Certified Nursing Assistant Psychosocial Care

1.You are meeting Mr. Okonkwo for the first time. His door is half closed, and the assignment sheet says he prefers Mr. Okonkwo rather than his first name. How do you begin?

2.Ms. Pell is in a wheelchair in the hall and wants to talk about her grandson. You are standing over her, and she keeps tilting her head back. What should you change?

3.Mr. Berg has hearing loss in both ears. The television is loud, and you need to tell him that lunch has arrived. He does not use sign language. What helps him hear you?

4.Ms. Cho does not answer your question about a sweater. You then notice her hearing aid is still in the case on the dresser. She usually wears it. What should you do?

5.Mr. Ellis cannot see. You are entering his room to walk with him to the chapel, and a chair has been left in a new spot near the bed. What should you do?

6.Ms. Navarro had a stroke and uses a communication board. She is pointing and getting frustrated while you guess the wrong word and keep talking. What should you do?

7.Mr. Dalton's speech is slurred after an illness. A visitor laughs and says he sounds drunk. He looks hurt and stops talking. What should you do?

8.Ms. Farooq has moderate dementia and is sitting in a chair facing the window. You need to help her to the toilet. She startles when you touch her shoulder from behind. What is a better approach?

9.Mr. Klein has dementia and cannot recall your name from five minutes ago. A coworker quizzes him: "Don't you remember who this is?" He looks ashamed. What should you do?

10.Ms. Brooks asks you to take her to the bus because her mother is waiting at school. Her mother died many years ago, and correcting her last week made her cry. What should you say and do?

11.Every late afternoon Mr. Abebe becomes restless, tries to leave the unit, and says the light feels wrong. Mornings are calm. Supper is still an hour away. What should you try?

12.Ms. Lange is walking the same safe loop of hallway and saying she needs air. She is not at an exit door. Her shoes are on, and she is steady with a walker. What should you do?

13.Mr. Petrov is in Mrs. Singh's room, going through her dresser drawers and pocketing a scarf. Mrs. Singh is upset. Mr. Petrov has dementia and often looks for folded cloth. What should you do?

14.Ms. Ortiz keeps bread and a carton of milk in her bedside drawer. Today the milk smells sour and the bread is hard. She says the food is her emergency supply. What should you do?

15.During a shower, Mr. Hale suddenly shouts, slaps at the water, and tries to climb out of the chair. He was calm ten minutes ago. The room is noisy because a radio is on. What should you do?

16.Ms. Grant swings a hand toward your face as you raise a washcloth. She misses. Her jaw is clenched and she says, "Get away." What should you do?

17.Mr. Brennan says quietly, "I do not want to wake up tomorrow. Everyone would be better off." He is alone in his room and is looking at you. What should you do?

18.Ms. Duarte's daughter leaves after a short visit. Ms. Duarte starts to cry and says, "She never stays." You have a few minutes. What is a respectful response?

19.Mr. Santos arrives from the hospital in the late afternoon. He does not know where the bathroom is, and his hands are shaking. A full tour is not possible before supper. What do you cover first?

20.Mrs. Cohen and Mrs. Blake share a room. Mrs. Cohen wants the evening news. Mrs. Blake wants quiet because of a headache. Both are alert and asking you to settle it. What should you do?

21.Mr. Rahman tells you he cannot accept a bath from you because you are a man. A woman aide is available on the unit. There is no emergency soiling. What should you do?

22.Ms. Haddad is praying on a mat in her room. You had planned to change the linen during this time. The linen is not soiled, and she is not unsafe. What should you do?

23.Mr. Weiss keeps kosher. The tray that arrives has a pork chop and a note that the utensils touched a meat dish from another tray. He is upset. What should you do?

24.Ms. Iyer eats a vegetarian tray. Today the kitchen put chicken on the plate. A coworker says, "Just pick the chicken off." She looks distressed. What should you do?

25.Mr. Chen's eight-year-old grandchild offers to interpret while you ask about chest discomfort and a new rash. Mr. Chen speaks little English. A phone interpreter is available. What should you do?

26.Ms. Bernard is crying quietly. You want to comfort her. Last week she pulled her hand away when someone held it without asking. What should you do?

27.Mr. Novak looks at the floor while you speak. A coworker says, "Make him look at you. That is how you know he is honest." He seems respectful and is answering your questions. What should you do?

