Certified Rehabilitation Registered Nurse (CRRN) — Questions and Answers

Question 1: 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 B12
Calcium
Vitamin D
Vitamin C (Correct answer)

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

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

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 3: 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
Assisting the patient to void at regular scheduled intervals regardless of urge, to prevent incontinence episodes (Correct answer)
Voiding only when urgency is felt to retrain bladder capacity
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 4: A patient with complete C7 tetraplegia will be discharged home. Which functional skill should the CRRN prioritize in the discharge plan?

Independent driving without adaptive equipment
Full independent transfers without any equipment
Independent manual wheelchair propulsion on all surfaces (Correct answer)
Independent ambulation with bilateral forearm crutches

Correct answer: Independent manual wheelchair propulsion on all surfaces

C7 tetraplegia preserves wrist extension and finger flexion, enabling independent manual wheelchair propulsion, which is a realistic and critical mobility goal for this level.

Question 5: 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 6: A patient with rheumatoid arthritis participates in a rehabilitation program. The nurse should schedule physical activity during which time of day to minimize the impact of morning stiffness?

Late evening when joints are most rested
After the morning stiffness period has resolved, typically mid-morning (Correct answer)
Immediately upon waking before stiffness worsens
Stiffness does not affect optimal scheduling

Correct answer: After the morning stiffness period has resolved, typically mid-morning

Morning stiffness in RA typically lasts 30 minutes to several hours; scheduling therapy after this period improves participation, range of motion, and patient comfort.

Question 7: 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 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
Spasticity should always be treated aggressively with neurolytic agents

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 8: A patient with post-polio syndrome (PPS) reports new-onset muscle weakness and fatigue 40 years after the original illness. The CRRN should advise the patient that the most appropriate exercise strategy is:

High-intensity resistance training to rebuild lost strength
Non-fatiguing aerobic and strengthening exercise with emphasis on avoiding overexertion (Correct answer)
Complete rest and avoidance of all physical exertion
Aquatic therapy is contraindicated due to the risk of respiratory compromise

Correct answer: Non-fatiguing aerobic and strengthening exercise with emphasis on avoiding overexertion

PPS management focuses on non-fatiguing exercise, energy conservation, and avoiding overuse, as overexertion can accelerate motor neuron loss and worsen weakness.

Question 9: A patient with upper motor neuron (spastic/reflexic) neurogenic bowel from SCI requires bowel care. Which intervention is MOST appropriate to trigger reflex defecation?

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

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

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

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 11: 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?

Catheterizing on a timed schedule to keep bladder volume under 400–500 mL (Correct answer)
Placing an indwelling Foley catheter until the patient regains consciousness
Using external condom catheters overnight only
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 12: A pulmonary rehabilitation patient asks about the benefits of respiratory muscle training. Which response by the CRRN is MOST accurate?

It increases FEV1 to normal levels in most patients
Respiratory muscle training cures COPD by reversing airway obstruction
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 13: Which finding during a bedside swallowing evaluation warrants immediate referral to speech-language pathology for a formal swallowing study?

Patient reports mild dry mouth
Patient requires two swallows per bolus
Wet or gurgly vocal quality after swallowing water (Correct answer)
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 14: 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)
Patch the left eye to eliminate visual input from that side
Place all items on the patient's right side to avoid frustration
Avoid verbal cues so the patient develops natural compensation

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 15: 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 16: 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)
Normal bladder emptying with healthy retention
Appropriate fluid restriction
Successful neurogenic bladder management

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 17: A CRRN notices that a patient's family frequently completes tasks the patient is capable of performing independently. The nurse's best approach is to:

Document the behavior and take no action to preserve family relationships
Educate the family about the therapeutic value of allowing the patient to attempt tasks independently (Correct answer)
Praise the family for their helpfulness and encourage them to continue
Exclude the family from care sessions to allow independent practice

Correct answer: Educate the family about the therapeutic value of allowing the patient to attempt tasks independently

Educating the family about how learned helplessness can undermine rehabilitation progress empowers them to become facilitators of independence rather than barriers.

Question 18: A patient with Guillain-Barré syndrome is in the recovery phase. Which nursing priority is MOST important during early mobilization?

