A resident with dementia becomes agitated, paces the hallway, and cries every afternoon around 4 p.m. This pattern is BEST described as:
Explanation
Sundowning is increased confusion, agitation, restlessness, or anxiety occurring in the late afternoon or evening in residents with dementia. Contributing factors: fatigue, lighting changes, hunger, unmet toileting needs. CNA interventions: maintain routine, increase daytime light, reduce noise, offer a snack, and engage in calming activities. Delirium (d) is an acute, fluctuating confusion usually from infection or medication and requires nurse evaluation. A 'stage 4 plateau' (b) is not a clinical term. Normal fatigue (c) does not explain consistent agitation. 42 CFR §483.40 requires individualized behavioral interventions.
Law Reference: 42 CFR §483.40; Title 22 CCR §72315This topic, taught in full in the Certified Nursing Assistant (CNA) guide. CNA — Complete Study Guide (2026) — PDF + EPUB, $19.99 · 14-day refund →
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