1. 1. Define important words in this chapter
airway
the natural passageway for air to enter into the lungs.
anxiety
unease or worry, often about a situation or condition.
artificial airway
any tube inserted into the respiratory tract for the purpose of maintaining an airway and facilitating ventilation.
coma
state of unconsciousness in which a person is unable to respond to any change in the environment, including pain.
combative
violent or hostile.

2. 1. Define important words in this chapter
confusion
the inability to think clearly and logically.
defense mechanisms
unconscious behaviors used to release tension and/or help a person cope with stress.
disorientation
confusion about person, place, or time; may be permanent or temporary.
dyspnea
difficulty breathing.
impairment
a partial or complete loss of function or ability.

3. 1. Define important words in this chapter
major depressive disorder
an illness that causes social withdrawal, lack of energy, and loss of interest in activities, as well as other symptoms.
masturbation
to touch or rub sexual organs in order to give oneself or another person sexual pleasure.
tracheostomy
a surgically-created opening through the neck into the trachea.
ventilation
in medicine, the exchange of air between the lungs and the environment.

4. 2. Identify communication guidelines for visual impairment
Define the following term: impairment a partial or complete loss of function or ability.

5. 2. Identify communication guidelines for visual impairment
REMEMBER: There are many causes for visual impairment, including diseases such as diabetes and glaucoma. A visual impairment is also something that can exist at birth. People of all ages can be visually impaired, and it can affect one or both eyes.

6. 2. Identify communication guidelines for visual impairment
Remember these guidelines for visual impairment:
Knock, announce yourself, and greet the resident when entering the room. Explain the care you are going to provide.
Face the resident while speaking to him.
Make sure there is proper lighting.
Do not shout.
Use the face of an imaginary clock to explain the position of objects.
Make sure the resident has his eyeglasses on if he wears them.

7. 2. Identify communication guidelines for visual impairment
Guidelines for visual impairment (cont’d):
Do not move personal items or furniture, and put everything back where it was found.
Read menus to the resident.
Encourage resident to use his other senses.
Let the resident know when you leave the area.
Do not play with, distract, or feed guide dogs.
Offer helpful items such as audiobooks, large-print books, digital books, and large clocks.
Be empathetic.

8. 3. Identify communication guidelines for hearing impairment
REMEMBER: Residents may have different kinds of hearing impairment. Having a partial hearing loss in one ear is one example. Being unable to hear at all is another example. Hearing may also be temporarily impaired due to the noise level in a room.

9. 3. Identify communication guidelines for hearing impairment
The following are symptoms of hearing loss to observe and report:
Trouble hearing high-pitched noises
Trouble hearing soft consonants, such as “s” and “t”
Trouble hearing what is said in a setting that has background noise
Not understanding the meaning of words

10. 3. Identify communication guidelines for hearing impairment
Symptoms of hearing loss (cont'd):
Being unable to hear people when they are not in the same room
Favoring one ear over the other one
Avoiding movies or special events due to not being able to understand the dialogue
Complaints of ringing in the ears
Complaints of pain in one or both ears

11. 3. Identify communication guidelines for hearing impairment
Remember these guidelines for hearing impairment:
Get resident’s attention before speaking.
Stand or sit so the resident can see your face.
Look at the resident directly while speaking.
Make sure hearing aids are worn and are turned on.
Turn off TV or radio.
Speak clearly and do not shout.

12. 3. Identify communication guidelines for hearing impairment
Guidelines for hearing impairment (cont'd):
Lower the pitch of your voice.
Do not chew gum, eat, or cover your mouth while speaking.
Do not exaggerate pronunciation of words or mouth words in an exaggerated way.
Use simple words and short sentences.
Use pen and paper or picture cards.

13. 3. Identify communication guidelines for hearing impairment
Think about these questions: How would it feel to not be able to hear? If you were in this position, what things could others do that you would appreciate?

14. 4. Explain defense mechanisms as methods of coping with stress
Define the following term: defense mechanisms unconscious behaviors used to release tension and/or help a person cope with stress.

15. 4. Explain defense mechanisms as methods of coping with stress
Defense mechanisms are unconscious behaviors, but they can prevent a person from dealing with his or her real feelings.
Can you think of examples of each of the following defense mechanisms?
Denial
Displacement
Projection
Rationalization
Repression
Regression

16. 4. Explain defense mechanisms as methods of coping with stress
Think about this question: Why might it be helpful for a nursing assistant to understand and be alert to different defense mechanisms?