Preventing autonomic dysreflexia
Monitoring for orthostatic hypotension (Correct answer)
Managing hyperreflexia
Preventing spasticity

Correct answer: Monitoring for orthostatic hypotension

Autonomic instability in GBS can cause significant orthostatic hypotension during position changes, making hemodynamic monitoring essential during mobilization.

Question 19: A patient who sustained a stroke 6 months ago reports feeling hopeless and has lost interest in therapy activities. Which standardized tool is MOST appropriate for screening for post-stroke depression?

Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
Beck Anxiety Inventory (BAI)
Montreal Cognitive Assessment (MoCA)
Hamilton Anxiety Rating Scale (HAM-A)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a validated, widely used 9-item self-report tool for screening and monitoring the severity of depression, including post-stroke depression.

Question 20: Heat therapy (thermotherapy) is contraindicated in a rehabilitation patient with which condition?

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

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 21: 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?

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

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 22: A family member of a patient with a traumatic brain injury (TBI) tells the nurse, 'He seems fine most of the time but just doesn't act like himself.' Which TBI sequela BEST explains this observation?

Personality and behavioral changes due to frontal lobe injury (Correct answer)
Post-traumatic seizure disorder
Retrograde amnesia
Receptive aphasia affecting comprehension

Correct answer: Personality and behavioral changes due to frontal lobe injury

Frontal lobe injury from TBI commonly produces personality changes, disinhibition, and impaired judgment that are noticeable to family even when the patient appears outwardly intact.

Question 23: A patient with pulmonary fibrosis begins pulmonary rehabilitation. Which adaptive strategy BEST helps conserve energy during ADLs?

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

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 24: A CRRN is advocating for a patient who requires home modifications prior to discharge. Which FIRST step best exemplifies the nurse's advocacy role?

Conduct or coordinate a home assessment to identify specific environmental barriers (Correct answer)
Contact the state disability agency for funding without assessing the home first
Instruct the family to purchase a wheelchair ramp before discharge
Order the home modifications directly through the hospital supply department

Correct answer: Conduct or coordinate a home assessment to identify specific environmental barriers

A thorough home assessment (in-person or via questionnaire with OT) is the essential first step to identify actual barriers before recommending or ordering specific modifications.

Question 25: Which patient statement indicates CORRECT understanding of pressure injury prevention after the CRRN's education session?

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 only need to check my skin weekly unless I feel pain
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 26: When reporting on a patient's capacity to operate independently using the Functional Independence Measure (FIM) guidelines, a task that the patient can complete with the aid of an assistive device or that requires more time than usual would be categorized as:

Modified independence. (Correct answer)
Minimal assistance.
Supervision.
Complete independence.

Correct answer: Modified independence.

According to the Functional Independence Measure (FIM) guidelines, 'Modified independence' is scored when a patient requires an assistive device to complete a task or takes more than a reasonable amount of time. They perform the activity independently, but with some modification or inefficiency, distinguishing it from complete independence (no device, normal time) or requiring physical assistance.

Question 27: 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?

Sit the patient upright, loosen constrictive clothing, and identify/remove the noxious stimulus (Correct answer)
Administer sublingual nifedipine immediately
Apply a cooling blanket to reduce fever
Lay the patient flat to improve cerebral perfusion

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

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

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 29: 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?

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

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

Check pulse oximetry only when symptomatic
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
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 31: A rehabilitation nurse notices a patient with Parkinson's disease is having difficulty initiating gait. Which cueing strategy is MOST effective for this patient?

Applying light manual resistance to the shoulders
Dimming room lights to reduce visual distraction
Asking the patient to walk faster to build momentum
Verbal counting or rhythmic auditory cues (Correct answer)

Correct answer: Verbal counting or rhythmic auditory cues

Rhythmic auditory cues (counting, metronome, music) bypass defective basal ganglia timing circuits in Parkinson's disease and effectively improve gait initiation.

Question 32: 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 33: 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 incorporates the impact of pain on the patient's ability to function (Correct answer)
It uses illustrated facial expressions to represent pain intensity
It only measures acute pain following surgical procedures
It is designed exclusively for pediatric rehabilitation patients

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 34: 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?

