimer’s disease, and there are different types of activities.• Meaningful activities help people with Alzheimer’s disease maintain or improve their ability to function in daily life. They draw on past skills the resident has used throughout his life. For example, if a resident was a person who filed medical records, giving her papers or folders to file can help her stay focused on a task.

• Other activities—called “doing” activities—keep residents busy. For example, folding towels can help the resident stay focused.



REMEMBER:Gather information from residents’ friends and family about residents’ likes, dislikes, and interests. This will help you to provide activities and work with residents.



Think about this question:What is the difference between “meaningful” activities and “doing” activities and when is each useful?



Remember these tips for meaningful activities:• Encourage family participation.• Limit some activities to small groups.• Use quiet areas.• Set short time frames for activities.• Plan events based on residents’ interests.



Meaningful activities (cont’d.):• Plan activities for the time of day when residents are feeling best.

• Encourage exercise.• Plan activities that allow residents to make things that can be utilized.

• Encourage specific skills.• Read or play music for immobile residents.


12. Describe therapies for residents with Alzheimer’s diseaseDefine the following terms:reality orientation type of therapy that uses calendars, clocks, signs, and lists to help people with Alzheimer’s disease remember who and where they are, along with the date and time.

validation therapy a type of therapy that lets people with Alzheimer’s disease believe they are living in the past or in imaginary circumstances.

validating giving value to or approving.


12. Describe therapies for residents with Alzheimer’s diseaseDefine the following terms:reminiscence therapy type of therapy that encourages people with Alzheimer’s disease to remember and talk about the past.

remotivation therapy type of group therapy that promotes self-esteem, self-awareness, and socialization for people with Alzheimer’s disease.


12. Describe therapies for residents with Alzheimer’s diseaseThink about this question:Can you think of a situation when each type of creative therapy would be most appropriate?


13. Discuss mental health, mental illness, and related disordersDefine the following terms:mental health refers to the normal function of emotional and intellectual abilities.

mental illness a disease that disrupts a person’s ability to function at a normal level in the family, home, or community.


13. Discuss mental health, mental illness, and related disordersA mentally healthy person will have successful relationships with family, friends, neighbors, and co-workers. He will perform well in professional and home settings and will meet his responsibilities.

Mental illness affects a person’s ability to function within family, home, work, or community settings. It often causes inappropriate behavior.


13. Discuss mental health, mental illness, and related disordersDefine the following terms:generalized anxiety disorder (GAD) an anxiety disorder characterized by chronic anxiety, excessive worrying, and tension, even when there is no cause for these feelings.

psychotherapy a method of treating mental illness that involves talking about one’s problems with mental health professionals.


13. Discuss mental health, mental illness, and related disordersRemember these points about generalized anxiety disorder (GAD):• Characterized by chronic anxiety and excessive worrying even when there is no cause for these feelings

• Symptoms: headache, muscle aches, sweating, shaking, difficulty swallowing, irritability

• Treatment: medication and psychotherapy


13. Discuss mental health, mental illness, and related disordersDefine the following term:post-traumatic stress disorder (PTSD) anxiety-related disorder caused by a traumatic experience.


13. Discuss mental health, mental illness, and related disordersKnow these points about post-traumatic stress disorder (PTSD):• May develop after a traumatic experience, crime, disaster or accident

• Symptoms: flashbacks, withdrawal, sleep disturbances• Treatment: medication and psychotherapy


13. Discuss mental health, mental illness, and related disordersDefine the following term:obsessive-compulsive disorder (OCD) an anxiety disorder characterized by repetitive thoughts or behaviors.


13. Discuss mental health, mental illness, and related disordersUnderstand these points about obsessive compulsive disorder (OCD):• Characterized by repetitive behavior used to cope with anxiety



13. Discuss mental health, mental illness, and related disordersDefine the following term:social anxiety disorder a disorder in which a person has excessive anxiety about social situations; also called social phobia.


