Certified Rehabilitation Registered Nurse (CRRN) — Questions and Answers

Question 1: A rehabilitation patient has a surgically debrided wound with no signs of infection and no contraindications to healing. Which wound bed characteristic indicates OPTIMAL healing progress?

Yellow fibrinous tissue covering >50% of the wound bed
Dry, dark eschar at the wound center
Bright red, moist granulation tissue filling the wound base (Correct answer)
Pale pink wound edges with no migration

Correct answer: Bright red, moist granulation tissue filling the wound base

Bright red, moist granulation tissue indicates robust vascular ingrowth and healthy wound healing; yellow fibrin and eschar indicate stalled or complicated healing.

Question 2: A CRRN is teaching a patient with MS about bladder dysfunction. Which bladder problem is MOST common in MS?

Overactive bladder with urgency, frequency, and urge incontinence (Correct answer)
Polyuria from renal involvement
Complete urinary retention with no leakage
Stress incontinence only with exertion

Correct answer: Overactive bladder with urgency, frequency, and urge incontinence

Overactive bladder with urgency and urge incontinence is the most prevalent bladder dysfunction in MS, caused by demyelination of pathways controlling the detrusor muscle.

Question 3: Which of the patient's demands must be satisfied FIRST, according to Maslow's hierarchy of requirements?

Self-actualization.
Safety and security.
Belonging and self-esteem.
Physiological. (Correct answer)

Correct answer: Physiological.

Maslow's hierarchy of needs posits that basic physiological needs, such as air, water, food, shelter, and sleep, must be satisfied before individuals can attend to higher-level needs. These are fundamental for survival and well-being, making them the absolute priority in patient care. Addressing these foundational needs is essential for overall health and progress.

Question 4: Which bowel program schedule is MOST consistent with evidence-based rehabilitation nursing practice for a patient with upper motor neuron (spastic) neurogenic bowel?

Manual disimpaction daily to ensure emptying
High-fiber diet alone without scheduled bowel care
Bowel care every other day using digital stimulation and suppositories at a consistent time (Correct answer)
As-needed laxatives based on patient complaint of constipation

Correct answer: Bowel care every other day using digital stimulation and suppositories at a consistent time

A scheduled bowel program (every 24–48 hours) using rectal stimulants and digital stimulation at a consistent time leverages the gastrocolic reflex and reflex arc in UMN bowel.

Question 5: When educating a patient with a new stroke about dysphagia precautions, which food consistency is typically SAFEST to introduce first?

Pureed foods only
Nectar-thick liquids (Correct answer)
Regular solids cut into small pieces
Thin liquids such as water

Correct answer: Nectar-thick liquids

Nectar-thick liquids are commonly the safest starting consistency for dysphagic stroke patients because they move more slowly and allow more time to trigger the swallow reflex.

Question 6: A rehabilitation nurse notes that a patient with spinal cord injury at C5 has spontaneous muscle spasms. Which statement about spasticity in SCI is CORRECT?

Spasticity should always be treated aggressively with neurolytic agents
Spasticity can be beneficial by maintaining muscle mass and preventing DVT (Correct answer)
Spasticity is absent in upper motor neuron lesions
Spasticity always indicates neurological deterioration

Correct answer: Spasticity can be beneficial by maintaining muscle mass and preventing DVT

In SCI, spasticity can have functional benefits including maintenance of muscle bulk, bone density, and venous return, though severe spasticity warrants management.

Question 7: A patient with Parkinson's disease exhibits a festinating gait. The rehabilitation nurse's best intervention is to:

Teach the patient to use visual cues such as floor lines or footsteps to regulate stride length (Correct answer)
Restrict ambulation to prevent falls
Apply bilateral ankle weights to slow gait velocity
Encourage the patient to take smaller, more rapid steps to match their cadence

Correct answer: Teach the patient to use visual cues such as floor lines or footsteps to regulate stride length

Visual cueing strategies (floor stripes, laser canes) help patients with Parkinson's overcome freezing and festination by bypassing impaired basal ganglia automatic movement circuits.

Question 8: A four-year-old girl who was born with a ventriculoperitoneal shunt and myelomeningocele at L3 underwent postnatal surgery to close the lesion on her back. The MOST suitable objective for a physical therapy program is which of the following?

Functional ambulation with orthotics, crutches. (Correct answer)
Normal, unassisted ambulation.
Independence in use of a manual wheelchair.
Independence in use of an electric wheelchair.

Correct answer: Functional ambulation with orthotics, crutches.

A child with myelomeningocele at L3 typically has significant motor weakness in the lower extremities, making normal unassisted ambulation unlikely. However, functional ambulation with assistive devices like orthotics and crutches is a realistic and appropriate goal. This allows for mobility and independence within their physical capabilities, promoting participation in daily activities.

Question 9: A rehabilitation nurse is teaching a patient with atrial fibrillation about anticoagulation therapy with warfarin. Which food should the patient be educated to maintain at a CONSISTENT level in their diet?

High-glycemic carbohydrates
Red meat
Dairy products
Vitamin K-rich foods such as leafy green vegetables (Correct answer)

Correct answer: Vitamin K-rich foods such as leafy green vegetables

Vitamin K affects warfarin metabolism; consistent (not eliminated) consumption of Vitamin K-rich foods is key to maintaining a stable INR.

Question 10: Which assessment finding in a patient with a long leg cast MOST warrants immediate notification of the physician?

Pallor, pulselessness, and paresthesias distal to the cast (Correct answer)
Minor itching under the cast
Slight warmth over the cast
Mild ankle swelling with dependent positioning

Correct answer: Pallor, pulselessness, and paresthesias distal to the cast

The 5 Ps (pain, pallor, pulselessness, paresthesias, paralysis) indicate compartment syndrome or neurovascular compromise requiring emergent intervention.

Question 11: A rehabilitation patient is receiving scheduled opioid analgesics for moderate-to-severe pain. Which nursing assessment finding requires immediate intervention?

Mild nausea after morning dose
Mild constipation requiring a bowel regimen
Respiratory rate of 8 breaths per minute with decreased arousal (Correct answer)
Dry mouth reported during medication teaching

Correct answer: Respiratory rate of 8 breaths per minute with decreased arousal

Respiratory depression with decreased level of consciousness is the most life-threatening adverse effect of opioid analgesics and requires immediate intervention, including administration of naloxone (Narcan) and supportive care.

Question 12: A patient with diabetes and a neuropathic plantar foot ulcer is in wound rehabilitation. Which offloading device is considered the GOLD STANDARD for plantar foot ulcer healing?

Therapeutic footwear and custom orthotics
Total contact cast (TCC) (Correct answer)
Crutches with non-weight-bearing to the affected foot
Removable walking boot (RCW) with strict compliance instructions

Correct answer: Total contact cast (TCC)

The total contact cast (TCC) is the gold standard for offloading diabetic neuropathic foot ulcers because it distributes pressure over the entire foot and ensures compliance.

Question 13: A patient with upper motor neuron (spastic/reflexic) neurogenic bowel from SCI requires bowel care. Which intervention is MOST appropriate to trigger reflex defecation?

High-volume tap water enema twice daily
Manual disimpaction every morning
Digital rectal stimulation or insertion of a suppository to trigger the gastrocolic reflex (Correct answer)
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.

Question 14: A patient with multiple sclerosis reports worsening fatigue by early afternoon. Which energy conservation strategy should the CRRN teach first?

Increase caffeine intake to maintain alertness
Schedule most demanding activities in the morning and plan rest periods (Correct answer)
Avoid all exercise to preserve energy
Perform all activities in one continuous session to reduce transitions

Correct answer: Schedule most demanding activities in the morning and plan rest periods

Energy conservation principles prioritize high-demand tasks when energy is greatest (morning) and incorporate planned rest breaks to prevent fatigue-induced exacerbation.

Question 15: Which scale is most widely used in rehabilitation settings to measure a patient's functional independence across motor and cognitive domains?

Glasgow Coma Scale (GCS)
Functional Independence Measure (FIM) (Correct answer)
Mini-Mental State Examination (MMSE)
Berg Balance Scale

Correct answer: Functional Independence Measure (FIM)

The FIM is the standard rehabilitation outcome tool rating 18 items across motor and cognitive subscales on a 1–7 scale, with 7 indicating complete independence.

Question 16: A patient with SCI at C5 is using a manual wheelchair. To prevent rotator cuff injury during propulsion, the nurse should teach the patient to:

Propel with a long, smooth arc keeping hands below the pushrim top (Correct answer)
Use wrist extension as the primary propulsion force
Use short, rapid push strokes to maximize speed
Lean forward aggressively with each stroke

Correct answer: Propel with a long, smooth arc keeping hands below the pushrim top

A long, smooth semicircular push pattern reduces repetitive impact on the shoulder joint and preserves rotator cuff integrity over time.

Question 17: A patient using a manual wheelchair asks about the most effective technique to prevent carpal tunnel syndrome. The CRRN should recommend:

Switching to an electric wheelchair immediately
Propelling with the heel of the hand in a smooth arc (Correct answer)
Wearing rigid wrist splints during all propulsion
Using finger-tip propulsion for greater control

Correct answer: Propelling with the heel of the hand in a smooth arc

Propelling with the heel of the hand in a semicircular arc reduces repetitive wrist flexion and nerve compression, lowering carpal tunnel risk.

Question 18: Which outcome measure is MOST appropriate to track functional independence in rehabilitation patients across multiple diagnoses?

Visual Analog Scale
Glasgow Coma Scale
Modified Ashworth Scale
Functional Independence Measure (FIM) (Correct answer)

Correct answer: Functional Independence Measure (FIM)

The FIM is the gold-standard measure of functional independence in rehabilitation settings, assessing 18 items across motor and cognitive domains.

Question 19: A patient with heel pressure injuries is being positioned in bed. Which position is BEST to protect the heels?

Elevate heels on a standard pillow with the knees straight
Keep the patient in Trendelenburg position at all times
Apply donut-shaped heel protectors to redistribute pressure
Float the heels completely off the surface using pillows placed under the calves (Correct answer)

Correct answer: Float the heels completely off the surface using pillows placed under the calves

Floating the heels by placing pillows under the calves completely offloads the heel from the mattress surface; donut devices create a pressure ring around the wound.

Question 20: A patient with pulmonary fibrosis begins pulmonary rehabilitation. Which adaptive strategy BEST helps conserve energy during ADLs?

Use pursed-lip breathing, sit for tasks when possible, and organize activities to avoid unnecessary steps (Correct answer)
Perform all ADLs rapidly to minimize total activity time
Avoid all ADLs and depend on caregivers entirely
Use supplemental oxygen only during sleep

Correct answer: Use pursed-lip breathing, sit for tasks when possible, and organize activities to avoid unnecessary steps

Energy conservation techniques — including sitting for tasks, organizing the environment, and controlled breathing — reduce oxygen demand and dyspnea during ADLs in pulmonary fibrosis.

Question 21: A patient with a T6 spinal cord injury suddenly develops a pounding headache, hypertension (BP 180/100), and profuse sweating above the level of injury. What is the priority nursing action?

Apply a cooling blanket to reduce fever
Sit the patient upright and identify the triggering stimulus (Correct answer)
Administer IV labetalol immediately
Obtain an ECG to rule out cardiac event

Correct answer: Sit the patient upright and identify the triggering stimulus

Autonomic dysreflexia requires immediately sitting the patient upright (to lower BP via orthostasis) and removing the noxious stimulus, most commonly a full bladder or bowel.