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

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 35: 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?

Americans with Disabilities Act (ADA) program.
The police.
Adult protective services.
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 36: A patient with a rotator cuff repair is at 6 weeks post-surgery. Which activity is APPROPRIATE at this stage?

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

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 37: A patient is being discharged home after rehabilitation for a stroke with residual right hemiparesis. Which community resource should the rehabilitation nurse prioritize recommending?

Acute inpatient rehabilitation readmission within 30 days for further gains
Home health therapy and outpatient stroke support group to maintain function and social participation (Correct answer)
Long-term skilled nursing facility placement due to residual deficits
Hospice services to provide comfort-focused care at home

Correct answer: Home health therapy and outpatient stroke support group to maintain function and social participation

Home health therapy continues functional gains after inpatient discharge, while stroke support groups address psychosocial needs and community reintegration.

Question 38: Which of the following best describes the role of the CRRN as a patient advocate in the rehabilitation team?

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

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

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

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

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

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 41: 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:

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

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

Built-up handled spoon only
Universal cuff with utensil holder to compensate for absent grip (Correct answer)
Long-handled spoon for shoulder range of motion deficits
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 43: 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?

Hyperkalemia leading to cardiac dysrhythmia
Gastrointestinal bleeding and peptic ulcer formation (Correct answer)
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 44: A patient with a stage 4 pressure injury exposing bone is being assessed for osteomyelitis. Which assessment finding is MOST indicative of this complication?

Wound healing progressing appropriately
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

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

Administer corticosteroids immediately
Implement cooling strategies before and during exercise (Correct answer)
Restrict all physical activity
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 46: 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?

Broca's aphasia (Correct answer)
Global aphasia
Wernicke's aphasia
Anomic 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 47: A rehabilitation nurse is caring for a patient with Parkinson's disease who has 'freezing' episodes during gait. Which nursing intervention is BEST to address this?

Use auditory or visual cues to initiate movement (Correct answer)
Encourage the patient to rest until freezing resolves
Apply a gait belt and pull the patient forward
Administer a PRN anxiolytic

Correct answer: Use auditory or visual cues to initiate movement

Auditory rhythmic cues (metronome) or visual floor markers help patients with Parkinson's overcome freezing by engaging alternative motor pathways.

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

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

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 49: 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
Wearing rigid wrist splints during all propulsion
Using finger-tip propulsion for greater control
Propelling with the heel of the hand in a smooth arc (Correct answer)

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

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

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

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

Correct answer: Use a calm, consistent approach and minimize stimulation

Rancho Level IV (confused-agitated) requires a calm, structured, low-stimulation environment with consistent nursing care rather than restraints or heavy sedation.

Question 52: 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?

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

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 53: 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?

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

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

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

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 55: 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?

12–14 METs
1–2 METs (Correct answer)
8–10 METs
5–6 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 56: 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 57: 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
Withhold exercise and notify the physician (Correct answer)
Have the patient rest 5 minutes and recheck once
Proceed with exercise at reduced intensity

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

Skin breakdown in upper extremities
Bladder distension or bowel impaction (Correct answer)
Upper extremity pain
Hypertension from dietary salt

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 59: A patient is being discharged home after stroke rehabilitation. Which finding MOST strongly indicates the patient is at risk for falls in the home environment?

Timed Up and Go (TUG) test result of 16 seconds (Correct answer)
Berg Balance Scale score of 41/56
Mini-Mental State Examination (MMSE) score of 24/30
Ability to walk 150 feet with a single-point cane

Correct answer: Timed Up and Go (TUG) test result of 16 seconds

A TUG score greater than 13.5 seconds has been validated as a threshold associated with significantly increased fall risk in community-dwelling adults.

Question 60: A patient with an ankle sprain is beginning rehabilitation in the subacute phase. Which intervention is MOST appropriate at this stage?

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

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 61: A rehabilitation nurse notes that a patient with incomplete SCI ambulates with a steppage gait pattern. Which nerve root level deficit BEST explains this finding?