13. Discuss mental health, mental illness, and related disordersKnow these points about social anxiety disorder:• Disorder in which a person has excessive anxiety about social situations

• Symptoms: sweating, shaking, upset stomach• Treatment: medication and psychotherapy


13. Discuss mental health, mental illness, and related disordersDefine the following term:panic disorder an anxiety disorder that causes a person to have repeated episodes of intense fear that something bad will occur.


13. Discuss mental health, mental illness, and related disordersUnderstand these points about panic disorder:• Anxiety disorder that causes repeated episodes of intense fear for no known reason

• Symptoms: dizziness, rapid heartbeat, chest pain, difficulty breathing, upset stomach, feeling of doom



13. Discuss mental health, mental illness, and related disordersRemember these points about depression:• Serious mental illness in which overwhelming sadness makes it difficult for person to function normally

• Symptoms: pain, fatigue, apathy, weight loss, sleep problems, irritability, feelings of worthlessness

• A person who is depressed cannot simply choose to be well.



13. Discuss mental health, mental illness, and related disordersDefine the following term:bipolar disorder a type of depression that causes a person to have mood swings and changes in energy levels and the ability to function; also called manic depression.


13. Discuss mental health, mental illness, and related disordersUnderstand these points about bipolar disorder:• Causes a person to have mood swings, changes in energy levels and ability to function

• Symptoms: high energy, little sleep, high self-esteem, poor judgment

• Treatment: long-term medication


13. Discuss mental health, mental illness, and related disordersDefine the following terms:schizophrenia a form of chronic mental illness that may involve acute episodes; affects a person’s ability to think, communicate, make decisions, and understand reality.

paranoid schizophrenia a form of mental illness characterized by hallucinations and delusions.


13. Discuss mental health, mental illness, and related disordersKnow these points about schizophrenia and paranoid schizophrenia:• Brain disorder that affects a person’s ability to think clearly

• Symptoms: hallucinations, delusions, disorganized thinking and speech, lack of interest in life and planning activities, poor hygiene, problems with memory

• Treatment: anti-psychotic medication


13. Discuss mental health, mental illness, and related disordersRemember these care guidelines for mentally ill residents:• Encourage self-care.• Encourage independence with ADLs.• Observe for changes in behavior.• Watch your body language.• Always treat adults like adults.


13. Discuss mental health, mental illness, and related disordersCare guidelines for mentally ill residents (cont’d.):• Do not yell or use a harsh tone of voice.• Use eye contact when communicating.• Provide support for resident, family and friends.• Report change in ability to perform ADLs; changes in mood and behavior; behavior that seems extreme or dangerous; hallucinations or delusions; comments or jokes about suicide; concern that medication is not being taken; or specific situations that cause behavior changes.


14. Discuss substance abuse and list signs of substance abuse to report

Define the following terms:substance abuse the use of legal or illegal substances in a way that is harmful to oneself or others.

withdrawal the physical and mental symptoms caused by ceasing to use a particular addictive substance.



Here are some of the types of substances that are abused:• Alcohol • Tobacco• Legal and illegal drugs• Glue• Paint• Permanent markers



These are risk factors for substance abuse:• Difficult childhood• Unstable home environment• Poor coping skills



Know the signs of substance abuse to report:• Changes in physical appearance• Changes in personality• Forgetfulness• Confusion• Loss of appetite



Signs of substance abuse to report (cont’d.):• Stealing money or valuables• Smell of alcohol, cigarettes or other substances in room or on clothing

• Strong smell of room fresheners• Increased use of breath fresheners• Hiding substances or alcohol



Signs of substance abuse to report (cont’d.):• Blackouts or memory loss• Problems with other residents, staff, friends or family

• Constricted or dilated pupils• Slurred speech• Thoughts of suicide


ExamMultiple Choice. Choose the correct answer.1. The basic working unit of the nervous system is the:(A) Brain(B) Spinal cord(C) Neuron(D) Receptor

2. The ______ is/are part of the peripheral nervous system.(A) Brain(B) Spinal cord(C) Cerebrum(D) Spinal nerves


Exam (cont’d.)3. The ______ is the circular opening which dilates and constricts to adjust the amount of light coming into the eye.(A) Sclera(B) Iris(C) Retina(D) Pupil

