CRRN Bowel and Bladder Management in Rehabilitation 1 — Questions and Answers
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?
- Upper extremity pain
- Bladder distension or bowel impaction (Correct answer)
- Hypertension from dietary salt
- Skin breakdown in upper extremities
Correct answer: Bladder distension or bowel impaction
Bladder distension is the most common trigger of autonomic dysreflexia in SCI at or above T6, causing uncontrolled sympathetic discharge below the injury level.
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?
- Administer sublingual nifedipine immediately
- Sit the patient upright, loosen constrictive clothing, and identify/remove the noxious stimulus (Correct answer)
- Lay the patient flat to improve cerebral perfusion
- Apply a cooling blanket to reduce fever
Correct answer: Sit the patient upright, loosen constrictive clothing, and identify/remove the noxious stimulus
The first priority in AD is sitting the patient upright (to lower BP via orthostasis) and identifying and removing the triggering noxious stimulus, such as bladder distension.
Question 3: A patient with a lower motor neuron (flaccid) neurogenic bladder dysfunction is most likely to exhibit which pattern?
- Hyperreflexic detrusor contractions with urge incontinence
- Urinary retention with overflow incontinence due to acontractile detrusor (Correct answer)
- Frequent small-volume voids with urgency
- Stress incontinence with normal post-void residuals
Correct answer: Urinary retention with overflow incontinence due to acontractile detrusor
Lower motor neuron lesions below the sacral micturition center cause flaccid/acontractile detrusor with urinary retention and overflow incontinence.
Question 4: A patient with SCI begins an intermittent catheterization (IC) program. Which teaching point is MOST important regarding catheter frequency?
- Catheterize only when the patient feels urgency
- Catheterize every 4–6 hours to keep bladder volume below 400–500 mL (Correct answer)
- Catheterize once daily before sleep
- Catheterize immediately after each fluid intake
Correct answer: Catheterize every 4–6 hours to keep bladder volume below 400–500 mL
Bladder volumes above 400–500 mL cause overdistension and increase AD and UTI risk; catheterizing every 4–6 hours maintains safe volumes in neurogenic bladder management.
Question 5: Which finding BEST indicates a successful neurogenic bowel program in a patient with SCI?
- Daily incontinence episodes with large-volume stool
- Predictable bowel evacuation every 1–2 days without incontinence episodes (Correct answer)
- Chronic constipation requiring daily enemas
- Spontaneous unscheduled bowel movements throughout the day
Correct answer: Predictable bowel evacuation every 1–2 days without incontinence episodes
A successful neurogenic bowel program produces predictable, timed evacuations every 1–2 days without incontinence, enabling social participation and skin integrity.
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?
- Manual disimpaction every morning
- Digital rectal stimulation or insertion of a suppository to trigger the gastrocolic reflex (Correct answer)
- High-volume tap water enema twice daily
- Valsalva maneuver and abdominal straining
Correct answer: Digital rectal stimulation or insertion of a suppository to trigger the gastrocolic reflex
Digital rectal stimulation (DRS) or suppository insertion triggers the anorectal reflex in UMN neurogenic bowel, promoting coordinated reflex evacuation.
CRRN Bowel and Bladder Management in Rehabilitation 1
A patient with a T6 complete spinal cord injury is at risk for autonomic dysreflexia (AD).
Which stimulus is the MOST common trigger?