L2-L3 (hip flexors)
L4-L5 (dorsiflexors) (Correct answer)
C6-C7 (wrist extensors)
S1-S2 (plantarflexors)

Correct answer: L4-L5 (dorsiflexors)

Steppage gait results from foot drop due to weakness of ankle dorsiflexors innervated primarily at L4-L5, causing the patient to exaggerate hip and knee flexion to clear the foot.

Question 62: A rehabilitation nurse is applying the Americans with Disabilities Act (ADA) framework when helping a patient plan community reintegration. Which principle does the ADA PRIMARILY protect?

Equal opportunity and reasonable accommodation in employment and public settings (Correct answer)
Guaranteed employment for individuals with disabilities
Priority access to government-funded rehabilitation programs
Free home health services for all persons with physical disabilities

Correct answer: Equal opportunity and reasonable accommodation in employment and public settings

The ADA mandates equal opportunity and reasonable accommodation for individuals with disabilities in employment, public services, and accommodations, but does not guarantee employment.

Question 63: A patient with a traumatic brain injury (TBI) is at Rancho Los Amigos Level V (confused-inappropriate). Which nursing approach is most appropriate?

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
Allow unrestricted visitation to provide maximum stimulation

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

PAINAD (Pain Assessment in Advanced Dementia) scale (Correct answer)
Numeric Rating Scale (NRS) with picture cards
Wong-Baker FACES Pain Rating Scale
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 65: When educating a patient about preventing UTIs during intermittent catheterization at home, which instruction is MOST important?

Maintain adequate hydration (2–2.5 L/day) and adhere to the scheduled catheterization frequency (Correct answer)
Use antibiotic irrigation after each catheterization
Limit fluid intake to 1 liter per day to reduce urine output
Perform IC only if the bladder feels full

Correct answer: Maintain adequate hydration (2–2.5 L/day) and adhere to the scheduled catheterization frequency

Adequate fluid intake dilutes urine and reduces bacterial colonization, while strict IC scheduling prevents overdistension — both are essential UTI prevention strategies.

Question 66: A patient recovering from a stroke develops central post-stroke pain. Which description BEST characterizes this condition?

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

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

Frequent small-volume voids with urgency
Stress incontinence with normal post-void residuals
Urinary retention with overflow incontinence due to acontractile detrusor (Correct answer)
Hyperreflexic detrusor contractions with urge incontinence

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 68: When repositioning a patient with a right-sided hemiplegia due to stroke, which position is considered most therapeutic for the affected upper extremity?

Shoulder in slight abduction with elbow extended and wrist supported in neutral (Correct answer)
Shoulder adducted with elbow flexed at 90°
Shoulder internally rotated with forearm pronated
Arm positioned across the chest in a sling at all times

Correct answer: Shoulder in slight abduction with elbow extended and wrist supported in neutral

Positioning the hemiplegic arm in slight abduction with elbow extended and wrist in neutral prevents contracture and maintains joint alignment.

Question 69: Undertreated chronic pain in a rehabilitation patient is most likely to result in which of the following outcomes?

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

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 70: 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?

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

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

Friction and Shear
Activity (Correct answer)
Nutrition
Moisture

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 72: 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:

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

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

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

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 74: A rehabilitation nurse assesses a patient with a right hemisphere stroke. Which cognitive-perceptual deficit is this patient MOST at risk for?

Acalculia
Wernicke's aphasia
Left hemispatial neglect and impaired spatial awareness (Correct answer)
Broca's aphasia

Correct answer: Left hemispatial neglect and impaired spatial awareness

Right hemisphere stroke commonly causes left hemispatial neglect, impaired visuospatial skills, and poor insight into deficits (anosognosia).

Question 75: The Functional Independence Measure (FIM) rates a patient at level 3 for feeding. This means the patient:

Needs only supervision or setup with no physical assistance
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

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

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

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

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

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

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

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 79: 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?

Unstageable (Correct answer)
Stage 2
Stage 4
Stage 1

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 80: A patient with gout is admitted to the rehabilitation unit with an acute flare. Which nursing intervention is PRIORITY during an acute attack?