17. 5. List communication guidelines for anxiety or fear
Define the following term: anxiety unease or worry, often about a situation or condition.

18. 5. List communication guidelines for anxiety or fear
REMEMBER: Feeling anxious is not the same as feeling afraid. Anxiety is a vague emotional state. The unpleasant feelings are coming from the anticipation of something bad that could happen or a future danger. The danger is not happening in the present time, but anxiety can cause physical symptoms such as nausea, shaking, sweating, chest pain, and rapid heartbeat. With fear, one is dealing with the present. Fear is a reaction to an actual danger.

19. 5. List communication guidelines for anxiety or fear
Remember these guidelines for communicating with a resident who is anxious or fearful:
Knock on the door, announce yourself, and greet the resident when you enter the room.
Speak softly. Reduce the noise level.
Speak slowly and calmly.
Listen to the resident. Be patient.
Be empathetic, calm, and reassuring.
Avoid demanding behavior.

20. 6. Discuss communication guidelines for depression
Define the following term: major depressive disorder an illness that causes social withdrawal, lack of energy, and loss of interest in activities, as well as other symptoms.

21. 6. Discuss communication guidelines for depression
Think about these questions: What different losses and changes occur in a person’s life when he or she has to move into a facility? How would it feel to experience these losses? What losses or changes would be hardest for you?

22. 6. Discuss communication guidelines for depression
Remember these guidelines for communicating with residents with depression:
Be pleasant, respectful, and supportive.
Use touch to help comfort the resident.
Listen carefully to the resident. Lean forward and maintain eye contact.
Think before you speak and be empathetic.
Use a normal tone of voice.
Talk about feelings if the resident wishes.
Encourage social interaction.

23. 6. Discuss communication guidelines for depression
REMEMBER: Clinical depression is an illness, just like any other illness. Depressed people cannot simply choose to be well. The nursing assistant’s role is to be supportive and compassionate, and to try to make each day as pleasant an experience as possible for residents.

24. 6. Discuss communication guidelines for depression
Think about this question: What can happen if a nursing assistant mistakenly thinks that residents who are depressed can simply choose to be well?

25. 7. Identify communication guidelines for anger
REMEMBER: Anger is a natural human emotion. Nursing assistants may see residents, their families and friends, and other staff members express anger. Residents may feel angry due to illness, fear, pain, grief, loneliness, or a loss of independence. Even minor things, such as a change in the dinner menu, can trigger anger. Anger may also just be a part of someone’s personality.

26. 7. Identify communication guidelines for anger
Remember these guidelines for angry behavior:
Be pleasant and supportive.
Try to find out what caused the anger.
Observe the resident’s body language.
Empathize with the resident.
Do not argue with the resident. Stay calm.
Treat the resident with dignity and respect.
Answer call lights promptly.
If the resident’s anger increases, get the nurse immediately.
Try to involve the resident in activities.

27. 8. Identify communication guidelines for combative behavior
Define the following term: combative violent or hostile.

28. 8. Identify communication guidelines for combative behavior
REMEMBER: When anger increases, a person may become combative. Combative means violent or hostile. Such behavior includes hitting, shoving, kicking, throwing things, and insulting others. Combative behavior may be due to a disease affecting the brain. It may be due to a worsening of anger or frustration. Medication or changes in health may cause a resident to become combative.

29. 8. Identify communication guidelines for combative behavior
REMEMBER: Combative behavior should not be taken personally. When a resident becomes combative, the role of the nursing assistant is to keep everyone safe.

30. 8. Identify communication guidelines for combative behavior
Remember these guidelines for combative behavior:
Call for the nurse immediately.
Keep yourself and others at a safe distance.
Stay calm and do not appear threatening to the resident.
Be reassuring. Consider what might have triggered the behavior.
Stay neutral. Do not respond to insults and do not argue.
Follow direction of the nurses.
Report facts you observed.
When the resident has calmed down, stay with her if she wishes to talk.

31. 9. Identify communication guidelines for inappropriate sexual behavior
Define the following term: masturbation to touch or rub sexual organs in order to give oneself or another person sexual pleasure.

32. 9. Identify communication guidelines for inappropriate sexual behavior
REMEMBER: Older adults, like all humans, are sexual beings. Residents have the right to choose how they express their sexuality. Sometimes residents will show inappropriate sexual behavior. This behavior does not seem normal or makes you or others uncomfortable. It includes sexual advances or comments. Inappropriate behavior also includes things like removing clothing in public places.