Question 22: In the PQRST pain assessment mnemonic used in rehabilitation nursing, what does the letter 'P' represent?

Pain level on a numeric scale
Position of the patient during pain
Pharmacological history of the patient
Precipitating and palliating factors (Correct answer)

Correct answer: Precipitating and palliating factors

In the PQRST mnemonic, 'P' stands for Precipitating and Palliating factors — what makes the pain better or worse — which helps direct both pharmacological and non-pharmacological interventions.

Question 23: A patient with a hip fracture after total hip replacement (posterior approach) asks which movement to avoid. The nurse correctly identifies:

External rotation of the operative hip
Full knee extension while seated
Hip flexion greater than 90 degrees (Correct answer)
Hip abduction past 30 degrees

Correct answer: Hip flexion greater than 90 degrees

Posterior approach hip precautions restrict flexion beyond 90°, adduction past midline, and internal rotation to prevent prosthetic dislocation.

Question 24: A patient has been using an indwelling urinary catheter for 3 weeks during acute rehabilitation. Which complication is the PATIENT AT HIGHEST RISK for?

Catheter-associated urinary tract infection (CAUTI) (Correct answer)
Bladder hyperreflexia
Renal calculi within 72 hours
Urethral stricture due to catheter size

Correct answer: Catheter-associated urinary tract infection (CAUTI)

Catheter-associated UTI (CAUTI) is the most common healthcare-associated infection and risk increases linearly with duration of indwelling catheter use.

Question 25: Which nutritional marker is the BEST indicator of a rehabilitation patient's long-term protein nutritional status?

Serum prealbumin (transthyretin)
Serum albumin (Correct answer)
Serum transferrin
C-reactive protein

Correct answer: Serum albumin

Serum albumin, with a half-life of approximately 20 days, reflects longer-term protein nutritional status, making it the best marker for chronic nutritional assessment.

Question 26: A rehabilitation nurse is providing care for a patient with chronic pain who is using progressive muscle relaxation (PMR). PMR reduces pain primarily by:

Systematically tensing and releasing muscle groups to reduce overall muscle tension and anxiety (Correct answer)
Providing direct mechanical stimulation to pain receptors in muscle tissue
Using controlled breathing patterns to increase oxygen delivery to painful tissues
Applying external pressure to trigger points to release myofascial adhesions

Correct answer: Systematically tensing and releasing muscle groups to reduce overall muscle tension and anxiety

Progressive muscle relaxation involves deliberately tensing and then releasing specific muscle groups in sequence, which promotes awareness of tension and its release, decreasing overall musculoskeletal tension and the anxiety component of chronic pain.

Question 27: A patient with a below-knee amputation is being fitted with a prosthesis. Which nursing instruction regarding residual limb care is most important?

Soak the residual limb in warm water nightly to maintain skin hydration
Inspect the residual limb daily for redness, skin breakdown, and changes in shape
Apply powder inside the prosthetic socket to reduce friction
Wrap the residual limb with elastic bandage in a figure-of-eight pattern starting distally (Correct answer)

Correct answer: Wrap the residual limb with elastic bandage in a figure-of-eight pattern starting distally

A figure-of-eight elastic wrap applied from distal to proximal shapes the residual limb, controls edema, and prepares it for prosthetic fitting.

Question 28: A patient with traumatic brain injury (TBI) exhibits difficulty with word-finding and expressive communication. Which type of aphasia is most consistent with this presentation?

Wernicke's aphasia
Anomic aphasia
Broca's aphasia (Correct answer)
Global aphasia

Correct answer: Broca's aphasia

Broca's aphasia is characterized by non-fluent speech with intact comprehension, typically caused by damage to Broca's area in the frontal lobe.

Question 29: A CRRN is teaching a patient with a T6 SCI about bowel management. Which statement about a neurogenic bowel program is correct?

Bowel care should occur at a random time each day to remain flexible.
A consistent scheduled time after a meal is recommended to utilize the gastrocolic reflex. (Correct answer)
High fluid intake should be avoided to prevent loose stools.
Laxatives should be used daily regardless of bowel output.

Correct answer: A consistent scheduled time after a meal is recommended to utilize the gastrocolic reflex.

Scheduling bowel care 20–30 minutes after a meal exploits the gastrocolic reflex, which increases colonic peristalsis and facilitates more predictable and complete evacuation.

Question 30: Which complication is the CRRN MOST concerned about in the first 24–48 hours following total joint arthroplasty?

Delayed wound healing
Surgical site hematoma
Heterotopic ossification
Deep vein thrombosis (DVT) and pulmonary embolism (Correct answer)

Correct answer: Deep vein thrombosis (DVT) and pulmonary embolism

DVT and PE are the leading causes of mortality after total joint arthroplasty; early mobilization and anticoagulation prophylaxis are critical preventive measures.

Question 31: A patient with a rotator cuff repair is at 6 weeks post-surgery. Which activity is APPROPRIATE at this stage?

Resisted strengthening exercises at full range
Return to heavy manual labor
Full active overhead lifting
Pendulum exercises and passive ROM within prescribed limits (Correct answer)

Correct answer: Pendulum exercises and passive ROM within prescribed limits

At 6 weeks post rotator cuff repair, passive ROM and gentle pendulum exercises are typically appropriate while the healing tendon is protected from active resistance.

Question 32: Heat therapy (thermotherapy) is contraindicated in a rehabilitation patient with which condition?

Fibromyalgia with widespread musculoskeletal pain
Acute thrombophlebitis of the lower extremity (Correct answer)
Subacute low back strain more than one week post-injury
Chronic muscle spasm in the cervical region

Correct answer: Acute thrombophlebitis of the lower extremity

Heat therapy is contraindicated in acute thrombophlebitis because vasodilation from heat application can dislodge a thrombus, increasing the risk of pulmonary embolism; it is also contraindicated over areas with impaired sensation, malignancy, or open wounds.

Question 33: Which principle guides the rehabilitation nurse when setting goals with a patient who has a newly acquired disability?

Goals should be set primarily by the interdisciplinary team based on clinical findings
Short-term goals should focus exclusively on preventing medical complications
Long-term goals should always aim for full pre-injury functional status
Goals should be patient-centered, specific, measurable, and reflect the patient's valued roles and activities (Correct answer)

Correct answer: Goals should be patient-centered, specific, measurable, and reflect the patient's valued roles and activities

Patient-centered, SMART goals grounded in the patient's own priorities and meaningful roles drive motivation, engagement, and relevant functional outcomes in rehabilitation.

Question 34: A patient enrolled in Phase II cardiac rehabilitation after MI is exercising on a treadmill. Which heart rate finding is the THRESHOLD for stopping the session?

Heart rate exceeding the prescribed target range or symptoms of angina/dyspnea (Correct answer)
Heart rate above 50 bpm
Any increase in heart rate from resting baseline
Heart rate above 60% of maximum heart rate

Correct answer: Heart rate exceeding the prescribed target range or symptoms of angina/dyspnea

Cardiac rehab exercise should stop if the patient's heart rate exceeds the individualized prescribed limit or if symptoms such as angina, dyspnea, or dizziness occur.

Question 35: As opposed to bilevel positive airway pressure (BPAP), which of the following conditions is typically treated with continuous positive airway pressure (CPAP)?

Central sleep apnea.
Obstructive sleep apnea. (Correct answer)
Chronic obstructive lung disease.
Obesity hypoventilation syndrome.

Correct answer: Obstructive sleep apnea.

Continuous Positive Airway Pressure (CPAP) is the most common and effective treatment for Obstructive Sleep Apnea (OSA). CPAP machines deliver a constant stream of air pressure to keep the airway open during sleep, preventing the collapses that characterize OSA. Bilevel positive airway pressure (BPAP) is typically reserved for more complex respiratory conditions.

Question 36: Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?

Non-steroidal anti-inflammatory drugs (NSAIDs)
Skeletal muscle relaxants
Anticonvulsants (gabapentinoids) (Correct answer)
Opioid analgesics

Correct answer: Anticonvulsants (gabapentinoids)

Anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica) are evidence-based first-line agents for neuropathic pain because they modulate calcium channels and reduce aberrant neuronal firing responsible for burning and shooting pain.

Question 37: A patient with an acquired brain injury has difficulty with memory consolidation. Which nursing strategy best supports this patient's learning of new self-care skills?

Rely primarily on written handouts for the patient to review independently
Delay all teaching until the patient demonstrates intact recall
Provide all education in one comprehensive session
Use errorless learning and spaced retrieval techniques with frequent repetition (Correct answer)

Correct answer: Use errorless learning and spaced retrieval techniques with frequent repetition

Errorless learning prevents the reinforcement of incorrect responses, while spaced retrieval strengthens long-term memory retention in patients with memory impairment after brain injury.

Question 38: When teaching a patient with limited mobility about skin inspection, which tool is MOST helpful for visualizing posterior body surfaces independently?

Ultraviolet light device
Long-handled mirror (Correct answer)
Pulse oximeter
Skin pH meter

Correct answer: Long-handled mirror

A long-handled mirror enables patients with mobility limitations to inspect posterior surfaces such as the sacrum, buttocks, and heels for early pressure injury detection.

Question 39: What is a patient's best course of nursing action? experiencing physical and/or psychological distress after moving from one setting to another recently?

encourage pt's verbalization of feelings (Correct answer)
encouraging coughing and deep breathing techniques
knowledge to comprehension to application
past learning difficulties

Correct answer: encourage pt's verbalization of feelings

Patients who have recently moved settings, especially in rehabilitation, often experience anxiety, fear, and a sense of loss or disorientation. Encouraging them to verbalize their feelings provides an outlet for these emotions and helps the nurse understand their specific concerns. This therapeutic communication fosters trust and allows for targeted interventions to address their distress.

Question 40: Which patient statement indicates CORRECT understanding of pressure injury prevention after the CRRN's education session?

I only need to check my skin weekly unless I feel pain
I will sit in my wheelchair all day to stay active and avoid being in bed
I will reposition every 2 hours in bed and perform weight shifts every 15–30 minutes in my wheelchair (Correct answer)
I will use a ring cushion to protect my tailbone when sitting

Correct answer: I will reposition every 2 hours in bed and perform weight shifts every 15–30 minutes in my wheelchair

Repositioning every 2 hours in bed and performing wheelchair weight shifts every 15–30 minutes are the evidence-based frequencies for preventing pressure injury in at-risk patients.

Question 41: A patient with C6 tetraplegia is learning to feed themselves. Which adaptive equipment is most appropriate to facilitate independence?

Long-handled spoon for shoulder range of motion deficits
Built-up handled spoon only
Universal cuff with utensil holder to compensate for absent grip (Correct answer)
Weighted fork to reduce tremor-related spilling

Correct answer: Universal cuff with utensil holder to compensate for absent grip

A universal cuff holds utensils without requiring grip, enabling patients with C6 injuries who have wrist extension but no hand function to feed independently.

Question 42: A rehabilitation patient with chronic low back pain asks about biofeedback therapy. The nurse correctly explains that biofeedback helps manage pain by:

Administering subliminal auditory cues to block pain perception during therapy
Using guided imagery to create a relaxation response that permanently eliminates pain
Providing external electrical stimulation directly to the painful nerve roots
Teaching patients to consciously control physiological responses such as muscle tension and heart rate (Correct answer)

Correct answer: Teaching patients to consciously control physiological responses such as muscle tension and heart rate

Biofeedback provides real-time information about physiological functions such as muscle tension, skin temperature, or heart rate variability, enabling patients to learn voluntary control over these processes to reduce pain and stress responses.

