Free CNA Practice Test
Mental Health and Cognitive Impairment
22 NNAAP-style questions, one at a time — just like exam day. Score and full explanations at the end.
Free CNA practice test on emotional and mental-health needs — depression, anxiety, dementia stages, sundowning, validation therapy, and behavioral interventions. Emotional and Mental Health Needs is one of the most frequently weighted NNAAP topics.
Need a refresher first? Read our free Mental Health & Cognitive Impairment study guide before taking the test.
Exam-simulator mode: picking an answer saves it and automatically moves you to the next question. You will not see right/wrong until you finish — just like the real NNAAP.
Question 1 of 22.Which BEST describes dementia?
Prefer to read? All 22 questions with answers
Which BEST describes dementia?
- A normal part of aging
- A progressive decline in cognitive function severe enough to interfere with daily life (correct answer)
- A short-term confusion that resolves
- A mood disorder
Dementia is a progressive, often irreversible decline in cognition affecting memory, judgment, language, and behavior — not a normal part of aging. Alzheimer's disease is the most common type.
Which is the difference between dementia and delirium?
- Both develop slowly
- Delirium is sudden and often reversible; dementia is gradual and progressive (correct answer)
- Delirium is permanent
- There is no difference
Delirium is acute, often caused by infection, medication, or dehydration, and is usually reversible. Dementia is chronic and progressive. Sudden confusion in an elderly resident should always be reported as a possible delirium.
Sundowning is BEST described as:
- Falling asleep in the afternoon
- Increased confusion, agitation, or restlessness in the late afternoon and evening (correct answer)
- A lab value
- A type of medication
Sundowning is increased confusion, anxiety, agitation, or wandering in the late afternoon and evening, common in dementia. Bright lighting, calm activity, and routine can help reduce it.
Which is an appropriate response to a dementia resident who is agitated?
- Argue with the resident
- Use a calm voice, simple words, and redirect to a familiar, soothing activity (correct answer)
- Restrain the resident
- Lock the resident in the room
Calmness, simple sentences, validation of feelings, and redirection are core dementia-care techniques. Identify and remove triggers (noise, pain, hunger, full bladder).
A resident with Alzheimer's keeps insisting she has to go to work. The CNA should:
- Tell her she has been retired for 20 years and stop arguing
- Acknowledge her feelings ('Work was important to you'), and redirect to a familiar activity (correct answer)
- Lock her in her room
- Call her family to scold her
Validation therapy acknowledges the emotion behind the behavior without correcting the fact. Reality orientation can sometimes worsen distress in advanced dementia.
Which is a sign of depression in an elderly resident?
- Increased engagement in hobbies
- Withdrawal, loss of appetite, sleeping more than usual, sad affect (correct answer)
- Strong appetite
- Frequent socializing
Common signs of depression in the elderly include social withdrawal, loss of appetite, weight change, sleep disturbance, slowed movement, hopelessness, and somatic complaints. Suicide risk is highest in older men.
Which statement requires the CNA to report IMMEDIATELY to the nurse?
- 'I had a nice visit with my daughter'
- 'I wish I could just go to sleep and not wake up.' (correct answer)
- 'My breakfast was great'
- 'I'd like to call my son'
Any statement suggesting suicidal thoughts must be reported immediately. Take all such statements seriously and stay with the resident until further evaluation by the nurse or mental-health professional.
Which intervention BEST helps an anxious resident?
- Ignoring them
- Sitting with the resident, speaking slowly, offering reassurance, and identifying triggers (correct answer)
- Telling them to stop worrying
- Increasing stimulation
Anxiety responds to presence, slow speech, gentle reassurance, deep breathing, and removal of triggers. Loud environments and rushed care worsen anxiety in cognitively impaired residents.
Which approach is appropriate for combative behavior in a resident with dementia?
- Physical force
- Identify and remove the trigger, allow the resident space, and use a calm voice (correct answer)
- Restrain immediately
- Argue
Behavior in dementia is communication. Look for pain, hunger, full bladder, fear, or overstimulation. Give space, speak softly, and remove the trigger. Restraint is a last resort with a physician's order.
Which is the BEST way to support a resident with mild cognitive impairment during meals?
- Feed them entirely
- Offer one-step verbal cues, use finger foods if helpful, and allow extra time (correct answer)
- Rush them
- Eat for them
Promote independence with one-step cues ('Pick up the spoon'), adapted utensils, finger foods, and a calm environment. Feeding the resident only when truly necessary preserves dignity.
Which is true about reminiscence therapy?
- It worsens dementia
- Looking through photo albums and discussing past events can help maintain identity and reduce agitation (correct answer)
- It should be avoided
- It is unsafe
Reminiscence using photos, music, or familiar objects taps long-term memory (often preserved later in dementia), supports identity, and is calming. It is widely used in person-centered care.
A resident in late-stage Alzheimer's no longer recognizes family. The CNA should:
- Stop bringing the family
- Encourage continued visits — emotional comfort often persists even when names are forgotten (correct answer)
- Speak loudly during visits
- Tell the family to leave
Emotional memory often persists long after factual recall. Familiar voices, gentle touch, and family visits can soothe the resident even when names are not remembered.