33. 9. Identify communication guidelines for inappropriate sexual behavior
Remember these guidelines for inappropriate sexual behavior:
Do not overreact. Try to distract the resident or move her to a private area.
Do not judge the behavior or gossip about it.
Watch for problems that mimic inappropriate behavior.
Report inappropriate behavior to the nurse.

34. 9. Identify communication guidelines for inappropriate sexual behavior
REMEMBER: Sometimes what appears to be inappropriate sexual behavior has an underlying cause like a rash, clothes that are too tight, too hot, or too scratchy, or the need to go to the bathroom. Nursing assistants should watch for these problems.

35. 9. Identify communication guidelines for inappropriate sexual behavior
REMEMBER: If you encounter consenting adults engaged in sexual behavior, you must provide privacy and leave the area.

36. 10. Identify communication guidelines for disorientation and confusion
Define the following terms: disorientation confusion about person, place, or time; may be permanent or temporary. confusion the inability to think clearly and logically.

37. 10. Identify communication guidelines for disorientation and confusion
Think about these questions: What is the difference between disorientation and confusion? What are some possible causes of confusion?

38. 10. Identify communication guidelines for disorientation and confusion
Remember these guidelines for disorientation or confusion:
Do not leave a confused resident alone.
Stay calm and provide a quiet environment.
Speak in a lower tone of voice. Speak clearly and slowly.
Introduce yourself each time you see the resident. Remind the resident of the location, his name, and the date.
Explain what you are going to do, using short, simple sentences. Break tasks into steps.

39. 10. Identify communication guidelines for disorientation and confusion
Guidelines for disorientation or confusion (cont'd):
Be patient with the resident.
Listen to the resident closely. Pay attention to body language.
Tell the resident the plans for the day.
Encourage the use of eyeglasses and hearing aids.
Tell the resident when you are leaving the area.
Report observations to the nurse.

40. 11. Identify communication guidelines for the comatose resident
Define the following term: coma state of unconsciousness in which a person is unable to respond to any change in the environment, including pain.

41. 11. Identify communication guidelines for the comatose resident
REMEMBER: A person in a coma cannot respond to any change in the environment, including pain. A resident who is comatose deserves the same respect as an alert resident.

42. 11. Identify communication guidelines for the comatose resident
Remember these guidelines for caring for a comatose resident:
Introduce yourself when entering the resident’s room.
Explain each step of each procedure you will be performing.
Do not hold personal discussions while caring for the resident.
Let the resident know when you are going to leave the room.

43. 11. Identify communication guidelines for the comatose resident
A person in a coma can transition to a persistent vegetative state (PVS), which means the person may have some level of consciousness. He may open his eyes and have some facial movements, but these are mostly physical reactions and not a response to external stimuli. A minimally conscious state (MCS) is different than a coma or vegetative state. The person exhibits some cognitive behavior and shows sporadic signs of consciousness, such as crying or laughing appropriately.

44. 12. Identify communication guidelines for functional barriers
Define the following terms: airway the natural passageway for air to enter into the lungs. artificial airway any tube inserted into the respiratory tract for the purpose of maintaining an airway and facilitating ventilation. tracheostomy a surgically-created opening through the neck into the trachea. ventilation in medicine, the exchange of air between the lungs and the environment.

45. 12. Identify communication guidelines for functional barriers
These functional problems may cause residents to have difficulty speaking:
Lip, mouth, or tongue sores
Dental problems of any kind
Poorly-fitting dentures
Birth defects, such as cleft palate
Paralysis of one side of the mouth due to stroke

46. 12. Identify communication guidelines for functional barriers
Remember these guidelines for functional barriers:
Give resident plenty of time to speak.
Ask the resident to write down anything you do not understand.
Allow for rest periods if resident becomes tired.
Do not remove a resident’s oxygen for any reason.
Report mouth sores, poorly-fitting dentures, or complaints of pain.
Use other methods of communication such as writing notes, drawing pictures, and communication boards.
Be reassuring, calm, and empathetic.