Question 43: A rehabilitation nurse is educating a patient with paraplegia about preventing pressure injuries. Which statement by the patient indicates a need for further teaching?

I will perform weight shifts every 15–30 minutes while sitting.
I will use a mirror to inspect my skin daily.
I should report any persistent redness to my care team.
Redness that goes away after 30 minutes is not a concern. (Correct answer)

Correct answer: Redness that goes away after 30 minutes is not a concern.

Redness (erythema) that does not blanch or that persists after pressure relief is a Stage 1 pressure injury and should always be reported and addressed.

Question 44: A patient post-prostatectomy has stress urinary incontinence. Which non-pharmacological intervention is the FIRST LINE treatment?

Bladder augmentation surgery
Anticholinergic medication
Pelvic floor muscle training (Kegel exercises) (Correct answer)
Indwelling urinary catheter for 6 weeks

Correct answer: Pelvic floor muscle training (Kegel exercises)

Pelvic floor muscle training (PFMT) is the first-line non-pharmacological intervention for stress urinary incontinence post-prostatectomy, strengthening the external urethral sphincter.

Question 45: A patient with bilateral knee replacements is in inpatient rehabilitation. Which nursing concern is HIGHEST priority when the patient reports sudden calf pain and dyspnea on day 3?

Muscle cramp from physical therapy
Pulmonary embolism (Correct answer)
Delayed analgesia effect
Postoperative ileus

Correct answer: Pulmonary embolism

Sudden calf pain with dyspnea after total joint arthroplasty is a classic PE presentation requiring immediate assessment, oxygen, and emergency notification.

Question 46: When using the numeric rating scale (NRS) for pain assessment, a patient with aphasia rates their pain as 0 but grimaces and guards during movement. What should the nurse do?

Document pain as 0/10 as self-reported
Administer an analgesic based on clinical suspicion alone
Use a behavioral pain observation tool to supplement assessment (Correct answer)
Defer pain assessment to the physiatrist

Correct answer: Use a behavioral pain observation tool to supplement assessment

For patients who cannot reliably self-report pain, behavioral observation tools (e.g., CPOT, PAINAD) should supplement or replace self-report scales.

Question 47: A patient with osteoporosis is being discharged after a vertebral compression fracture. Which activity instruction is MOST appropriate?

Avoid spinal flexion exercises; focus on extension and balance (Correct answer)
Bed rest for 6 weeks before any mobilization
Perform daily sit-ups to strengthen core muscles
Resume all pre-fracture activities immediately

Correct answer: Avoid spinal flexion exercises; focus on extension and balance

Spinal flexion increases anterior vertebral loading and fracture risk in osteoporosis; extension exercises and balance training are the safer rehabilitation approach.

Question 48: A patient with rheumatoid arthritis asks about joint protection principles during ADL training. Which instruction reflects correct joint protection technique?

Avoid all activity during periods of low inflammation to protect joints
Distribute force over larger joints to reduce stress on smaller joints (Correct answer)
Use the smallest joint available to perform a task to conserve energy
Perform fine motor tasks with the dominant hand only

Correct answer: Distribute force over larger joints to reduce stress on smaller joints

Joint protection principles include distributing loads across larger, stronger joints (e.g., using the palm instead of fingers to carry a bag) to reduce deforming forces on vulnerable smaller joints.

Question 49: In rehabilitation nursing, the term 'learned non-use' most accurately describes:

Suppression of movement in an affected limb due to early failed attempts post-injury (Correct answer)
The tendency of caregivers to perform tasks for patients unnecessarily
A patient refusing to participate in therapy due to depression
Cognitive neglect of one side of the body following stroke

Correct answer: Suppression of movement in an affected limb due to early failed attempts post-injury

Learned non-use occurs when a patient stops attempting to use an affected limb after early painful or unsuccessful efforts, which can be reversed with constraint-induced movement therapy.

Question 50: A patient with chronic low back pain is started on gabapentin. What is the primary therapeutic mechanism relevant to rehabilitation nursing?

It modulates calcium channel activity to reduce neuropathic pain transmission (Correct answer)
It acts as a centrally acting muscle relaxant
It inhibits COX-2 enzymes to reduce peripheral inflammation
It blocks opioid receptors to produce analgesia

Correct answer: It modulates calcium channel activity to reduce neuropathic pain transmission

Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels in the dorsal horn, reducing neuropathic pain signal transmission.

Question 51: A patient in rehabilitation is using a fentanyl transdermal patch for chronic pain management. Which instruction is most important for the nurse to include in patient education?

Apply the patch to a clean, dry, non-irritated flat skin surface (Correct answer)
Change the patch every 12 hours for consistent pain control
Apply the patch to a hairy area of skin to improve absorption
Applying a heating pad over the patch will not affect drug absorption

Correct answer: Apply the patch to a clean, dry, non-irritated flat skin surface

Fentanyl transdermal patches must be applied to clean, dry, non-irritated, flat skin to ensure consistent absorption; heat sources over the patch increase drug absorption and can cause fatal overdose due to accelerated fentanyl release.

Question 52: When speaking, a patient with a Middle Eastern background stands uncomfortably close to the CRRN (about two feet away). What does this likely imply?

The CRRN is culturally insensitive.
The patient and the CRRN have different concepts of personal space. (Correct answer)
The CRRN does not like the patient.
The patient is being intimidating.

Correct answer: The patient and the CRRN have different concepts of personal space.

Personal space is a culturally influenced concept, with different cultures having varying norms for comfortable proximity during conversation. A patient from a Middle Eastern background might have a smaller personal space bubble than someone from a Western background, making two feet feel normal to them but uncomfortably close to the CRRN. This is a cultural difference, not an intentional act of intimidation or dislike.

Question 53: A patient with a C4 complete spinal cord injury is most likely to require which form of respiratory support?

Mechanical ventilation, at least initially (Correct answer)
No respiratory support, as breathing is above the injury
Bipap therapy at night only
Incentive spirometry only

Correct answer: Mechanical ventilation, at least initially

C4 injuries affect the phrenic nerve (C3–C5) that drives diaphragm function, often necessitating mechanical ventilation because spontaneous breathing is severely impaired or absent.

Question 54: A patient recovering from a right hemisphere stroke demonstrates left-sided spatial neglect. Which nursing intervention is most appropriate?

Approach and place items on the left side to encourage awareness (Correct answer)
Avoid verbal cues so the patient develops natural compensation
Place all items on the patient's right side to avoid frustration
Patch the left eye to eliminate visual input from that side

Correct answer: Approach and place items on the left side to encourage awareness

Approaching from and placing items on the neglected left side encourages the patient to attend to that hemispace and can help remediate unilateral neglect.

Question 55: A patient receiving baclofen for spasticity following SCI reports sudden onset of hallucinations, confusion, and fever. What complication should the nurse suspect first?

Neuroleptic malignant syndrome
Baclofen toxicity from overdose
Autonomic dysreflexia episode
Abrupt baclofen withdrawal syndrome (Correct answer)

Correct answer: Abrupt baclofen withdrawal syndrome

Abrupt baclofen withdrawal can cause life-threatening symptoms including hallucinations, agitation, hyperthermia, and seizures; the baclofen should be restarted immediately.

Question 56: Undertreated chronic pain in a rehabilitation patient is most likely to result in which of the following outcomes?

Improved quality of sleep and rest
Increased motivation for physical therapy participation
Enhanced ability to perform activities of daily living
Functional decline and development of depression (Correct answer)

Correct answer: Functional decline and development of depression

Undertreated pain interferes with participation in rehabilitation activities, disrupts sleep, and is strongly associated with depression and functional decline, all of which impede the rehabilitation process.

Question 57: Which intervention is the FIRST priority when autonomic dysreflexia is suspected in a patient with a T6 complete spinal cord injury?

Sit the patient upright and loosen any constrictive clothing (Correct answer)
Call the physician immediately
Apply a cold compress to the forehead
Administer antihypertensive medication

Correct answer: Sit the patient upright and loosen any constrictive clothing

Sitting the patient upright uses orthostatic hypotension to lower BP and removing constricting clothing helps identify and eliminate the noxious stimulus first.

Question 58: What kind of living situation offers supervised living for people with comparable disabilities and employees who are on call day and night?

group home (Correct answer)
nursing home
half-way house
respite care

Correct answer: group home

A group home is specifically designed to provide a supportive, supervised living environment for individuals with similar disabilities who require assistance with daily living activities. These homes typically have staff available around the clock to provide care, supervision, and support, fostering independence while ensuring safety and assistance when needed.

Question 59: Which bladder management strategy is most appropriate for a patient with a complete T10 spinal cord injury who has a flaccid neurogenic bladder?

Intermittent catheterization every 4–6 hours (Correct answer)
Triggered voiding with suprapubic tapping
Credé maneuver every 4 hours
Indwelling Foley catheter long-term

Correct answer: Intermittent catheterization every 4–6 hours

Intermittent catheterization is the gold standard for managing a flaccid neurogenic bladder, preserving upper urinary tract function and reducing infection risk.

Question 60: Which oxygen saturation level during pulmonary rehabilitation exercise REQUIRES supplemental oxygen to be initiated or increased?

SpO2 90–94%
SpO2 85% at rest only
SpO2 ≥ 95%
SpO2 < 88% (Correct answer)

Correct answer: SpO2 < 88%

An SpO2 below 88% during exercise indicates significant hypoxemia requiring supplemental oxygen to prevent exercise-induced desaturation complications.

Question 61: A rehabilitation nurse is caring for a patient with lateral epicondylitis (tennis elbow). Which activity modification is MOST appropriate?

Wear a wrist splint in maximum extension position
Avoid repetitive wrist extension and gripping; use ergonomic tools (Correct answer)
Apply heat for 20 minutes before any activity
Perform forceful wrist extension exercises daily

Correct answer: Avoid repetitive wrist extension and gripping; use ergonomic tools

Lateral epicondylitis results from repetitive wrist extension overuse; activity modification to reduce that load is the cornerstone of conservative management.

Question 62: Which pressure redistribution surface is MOST appropriate for a patient with multiple stage 2 pressure injuries who requires full-time bed rest?

Low-air-loss or alternating pressure mattress system (Correct answer)
Sheepskin pad over the existing mattress
Donut cushion placed under bony prominences
Standard hospital mattress with a thin foam overlay

Correct answer: Low-air-loss or alternating pressure mattress system

Low-air-loss or alternating pressure mattress systems provide superior pressure redistribution for high-risk patients with existing injuries compared to passive foam surfaces.

Question 63: Mr. Miller must keep a sleep journal prior to his polysomnogram, which is planned. What one of the following is evaluated using a sleep log?

Number of arousals during the night and hours of total sleep.
Mood on awakening and number of arousals during the sleep period.
Mood before sleep and on awakening and estimate of time of onset of sleep and number of arousals. (Correct answer)
Hours sleeping and hour awake.

Correct answer: Mood before sleep and on awakening and estimate of time of onset of sleep and number of arousals.

A sleep journal (or log) is used to gather subjective information about a patient's sleep patterns and related factors over a period. It typically records details like bedtime, wake time, estimated sleep onset latency, number and duration of awakenings, and subjective feelings or mood before sleep and upon waking. This provides a comprehensive picture for polysomnogram interpretation and diagnosis.

Question 64: A patient in cardiac rehab has a resting blood pressure of 180/105 mmHg before the exercise session. What is the APPROPRIATE nursing action?

