CRRN Musculoskeletal and Orthopedic Rehabilitation 1 — Questions and Answers
Question 1: A patient who underwent total hip arthroplasty (THA) via posterior approach is being educated on hip precautions. Which movement is CONTRAINDICATED?
- Hip abduction past midline
- Hip flexion beyond 90 degrees (Correct answer)
- Hip extension exercises
- Isometric gluteal sets
Correct answer: Hip flexion beyond 90 degrees
After posterior approach THA, hip flexion beyond 90 degrees risks posterior dislocation of the prosthetic joint and must be strictly avoided.
Question 2: A patient post-total knee arthroplasty (TKA) has a target of 90 degrees of knee flexion before discharge. Which intervention BEST achieves this goal?
- Strict bed rest with the knee in extension
- Continuous passive motion (CPM) combined with active ROM exercises (Correct answer)
- Ice therapy only, avoiding movement for 72 hours
- Application of a knee immobilizer at all times
Correct answer: Continuous passive motion (CPM) combined with active ROM exercises
CPM combined with active ROM exercises promotes early joint mobility, reduces adhesion formation, and helps achieve the 90-degree flexion discharge benchmark.
Question 3: A patient with rheumatoid arthritis is scheduled for hand rehabilitation. Which principle BEST guides joint protection education?
- Use smaller joints to perform tasks requiring strength
- Distribute force over larger joints and avoid prolonged static gripping (Correct answer)
- Avoid all exercise to protect inflamed joints
- Perform forceful grip exercises daily to strengthen hand muscles
Correct answer: Distribute force over larger joints and avoid prolonged static gripping
Joint protection principles for RA include using larger joints for heavy tasks, distributing loads, and avoiding prolonged or forceful gripping to reduce joint stress.
Question 4: Following a lower extremity amputation, which positioning practice in the early post-operative period is MOST likely to cause a hip flexion contracture?
- Elevating the residual limb on a pillow for extended periods (Correct answer)
- Prone lying for 30 minutes twice daily
- Keeping the residual limb flat and extended when in bed
- Active hip extension exercises
Correct answer: Elevating the residual limb on a pillow for extended periods
Prolonged residual limb elevation in hip flexion promotes hip flexor shortening, leading to a flexion contracture that complicates prosthetic fitting and gait.
Question 5: A patient with an above-knee amputation is beginning prosthetic gait training. Which nursing observation indicates the prosthetic socket fit is INAPPROPRIATE?
- Stable pelvis during single-limb stance
- Circumferential skin redness and blistering on the distal residual limb (Correct answer)
- Symmetrical step length
- Absence of lateral trunk lean
Correct answer: Circumferential skin redness and blistering on the distal residual limb
Skin breakdown, blistering, and redness on the residual limb indicate excessive pressure or pistoning within the socket, signaling a poor fit requiring adjustment.
Question 6: A rehabilitation nurse is caring for a patient with complex regional pain syndrome (CRPS) of the right hand. Which nursing priority is MOST appropriate?
- Immobilize the hand in a cast to reduce pain
- Facilitate desensitization therapy and graded motor imagery (Correct answer)
- Avoid all touch to the affected extremity
- Administer IV opioids around the clock
Correct answer: Facilitate desensitization therapy and graded motor imagery
CRPS management includes desensitization techniques and graded motor imagery to retrain the central nervous system's pain processing and restore function.
CRRN Musculoskeletal and Orthopedic Rehabilitation 1
A patient who underwent total hip arthroplasty (THA) via posterior approach is being educated on hip precautions.
Which movement is CONTRAINDICATED?