47. Exam 1
Multiple Choice. Choose the correct answer. 1. One way for a nursing assistant to communicate effectively with a visually-impaired resident is to (A) Wait until the resident speaks to her before identifying herself (B) Touch the resident on the arm before identifying herself to let her know the NA is there (C) Speak as little as possible while providing care (D) Use the face of an imaginary clock to explain the position of objects 2. If a resident is hearing impaired, a nursing assistant should (A) Make sure the light is on the resident’s face, not the NA’s (B) Make sure the light is on the nursing assistant’s face, not the resident’s (C) Raise the pitch of her voice so that the NA is heard (D) Look at the ground when speaking to the resident

48. Exam 1 (cont'd)
3. While distributing meal trays, Brenda gives the wrong meal to a resident who has diabetes. She says that the resident distracted her by complaining about the food. Which defense mechanism is she using? (A) Denial (B) Projection (C) Repression (D) Rationalization 4. Laura’s supervisor reprimands her for being late to work. Later that day, Laura yells at a resident for being incontinent. Which defense mechanism is she using? (A) Displacement (B) Regression (C) Denial

49. Exam 1 (cont'd)
5. Which of the following is the best example of how a nursing assistant should communicate with an anxious resident? (A) The NA should gently ask the resident what is bothering him. (B) The NA should speak more loudly. (C) The NA should suggest medication that is commonly used for anxiety. (D) The NA should tell the resident that it is best to stop worrying so much. 6. Which of the following is the best way for a nursing assistant to communicate with a resident who is depressed? (A) The NA should use body language that shows interest. (B) The NA should avoid eye contact with the resident. (C) The NA should discourage other residents from talking to the resident who is depressed. (D) The NA should change the subject when the resident wants to talk about his feelings.

50. Exam 1 (cont'd)
7. Which of the following is the best way for a nursing assistant to respond to a resident who is angry? (A) The NA should ignore the angry resident until the resident calms down. (B) The NA should try to find out what is causing the resident’s anger. (C) The NA should ask the resident to stop being angry. (D) The NA should restrain the resident. 8. Which of the following is an example of aggressive, rather than assertive, behavior? (A) A resident tells a nursing assistant that she needs help cutting her food. (B) A nursing assistant tells her supervisor that she does not have the training to complete an assigned task. (C) A resident tells a nursing assistant that she is clumsy and is moving too slowly. (D) A nursing assistant tells a resident that he has a stain on his shirt and helps him clean it.

51. Exam 1 (cont'd)
9. Which of the following is true of combative behavior? (A) The behavior is usually a reaction to a specific person. (B) The behavior is not a concern to staff or other residents. (C) The behavior may be caused by disease or medication. (D) The behavior does not need to be reported. 10. If a resident becomes combative, a nursing assistant should (A) Try to find out what triggered the behavior (B) Leave the resident alone to calm down (C) Tell the resident that he may be removed from the facility if he does not stop soon (D) Argue with the resident to make him understand what is best

52. Exam 1 (cont'd)
11. When is it appropriate for a nursing assistant to hit a resident? (A) When a resident is uncooperative during care (B) When a resident threatens the nursing assistant or others (C) When a resident hits the nursing assistant first (D) Never 12. Which of the following would be the best response by a nursing assistant if a resident is demonstrating inappropriate sexual behavior? (A) The NA should distract the resident or direct her to a private area. (B) The NA should ignore the behavior. (C) The NA should let the resident know that everyone is very upset by this behavior. (D) The NA should discuss the behavior with other residents to see if they found it upsetting.

53. Exam 1 (cont'd)
13. When a resident is confused, the nursing assistant should (A) Leave the resident alone until she is oriented (B) Provide a quiet environment (C) Avoid telling the resident about plans for the day because it increases confusion (D) Speak quickly to distract the resident 14. A person in a coma may still be able to (A) Hear (B) Speak (C) See (D) Walk

54. Exam 1 (cont'd)
15. When communicating with a resident who has a functional barrier, a nursing assistant should (A) Give the resident time to speak (B) Remove oxygen before the resident speaks (C) Insert the tracheostomy tube before the resident speaks (D) Insist that the resident speak

55. Exam 2
Multiple Choice. Choose the correct answer. 1. ____________means that a person is confused about person, place, and time (A) Disorganization (B) Disruptive (C) Disorientation (D) Disinfection 2. A resident lashes out at a roommate on the same day that her relative cancelled a visit. Which defense mechanism is this example illustrating? (A) Projection (B) Rationalization (C) Displacement (D) Regression