Administer an emergency antihypertensive and continue
Have the patient rest 5 minutes and recheck once
Proceed with exercise at reduced intensity
Withhold exercise and notify the physician (Correct answer)

Correct answer: Withhold exercise and notify the physician

A resting BP ≥ 180/110 mmHg is a contraindication to cardiac rehabilitation exercise; the nurse should withhold exercise and notify the supervising physician.

Question 65: The patient exhibits signs of extreme anxiety throughout the initial interview and health history, including fidgeting, licking lips, and shaking. What is the BEST reaction out of the following?

“You are trembling. Can you tell me how you are feeling?” (Correct answer)
“Just relax, I’m only asking questions.”
“Would you like your spouse to answer these questions?”
“Let’s finish this later when you’re more relaxed.”

Correct answer: “You are trembling. Can you tell me how you are feeling?”

Acknowledging the patient's non-verbal cues and directly but gently inquiring about their feelings is the most empathetic and therapeutic response. This approach validates their experience, opens a channel for communication, and allows the patient to express their anxiety. Building trust and addressing their immediate emotional state is crucial for a productive interview.

Question 66: Which of the following best describes the role of the CRRN as a patient advocate in the rehabilitation team?

Deferring all advocacy to the social worker
Ensuring the patient's goals and preferences are communicated and integrated into the care plan (Correct answer)
Limiting family involvement to prevent conflicting opinions
Making all care decisions on behalf of the patient

Correct answer: Ensuring the patient's goals and preferences are communicated and integrated into the care plan

Patient advocacy in rehabilitation nursing centers on amplifying the patient's voice, ensuring their values and preferences drive individualized goal-setting and care planning.

Question 67: A patient with chronic obstructive pulmonary disease is performing diaphragmatic breathing exercises. Which cue is MOST appropriate for the nurse to provide?

Breathe with your chest, keeping your belly still
Place one hand on your chest and one on your belly; let your belly rise first (Correct answer)
Breathe as fast as possible to increase tidal volume
Hold your breath for 10 seconds between each breath

Correct answer: Place one hand on your chest and one on your belly; let your belly rise first

Diaphragmatic breathing training cues the patient to use the diaphragm by expanding the abdomen (belly) rather than the chest during inhalation.

Question 68: A rehabilitation nurse discovers a Stage 2 pressure injury on a patient's sacrum. Which intervention is the PRIORITY?

Apply a wet-to-dry dressing and change every 4 hours
Obtain a wound culture before initiating any treatment
Reposition the patient off the area and implement a pressure redistribution surface (Correct answer)
Debride the wound immediately at the bedside

Correct answer: Reposition the patient off the area and implement a pressure redistribution surface

Pressure relief is the cornerstone of pressure injury treatment; offloading the affected area and using a pressure-redistributing surface address the causative factor.

Question 69: What is a typical adverse reaction to hyperosmotic tube feedings?

hypotension
dysphagia
fatigue
diarrhea (Correct answer)

Correct answer: diarrhea

Hyperosmotic tube feedings contain a high concentration of solutes, which can draw water into the gastrointestinal tract. This influx of fluid increases bowel motility and can lead to osmotic diarrhea. This is a common adverse effect, often managed by adjusting the feeding's concentration or rate.

Question 70: A patient in Phase III cardiac rehabilitation reports new onset exertional chest pain with radiation to the left arm during today's session. Which is the PRIORITY nursing action?

Stop exercise immediately, administer nitroglycerin if prescribed, call emergency services (Correct answer)
Reduce exercise intensity by 50% and monitor
Ask the patient to rate the pain and continue if below 5/10
Finish the session and document the complaint

Correct answer: Stop exercise immediately, administer nitroglycerin if prescribed, call emergency services

New exertional chest pain with radiation is a cardiac emergency; exercise must stop immediately, prescribed nitroglycerin administered, and emergency services activated.

Question 71: A patient with rheumatoid arthritis is scheduled for hand rehabilitation. Which principle BEST guides joint protection education?

Perform forceful grip exercises daily to strengthen hand muscles
Avoid all exercise to protect inflamed joints
Use smaller joints to perform tasks requiring strength
Distribute force over larger joints and avoid prolonged static gripping (Correct answer)

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 72: A patient with stroke has urge urinary incontinence due to neurogenic detrusor overactivity. Which pharmacological intervention is most commonly used?

Anticholinergic medication such as oxybutynin (Correct answer)
Loop diuretic such as furosemide
Beta-blocker therapy
Alpha-blocker such as tamsulosin

Correct answer: Anticholinergic medication such as oxybutynin

Anticholinergic medications such as oxybutynin reduce involuntary detrusor contractions, decreasing urge incontinence in patients with neurogenic overactive bladder.

Question 73: A CRRN is discharging a patient who will self-manage anticoagulation therapy after DVT. Which teaching point is the highest priority?

Take double doses if a scheduled dose is missed
Avoid all physical activity until anticoagulation is complete
Report any unusual bleeding, bruising, or blood in urine or stool immediately (Correct answer)
Discontinue medication when leg swelling resolves

Correct answer: Report any unusual bleeding, bruising, or blood in urine or stool immediately

Recognizing and promptly reporting signs of bleeding is the highest priority safety concern for patients on anticoagulation therapy, as hemorrhagic complications can be life-threatening.

Question 74: Which assessment tool is most appropriate for measuring cognitive function and rehabilitation potential in a patient with acquired brain injury?

Barthel Index
Rancho Los Amigos Scale (Correct answer)
FIM Instrument
Berg Balance Scale

Correct answer: Rancho Los Amigos Scale

The Rancho Los Amigos Scale (Levels of Cognitive Functioning) is specifically designed to assess cognitive recovery stages following brain injury.

Question 75: When communicating with a patient who has expressive aphasia, which approach is most effective?

Complete the patient's sentences quickly to reduce frustration
Use simple sentences, yes/no questions, and allow adequate response time (Correct answer)
Ask open-ended questions to encourage full sentence responses
Speak in a louder voice to ensure comprehension

Correct answer: Use simple sentences, yes/no questions, and allow adequate response time

Simple sentences, closed-ended questions, and patience allow the patient with expressive aphasia to communicate within their preserved abilities without increasing frustration.

Question 76: Which outcome is EXPECTED for a patient with a complete C6 spinal cord injury regarding self-care?

Full ambulation with ankle-foot orthoses
Ability to perform upper body dressing independently with adaptive equipment (Correct answer)
Complete dependence in all self-care activities
Complete independence in all ADLs without assistive devices

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 77: A patient with an implantable cardioverter-defibrillator (ICD) is enrolled in cardiac rehabilitation. Which safety parameter is MOST important to establish before exercise?

Patient's previous athletic history
Maximum walking distance
Preferred exercise equipment type
ICD firing threshold and prescribed heart rate ceiling for exercise (Correct answer)

Correct answer: ICD firing threshold and prescribed heart rate ceiling for exercise

The ICD shock threshold and exercise heart rate ceiling must be established with the electrophysiologist to prevent inappropriate device activation during cardiac rehab.

Question 78: When assessing pain in a rehabilitation patient with severe cognitive impairment who is unable to self-report, the nurse should use:

Wong-Baker FACES Pain Rating Scale
PAINAD (Pain Assessment in Advanced Dementia) scale (Correct answer)
Numeric Rating Scale (NRS) with picture cards
Visual Analog Scale with verbal prompts

Correct answer: PAINAD (Pain Assessment in Advanced Dementia) scale

The PAINAD scale observes behavioral indicators including breathing, vocalization, facial expression, body language, and consolability to assess pain in non-verbal patients.

Question 79: When teaching weight-bearing precautions after a femur fracture, the CRRN distinguishes 'toe-touch weight bearing' (TTWB). Which description is CORRECT?

50% of body weight through the extremity
Foot contact for balance only, with minimal weight transfer (approximately 10–15% body weight) (Correct answer)
No contact with the ground whatsoever
Full body weight through the extremity

Correct answer: Foot contact for balance only, with minimal weight transfer (approximately 10–15% body weight)

TTWB (also called touch-down weight bearing) allows only foot contact for balance with minimal weight transfer, protecting fracture or surgical sites during early healing.

Question 80: When educating the family of a patient with moderate TBI about rehabilitation prognosis, the CRRN should state that recovery is most rapid during which period?

Years 5–10 post-injury
Recovery occurs only with surgical intervention
The first 6 months post-injury (Correct answer)
After age-related neuroplasticity peaks at age 40

Correct answer: The first 6 months post-injury

Neurological recovery after TBI is most rapid in the first 6 months, though meaningful gains can continue for years with sustained rehabilitation.

Question 81: A patient with fibromyalgia is starting a rehabilitation program. Which exercise approach has the STRONGEST evidence for improving symptoms?

Low-impact aerobic exercise such as water aerobics or walking (Correct answer)
Complete rest and activity avoidance
Heavy resistance training five days per week
High-intensity interval training three times weekly

Correct answer: Low-impact aerobic exercise such as water aerobics or walking

Low-impact aerobic exercise (aquatic therapy, walking, cycling) is the most evidence-supported intervention for reducing pain, fatigue, and depression in fibromyalgia.

Question 82: What is the maximum recommended daily dose of acetaminophen for a healthy adult patient in a rehabilitation setting?

6,000 mg/day
2,000 mg/day
3,000 mg/day
4,000 mg/day (Correct answer)

Correct answer: 4,000 mg/day

The maximum recommended daily dose of acetaminophen for healthy adults is 4,000 mg/day; however, many clinicians and guidelines recommend limiting to 3,000 mg/day in elderly patients or those with liver disease risk to prevent hepatotoxicity.

Question 83: The Functional Independence Measure (FIM) rates a patient at level 3 for feeding. This means the patient:

Requires moderate assistance — the helper does 50–74% of the effort
Requires moderate assistance — the helper does 25–49% of the effort (Correct answer)
Is independent with feeding using adaptive equipment
Needs only supervision or setup with no physical assistance

Correct answer: Requires moderate assistance — the helper does 25–49% of the effort

FIM level 3 (Moderate Assistance) means the patient performs 50–74% of the task themselves, with the helper contributing 25–49% of the effort.

Question 84: A rehabilitation nurse is assessing a patient who had a right-hemisphere stroke. Which deficit is MOST characteristic of right-hemisphere damage?

Expressive aphasia (Broca's)
Receptive aphasia (Wernicke's)
Left-sided neglect and impulsive behavior (Correct answer)
Right homonymous hemianopia

Correct answer: Left-sided neglect and impulsive behavior

Right-hemisphere strokes commonly cause left-sided neglect, poor safety judgment, and impulsive behavior, while left-hemisphere strokes more commonly cause aphasia.

Question 85: A rehabilitation nurse is performing a Braden Scale assessment. Which subscale DIRECTLY assesses the patient's level of physical activity?

Friction and Shear
Moisture
Activity (Correct answer)
Nutrition

Correct answer: Activity

The Braden Scale 'Activity' subscale directly scores the degree of physical activity, ranging from bedfast (1) to walks frequently (4), indicating mobility-related pressure injury risk.

Question 86: A rehabilitation nurse is educating a patient with chronic pain about cognitive-behavioral therapy (CBT). The primary focus of CBT for pain management is to:

Replace all pharmacological pain management with psychological interventions
Achieve complete elimination of all pain through psychological techniques alone
Identify and restructure maladaptive thought patterns and behaviors associated with pain (Correct answer)
Encourage total bed rest to prevent pain exacerbation during recovery

Correct answer: Identify and restructure maladaptive thought patterns and behaviors associated with pain

CBT for chronic pain targets the relationship between thoughts, emotions, and behaviors by teaching patients to identify catastrophizing and fear-avoidance beliefs and replace them with adaptive coping strategies that improve function despite pain.