28.Ms. Park nods while you explain a shower, but she does not speak much English. When you turn the water on, she pulls back and shakes her head. An interpreter is available by phone. What should you do?

29.Mr. Gallagher says he is frightened tonight and asks if you will pray with him. You are willing to sit quietly while he prays. You do not share his religion. What should you do?

30.Reverend Cole is visiting Ms. Trent at her request. You need to drop off a clean gown. The curtain is drawn and you hear them talking. What should you do?

31.While you change Mr. Ali's gown, his religious medal comes loose and nearly goes into the linen bag. He wants it kept near him. What should you do?

32.Ms. Brennan, who is alert, says she wants last rites and asks you to get someone tonight. You are not clergy. What should you do?

33.Mr. Olsen's wife died last month. He tells the same story about her garden every evening. A coworker says, "He should be over it by now." He is not asking you to fix anything. What should you do?

34.Ms. Clark waited 25 minutes for help to the toilet. She is angry and says you forgot her. You were in another room and have just arrived. She is wet and cold. What should you do?

35.Mr. Pike shouts, "You are stupid," while you are putting on his shoes. He is not raising a hand. He has been angry since a phone call. What should you do?

36.During a shave, Mr. Cole smiles and makes a sexual comment about your body. You feel uncomfortable. He is alert and has been told this before. What should you say and do?

37.Mr. and Mrs. Adelman, who are both alert and married, ask you to close the door so they can be alone together. Nothing in the plan restricts the visit. What should you do?

38.Ms. Foley has advanced dementia and cannot say what she wants. Another resident, who is also confused, is touching her in a sexual way in the dayroom. She is pulling away and whimpering. What should you do?

39.You enter Mr. Shaw's room and see that he is masturbating. He did not call you. The curtain is open toward the hallway, and he is alert. What should you do?

40.Ms. Krueger, who has a serious illness, asks, "Am I dying?" You do not know her medical details. She is looking straight at you. What should you do?

41.Mr. Bennett has stayed in bed for three days, refused activities he used to like, and eaten little. He says, "What is the point?" He is not sleepy from a new medicine that you know of. What should you do?

42.Mrs. Kapoor presses a folded twenty-dollar bill into your hand and says, "For being kind." Facility policy forbids staff from accepting money. She will not be offended if you explain. What should you do?

43.A coworker wants a selfie with Mr. Alvarez for a personal social media story. Mr. Alvarez is dozing and has not been asked. The facility has a separate process for publicity photos. What should you do?

44.Ms. Romano's daughter arrives. Ms. Romano, who has dementia, does not recognize her and pulls away in fear. The daughter is hurt and reaches for a hug. What should you do?

45.Mr. Blake is mildly confused this morning and asks what day it is. He accepts help and does not get angry when you answer. A calendar is on the wall. What should you do?

46.Ms. Yuen has advanced dementia. Each time you say, "Your son is not here today," she cries and searches the hall. The son visits on Sundays, and today is Wednesday. What should you do?

47.Mrs. Paul is usually alert and oriented. This morning she thinks she is at her first job and does not know you. Her temperature is 100.4 F by the oral route the nurse asked you to use. What should you do?

48.Mr. Duffy has dementia. He strikes out while you are changing a wet brief. After you stop and cover him, he holds his lower abdomen and grimaces. What should you tell the nurse?

49.Ms. Ortega paces the square hallway in slippers. She has not used the toilet since early morning, and lunch is near. She is not trying to leave the unit. What should you offer first?

50.Mr. Rossi puts on his coat at 4 p.m. and says he will be late for his shift at the mill. He has not worked in many years. Grabbing his sleeve makes him pull harder toward the exit. What should you try?

51.Four staff are about to hold Ms. Green down for a routine bath. She is not soiled, she is cold, and she has refused twice. She is crying. What should you do?

52.Mr. Walsh eats two bites and pushes the tray away. He can swallow safely. The dessert on his diabetic tray is allowed. A coworker says, "No dessert unless the meat is gone." What should you do?

53.Ms. Bergstrom is wearing three sweaters in a warm activity room. Her face is flushed, she is sweaty, and she says she feels dizzy. She agreed to keep one sweater. What should you do?

54.Mr. Nguyen follows you from room to room. He is safe and keeps asking if you will come back. You need to help another resident briefly. What should you do?