56. Exam 2 (cont’d)
3. Ventilation is a term that means exchanging air between the lungs and the (A) Kidneys (B) Heart (C) Small intestine (D) Environment 4. An example of a type of impairment is (A) A resident is unable to hear properly (B) A resident does not get along well with certain staff members (C) A resident is unable to resolve an argument between two roommates (D) A resident has few close friends

57. Exam 2 (cont’d)
5. The medical term for difficulty breathing is (A) Airway (B) Ventilation (C) Dyspnea (D) Tracheostomy 6. Which of the following is an example of inappropriate sexual behavior? (A) Two residents hugging each other for a long time (B) A male resident holding hands with another male resident (C) A resident noticeably flirting with another resident (D) A resident touching his genitals in the hallway

58. Exam 2 (cont’d)
7. Which of the following conditions may cause a resident to become confused? (A) A resident receives the proper amount of oxygen. (B) A resident takes the wrong medication. (C) A resident eats dinner. (D) A resident exercises. 8. Which of the following would be the best response by a nursing assistant when a resident becomes angry? (A) The NA can listen closely to the resident to try to find out what caused the anger. (B) The NA can share some of her personal problems with the resident to distract him. (C) The NA can joke with the resident to make him laugh. (D) The NA can offer suggestions on how the resident can leave the facility.

59. Exam 2 (cont’d)
9. ________________ is a type of mental illness that can cause withdrawal, lack of energy, and loss of interest in activities. (A) Dementia (B) Disorientation (C) Assertiveness (D) Depression 10. Which of the following should the nursing assistant do when working with a resident who has hearing loss? (A) The NA should discourage the resident’s attendance at movies and special events. (B) The NA should raise the pitch of his voice when speaking to the resident. (C) The NA should encourage the resident to wear his hearing aid. (D) The NA should shout when the resident cannot hear him properly.

60. Exam 2 (cont’d)
11. A resident refuses to believe his roommate has died. He continues to talk to staff members and family and friends as if the roommate were still alive. Which defense mechanism is this example illustrating? (A) Repression (B) Denial (C) Projection (D) Displacement 12. When a resident feels anxiety, it is the same as feeling (A) Frightened (B) Angry (C) Worried (D) Excited

61. Exam 2 (cont’d)
13. Which of the following should the nursing assistant do when working with a resident who has a visual impairment? (A) The NA should encourage the resident to use his other senses such as smell and hearing. (B) The NA should shout at the resident upon entering the room to announce her arrival. (C) The NA should lower the room lighting to make the room more inviting to the resident. (D) The NA should change the location of familiar objects in the resident’s room to keep him mentally active. 14. A resident who hugs a teddy bear throughout the day may be using a defense mechanism called (A) Repression (B) Projection (C) Denial (D) Regression

62. Exam 2 (cont’d)
15. A resident who is disoriented might not be able to correctly identify the following (A) The linen company the facility utilizes (B) The current season of the year (C) The car the administrator drives (D) The location of the emergency cart on the unit 16. When dealing with a confused resident, a nursing assistant should (A) Provide enough time for the resident to be alone (B) Encourage the use of eyeglasses and hearing aids (C) Limit introducing herself to the first time she sees the resident (D) Turn up the volume of electronic devices such as radios and televisions

63. Exam 2 (cont’d)
17. A resident in a persistent vegetative state (PVS) (A) May have some facial movements (B) Will never open his eyes (C) Can cry occasionally (D) Might laugh at funny television shows 18. Which of the following is the best way for a nursing assistant to care for a resident with a functional barrier? (A) The NA should prevent the resident from resting to help keep his body active. (B) The NA should remove oxygen only long enough to clean the resident’s face and ears. (C) The NA should encourage the resident to speak quickly during conversations to keep the vocal cords strong. (D) The NA should use a communication board to help the resident ask questions.

64. Exam 2 (cont’d)
19. Which is an example of assertive, rather than aggressive, behavior? (A) A nursing assistant lets a resident know he has to hurry while eating or he will not receive help when he gets ready for bed. (B) A resident makes fun of a nursing assistant’s hairstyle. (C) A nursing assistant tells a resident that he is not working hard enough so he will never regain his ability to walk. (D) A resident asks a nursing assistant for help after he has urinated in the bed. 20. A resident who says she failed a hearing test because the machine was not working properly may be exhibiting the defense mechanism called (A) Regression (B) Displacement (C) Rationalization (D) Denial