Question 87: A COPD patient's rehabilitation outcome goal is to climb one flight of stairs independently. Which functional outcome measure BEST tracks this specific goal?

Arterial blood gas values
Peak expiratory flow rate
Six-Minute Walk Test (6MWT) (Correct answer)
FEV1/FVC ratio

Correct answer: Six-Minute Walk Test (6MWT)

The 6MWT measures submaximal functional exercise capacity and correlates with daily activity limitations, making it the most appropriate tool to track functional goals in COPD rehab.

Question 88: Which nutritional parameter is most useful for monitoring a rehabilitation patient's short-term protein status?

Serum albumin
Hemoglobin A1c
Total cholesterol
Prealbumin (transthyretin) (Correct answer)

Correct answer: Prealbumin (transthyretin)

Prealbumin has a half-life of 2–3 days, making it the most sensitive short-term marker of protein status and response to nutritional intervention.

Question 89: A patient post-stroke has left-sided neglect. Which nursing strategy BEST compensates for this deficit during meals?

Feed the patient to ensure adequate nutrition
Position the meal tray on the left side to stimulate awareness (Correct answer)
Dim the lights on the left side of the room
Place food on the right side of the tray only

Correct answer: Position the meal tray on the left side to stimulate awareness

Placing items on the neglected side and encouraging the patient to scan left promotes awareness and rehabilitation of unilateral neglect.

Question 90: Transcutaneous Electrical Nerve Stimulation (TENS) is believed to reduce pain in rehabilitation patients primarily through which mechanism?

Increasing systemic cortisol release to suppress inflammation
Directly destroying peripheral pain receptors at the skin surface
Permanently blocking small-diameter nociceptive nerve fibers
Stimulating large-diameter nerve fibers to inhibit pain signal transmission via gate control theory (Correct answer)

Correct answer: Stimulating large-diameter nerve fibers to inhibit pain signal transmission via gate control theory

According to the gate control theory of pain, TENS works by activating large-diameter A-beta nerve fibers that compete with and inhibit the transmission of pain signals carried by smaller A-delta and C fibers at the level of the spinal cord dorsal horn.

Question 91: A patient with a T6 spinal cord injury develops sudden severe headache, flushing above the injury, and bradycardia. The nurse's priority action is to:

Administer IV morphine for pain relief
Apply a cooling blanket for fever management
Increase IV fluid rate to improve perfusion
Sit the patient upright and identify the noxious stimulus (Correct answer)

Correct answer: Sit the patient upright and identify the noxious stimulus

These are classic signs of autonomic dysreflexia; sitting the patient upright lowers blood pressure while the noxious stimulus (commonly full bladder or bowel) must be identified and removed immediately.

Question 92: Which complication is a rehabilitation nurse most vigilant for in a patient who is post-stroke and has been prescribed subcutaneous heparin for DVT prophylaxis?

Systemic corticosteroid toxicity
Heparin-induced thrombocytopenia (HIT) (Correct answer)
Rebound anticoagulation after discontinuation
Adrenal insufficiency

Correct answer: Heparin-induced thrombocytopenia (HIT)

HIT is an immune-mediated reaction to heparin causing paradoxical thrombosis and requires platelet monitoring, typically between days 4–14 of therapy.

Question 93: A CRRN is planning care for a patient with myasthenia gravis admitted for rehabilitation. Which factor requires the MOST careful monitoring?

Skin integrity over bony prominences
Blood glucose fluctuations
Urinary retention
Respiratory muscle strength and pulmonary function (Correct answer)

Correct answer: Respiratory muscle strength and pulmonary function

Myasthenic crisis involves life-threatening respiratory muscle failure; continuous monitoring of respiratory function is the highest priority in MG rehabilitation.

Question 94: A patient with an ankle sprain is beginning rehabilitation in the subacute phase. Which intervention is MOST appropriate at this stage?

High-load strength training of the ankle plantar flexors
Surgical consultation for ligament repair
Proprioceptive and balance training to restore neuromuscular control (Correct answer)
RICE protocol with complete rest for another 4 weeks

Correct answer: Proprioceptive and balance training to restore neuromuscular control

In the subacute phase of ankle sprain, proprioceptive training and balance exercises restore neuromuscular control and reduce re-injury risk.

Question 95: During a neurogenic bowel program, a patient with complete T8 SCI is found to have a fecal impaction. Which is the MOST appropriate initial intervention?

Withhold all fluids to firm up the stool
Administer a high-volume soap-suds enema immediately
Perform manual removal of impacted stool using a well-lubricated, gloved finger (Correct answer)
Schedule a colonoscopy the following morning

Correct answer: Perform manual removal of impacted stool using a well-lubricated, gloved finger

Manual disimpaction is the appropriate first intervention for fecal impaction in SCI patients; it must be performed carefully to avoid triggering autonomic dysreflexia.

Question 96: Which of the following methods of massage therapy typically uses broad, rhythmic strokes that start out gently and get stronger as they relax the recipient and reveal any tightness or pain?

Friction
Trigger point.
Effleurage. (Correct answer)
Pétrissage.

Correct answer: Effleurage.

Effleurage is a massage technique characterized by long, gliding strokes that are typically performed at the beginning and end of a massage. These strokes are designed to warm up the tissues, spread oil, and help the therapist assess underlying muscle tension, starting gently and gradually increasing pressure. It promotes relaxation and prepares the tissues for deeper work.

Question 97: A patient with a C5 spinal cord injury is at risk for autonomic dysreflexia. Which blood pressure reading should prompt immediate intervention?

Systolic 20 mmHg above baseline (Correct answer)
Diastolic above 90 mmHg
Systolic 140 mmHg in a previously normotensive patient
Any reading above 120/80 mmHg

Correct answer: Systolic 20 mmHg above baseline

Autonomic dysreflexia is defined as a sudden rise in systolic BP of 20–40 mmHg above the patient's baseline, which requires immediate assessment and intervention.

Question 98: Which intervention BEST prevents heterotopic ossification (HO) in a patient with severe TBI?

Administer prophylactic indomethacin and maintain gentle ROM (Correct answer)
Encourage early forceful stretching of stiff joints
Apply heat to joints with early signs of HO
Restrict passive range of motion exercises

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.

Question 99: A patient with heart failure (HF) is discharged from inpatient rehabilitation. Which daily monitoring instruction is MOST important for early detection of decompensation?

Weigh daily at the same time and report a gain of 2–3 lbs in 24 hours or 5 lbs in a week (Correct answer)
Monitor urine color for hydration status
Check pulse oximetry only when symptomatic
Measure blood glucose every morning

Correct answer: Weigh daily at the same time and report a gain of 2–3 lbs in 24 hours or 5 lbs in a week

Daily weights detect fluid retention early in HF; a weight gain of 2–3 lbs in 24 hours or 5 lbs in a week signals impending decompensation requiring immediate medical contact.

Question 100: A rehabilitation nurse is assessing a patient one week post-coronary artery bypass graft (CABG). Which finding requires IMMEDIATE reporting?

Minor incision site bruising
Mild sternal discomfort with deep breathing
Fatigue with low-level activity
Sternal clicking with movement and fever of 101.8°F (Correct answer)

Correct answer: Sternal clicking with movement and fever of 101.8°F

Sternal instability (clicking) combined with fever suggests sternal dehiscence or mediastinitis, a life-threatening post-CABG complication requiring emergent evaluation.

Question 101: A patient who underwent total hip arthroplasty (THA) via posterior approach is being educated on hip precautions. Which movement is CONTRAINDICATED?

Hip extension exercises
Hip abduction past midline
Isometric gluteal sets
Hip flexion beyond 90 degrees (Correct answer)

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 102: A wound care nurse is selecting a dressing for a stage 3 pressure injury with moderate exudate and a clean, granulating base. Which dressing type is MOST appropriate?

Transparent film dressing to observe the wound
Dry gauze dressing changed every 8 hours
Iodine-soaked gauze packing
Alginate or foam dressing to maintain moist wound healing while managing exudate (Correct answer)

Correct answer: Alginate or foam dressing to maintain moist wound healing while managing exudate

Alginate and foam dressings absorb moderate-to-heavy exudate while maintaining the moist environment proven to optimize wound healing and granulation tissue formation.

Question 103: A patient with paraplegia develops a stage 3 pressure injury over the ischial tuberosity. Which factor is the PRIMARY cause of ischial pressure injuries in wheelchair users?

Shear force from ambulation
Moisture from urinary incontinence alone
Sustained pressure exceeding capillary closing pressure during prolonged sitting (Correct answer)
Friction from bed linen

Correct answer: Sustained pressure exceeding capillary closing pressure during prolonged sitting

Ischial pressure injuries in wheelchair users result from sustained pressure exceeding capillary closing pressure (~32 mmHg), causing tissue ischemia during prolonged sitting.

Question 104: At the level of the: motor nerve fibers cross over in the brainstem.

hypothalamus
sacral
refle
medulla (Correct answer)

Correct answer: medulla

The decussation of the pyramids, where the majority of motor nerve fibers (corticospinal tracts) cross from one side of the brainstem to the opposite side of the spinal cord, occurs in the medulla oblongata. This crossing explains why one side of the brain controls movement on the opposite side of the body.

Question 105: A rehabilitation patient with a T6 spinal cord injury suddenly reports a severe pounding headache and diaphoresis above the level of injury along with worsening pain. The nurse's priority action is to:

Administer a PRN analgesic immediately
Apply a heating pad to relieve muscle spasm
Assess for and eliminate the triggering stimulus for autonomic dysreflexia (Correct answer)
Notify dietary services about a potential food sensitivity

Correct answer: Assess for and eliminate the triggering stimulus for autonomic dysreflexia

Sudden severe headache with diaphoresis above the level of injury in a patient with SCI at T6 or above is a hallmark presentation of autonomic dysreflexia, a medical emergency requiring immediate identification and removal of the noxious stimulus.

Question 106: A patient recovering from a stroke develops central post-stroke pain. Which description BEST characterizes this condition?

Burning or aching pain on the side affected by the stroke, often allodynia (Correct answer)
Muscle pain from spasticity only
Pain limited to the shoulder and upper extremity
Sharp, well-localized pain at the stroke site in the brain

Correct answer: Burning or aching pain on the side affected by the stroke, often allodynia

Central post-stroke pain is a neuropathic pain syndrome with burning, aching, or lancinating pain and allodynia (pain from non-painful stimuli) on the hemiplegic side.

Question 107: The cause of esophageal speech.

knowledge to comprehension to application
less likelihood for systemic side effects
use repetition
burping to exert pressure and produce vibration (Correct answer)

Correct answer: burping to exert pressure and produce vibration

Esophageal speech is a method of voice production used by individuals who have had their larynx removed (laryngectomy). It involves swallowing air into the esophagus and then expelling it, causing the upper esophageal sphincter to vibrate. This vibration produces a sound that can then be articulated into speech.

Question 108: A patient with a diabetic foot ulcer has signs of wound infection. Which assessment finding BEST confirms local wound infection?

Granulating tissue at the wound margins
Thin serous drainage and no odor
Mild redness at wound edges only
Increased wound pain, warmth, purulent exudate, and periwound erythema > 2 cm (Correct answer)

Correct answer: Increased wound pain, warmth, purulent exudate, and periwound erythema > 2 cm

Local wound infection is confirmed by classic signs: increased pain, warmth, purulent exudate, odor, and periwound erythema extending more than 2 cm from the wound edge.

