CRRN Bowel and Bladder Management in Rehabilitation

Question 1

A patient with a T6 complete spinal cord injury is at risk for autonomic dysreflexia (AD). Which stimulus is the MOST common trigger?

Accepted Answer

Bladder distension or bowel impaction

Answer

Upper extremity pain

Answer

Hypertension from dietary salt

Answer

Skin breakdown in upper extremities

Question 2

A CRRN identifies that a patient with T4 SCI is experiencing autonomic dysreflexia. The patient's BP is 195/110 mmHg. Which is the PRIORITY intervention?

Accepted Answer

Sit the patient upright, loosen constrictive clothing, and identify/remove the noxious stimulus

Answer

Administer sublingual nifedipine immediately

Answer

Lay the patient flat to improve cerebral perfusion

Answer

Apply a cooling blanket to reduce fever

Question 3

A patient with a lower motor neuron (flaccid) neurogenic bladder dysfunction is most likely to exhibit which pattern?

Accepted Answer

Urinary retention with overflow incontinence due to acontractile detrusor

Answer

Hyperreflexic detrusor contractions with urge incontinence

Answer

Frequent small-volume voids with urgency

Answer

Stress incontinence with normal post-void residuals

Question 4

A patient with SCI begins an intermittent catheterization (IC) program. Which teaching point is MOST important regarding catheter frequency?

Accepted Answer

Catheterize every 4–6 hours to keep bladder volume below 400–500 mL

Answer

Catheterize only when the patient feels urgency

Answer

Catheterize once daily before sleep

Answer

Catheterize immediately after each fluid intake

Question 5

Which finding BEST indicates a successful neurogenic bowel program in a patient with SCI?

Accepted Answer

Predictable bowel evacuation every 1–2 days without incontinence episodes

Answer

Daily incontinence episodes with large-volume stool

Answer

Chronic constipation requiring daily enemas

Answer

Spontaneous unscheduled bowel movements throughout the day

Question 6

A patient with upper motor neuron (spastic/reflexic) neurogenic bowel from SCI requires bowel care. Which intervention is MOST appropriate to trigger reflex defecation?

Accepted Answer

Digital rectal stimulation or insertion of a suppository to trigger the gastrocolic reflex

Answer

Manual disimpaction every morning

Answer

High-volume tap water enema twice daily

Answer

Valsalva maneuver and abdominal straining