4. The tiny bones within the middle ear that pick up vibrations and send impulses to the brain are the:(A) Ossicles(B) Eardrums(C) Cochleas(D) Auricles


Exam (cont’d.)5. Which of the following is a function of the nervous system?(A) Gives the body shape and structure(B) Provides a natural protective covering to the body(C) Produces and supplies antibodies and other infection-fighting blood cells(D) Senses and interprets information from outside the body

6. Normal age-related changes for the nervous system include:(A) Responses and reflexes speed up(B) Some memory loss occurs(C) Sensitivity of nerve endings in skin increases(D) Senses of vision, smell, and taste become stronger


Exam (cont’d.)7. Which of the following is a care guideline for residents recovering from a CVA?(A) Do as much as possible for the resident so that care can be completed more efficiently.(B) Encourage resident to finish tasks as quickly as possible to help speed recovery.(C) Assist with ambulation to prevent falls. (D) Place food in the affected/weaker side of the mouth when feeding. 8. Parkinson’s disease typically causes(A) A shuffling gait(B) Extremely straight posture(C) Memory loss(D) Aggressive behavior


Exam (cont’d.)9. Guidelines for caring for a resident with multiple sclerosis include(A) Rushing resident through tasks(B) Administering medications(C) Preventing falls(D) Encouraging the resident to speak faster

10. ______ is the loss of function of the lower body and legs.(A) Concussion(B) Paraplegia(C) Quadriplegia(D) Hemiplegia


Exam (cont’d.)11. Treatment for seizures includes:(A) Range of motion exercises(B) Restraining the resident when seizures occur(C) Medication or surgery(D) Physical therapy

12. Which of the following is a care guideline for visual impairments?(A) Use the face of an imaginary clock as a guide to explain position of objects in the room.(B) Keep the room as dark as possible.(C) Walk behind the resident while touching is back.(D) Touch the resident before identifying yourself, so as not to startle him or her.


Exam (cont’d.)13. How should an artificial eye be cleaned?(A) With alcohol(B) With water(C) With toothpaste(D) With bleach

14. Guidelines for hearing aids include:(A) Hearing aids should be left on when not in use(B) The batteries in a hearing aid last for the life of the hearing aid and do not need to be changed(C) Make sure residents with hearing aids have them turned on(D) Soaking hearing aids in water makes cleaning them easier


Exam (cont’d.)15. The ability to think logically and quickly is called:(A) Cognition(B) Dementia(C) Awareness(D) Dysphagia 16. Which of the following terms means “a serious loss of mental abilities?”(A) Cognition(B) Irreversible(C) Dementia(D) Onset


Exam (cont’d.)17. Which of the following statements is true of Alzheimer’s disease (AD)?(A) Skills a person has used over a lifetime are usually kept longer.(B) Residents with AD will show the same signs at the same times.(C) NAs should do everything for residents with AD.(D) Alzheimer’s disease is a normal part of aging.

18. Strategies for better communication with residents who have AD include:(A) Only talk about one subject at a time, using simple, short sentences(B) Do not repeat instructions or questions because this may upset the resident(C) Watching for nonverbal cues is usually not helpful with residents with AD(D) If the resident does something that is unsafe, tell him to stop immediately


Exam (cont’d.)19. If a resident with AD has lost most of his verbal skills, the NA should:(A) Assume the resident cannot understand what is being said(B) Use touch, smiles, and laughter(C) Ask the resident questions(D) Do not involve resident in activities

20. If a resident with AD is incontinent, the nursing assistant should:(A) Withhold fluids(B) Dim the bathroom lights(C) Mark the restroom with a sign or picture(D) Wait longer periods of time before taking the resident to the bathroom so that he will really need to go when he gets there


Exam (cont’d.)21. If a resident with AD has problems with bathing, the nursing assistant should:(A) Schedule bathing when the resident is least agitated(B) Hurry the resident through the bath(C) Insist that the resident bathe even if she does not want to(D) Surprise the resident with the bath