Question 109: Tricyclic antidepressants (TCAs) such as amitriptyline are sometimes prescribed for rehabilitation patients with chronic pain primarily because they:

Significantly increase opioid receptor sensitivity to reduce opioid doses
Eliminate the need for participation in physical therapy
Have demonstrated analgesic properties for neuropathic and central pain (Correct answer)
Work exclusively as antidepressants to improve mood and pain tolerance

Correct answer: Have demonstrated analgesic properties for neuropathic and central pain

TCAs have analgesic properties independent of their antidepressant effects, modulating norepinephrine and serotonin reuptake to inhibit pain signal transmission in the spinal cord, making them effective adjuvant analgesics for neuropathic pain.

Question 110: Which finding during a bedside swallowing evaluation warrants immediate referral to speech-language pathology for a formal swallowing study?

Patient requires two swallows per bolus
Wet or gurgly vocal quality after swallowing water (Correct answer)
Patient reports mild dry mouth
Slow oral preparation of solid foods

Correct answer: Wet or gurgly vocal quality after swallowing water

A wet or gurgly vocal quality after swallowing indicates residue on or near the vocal cords, suggesting aspiration or penetration requiring formal evaluation.

Question 111: A rehabilitation patient describes pain as 'burning, shooting, and electric shock-like' that radiates along the arm following a nerve distribution. This pain is best classified as:

Inflammatory pain
Neuropathic pain (Correct answer)
Visceral pain
Somatic pain

Correct answer: Neuropathic pain

Neuropathic pain arises from damage or dysfunction of the nervous system and is characteristically described as burning, shooting, tingling, or electric shock-like, often following a dermatomal or nerve distribution pattern.

Question 112: A patient with COPD is learning pursed-lip breathing in pulmonary rehabilitation. What is the PRIMARY purpose of this technique?

Deliver higher FiO2 without supplemental oxygen
Slow exhalation to reduce air trapping and dynamic hyperinflation (Correct answer)
Strengthen the diaphragm through resistance
Increase the respiratory rate to improve oxygenation

Correct answer: Slow exhalation to reduce air trapping and dynamic hyperinflation

Pursed-lip breathing creates back-pressure that slows expiratory flow, preventing small airway collapse and reducing dynamic hyperinflation in COPD.

Question 113: A patient 3 days post-total hip arthroplasty (posterior approach) asks to cross their legs while sitting. What is the correct nursing response?

Instruct the patient to avoid crossing the legs to prevent hip dislocation (Correct answer)
Explain that crossing legs is allowed after 6 weeks
Allow it if the patient is comfortable and pain-free
Apply a hip abduction pillow only during sleep

Correct answer: Instruct the patient to avoid crossing the legs to prevent hip dislocation

After a posterior-approach total hip arthroplasty, crossing the legs is prohibited as it causes hip adduction and internal rotation, placing the patient at risk for dislocation.

Question 114: Which test is used primarily to determine a patient's risk of falling while the CRRN is evaluating their functional ability?

Instrumental Activities of Daily Living.
Timed Up and Go (TUG). (Correct answer)
Katz Activities of Daily Living (ADL) scale.
Functional Ability Rating scale.

Correct answer: Timed Up and Go (TUG).

The Timed Up and Go (TUG) test is a widely used and validated clinical test for assessing mobility, balance, and fall risk in older adults and individuals with various conditions. It measures the time it takes for a person to stand up from a chair, walk three meters, turn around, walk back to the chair, and sit down. This provides a quick and reliable indicator of functional ability related to falling.

Question 115: What are the three PRIMARY variables that should be taken into account while conducting a pretransfer assessment?

Strength and motivation.
Physical, cognitive, and emotional status. (Correct answer)
Safety awareness, strength, and cognition.
Weight, extension, and balance.

Correct answer: Physical, cognitive, and emotional status.

When conducting a pre-transfer assessment, it's crucial to evaluate the patient's holistic capacity to participate safely and effectively. This includes their physical strength, balance, and mobility; their cognitive ability to understand and follow instructions; and their emotional state, which can significantly impact cooperation and safety during the transfer. All three variables are interdependent and vital for a successful transfer.

Question 116: A strong gag reaction means that:

pharyngeal muscles are constricting (Correct answer)
aid in venous return and reduce swelling
hip flexion contracture
decreased

Correct answer: pharyngeal muscles are constricting

A gag reflex is an involuntary contraction of the pharyngeal muscles, specifically the constrictor muscles of the pharynx. This reflex is a protective mechanism designed to prevent foreign objects from entering the trachea and is triggered by stimulation of the back of the throat or soft palate.

Question 117: What does the term "reliability" mean when analyzing data and results?

Results are supported by observation.
Results are reproducible. (Correct answer)
Data were evaluated by a statistician.
Data come from reliable sources.

Correct answer: Results are reproducible.

In data analysis and research, 'reliability' refers to the consistency of a measure. If a measurement is reliable, it will produce the same results under the same conditions when repeated. This means that the results are reproducible, indicating the trustworthiness and consistency of the data collection method rather than just the source or evaluation.

Question 118: A rehabilitation nurse is educating a patient about the Borg Rating of Perceived Exertion (RPE) scale for home exercise after heart failure. Which RPE level indicates APPROPRIATE exercise intensity?

RPE 17–19 (very hard to extremely hard)
RPE 6–8 (nothing to very, very light)
RPE 20 (maximum exertion)
RPE 11–14 (fairly light to somewhat hard) (Correct answer)

Correct answer: RPE 11–14 (fairly light to somewhat hard)

An RPE of 11–14 on the 6–20 Borg scale represents moderate exercise intensity, which is safe and therapeutic for most cardiac rehabilitation patients.

Question 119: When documenting a cardiac rehabilitation patient's exercise tolerance using METs (metabolic equivalents), which MET level corresponds to light household activities such as slow walking?

5–6 METs
12–14 METs
1–2 METs (Correct answer)
8–10 METs

Correct answer: 1–2 METs

Light household activities and slow walking require approximately 1–2 METs, which is used as a baseline for graded activity prescriptions in cardiac rehab.

Question 120: Which non-pharmacological intervention is most appropriate and evidence-based for a rehabilitation patient experiencing phantom limb pain following lower extremity amputation?

Keeping the residual limb in a dependent position to reduce edema and pain
Applying a tight constrictive bandage to the residual limb around the clock
Mirror therapy combined with residual limb desensitization techniques (Correct answer)
Avoiding all tactile contact with the residual limb to prevent stimulation

Correct answer: Mirror therapy combined with residual limb desensitization techniques

Mirror therapy uses visual feedback of the intact limb's reflection to 'trick' the brain into perceiving the amputated limb as present and moving, which has demonstrated effectiveness in reducing phantom limb pain by reorganizing the cortical representation of the missing limb.

Question 121: The management of a long-term board and care facility has refused to move a patient with disabilities' verbally abusive roommate to another room, despite the patient's claims that the roommate is abusive. Which agency is MOST suited to handle the patient's worries?

Adult protective services.
Americans with Disabilities Act (ADA) program.
The police.
Long-Term Care Ombudsman Program. (Correct answer)

Correct answer: Long-Term Care Ombudsman Program.

The Long-Term Care Ombudsman Program is specifically designed to advocate for the rights of residents in nursing homes, assisted living facilities, and other long-term care settings. They investigate and resolve complaints made by or on behalf of residents, including issues like abuse, neglect, and violations of resident rights. This makes them the most appropriate agency to address the patient's concerns.

Question 122: Which non-pharmacological intervention is most appropriate for a rehabilitation patient experiencing acute musculoskeletal pain within the first 24 to 48 hours of injury?

Therapeutic ultrasound at deep tissue level
Moist heat therapy applied for 20 minutes
Deep tissue massage over the acute injury site
Cold therapy (cryotherapy) applied to the injured area (Correct answer)

Correct answer: Cold therapy (cryotherapy) applied to the injured area

Cold therapy (cryotherapy) is the preferred intervention in the acute phase of musculoskeletal injury because it causes vasoconstriction that reduces swelling, decreases inflammatory mediators, and produces local analgesia by slowing nerve conduction velocity.

Question 123: A patient post-total knee arthroplasty (TKA) has a target of 90 degrees of knee flexion before discharge. Which intervention BEST achieves this goal?

Application of a knee immobilizer at all times
Ice therapy only, avoiding movement for 72 hours
Continuous passive motion (CPM) combined with active ROM exercises (Correct answer)
Strict bed rest with the knee in extension

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 124: A rehabilitation nurse is caring for a patient with complex regional pain syndrome (CRPS) of the right hand. Which nursing priority is MOST appropriate?

Avoid all touch to the affected extremity
Facilitate desensitization therapy and graded motor imagery (Correct answer)
Immobilize the hand in a cast to reduce pain
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.

Question 125: 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
Skin breakdown in upper extremities
Hypertension from dietary salt
Bladder distension or bowel impaction (Correct answer)

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 126: A patient's sacral wound is being treated with negative pressure wound therapy (NPWT/wound VAC). Which assessment finding requires IMMEDIATE intervention?

Canister filling at the expected rate
Sudden loss of suction with bright red blood visible in the foam dressing (Correct answer)
Mild vacuum noise from the device
Moderate serous drainage in the canister

Correct answer: Sudden loss of suction with bright red blood visible in the foam dressing

Bright red blood in the NPWT dressing or canister indicates wound bleeding, which requires immediate foam removal, manual pressure, and urgent physician notification.

Question 127: When setting functional goals for a patient after a stroke, the rehabilitation nurse should ensure goals are:

Specific, measurable, attainable, relevant, and time-bound (SMART) (Correct answer)
Set exclusively by the physician based on imaging findings
Based solely on the nurse's clinical experience
Broad and long-term to allow flexibility

Correct answer: Specific, measurable, attainable, relevant, and time-bound (SMART)

SMART goals provide a clear framework that guides interdisciplinary care planning, tracks progress, and promotes patient-centered rehabilitation outcomes.

Question 128: Which pressure injury stage is characterized by full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone?

Stage 4 (Correct answer)
Deep tissue pressure injury
Stage 3
Unstageable

Correct answer: Stage 4

Stage 4 pressure injuries involve full-thickness loss with visible or directly palpable underlying structures such as fascia, muscle, tendon, bone, or cartilage.

Question 129: Which pain assessment tool is most appropriate for evaluating pain in a non-verbal adult patient with cognitive impairment in a rehabilitation setting?

PAINAD Scale (Correct answer)
Visual Analog Scale (VAS)
Wong-Baker FACES Scale
Numeric Rating Scale (NRS)

Correct answer: PAINAD Scale

The PAINAD (Pain Assessment in Advanced Dementia) scale was specifically designed to assess pain in non-verbal patients who cannot self-report, using behavioral indicators such as breathing, vocalization, facial expression, body language, and consolability.

Question 130: A CRRN documents a deep tissue pressure injury (DTPI) on the heel. Which description BEST matches this classification?

A localized area of discolored, intact or non-intact skin due to underlying soft tissue injury from pressure (Correct answer)
Superficial skin erosion with a pink wound bed
Full-thickness skin loss with exposed bone
A blister filled with serous fluid over an area of redness

Correct answer: A localized area of discolored, intact or non-intact skin due to underlying soft tissue injury from pressure

DTPI presents as persistent non-blanchable deep red, maroon, or purple discoloration from injury to underlying tissue, which may evolve rapidly even when skin appears intact.