Wandering in dementia is BEST managed with:
- Restraints
- Locked rooms
- Wander alarms, secure outdoor courtyards, scheduled toileting, and meaningful activity (correct answer)
- Sedating medication
Wandering is managed with environmental cues (alarms, secure courtyards), structured routine, scheduled toileting, distraction, and meeting the underlying need (often exercise, hunger, or anxiety).
Which is a defense mechanism?
- Denial (correct answer)
- Sweating
- Crying
- Yawning
Defense mechanisms protect the psyche from painful realities — denial, projection, rationalization, displacement, regression, and repression are commonly seen in long-term care residents adjusting to loss.
Which environmental change helps reduce sundowning?
- Increased noise after dinner
- Bright daylight exposure during the day, calm routine, and adequate lighting in the late afternoon (correct answer)
- Loud music at night
- Cold rooms
Daytime light exposure, predictable routines, calm late-afternoon activities, and adequate evening lighting help reduce sundowning. Caffeine, naps after 3 p.m., and overstimulation worsen it.
A resident with Alzheimer's tries to leave the unit at night and says 'I have to pick up my kids.' The CNA should:
- Argue and explain her kids are grown
- Walk with her, validate her feelings, redirect with a snack and a calming activity (correct answer)
- Lock the door and ignore her
- Restrain her
Walk with her (companion walking), validate the emotion, and gently redirect with a snack, a familiar object, or activity. Identify the underlying need — often anxiety, hunger, or full bladder.
Which is true about the use of antipsychotic medications in dementia?
- They are first-line treatment
- Federal regulations require non-drug interventions to be tried first; antipsychotics carry a black-box warning in elderly (correct answer)
- They are harmless
- Every dementia resident should be on one
OBRA and FDA both require trials of non-pharmacologic interventions first. Antipsychotics in dementia carry a black-box warning for increased mortality and are used only when behaviors threaten safety.
Which is the BEST environment for a resident with dementia?
- Cluttered and stimulating
- Loud and bright at all hours
- Calm, familiar, well-lit, with a consistent routine and recognizable cues (correct answer)
- Frequent room changes
Person-centered dementia care emphasizes consistency: same staff, same routine, familiar objects, clear signage, calm lighting, and minimal noise. Change is destabilizing for cognitively impaired residents.
A resident is grieving the recent death of a spouse. The CNA should:
- Avoid the topic
- Allow expression of feelings, use silence, offer presence, and report changes in mood or appetite (correct answer)
- Tell the resident to move on
- Distract with constant activity
Grief is expressed through tears, anger, withdrawal, and somatic complaints. Allow expression, sit in silence if needed, offer presence, and report any signs of complicated grief or depression.
Which is a sign of possible elder ABUSE in a resident with dementia?
- A new bruise in a patterned shape, fearful flinching, and unexplained weight loss (correct answer)
- Smiling at visitors
- Eating well
- Good sleep
Signs of possible abuse include patterned bruising, flinching, withdrawal, weight loss, untreated injuries, and inconsistent explanations. Mandatory reporting applies even when the resident cannot verbalize the abuse.
Which approach is recommended for a resident with paranoid delusions ('They're stealing from me!')?
- Argue that no one is stealing
- Reassure calmly, do not argue, validate the feeling, and help look for the missing item (correct answer)
- Tell other residents
- Ignore the resident
Do not argue or try to reason the delusion away. Validate the feeling ('That sounds upsetting'), reassure calmly, and help search for misplaced items. Notify the nurse if delusions are new or worsening.
Which is a stage of Alzheimer's disease?
- Acute, chronic, and resolution
- Early (mild), middle (moderate), and late (severe) (correct answer)
- Stage 1, 2, and 3 only
- Beginning and end only
Alzheimer's progresses through early (mild), middle (moderate), and late (severe) stages. Early stage involves short-term memory loss; middle stage adds disorientation and ADL difficulty; late stage requires full assistance.
FAQ: Mental Health and Cognitive Impairment on the CNA Exam
How many mental health and cognitive impairment questions are on the actual NNAAP exam?
The NNAAP written exam has 60 scored questions distributed across eight content areas. Mental Health and Cognitive Impairment is one of the most heavily tested categories, with several questions appearing on every form of the exam. Drilling these questions repeatedly until you can explain why each correct answer is correct is the best way to lock in the material.
What should I do if I miss several questions on this mental health and cognitive impairment practice test?
Re-read the corresponding free study guide (linked above and below) before retaking the test. Take notes on the exact concept you missed — for example, 'I confused contact and droplet precautions' — and review the explanations until the pattern is clear. Most students need 2 to 3 cycles of test, review, and retake before consistently scoring above 80%.
Are these questions identical to the real CNA exam?
No. The actual NNAAP, Prometric, Headmaster, and PSI exams are confidential and only the official testing vendors have access to live items. Our questions are written by us to mirror NNAAP style, difficulty, and content distribution based on the publicly available NNAAP content outline. Performing well here is a strong predictor of passing the real test.
Do I have to pay or sign up to take this practice test?
No. Every practice test, study guide, and resource on freecnatraining.org is 100% free, with no signup or paywall. Most other CNA practice test sites charge $30 to $100 per month for access; we are funded by our nursing-school directory and keep the study material free for students.