Encourage vigorous physical therapy of the affected joint
Apply moist heat to the inflamed joint
Rest the affected joint, apply ice, and administer prescribed anti-inflammatory medication (Correct answer)
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 81: 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
Any reading above 120/80 mmHg
Systolic 140 mmHg in a previously normotensive patient

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 82: A rehabilitation patient with spinal cord injury is being taught pressure relief techniques for wheelchair use. Which frequency of pressure relief is RECOMMENDED to prevent ischial pressure injuries?

Only when the patient feels discomfort
Every 4 hours
Once in the morning and once at night
Every 15–30 minutes for at least 1–2 minutes (Correct answer)

Correct answer: Every 15–30 minutes for at least 1–2 minutes

Pressure relief maneuvers every 15–30 minutes for 1–2 minutes are the standard SCI guideline to restore tissue perfusion and prevent ischial pressure injuries.

Question 83: What are the three PRIMARY variables that should be taken into account while conducting a pretransfer assessment?

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

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

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

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

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

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

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

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 87: The rehabilitation nurse is a member of an interdisciplinary team (IDT). Which statement best distinguishes an interdisciplinary team from a multidisciplinary team?

IDT members communicate only through written documentation
A multidisciplinary team always includes more specialties than an IDT
In an IDT, disciplines work collaboratively toward shared goals with integrated care plans rather than independently (Correct answer)
An IDT includes a physician while a multidisciplinary team does not

Correct answer: In an IDT, disciplines work collaboratively toward shared goals with integrated care plans rather than independently

Interdisciplinary teams are defined by collaborative integration of disciplines around shared patient goals, whereas multidisciplinary teams may each work in parallel silos without integration.

Question 88: A patient with chronic obstructive pulmonary disease is performing diaphragmatic breathing exercises. Which cue is MOST appropriate for the nurse to provide?

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

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

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

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 90: A patient post-lumbar laminectomy is ready for discharge. Which activity is MOST important to include in discharge teaching?

Use proper body mechanics and log-roll technique when changing positions (Correct answer)
Avoid all walking for 4 weeks post-surgery
Resume lifting objects over 20 pounds within one week
Perform trunk flexion exercises to stretch the surgical area

Correct answer: Use proper body mechanics and log-roll technique when changing positions

Proper body mechanics and the log-roll technique protect the lumbar surgical site during position changes and reduce re-injury risk after laminectomy.

Question 91: 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 92: What is the maximum recommended daily dose of acetaminophen for a healthy adult patient in a rehabilitation setting?

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

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

Does not cause respiratory depression at therapeutic doses
Has a long and variable half-life that increases risk of accumulation (Correct answer)
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 94: A rehabilitation nurse is assessing a patient's pressure injury risk. Which tool is specifically validated and widely used in rehabilitation settings?

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

Correct answer: Braden Scale

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

Question 95: As opposed to bilevel positive airway pressure (BPAP), which of the following conditions is typically treated with continuous positive airway pressure (CPAP)?

bitemporal hemianopsia
homonymous hemianopsia (Correct answer)
unilateral neglect
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 96: A CRRN is evaluating a patient's readiness to learn how to perform self-catheterization at home. Which factor MOST affects the patient's ability to learn this skill?

The patient's hand function, cognition, and motivation (Correct answer)
Whether the patient has a caregiver available at all times
The distance from the patient's home to the outpatient clinic
The patient's insurance coverage for catheter supplies

Correct answer: The patient's hand function, cognition, and motivation

Adequate hand function, cognitive ability to follow a multi-step procedure, and motivation are the core patient-centered factors that determine ability to perform self-catheterization.

Question 97: A patient with multiple sclerosis is experiencing Uhthoff's phenomenon. The nurse should instruct the patient to:

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

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.

Question 98: A patient with Parkinson's disease exhibits a festinating gait. The rehabilitation nurse's best intervention is to:

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

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 99: A patient post-myocardial infarction asks when sexual activity can be safely resumed. Which guideline is MOST appropriate for the CRRN to share?

Sexual activity equivalent to climbing two flights of stairs (approximately 3–5 METs) can typically resume in 2–4 weeks if the patient is stable (Correct answer)
Sexual activity should be permanently avoided after MI
Sexual activity has no cardiac risk and can resume immediately
Wait at least 6 months before any sexual activity

Correct answer: Sexual activity equivalent to climbing two flights of stairs (approximately 3–5 METs) can typically resume in 2–4 weeks if the patient is stable

Sexual activity requires approximately 3–5 METs, similar to climbing two flights of stairs; stable post-MI patients are typically cleared for resumption within 2–4 weeks.