Question 131: 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)
Preventing spasticity
Managing hyperreflexia

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 132: A rehabilitation nurse is assessing a patient's pressure injury risk. Which tool is specifically validated and widely used in rehabilitation settings?

Glasgow Coma Scale
Braden Scale (Correct answer)
Functional Independence Measure (FIM)
Berg Balance Scale

Correct answer: Braden Scale

The Braden Scale assesses sensory perception, moisture, activity, mobility, nutrition, and friction/shear to predict pressure injury risk.

Question 133: A patient with a lower motor neuron neurogenic bowel (flaccid) requires which bowel management strategy?

Rectal suppositories twice daily to trigger reflexic defecation
High-fiber diet alone without any manual techniques
Scheduled timed evacuations using Valsalva maneuver, abdominal massage, and manual evacuation (Correct answer)
Digital rectal stimulation to trigger the defecation reflex

Correct answer: Scheduled timed evacuations using Valsalva maneuver, abdominal massage, and manual evacuation

LMN neurogenic bowel lacks the anorectal reflex, so evacuation relies on Valsalva, abdominal massage, and manual techniques rather than reflex stimulation methods.

Question 134: A rehabilitation nurse notes that a patient's pain is consistently worse during morning physical therapy sessions and improves with rest and ice application. This pain pattern is most consistent with:

Central sensitization syndrome
Musculoskeletal pain aggravated by mechanical loading (Correct answer)
Visceral pain from an internal organ
Neuropathic pain from nerve root compression

Correct answer: Musculoskeletal pain aggravated by mechanical loading

Pain that worsens with movement and physical loading during therapy but improves with rest and cryotherapy is characteristic of musculoskeletal pain, which is mechanical in nature and responds to activity modification and conservative interventions.

Question 135: A patient with a neurogenic bowel is experiencing constipation despite a scheduled bowel program. Which dietary intervention is MOST appropriate?

Initiate a liquid-only diet for 48 hours
Increase dietary fiber to 25–38 grams per day and ensure adequate fluid intake (Correct answer)
Eliminate all fruits and vegetables from the diet
Decrease fluid intake to prevent loose stools

Correct answer: Increase dietary fiber to 25–38 grams per day and ensure adequate fluid intake

Adequate dietary fiber (25–38 g/day) combined with sufficient fluid intake (1.5–2 L/day) promotes stool bulk and motility, improving constipation in neurogenic bowel.

Question 136: Which finding BEST indicates a successful neurogenic bowel program in a patient with SCI?

Chronic constipation requiring daily enemas
Spontaneous unscheduled bowel movements throughout the day
Predictable bowel evacuation every 1–2 days without incontinence episodes (Correct answer)
Daily incontinence episodes with large-volume stool

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 137: Which outcome measure is MOST appropriate for assessing functional independence across motor and cognitive domains in an inpatient rehabilitation setting?

Berg Balance Scale
Barthel Index
Glasgow Coma Scale (GCS)
Functional Independence Measure (FIM) (Correct answer)

Correct answer: Functional Independence Measure (FIM)

The FIM assesses 18 items across motor and cognitive domains using a 7-level ordinal scale and is the standard tool in inpatient rehabilitation settings.

Question 138: A patient with a traumatic brain injury (TBI) is at Rancho Los Amigos Level V (confused-inappropriate). Which nursing approach is most appropriate?

Allow unrestricted visitation to provide maximum stimulation
Provide complex multi-step ADL tasks to stimulate cognition
Use consistent routine, simple one-step commands, and minimize environmental distractions (Correct answer)
Encourage group therapy sessions to promote social engagement

Correct answer: Use consistent routine, simple one-step commands, and minimize environmental distractions

At RLA Level V, patients are confused and need a structured, low-stimulation environment with consistent routine and simple directions to support cognitive recovery.

Question 139: A patient with a TBI demonstrates impulsive behavior and poor safety awareness. Which nursing intervention best addresses this deficit?

Administer sedatives before therapy sessions
Restrict all mobility until behavior improves
Document the behavior and defer to psychiatry alone
Use consistent cueing, structured routines, and environmental modifications (Correct answer)

Correct answer: Use consistent cueing, structured routines, and environmental modifications

Structured routines, consistent cues, and environmental modifications reduce cognitive overload and compensate for executive function deficits common after TBI.

Question 140: During discharge planning for a patient with dysphagia following a stroke, the CRRN should coordinate with which specialist first?

Physiatrist
Speech-language pathologist (Correct answer)
Dietitian
Occupational therapist

Correct answer: Speech-language pathologist

The speech-language pathologist (SLP) is the primary specialist for evaluating swallowing function and recommending diet texture modifications in post-stroke dysphagia.

Question 141: A patient with a C6 complete SCI is at high risk for heterotopic ossification (HO). Which early clinical finding MOST suggests HO in the hip region?

Increased spasticity in the lower extremities
Elevated serum creatinine and BUN
Localized warmth, swelling, and decreased range of motion below the injury (Correct answer)
Sudden onset of leg pain with positive Homans' sign

Correct answer: Localized warmth, swelling, and decreased range of motion below the injury

Early HO presents with localized warmth, swelling, erythema, and progressive loss of range of motion, often mimicking deep vein thrombosis or infection.

Question 142: A rehabilitation nurse is reviewing a clean intermittent catheterization technique with a patient for home use. Which modification distinguishes CLEAN from sterile technique for home IC?

Reusable catheters cleaned with soap and water; handwashing and clean technique are acceptable (Correct answer)
IC must only be performed by a licensed nurse at home
Sterile saline irrigation required before each catheterization
Single-use sterile catheters and sterile gloves required

Correct answer: Reusable catheters cleaned with soap and water; handwashing and clean technique are acceptable

Clean IC at home uses clean (not sterile) technique with reusable catheters washed with soap and water, which is safe and evidence-based for outpatient neurogenic bladder management.

Question 143: 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?

Lay the patient flat to improve cerebral perfusion
Administer sublingual nifedipine immediately
Sit the patient upright, loosen constrictive clothing, and identify/remove the noxious stimulus (Correct answer)
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 144: Which lab value change MOST warrants withholding cardiac rehabilitation exercise and notifying the physician?

Hemoglobin 13.5 g/dL
Sodium 138 mEq/L
Blood glucose 105 mg/dL
Potassium 2.8 mEq/L (Correct answer)

Correct answer: Potassium 2.8 mEq/L

Hypokalemia (K+ < 3.0 mEq/L) increases the risk of life-threatening cardiac arrhythmias during exercise and is a contraindication to proceeding with cardiac rehab.

Question 145: When assessing a patient with amyotrophic lateral sclerosis (ALS) for aspiration risk, which finding is MOST concerning?

Bilateral hand weakness
Weak cough and wet vocal quality after swallowing (Correct answer)
Increased deep tendon reflexes
Spastic gait pattern

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

Urinary retention with overflow incontinence due to acontractile detrusor (Correct answer)
Frequent small-volume voids with urgency
Hyperreflexic detrusor contractions with urge incontinence
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 147: A patient with gout is admitted to the rehabilitation unit with an acute flare. Which nursing intervention is PRIORITY during an acute attack?

Apply moist heat to the inflamed joint
Rest the affected joint, apply ice, and administer prescribed anti-inflammatory medication (Correct answer)
Encourage vigorous physical therapy of the affected joint
Increase dietary purine intake to promote uric acid excretion

Correct answer: Rest the affected joint, apply ice, and administer prescribed anti-inflammatory medication

Acute gout management centers on joint rest, ice application, and anti-inflammatory medications (NSAIDs, colchicine, or corticosteroids) to reduce inflammation.

Question 148: As opposed to bilevel positive airway pressure (BPAP), which of the following conditions is typically treated with continuous positive airway pressure (CPAP)?

unilateral neglect
homonymous hemianopsia (Correct answer)
bitemporal hemianopsia
blurry vision

Correct answer: homonymous hemianopsia

CPAP (Continuous Positive Airway Pressure) is a respiratory therapy primarily used to treat conditions like sleep apnea by maintaining an open airway. Homonymous hemianopsia, however, is a visual field defect resulting from neurological damage, such as a stroke. These two conditions are medically unrelated, and CPAP is not a typical treatment for visual impairments, suggesting a potential error in the question or provided answer.

Question 149: A CRRN is educating a patient about the timed voiding program for functional urinary incontinence. Which description BEST explains this program?

Strengthening the pelvic floor with biofeedback daily
Voiding only when urgency is felt to retrain bladder capacity
Assisting the patient to void at regular scheduled intervals regardless of urge, to prevent incontinence episodes (Correct answer)
Restricting fluid intake after noon to reduce nighttime voids

Correct answer: Assisting the patient to void at regular scheduled intervals regardless of urge, to prevent incontinence episodes

Timed voiding (prompted or scheduled) is a caregiver-assisted program where the patient is taken to the toilet at fixed intervals to prevent incontinence in patients who cannot self-initiate.

Question 150: A CRRN is teaching a patient with paraplegia to perform weight shifts in the wheelchair. How frequently should weight shifts be performed to prevent pressure injuries?

Every 15–20 minutes (Correct answer)
Once per hour
Every 30 minutes
Every 2 hours

Correct answer: Every 15–20 minutes

Wheelchair push-ups or forward lean weight shifts should be performed every 15–20 minutes to relieve ischial pressure and prevent pressure injury formation in seated individuals.

Question 151: A rehabilitation patient with SCI consistently has post-void residual (PVR) volumes of 350 mL after voiding attempts. What does this indicate?

Incomplete bladder emptying indicating potential for UTI and upper urinary tract damage (Correct answer)
Appropriate fluid restriction
Successful neurogenic bladder management
Normal bladder emptying with healthy retention

Correct answer: Incomplete bladder emptying indicating potential for UTI and upper urinary tract damage

A PVR of 350 mL indicates significant urinary retention; volumes above 100 mL are associated with increased UTI risk and potential hydronephrosis from reflux.

Question 152: A CRRN is staging a wound with slough covering 70% of the wound bed. The visible tissue appears to reach subcutaneous fat. Which pressure injury stage is CORRECT?

Stage 4
Unstageable (Correct answer)
Stage 1
Stage 2

Correct answer: Unstageable

When slough or eschar obscures the wound base and prevents accurate depth assessment, the injury is classified as unstageable until the wound bed is debrided.

Question 153: A patient with rheumatoid arthritis attending rehabilitation asks about joint protection strategies for the hands. The nurse should teach the patient to:

Use a tight grip and pinch technique for maximum strength
Perform repetitive resistive hand exercises daily to maintain strength
Apply heat before all manual activities to improve flexibility
Use the larger, stronger joints for tasks whenever possible and avoid sustained gripping (Correct answer)

Correct answer: Use the larger, stronger joints for tasks whenever possible and avoid sustained gripping

Joint protection principles in rheumatoid arthritis include using larger joints for load-bearing tasks, avoiding prolonged static positions, and distributing stress across multiple joints.

Question 154: A patient with neurogenic bladder after SCI is being taught intermittent catheterization (CIC). The nurse should instruct the patient to catheterize every:

1–2 hours regardless of fluid intake
8–12 hours to reduce urethral trauma
4–6 hours with a goal of volumes under 400–500 mL (Correct answer)
Only when feeling a strong urge to void

Correct answer: 4–6 hours with a goal of volumes under 400–500 mL

CIC every 4–6 hours maintains bladder volumes below 400–500 mL, which prevents overdistension, reduces infection risk, and protects upper urinary tract function.

Question 155: A CRRN is planning bladder retraining for a patient with a neurogenic bladder following TBI. Which intervention is the foundation of an intermittent catheterization program?