55.Ms. Levy asks, "When is lunch?" every few minutes. You have answered kindly three times. She has moderate dementia and becomes hurt if you sound sharp. Lunch is at noon. What should you do?

56.Mr. Owen tells you a cat is sitting on the foot of his bed. You do not see a cat. He is smiling and is not trying to get up. What should you say?

57.Ms. Sharp screams that spiders are covering the walls. She is trying to climb out of bed to escape them. You do not see spiders. The room has a chair in her path. What should you do?

58.Mr. Bauer will not eat because he believes the kitchen is poisoning the soup. He is alert, hungry, and watching the hallway. His diet is a regular tray. What should you try?

59.Ms. Peralta starts breathing fast and saying she cannot face the shower. She is sweaty and has not stepped into the room yet. She can speak in full sentences. What should you do?

60.Mr. Whitaker flinches and raises his arms when you enter quietly and touch his shoulder. He is a combat veteran and has asked staff to speak before any touch. He is not injured. What should you do now?

61.A student asks Mr. Harlow, a veteran, to describe the worst day of the war for a school project. Mr. Harlow says, "I do not talk about that," and looks away. What should you do?

62.Mrs. Kim's family brings a favorite stew for a holiday. Her plan is a pureed diet with nectar-thick liquids because she coughs on regular food. The stew is chunky. What should you do?

63.Mr. Hassan is observing a religious fast. He tells you not to bring breakfast. He is alert, and the nurse was already informed yesterday. Midmorning he is dizzy when he stands. What should you do?

64.Mr. Cole has dementia and often kicks the sheet off. You need to wash his legs in a shared room. The curtain is open, and a visitor is walking by. What should you do?

65.In a crowded elevator, your coworker starts to describe a resident's incontinence and room number. Visitors are listening. What should you do?

66.Ms. Sato rarely complains. During a transfer she grimaces, holds her breath, and guards her shoulder. When you ask if she hurts, she says, "It is nothing. Please continue." What should you do?

67.You have been saying Ms. Ndoye's name incorrectly. She finally says the pronunciation and looks relieved when you repeat it once the right way. What should you do for the rest of the shift?

68.Alex, a resident, says, "Please call me Alex, and use he." The old chart name is different. A coworker keeps using the old name and she. Alex looks away. What should you do?

69.Jordan is transgender and is about to receive a bath from you. Jordan has asked for privacy and for staff not to ask questions that are only curious. A coworker wants to ask about surgery. What should you do?

70.Mr. and Mrs. Pell, who are both residents, ask to share a room. They are alert and have made the request before. A coworker says it is easier to keep them apart. What should you do?

71.Devin is 24 and has a spinal cord injury. A visitor talks to Devin in baby talk and directs every question to the parent. Devin can speak and is frowning. What should you do?

72.Ms. Carpenter has an intellectual disability. She can point to clothes and say yes and no. Her brother starts answering every question you ask her about the bath. She is looking at the blue shirt. What should you do?

73.A six-year-old grandchild is scared to enter Mr. Patrick's room and starts to cry at the door. Mr. Patrick is smiling and wants the visit. The child does not know the medical details. What should you do?

74.During bingo, Mr. Foster leaks urine onto his chair. He freezes and looks at the other players. He can walk with you. What should you do?

75.The activity aide invites Ms. Rowe to a loud sing-along. She says, "No, I want to stay here with my book." She is alert and safe in the room. What should you do?

76.Mr. Bianchi relaxes when opera plays softly during his evening care. His roommate is at a program, and the care plan notes that this music helps him. What should you do?

77.Ms. Green's roommate is asleep with a headache. Ms. Green wants a radio play at a high volume. Both women are alert. What should you do?

78.A visiting dog is approved for the unit. Mr. Stein backs into the corner, says he is afraid, and asks for the dog to leave the room. The handler is present. What should you do?

79.Ms. Adler shows you a photo of a bakery she ran and starts telling a long story. You have time while she rests after a bath. Some details do not match what her daughter said yesterday. She is enjoying herself. What should you do?

80.Mr. Costa lights up when tea is served at 4 p.m., which is the routine written in his care plan. Today the cart is late and he is asking for the tea. Fluids are encouraged, and tea is allowed. What should you do?

81.Ms. Heller says, "Losing my car keys and my license feels like losing my life." She is not asking to drive. She is sitting with the keys in her lap. What should you say?