Question 100: A patient with multiple sclerosis reports worsening fatigue by early afternoon. Which energy conservation strategy should the CRRN teach first?

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

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 101: 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
Vitamin K-rich foods such as leafy green vegetables (Correct answer)
Dairy products

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

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

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 103: 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 11–14 (fairly light to somewhat hard) (Correct answer)
RPE 6–8 (nothing to very, very light)
RPE 20 (maximum exertion)
RPE 17–19 (very hard to extremely hard)

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 104: 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
Eliminate all fruits and vegetables from the diet
Decrease fluid intake to prevent loose stools
Increase dietary fiber to 25–38 grams per day and ensure adequate fluid intake (Correct answer)

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

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

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

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

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

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

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

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

Correct answer: SpO2 < 88%

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

Question 109: A rehabilitation patient with SCI develops skin maceration around an indwelling catheter site. Which intervention is MOST appropriate?

Discontinue the catheter immediately regardless of clinical indication
Use a moisture-barrier ointment or film, ensure proper catheter securement to reduce tension and movement (Correct answer)
Apply a dry gauze dressing and change every 2 hours
Apply a thick layer of moisture barrier ointment and leave the area uncovered

Correct answer: Use a moisture-barrier ointment or film, ensure proper catheter securement to reduce tension and movement

Moisture-barrier products protect periwound skin, while proper catheter securement reduces mechanical trauma — both are essential to manage and prevent catheter-associated skin breakdown.

Question 110: 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)
Allow it if the patient is comfortable and pain-free
Explain that crossing legs is allowed after 6 weeks
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 111: Which pain assessment tool is most appropriate for evaluating pain in a non-verbal adult patient with cognitive impairment in a rehabilitation setting?

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

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 112: Which transfer technique is MOST appropriate for a patient with complete right hemiplegia who has good left-sided strength and is cooperative?

Sliding board transfer with minimal assist
Two-person full lift transfer
Stand-pivot transfer toward the weaker (right) side
Pivot transfer toward the stronger (left) side (Correct answer)

Correct answer: Pivot transfer toward the stronger (left) side

Pivot transfers should be performed toward the patient's stronger side to maximize their ability to assist and improve safety and success.

Question 113: 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
Mild vacuum noise from the device
Sudden loss of suction with bright red blood visible in the foam dressing (Correct answer)
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 114: A patient with an above-knee amputation is beginning prosthetic gait training. Which nursing observation indicates the prosthetic socket fit is INAPPROPRIATE?

Absence of lateral trunk lean
Circumferential skin redness and blistering on the distal residual limb (Correct answer)
Symmetrical step length
Stable pelvis during single-limb stance

Correct answer: Circumferential skin redness and blistering on the distal residual limb

Skin breakdown, blistering, and redness on the residual limb indicate excessive pressure or pistoning within the socket, signaling a poor fit requiring adjustment.

Question 115: A patient with a complete C5 spinal cord injury is being taught tenodesis grasp. What is the functional goal of this technique?

Strengthening intrinsic hand muscles for fine motor tasks
Training the patient to use a power wheelchair joystick
Preventing contractures through passive range of motion
Using wrist extension to passively close the fingers for functional grip (Correct answer)

Correct answer: Using wrist extension to passively close the fingers for functional grip

Tenodesis uses the biomechanical relationship between wrist extension and passive finger flexion, allowing C5-C6 patients to grasp objects without intact hand musculature.

Question 116: Which test is used primarily to determine a patient's risk of falling while the CRRN is evaluating their functional ability?

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

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

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

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

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

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 119: 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)
Left-sided neglect and impulsive behavior (Correct answer)
Receptive aphasia (Wernicke's)
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 120: 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 121: A patient with COPD is learning pursed-lip breathing in pulmonary rehabilitation. What is the PRIMARY purpose of this technique?