22. If a resident with AD becomes violent, the NA should:(A) Step out of the way and remove triggers if possible(B) Restrain the resident(C) Hit the resident(D) Ignore the resident


Exam (cont’d.)23. One way for a nursing assistant to help a resident with AD with eating is to:(A) Put a few types of food on the plate at the same time(B) Use dishes without a pattern and a simple place setting(C) Withhold food until the resident is really hungry(D) Serve steaming hot foods and drinks 24. If a resident with AD has problems with dressing, the nursing assistant should:(A) Lay out clothes in the order they should be put on(B) Dress the resident in the hallway(C) Choose the resident’s clothing for the resident(D) Give the resident multiple steps to follow


Exam (cont’d.)25. A good way for a nursing assistant to respond to hallucinations is to:(A) Tell the resident that what she thinks she sees isn’t real(B) Tell the resident that she can see the hallucination, too(C) Reassure a resident who is upset and worried(D) Laugh at the resident to ease tensions

26. A nursing assistant can respond to sundowning by:(A) Adding more caffeine to the resident’s diet(B) Setting a bedtime routine and keeping it(C) Restricting exercise during the day(D) Scheduling activities during this time


Exam (cont’d.)27. If a resident with AD shows violent behavior, the nursing assistant should:(A) Hit back(B) Remove triggers(C) Leave the resident alone until he calms down(D) Yell at the resident to scare him into stopping

28. Which of the following is a good way for a nursing assistant to respond to inappropriate sexual behavior?(A) Let other residents know what is happening(B) Take the resident to a private area(C) Inform other nursing assistants that the resident has a dirty mind(D) Loudly reprimand the resident to shame him into stopping


Exam (cont’d.)29. When a resident with AD pillages and hoards, the nursing assistant should:(A) Let the family know that the resident is stealing things(B) Lock the resident in his room if the NA does not have time to watch him(C) Warn the other residents that the resident with AD is a thief(D) Provide a rummage drawer

30. Therapy that allows residents with AD to believe that they live in the past or in imaginary circumstances is:(A) Reality orientation(B) Validation therapy(C) Reminiscence therapy(D) Remotivation therapy


Exam (cont’d.)31. A person who is mentally healthy:(A) Can’t respond to emotions appropriately(B) Is unlikely to have relationships with others(C) Does not control impulses well(D) Performs well in professional settings 32. The anxiety disorder that is characterized by repetitive thoughts or behavior is:(A) Generalized anxiety disorder(B) Post-traumatic stress disorder(C) Obsessive-compulsive disorder(D) Social anxiety disorder


Exam (cont’d.)33. Signs and symptoms of clinical depression include:(A) Intense hunger(B) Breath that smells fruity(C) Intense, sudden chest pain(D) Apathy

34. Which of the following is a good way to for a nursing assistant to care for a mentally ill resident?(A) Do everything for the resident.(B) Give the resident his or her medication.(C) Support the resident and his or her family and friends.(D) Let the resident know that mental illness is not real.


Exam (cont’d.)35. Which of the following statements about observing mentally ill residents is true?(A) An NA does not need to report a comment about suicide as long as it is a joke.(B) An NA needs to report changes in mood.(C) Social withdrawal does not need to be reported.(D) Changes in abilities to perform ADLs do not need to be reported.

36. Which of the following is a common set of treatments for anxiety disorders?(A) Electroconvulsive (shock) therapy and psychosurgery(B) Medication and psychotherapy(C) Psychotherapy and psychosurgery(D) Medication and electroconvulsive (shock) therapy


Exam (cont’d.)37. A resident has been acting a little strangely lately. She gets upset very easily and her eyes are always red. She does not eat much, and sometimes the nursing assistant can smell alcohol on her breath, even in the morning. What should the nursing assistant do?(A) Confront the resident about what she has noticed.(B) Call Alcoholics Anonymous.(C) Report her observations to the nurse.(D) Tell the facility’s chaplain.

22 The Nervous System 1. Define important words in this chapter age-related macular degeneration...

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