82.A visitor stares at Mr. Ahmad's amputated leg and whispers about it. Mr. Ahmad pulls the blanket up and goes quiet. He had been eager for the visit. What should you do?

83.Ms. Brooks is losing hair during cancer treatment. She has a scarf she likes and asks for help tying it before her sister arrives. She does not want comments about looking sick. What should you do?

84.Mr. Diaz has a colostomy. Visitors are due in twenty minutes, and the pouch is inflated with gas. He is embarrassed and asks you to empty it first. You have been trained to empty the pouch. What should you do?

85.You called Ms. Hart sweetie. She says, "My name is Ms. Hart. Please do not call me sweetie." She is calm and clear. What should you do?

86.Mr. Frank has advanced dementia and becomes overwhelmed when you open the whole closet and ask what he wants to wear. He can still point. Two clean shirts are appropriate for the weather. What should you do?

87.Ms. Olsson answers slowly. You asked whether she wants the chair by the window. She has not spoken for several seconds, but she is thinking and looking at the window. What should you do?

88.You realize you are standing over Mr. Banks with your arms crossed while he talks about his brother. He lowers his voice and looks at your posture. There is a chair he has offered. What should you do?

89.Mr. Lane's son shouts at you because a sheet was wrinkled. He is not threatening. Mr. Lane looks embarrassed. The sheet is an easy fix. What should you do?

90.Mrs. Stein's daughter calls the desk and asks you for yesterday's lab results and what they mean. You saw a number on a report at the nurses' station. What should you say?

91.Your neighbor asks whether Mr. Hollis from your street is on your unit and how his surgery went. You do provide his care. What should you say?

92.Ms. Pereira finished a letter and asks you to mail it. The envelope is sealed. She does not want it opened. Stamps and the outgoing mail slot are available. What should you do?

93.Mr. Doyle asks for help marking a mail-in ballot. He can state his choices. He wants you to fill the circles he names and then seal the envelope. What should you do?

94.Ms. Charles wants to complain at resident council that breakfast is cold. She asks if complaining will get her in trouble. She is alert. What should you tell her?

95.Mr. Rivera's daughter wants you to rub a homemade herbal paste on a red area of his heel. The paste is in an unlabeled jar. It is not on the care plan. What should you do?

96.You are using a phone interpreter for Ms. Alvarez, who has questions about tomorrow's bath time. The interpreter is on speaker. Ms. Alvarez keeps looking at the phone instead of at you. What should you do?

97.Mr. Blake is deaf, does not use sign, and reads short notes. You need to tell him that his daughter is in the lobby. The hallway is noisy. What should you do?

98.A sign-language interpreter is explaining evening care to Ms. Cole. You need to know whether she wants a shower or a bed bath. Where do you look while you speak?

99.Ms. Pruitt, who has moderate dementia, pats your hand and says, "Come to bed, you are my husband." You are not her husband. She is smiling and is not undressed. What should you do?

100.At 1 a.m. Mr. Shah wakes, needs the toilet, and then says he is not sleepy. His fluids are allowed. The hallway is quiet and his roommate is asleep. What should you do?

101.The unit is hanging holiday symbols on doors. Mr. Goldstein does not observe that holiday and says he does not want a symbol on his door. A coworker has the decoration ready. What should you do?

102.A visiting clergy member you do not know wants to pray over Ms. Untiedt while she is asleep. She has not asked for this person, and her plan lists a different faith visitor. What should you do?

103.Ms. O'Donnell's son says, "Do not tell my mother what the doctor said. Just tell her she is fine." She is alert and has been asking you why she feels worse. You do not know the doctor's words. What should you do?

104.Mr. Ellis eats alone and tells you the evenings feel empty since his brother died. You have ten free minutes before the next assignment. He asks you to sit. What should you do?

105.Mr. Vaughn says, "If you come closer I will hit you," and raises a fist. You are between him and the door. He has not been touched. What should you do?

106.Ms. Bernard is embarrassed about her accent and stops mid-sentence when a coworker chuckles. She was telling you about pain in her knee. The coworker has left. What should you do?

107.Mr. Coleman's family speaks loudly and sings a short blessing at the bedside. No one is in isolation, and the roommate has said the singing does not bother him. A coworker wants them asked to leave for being "too much." What should you do?

108.Ms. Khan wears a head covering for religious reasons and has asked staff not to remove it in public. You need to check a sore on her scalp that she already reported. She agrees to have it looked at in her room. What should you do?