CRRN Neurological Rehabilitation 2 — Questions and Answers
Question 1: A patient with Guillain-Barré syndrome is in the recovery phase. Which nursing priority is MOST important during early mobilization?
- Preventing autonomic dysreflexia
- Monitoring for orthostatic hypotension (Correct answer)
- Managing hyperreflexia
- Preventing spasticity
Correct answer: Monitoring for orthostatic hypotension
Autonomic instability in GBS can cause significant orthostatic hypotension during position changes, making hemodynamic monitoring essential during mobilization.
Question 2: Which outcome is EXPECTED for a patient with a complete C6 spinal cord injury regarding self-care?
- Complete independence in all ADLs without assistive devices
- Ability to perform upper body dressing independently with adaptive equipment (Correct answer)
- Full ambulation with ankle-foot orthoses
- Complete dependence in all self-care activities
Correct answer: Ability to perform upper body dressing independently with adaptive equipment
A patient with C6 complete injury retains wrist extension, enabling use of adaptive equipment for upper body dressing but requiring assistance for lower body care.
Question 3: A rehabilitation nurse is teaching a patient with epilepsy about seizure precautions. Which instruction is MOST important?
- Avoid all physical activity to prevent seizures
- Never drive until seizure-free per state law guidelines (Correct answer)
- Take seizure medications only when feeling a seizure coming on
- Keep a supply of rectal diazepam for all seizure types
Correct answer: Never drive until seizure-free per state law guidelines
State laws govern driving restrictions after a seizure, and patients must understand these legal and safety requirements as a priority safety teaching point.
Question 4: When assessing a patient with amyotrophic lateral sclerosis (ALS) for aspiration risk, which finding is MOST concerning?
- Increased deep tendon reflexes
- Weak cough and wet vocal quality after swallowing (Correct answer)
- Spastic gait pattern
- Bilateral hand weakness
Correct answer: Weak cough and wet vocal quality after swallowing
A wet or gurgling vocal quality after swallowing combined with a weak cough indicates laryngeal penetration and significantly elevated aspiration risk.
Question 5: A patient with TBI at Rancho Level IV is agitated and pulling at tubes. Which nursing intervention is MOST appropriate?
- Apply soft restraints to all four extremities
- Administer high-dose sedatives to reduce agitation
- Use a calm, consistent approach and minimize stimulation (Correct answer)
- Transfer the patient to a psychiatric unit
Correct answer: Use a calm, consistent approach and minimize stimulation
Rancho Level IV (confused-agitated) requires a calm, structured, low-stimulation environment with consistent nursing care rather than restraints or heavy sedation.
Question 6: Which intervention BEST prevents heterotopic ossification (HO) in a patient with severe TBI?
- Restrict passive range of motion exercises
- Administer prophylactic indomethacin and maintain gentle ROM (Correct answer)
- Apply heat to joints with early signs of HO
- Encourage early forceful stretching of stiff joints
Correct answer: Administer prophylactic indomethacin and maintain gentle ROM
NSAIDs such as indomethacin help prevent HO formation, and gentle ROM preserves joint mobility without the trauma that can trigger HO progression.
CRRN Neurological Rehabilitation 2
A patient with Guillain-Barré syndrome is in the recovery phase.
Which nursing priority is MOST important during early mobilization?