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Quiz: Managing Challenging Behaviors

Test your understanding of challenging behaviors in dementia and effective management strategies with these 10 review questions. Click "Show Answer" to check your work.

1. What is sundowning?

  1. A type of sunburn experienced by older adults
  2. Increased confusion, agitation, or restlessness in the late afternoon or evening
  3. A sleep disorder causing early morning waking
  4. A vision problem related to sunset
Show Answer

The correct answer is B. Sundowning is a pattern of increased confusion, agitation, or restlessness that occurs in the late afternoon and evening. It may be triggered by fatigue, reduced light, disruptions to circadian rhythms, or accumulated stimulation from the day. Helpful strategies include consistent routines, calming activities in the evening, and good lighting.

Concept Tested: Sundowning

2. The ABC framework for analyzing challenging behaviors stands for:

  1. Alzheimer's, Behavior, Cognition
  2. Antecedent, Behavior, Consequence
  3. Activity, Break, Comfort
  4. Age, Brain, Care
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The correct answer is B. The ABC framework helps caregivers identify what triggers a behavior (antecedent), describe the behavior objectively, and note what followed (consequence). This detective work reveals patterns, allowing caregivers to modify triggers and respond more effectively. For example, if bathing triggers resistance, changing the approach can reduce the behavior.

Concept Tested: Agitation

3. A caregiver's husband insists there are strangers in the house who want to steal from him, even when the caregiver explains no one is there. This is best described as a:

  1. Hallucination
  2. Delusion
  3. Catastrophic reaction
  4. Repetitive behavior
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The correct answer is B. A delusion is a fixed false belief that cannot be changed by evidence or logic, such as believing people are stealing or that a spouse is unfaithful. A hallucination, by contrast, involves actually seeing or hearing things that are not there. Both are common in dementia, especially Lewy body dementia. Arguing rarely helps; reassurance and distraction are usually more effective.

Concept Tested: Delusions

4. A woman with dementia suddenly sees cats walking across the kitchen floor that no one else can see. This is an example of a:

  1. Delusion
  2. Hallucination
  3. Memory problem
  4. Normal vision change
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The correct answer is B. Hallucinations involve seeing, hearing, or feeling things that are not actually there. Visual hallucinations, especially of animals or people, are particularly common in Lewy body dementia. Caregivers should avoid arguing about the reality of the experience and instead offer gentle reassurance and ensure the environment is well-lit to reduce misinterpretation of shadows.

Concept Tested: Hallucinations

5. What is a catastrophic reaction in dementia?

  1. A sudden, extreme emotional outburst often triggered by stress, confusion, or overwhelming stimulation
  2. A predicted medical emergency
  3. A natural disaster affecting a person with dementia
  4. A planned behavior to get attention
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The correct answer is A. A catastrophic reaction is a sudden, exaggerated emotional outburst, such as crying, yelling, or lashing out, that occurs when the person feels overwhelmed by stress, confusion, or demands beyond their cognitive ability. The best response is to remain calm, reduce stimulation, validate feelings, and simplify the situation rather than arguing or insisting.

Concept Tested: Catastrophic Reactions

6. A caregiver is frustrated that her father asks "What time is it?" every few minutes. What is the most helpful response?

  1. Scold him for asking the same question
  2. Ignore him so he stops asking
  3. Answer calmly each time, place a large clock in view, and try to identify the underlying anxiety
  4. Tell him he has dementia and should know better
Show Answer

The correct answer is C. Repetitive questions often reflect anxiety, boredom, or an unmet need rather than a desire for information. Answering calmly, using visual aids like clocks or notes, and addressing the underlying feeling (e.g., "Is there something you're worried about?") are more effective than scolding. Remember, the person cannot help forgetting they asked.

Concept Tested: Repetitive Behaviors

7. Which of the following is the most appropriate first step when a loved one with dementia starts wandering?

  1. Lock them in a room
  2. Install safety measures such as door alarms, identification bracelets, and secure outdoor areas, and investigate possible triggers
  3. Ignore the behavior, as it is harmless
  4. Argue with them about why they should not leave
Show Answer

The correct answer is B. Wandering is one of the most dangerous dementia behaviors and requires proactive safety planning. Door alarms, ID bracelets (such as MedicAlert), secure fencing, and enrollment in wandering response programs can prevent tragedy. Additionally, wandering often has triggers such as boredom, looking for someone, or needing to use the bathroom, which can be addressed.

Concept Tested: Wandering

8. Why should caregivers generally avoid arguing with someone who is having a delusion?

  1. Because the person will remember the argument and hold a grudge
  2. Because delusions are fixed beliefs that cannot be changed by logic, and arguing usually increases distress
  3. Because it is illegal to disagree with someone with dementia
  4. Because caregivers are always wrong
Show Answer

The correct answer is B. Delusions are fixed false beliefs that cannot be corrected by evidence or argument. Trying to convince the person otherwise usually increases their agitation and damages trust. More effective approaches include acknowledging their feelings, gently redirecting attention, ensuring safety, and discussing options like medication with the medical team if delusions become distressing.

Concept Tested: Delusions

9. Sleep disturbances in dementia may include all of the following EXCEPT:

  1. Waking frequently during the night
  2. Confusing day and night
  3. Restlessness or acting out dreams
  4. Improved sleep quality compared to younger years
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The correct answer is D. Sleep disturbances are very common in dementia and typically include frequent night waking, day-night confusion, restlessness, and in some cases acting out dreams (especially in Lewy body dementia). Sleep almost never improves with dementia. Helpful strategies include consistent routines, daytime activity, limiting caffeine, and creating a calm evening environment.

Concept Tested: Sleep Disturbances

10. A man with dementia becomes physically aggressive during bathing. What is the best first step before assuming medication is needed?

  1. Use physical restraints for safety
  2. Investigate triggers, such as cold water, fear, pain, or feeling exposed, and adjust the approach
  3. Stop bathing him entirely
  4. Demand that he cooperate
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The correct answer is B. Aggression during care is usually a response to fear, pain, cold, embarrassment, or feeling overwhelmed. Investigating and modifying triggers, such as warming the room, offering a towel for modesty, playing calming music, or breaking the task into smaller steps, can reduce aggression without medication. Medications have risks and should be considered only after non-drug approaches fail.

Concept Tested: Aggression