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

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 122: 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)
Occupational therapist
Dietitian

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

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

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 124: 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
Pack the wound tightly with dry gauze to absorb drainage
Apply hydrogen peroxide daily to reduce bacterial colonization
Maintain a moist wound environment to promote healing and granulation (Correct answer)

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 125: When using the Braden Scale to assess a patient's pressure injury risk, which subscale score of '1' indicates the GREATEST risk?

Moisture: Rarely moist
Mobility: Completely immobile (Correct answer)
Activity: Walks frequently
Sensory perception: No impairment

Correct answer: Mobility: Completely immobile

A Braden mobility score of 1 (completely immobile) indicates the highest risk in that subscale; lower total Braden scores reflect higher overall pressure injury risk.

Question 126: The cause of esophageal speech.

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

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

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

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 128: Which ethical principle is MOST directly applied when a rehabilitation nurse ensures that a patient with cognitive deficits has a legally designated surrogate decision-maker involved in care planning?

Justice
Autonomy (Correct answer)
Nonmaleficence
Beneficence

Correct answer: Autonomy

Autonomy requires respecting the patient's right to make informed decisions; when capacity is lacking, a surrogate preserves that right by making decisions consistent with the patient's known values.

Question 129: In the PQRST pain assessment mnemonic used in rehabilitation nursing, what does the letter 'P' represent?

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

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

Chronic obstructive lung disease.
Central sleep apnea.
Obstructive sleep apnea. (Correct answer)
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 131: 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
Administer IV labetalol immediately
Sit the patient upright and identify the triggering stimulus (Correct answer)
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 132: When communicating with a patient who has expressive aphasia, which approach is most effective?

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

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

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

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

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

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 135: 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 should report any persistent redness to my care team.
I will use a mirror to inspect my skin daily.
I will perform weight shifts every 15–30 minutes while sitting.
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 136: Which psychological stage according to Kübler-Ross is a patient demonstrating when they say, 'If I work hard enough in therapy, maybe I'll walk again by Christmas'?

Depression
Acceptance
Anger
Bargaining (Correct answer)

Correct answer: Bargaining

Bargaining involves making deals or setting conditional goals as a way of coping with loss—hoping that effort or behavior can reverse or limit the disability.

Question 137: 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 138: A patient post-total knee arthroplasty (TKA) has a target of 90 degrees of knee flexion before discharge. Which intervention BEST achieves this goal?

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

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 139: 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
Postoperative ileus
Delayed analgesia effect
Pulmonary embolism (Correct answer)

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

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

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

Catheterize every 4–6 hours to keep bladder volume below 400–500 mL (Correct answer)
Catheterize only when the patient feels urgency
Catheterize once daily before sleep
Catheterize immediately after each fluid intake

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

Bladder volumes above 400–500 mL cause overdistension and increase AD and UTI risk; catheterizing every 4–6 hours maintains safe volumes in neurogenic bladder management.

Question 142: 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?

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

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

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

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 144: When conducting a discharge planning assessment for a stroke patient returning home with a spouse as caregiver, the rehabilitation nurse should prioritize:

Arranging nursing home placement if any ADL assistance is needed
Scheduling outpatient therapy before assessing the home environment
Assessing the caregiver's physical and emotional capacity to provide care safely (Correct answer)
Ensuring the patient can perform all ADLs independently before discharge

Correct answer: Assessing the caregiver's physical and emotional capacity to provide care safely

Caregiver capacity — including physical ability, knowledge, emotional readiness, and support systems — is central to safe discharge planning and prevention of caregiver burnout.

Question 145: Which lab value change MOST warrants withholding cardiac rehabilitation exercise and notifying the physician?

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

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

Surgical site hematoma
Delayed wound healing
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 147: A rehabilitation nurse is teaching a patient with epilepsy about seizure precautions. Which instruction is MOST important?

Keep a supply of rectal diazepam for all seizure types
Avoid all physical activity to prevent seizures
Take seizure medications only when feeling a seizure coming on
Never drive until seizure-free per state law guidelines (Correct answer)

Correct answer: Never drive until seizure-free per state law guidelines

State laws govern driving restrictions after a seizure, and patients must understand these legal and safety requirements as a priority safety teaching point.