Using external condom catheters overnight only
Placing an indwelling Foley catheter until the patient regains consciousness
Catheterizing on a timed schedule to keep bladder volume under 400–500 mL (Correct answer)
Limiting fluid intake to 1,000 mL per day

Correct answer: Catheterizing on a timed schedule to keep bladder volume under 400–500 mL

Intermittent catheterization programs are based on timed schedules (typically every 4–6 hours) to prevent overdistension and maintain bladder volumes below 400–500 mL.

Question 156: When caring for a patient in the subacute phase of a stroke, the CRRN observes shoulder subluxation on the hemiplegic side. The priority nursing action is:

Massage the shoulder vigorously to stimulate muscle tone
Apply a tightly bound sling at all times
Position the arm with proper support and educate the patient and family on handling techniques (Correct answer)
Restrict all use of the affected arm to prevent further injury

Correct answer: Position the arm with proper support and educate the patient and family on handling techniques

Proper positioning, arm support troughs, and education on safe handling prevent further subluxation and shoulder-hand syndrome without restricting therapeutic use of the limb.

Question 157: The rehabilitation nurse is using the Functional Pain Scale (FPS) to assess a patient. How does this scale differ from the standard Numeric Rating Scale (NRS)?

It only measures acute pain following surgical procedures
It is designed exclusively for pediatric rehabilitation patients
It incorporates the impact of pain on the patient's ability to function (Correct answer)
It uses illustrated facial expressions to represent pain intensity

Correct answer: It incorporates the impact of pain on the patient's ability to function

The Functional Pain Scale differs from the NRS by combining pain intensity with its functional impact, rating both how much pain the patient has and how it affects their ability to tolerate and perform activities — critical information in a rehabilitation context.

Question 158: A rehabilitation nurse is teaching a patient about the risks of long-term NSAID use. Which adverse effect is of greatest concern for patient safety?

Gastrointestinal bleeding and peptic ulcer formation (Correct answer)
Hyperkalemia leading to cardiac dysrhythmia
Peripheral neuropathy causing sensory deficits
Hyperglycemia requiring insulin adjustment

Correct answer: Gastrointestinal bleeding and peptic ulcer formation

Long-term NSAID use inhibits prostaglandin synthesis, which reduces protective gastric mucosa production, significantly increasing the risk of gastrointestinal bleeding and peptic ulcer disease, especially in older rehabilitation patients.

Question 159: A patient with post-polio syndrome reports new onset fatigue and weakness decades after initial polio. Which nursing recommendation is MOST appropriate?

Suggest aggressive strengthening of already-weakened muscles
Advise complete bed rest until symptoms resolve
Encourage a 'push through the pain' exercise philosophy
Recommend energy conservation techniques and paced activity (Correct answer)

Correct answer: Recommend energy conservation techniques and paced activity

Post-polio syndrome requires energy conservation and activity pacing because overexertion accelerates the loss of surviving motor neurons.

Question 160: A patient with a stage 3 pressure injury over the sacrum is being treated. Which wound care principle should guide the rehabilitation nurse's practice?

Leave the wound open to air to speed epithelialization
Apply hydrogen peroxide daily to reduce bacterial colonization
Maintain a moist wound environment to promote healing and granulation (Correct answer)
Pack the wound tightly with dry gauze to absorb drainage

Correct answer: Maintain a moist wound environment to promote healing and granulation

Moist wound healing promotes granulation tissue formation, facilitates autolytic debridement, and accelerates re-epithelialization compared to dry wound management.

Question 161: A patient with TBI at Rancho Level IV is agitated and pulling at tubes. Which nursing intervention is MOST appropriate?

Administer high-dose sedatives to reduce agitation
Apply soft restraints to all four extremities
Transfer the patient to a psychiatric unit
Use a calm, consistent approach and minimize stimulation (Correct answer)

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 162: 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 immediately after each fluid intake
Catheterize every 4–6 hours to keep bladder volume below 400–500 mL (Correct answer)
Catheterize once daily before sleep

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 163: When performing neurovascular checks on a patient in skeletal traction, which finding requires IMMEDIATE intervention?

2+ distal pulses
Minor edema distal to the traction site
Paresthesias and absent distal pulse in the affected extremity (Correct answer)
Capillary refill of 2 seconds

Correct answer: Paresthesias and absent distal pulse in the affected extremity

Absent distal pulse and paresthesias indicate neurovascular compromise, which is a limb-threatening emergency requiring immediate traction adjustment and physician notification.

Question 164: A patient with a spinal cord injury at L1 reports difficulty initiating urination. Urodynamic testing reveals detrusor areflexia. Which bladder management strategy is MOST appropriate?

Indwelling Foley catheter long-term
Clean intermittent catheterization (CIC) program (Correct answer)
Triggered reflex voiding using suprapubic tapping
Credé maneuver as the sole emptying method

Correct answer: Clean intermittent catheterization (CIC) program

Detrusor areflexia means the bladder cannot contract; clean intermittent catheterization is the gold-standard management to ensure regular, complete bladder emptying.

Question 165: A patient with a stage 4 pressure injury exposing bone is being assessed for osteomyelitis. Which assessment finding is MOST indicative of this complication?

Bone that is visible or palpable in the wound base with elevated ESR and CRP (Correct answer)
Intact periwound skin with no erythema
Clear serous drainage with no odor
Wound healing progressing appropriately

Correct answer: Bone that is visible or palpable in the wound base with elevated ESR and CRP

Visible or probe-to-bone positive wounds with elevated inflammatory markers (ESR, CRP) strongly suggest osteomyelitis, which requires MRI confirmation and prolonged antibiotic therapy.

Question 166: A rehabilitation patient prescribed methadone for chronic pain management requires close monitoring because methadone:

Has a long and variable half-life that increases risk of accumulation (Correct answer)
Does not cause respiratory depression at therapeutic doses
Has a short and predictable half-life of 2 to 4 hours
Is approved only for opioid use disorder and not for pain

Correct answer: Has a long and variable half-life that increases risk of accumulation

Methadone has a highly variable and prolonged half-life (8–59 hours) that can lead to drug accumulation and delayed respiratory depression, making careful dose titration and monitoring essential in rehabilitation settings.

Question 167: Which intervention is PRIORITY for a patient with multiple sclerosis (MS) experiencing Uhthoff's phenomenon?

Restrict all physical activity
Implement cooling strategies before and during exercise (Correct answer)
Administer corticosteroids immediately
Encourage vigorous physical therapy in a warm pool

Correct answer: Implement cooling strategies before and during exercise

Uhthoff's phenomenon is a temporary worsening of MS symptoms with elevated body temperature; cooling measures prevent this during rehabilitation activities.

Question 168: 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)
Active hip extension exercises
Prone lying for 30 minutes twice daily
Keeping the residual limb flat and extended when in bed

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 169: A rehabilitation patient is being evaluated for a urinary tract infection. Which clinical finding is a reliable indicator of UTI in a patient with SCI who has no bladder sensation?

Increased spasticity, autonomic dysreflexia, cloudy urine with foul odor, and fever (Correct answer)
Slightly elevated post-void residual
Dysuria reported by the patient
Urge incontinence only

Correct answer: Increased spasticity, autonomic dysreflexia, cloudy urine with foul odor, and fever

In patients with SCI who lack bladder sensation, UTI presents with systemic and indirect signs including increased spasticity, AD, cloudy/foul urine, and fever rather than dysuria.

Question 170: A spinal cord injury patient with an incomplete T10 injury is classified by the ASIA Impairment Scale as 'D'. This means:

Sensory but not motor function is preserved below the neurological level
Motor function is preserved below the level and most key muscles grade ≥3/5 (Correct answer)
No motor or sensory function below the level of injury
Normal sensory and motor function

Correct answer: Motor function is preserved below the level and most key muscles grade ≥3/5

ASIA D indicates motor-incomplete injury where more than half of key muscles below the neurological level have a muscle grade of 3 or greater.

Question 171: A patient has a venous stasis ulcer on the medial gaiter area of the right leg. Which treatment is FUNDAMENTAL to healing this wound type?

Strict elevation with no ambulation
Daily wet-to-dry gauze dressing changes
Arterial revascularization surgery
Multilayer compression therapy to reduce venous hypertension (Correct answer)

Correct answer: Multilayer compression therapy to reduce venous hypertension

Venous leg ulcers are caused by chronic venous hypertension; multilayer compression therapy (e.g., 30–40 mmHg) is the cornerstone treatment that addresses the underlying pathophysiology.

Question 172: A pulmonary rehabilitation patient asks about the benefits of respiratory muscle training. Which response by the CRRN is MOST accurate?

Respiratory muscle training cures COPD by reversing airway obstruction
It increases FEV1 to normal levels in most patients
It is only beneficial in patients on mechanical ventilation
It can improve inspiratory muscle strength, reduce dyspnea, and enhance exercise capacity (Correct answer)

Correct answer: It can improve inspiratory muscle strength, reduce dyspnea, and enhance exercise capacity

Inspiratory muscle training strengthens the respiratory muscles, which reduces dyspnea perception and improves functional exercise capacity, though it does not reverse underlying COPD pathology.

Question 173: A CRRN is educating a patient about nutrition to promote wound healing. Which nutrient is MOST critical for collagen synthesis and immune function in wound repair?

Vitamin D
Calcium
Vitamin C (Correct answer)
Vitamin B12

Correct answer: Vitamin C

Vitamin C is essential for hydroxylation of proline and lysine in collagen synthesis, and deficiency significantly impairs wound healing and immune response.

Question 174: A patient with a hip replacement is being taught posterior hip precautions. Which instruction is correct?

Avoid hip extension, external rotation, and abduction past 45°
Avoid hip flexion beyond 60° and all rotation for 12 months
Avoid hip abduction and keep legs together at all times
Avoid hip flexion beyond 90°, hip adduction past midline, and internal rotation (Correct answer)

Correct answer: Avoid hip flexion beyond 90°, hip adduction past midline, and internal rotation

Standard posterior hip precautions after total hip arthroplasty restrict flexion >90°, adduction past neutral, and internal rotation to prevent prosthetic dislocation.

Question 175: A patient with peripheral arterial disease (PAD) begins supervised exercise rehabilitation. Which type of exercise has the STRONGEST evidence for improving walking distance?

Swimming laps in a heated pool
Supervised treadmill walking to the point of moderate claudication pain, then rest (Correct answer)
Stationary cycling at low resistance
Arm ergometry only to avoid leg pain

Correct answer: Supervised treadmill walking to the point of moderate claudication pain, then rest

Supervised treadmill walking to the threshold of claudication pain followed by rest is the most evidence-based exercise intervention for improving walking distance in PAD.

Question 176: A patient with multiple sclerosis is experiencing Uhthoff's phenomenon. The nurse should instruct the patient to:

Use warm baths to relax spastic muscles before activity
Restrict fluids to reduce edema-related symptoms
Increase exercise intensity to build heat tolerance
Avoid overheating through cool environments, cooling vests, and cold drinks (Correct answer)

Correct answer: Avoid overheating through cool environments, cooling vests, and cold drinks

Uhthoff's phenomenon is a temporary worsening of MS symptoms with increased body temperature; cooling strategies prevent and manage this effect.

Certified Rehabilitation Registered Nurse (CRRN)

The CRRN certifies registered nurses in rehabilitation nursing practice, validating expertise in caring for patients with disabilities across functional health, legal/ethical issues, team collaboration, and nursing theory frameworks. It is administered by the Rehabilitation Nursing Certification Board (RNCB).

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