5.1 Mental Health Overview
Key Takeaways
- Mental Health and cognitive/psychosocial care is a tested area on the Ohio STNA written exam, which has 79 multiple-choice questions and requires 70% (about 55 correct) to pass.
- The STNA exam is administered by D&S Diversified Technologies (Headmaster) under the Ohio Board of Nursing, with a written test and a 5-skill clinical evaluation.
- Dementia, delirium, and depression look similar but demand different STNA responses; distinguishing them is a high-yield exam skill.
- Person-centered, non-restraint approaches and prompt reporting to the nurse are the STNA's safest answers in almost every behavioral scenario.
5.1 Mental Health Overview
The mental health and psychosocial portion of the Ohio State Tested Nurse Aide (STNA) exam tests how you support residents with cognitive, emotional, and end-of-life needs. It pulls together dementia and Alzheimer's care, depression, delirium, grief, hospice/palliative comfort care, and behavioral techniques like validation and redirection. The STNA's job is to observe, comfort, protect dignity, and report to the licensed nurse, never to diagnose, counsel formally, or give medications.
Exam logistics you must know
The STNA exam is administered by D&S Diversified Technologies (Headmaster) under the Ohio Board of Nursing. It has two parts:
| Component | Key facts |
|---|---|
| Written (knowledge) test | 79 multiple-choice questions; 70% to pass (about 55 of 79 correct) |
| Skills evaluation | 3 or 4 randomly selected tasks from a 21-task pool, performed in roughly 35 minutes |
| Oral option | An audio/oral version of the written test is available for candidates who request it |
| Source | Primary: Ohio Headmaster CNA Testing |
Always confirm current fees, scheduling, and retake rules in the official Ohio Candidate Handbook before exam day; secondary summaries go stale.
The three conditions that get confused
Most mental-health questions hinge on telling apart three states. Dementia is a chronic, gradual, irreversible decline in memory and thinking (Alzheimer's is the most common type). Delirium is a sudden (hours to days) confusion, often reversible, frequently caused by infection (urinary tract infection is classic), dehydration, low oxygen, medication, or pain. Depression is a persistent low mood with low energy, appetite or sleep changes, and withdrawal.
| Condition | Onset | Key cue on the exam | STNA action |
|---|---|---|---|
| Dementia | Slow, months/years | Long-standing memory loss, repeats questions | Routine, simple cues, validation, report new changes |
| Delirium | Sudden, hours/days | NEW confusion, restlessness, often with fever | Report to nurse immediately as possible illness |
| Depression | Weeks | Sad, withdrawn, poor appetite/sleep, hopeless | Encourage, offer companionship, report mood and food/fluid intake |
Why this distinction is high-yield
A resident with stable dementia who suddenly becomes more confused or combative is almost never "just getting worse" on the exam; that sudden change signals delirium and a possible acute medical problem, so the correct answer is to report it now. Treat any new onset of confusion, combativeness, or behavior change as a change in condition that the nurse must assess.
Core STNA principles for behavior
- Never use physical or chemical restraints to control behavior; restraints require a physician order and are a last resort, never the aide's choice.
- Look for the unmet need behind a behavior: pain, hunger, toileting needs, fear, overstimulation, or boredom.
- Stay calm, approach from the front, use the resident's name, speak slowly, and give one simple instruction at a time.
- Protect dignity and the resident's right to refuse; document and report refusals rather than forcing care.
Dementia and Alzheimer's care in depth
Alzheimer's disease is the most common cause of dementia and progresses through early, middle, and late stages. In the early stage a resident has mild forgetfulness and can still do many tasks with cues. In the middle stage they need more help, may wander, repeat questions, and have trouble with names and sequencing dressing or bathing. In the late stage they may lose speech, become bedbound, and need total care, including help with eating and incontinence. The STNA adapts the level of cueing to the stage: more independence early, more hands-on help and simpler language later.
Practical dementia strategies the exam expects: keep a consistent daily routine, break tasks into one step at a time, reduce noise and clutter, use familiar objects and photos, approach slowly from the front, make eye contact, and never argue or quiz the resident on facts they cannot recall. Wandering is managed with safe walking paths, supervision, exercise, and alarms, never by locking a resident in a room or restraining them.
Depression versus the blues
Depression in older adults is common but is not a normal part of aging. Watch for and report: persistent sadness, loss of interest, fatigue, changes in appetite or weight, sleeping too much or too little, slowed movement, expressions of worthlessness or hopelessness, and any talk of death or suicide. The STNA offers companionship, encourages participation in activities the resident enjoys, maintains routine, and reports mood and intake changes so the nurse and team can act. Depression is treatable, and accurate observation by the aide often triggers that treatment.
Anxiety, paranoia, and hallucinations
Residents with cognitive change may show anxiety, suspicion (paranoia, such as believing staff stole an item), or hallucinations (seeing or hearing things that are not there). The STNA stays calm, does not argue or agree with a false perception, offers reassurance and a safe environment, removes triggers when possible, and reports new or worsening symptoms. Sudden new hallucinations or paranoia, like sudden confusion, can signal delirium and must be reported.
Work these questions as scenarios. Identify the cue (sudden vs. chronic, mood vs. cognition), then choose the action that is safe, person-centered, and within the STNA scope.
A resident with dementia repeatedly tries to remove their incontinence brief. The best nurse aide approach is to:
Which finding most strongly suggests delirium rather than chronic dementia in an older resident?