Question 148: A patient with a C4 complete spinal cord injury is most likely to require which form of respiratory support?

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

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 149: A rehabilitation nurse is conducting a community reintegration assessment for a patient with TBI. Which factor is MOST critical to evaluate for return to work?

Cognitive, behavioral, and physical demands of the specific job (Correct answer)
Patient's desire to return to work alone
Pre-injury job title and salary
Distance from home to workplace

Correct answer: Cognitive, behavioral, and physical demands of the specific job

Matching the patient's current cognitive, behavioral, and physical abilities to the specific functional demands of their job is essential for safe and successful return-to-work planning.

Question 150: 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:

Lean forward aggressively with each stroke
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

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

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

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

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

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 153: 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?

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

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 154: Following a lower extremity amputation, which positioning practice in the early post-operative period is MOST likely to cause a hip flexion contracture?

Prone lying for 30 minutes twice daily
Active hip extension exercises
Elevating the residual limb on a pillow for extended periods (Correct answer)
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 155: A patient with a new spinal cord injury expresses to the nurse: 'I will never accept this — I'd rather be dead.' The nurse's priority response is to:

Document the statement and notify the physician at the next shift change
Encourage the patient to focus on therapy goals to build hope
Reassure the patient that many SCI patients lead fulfilling lives
Perform a structured suicide risk assessment and involve the psychologist immediately (Correct answer)

Correct answer: Perform a structured suicide risk assessment and involve the psychologist immediately

Suicidal ideation in newly injured patients is a psychiatric emergency requiring immediate structured risk assessment and interdisciplinary psychological intervention.

Question 156: 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?

Ask the patient to rate the pain and continue if below 5/10
Stop exercise immediately, administer nitroglycerin if prescribed, call emergency services (Correct answer)
Reduce exercise intensity by 50% and monitor
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 157: Tricyclic antidepressants (TCAs) such as amitriptyline are sometimes prescribed for rehabilitation patients with chronic pain primarily because they:

Have demonstrated analgesic properties for neuropathic and central pain (Correct answer)
Significantly increase opioid receptor sensitivity to reduce opioid doses
Eliminate the need for participation in physical therapy
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 158: A patient has been using an indwelling urinary catheter for 3 weeks during acute rehabilitation. Which complication is the PATIENT AT HIGHEST RISK for?

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

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

Apply donut-shaped heel protectors to redistribute pressure
Keep the patient in Trendelenburg position at all times
Elevate heels on a standard pillow with the knees straight
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 160: A CRRN is discharging a patient who will self-manage anticoagulation therapy after DVT. Which teaching point is the highest priority?

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

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

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

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 162: 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:

Identify and restructure maladaptive thought patterns and behaviors associated with pain (Correct answer)
Replace all pharmacological pain management with psychological interventions
Achieve complete elimination of all pain through psychological techniques alone
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 163: A rehabilitation nurse discovers a Stage 2 pressure injury on a patient's sacrum. Which intervention is the PRIORITY?

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

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 164: Which outcome measure is specifically designed to assess ambulation ability and community mobility in patients with lower-limb impairment?

Hamilton Anxiety Rating Scale
10-Meter Walk Test (10MWT) (Correct answer)
Montreal Cognitive Assessment (MoCA)
Functional Independence Measure (FIM)

Correct answer: 10-Meter Walk Test (10MWT)

The 10-Meter Walk Test measures walking speed over a short distance and is a reliable, sensitive indicator of gait speed changes and functional ambulation in rehabilitation populations.

Question 165: Which finding BEST indicates a successful neurogenic bowel program in a patient with SCI?

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

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

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

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 167: 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?

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

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

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

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 169: 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?

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

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 170: 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:

Neuropathic pain (Correct answer)
Visceral pain
Somatic pain
Inflammatory 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 171: At the level of the: motor nerve fibers cross over in the brainstem.

hypothalamus
refle
sacral
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 172: 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
Opioid analgesics
Anticonvulsants (gabapentinoids) (Correct answer)

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 173: 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:

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

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

Minor edema distal to the traction site
2+ distal pulses
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 175: Which outcome is EXPECTED for a patient with a complete C6 spinal cord injury regarding self-care?

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

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

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

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.

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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