Certified Rehabilitation Registered Nurse (CRRN) — Questions and Answers

Question 1: What is the maximum recommended daily dose of acetaminophen for a healthy adult patient in a rehabilitation setting?

6,000 mg/day
4,000 mg/day (Correct answer)
3,000 mg/day
2,000 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 2: A CRRN documents a deep tissue pressure injury (DTPI) on the heel. Which description BEST matches this classification?

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

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

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

Question 3: A patient with a lower motor neuron (flaccid) neurogenic bladder dysfunction is most likely to exhibit which pattern?

Urinary retention with overflow incontinence due to acontractile detrusor (Correct answer)
Frequent small-volume voids with urgency
Stress incontinence with normal post-void residuals
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 4: A patient with a rotator cuff repair is at 6 weeks post-surgery. Which activity is APPROPRIATE at this stage?

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

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

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

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 6: 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?

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

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

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

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

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

Correct answer: Multilayer compression therapy to reduce venous hypertension

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

Question 9: A rehabilitation patient is receiving scheduled opioid analgesics for moderate-to-severe pain. Which nursing assessment finding requires immediate intervention?

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

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

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

Question 10: What does the term "reliability" mean when analyzing data and results?

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

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

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

Correct answer: Serum albumin

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

Question 12: 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
Allow unrestricted visitation to provide maximum stimulation
Encourage group therapy sessions to promote social engagement
Use consistent routine, simple one-step commands, and minimize environmental distractions (Correct answer)

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 13: 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?

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

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

Nutrition
Activity (Correct answer)
Moisture
Friction and Shear

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 15: A 35-year-old MS patient experiences chronic constipation but only infrequent fecal incontinence. What intervention is MOST appropriate from the list below?

Laxatives as needed (prn) for constipation.
Bowel training (timed defecation, high fiber, adequate liquids, and stool softeners). (Correct answer)
Nutritional assessment.
Daily glycerin suppository.

Correct answer: Bowel training (timed defecation, high fiber, adequate liquids, and stool softeners).

For a patient with chronic constipation and infrequent fecal incontinence due to MS, a comprehensive bowel training program is most appropriate. This approach addresses the underlying constipation through lifestyle modifications (fiber, liquids) and aids (stool softeners), while timed defecation helps establish a regular bowel pattern. This holistic strategy prevents both constipation and incontinence effectively.

Question 16: Which non-pharmacological intervention is most appropriate for a rehabilitation patient experiencing acute musculoskeletal pain within the first 24 to 48 hours of injury?

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

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

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

Question 17: A patient with rheumatoid arthritis asks about joint protection principles during ADL training. Which instruction reflects correct joint protection technique?

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

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

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

Question 18: A patient with gout is admitted to the rehabilitation unit with an acute flare. Which nursing intervention is PRIORITY during an acute attack?

Apply moist heat to the inflamed joint
Encourage vigorous physical therapy of the affected 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 19: A COPD patient's rehabilitation outcome goal is to climb one flight of stairs independently. Which functional outcome measure BEST tracks this specific goal?

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

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

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

Question 20: A patient with peripheral arterial disease (PAD) begins supervised exercise rehabilitation. Which type of exercise has the STRONGEST evidence for improving walking distance?

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

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

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

Question 21: A patient with heel pressure injuries is being positioned in bed. Which position is BEST to protect the heels?

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

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 22: 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?

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

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 23: A patient with an above-knee amputation is beginning prosthetic gait training. Which nursing observation indicates the prosthetic socket fit is INAPPROPRIATE?

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

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

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

Correct answer: SpO2 < 88%

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

Question 25: A patient with pulmonary fibrosis begins pulmonary rehabilitation. Which adaptive strategy BEST helps conserve energy during ADLs?

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)
Avoid all ADLs and depend on caregivers entirely

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

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

Correct answer: Weak cough and wet vocal quality after swallowing

A wet or gurgling vocal quality after swallowing combined with a weak cough indicates laryngeal penetration and significantly elevated aspiration risk.

Question 27: Which of the following methods of massage therapy typically uses broad, rhythmic strokes that start out gently and get stronger as they relax the recipient and reveal any tightness or pain?

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

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

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

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

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

Question 29: 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?

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

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

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

Question 30: When using the numeric rating scale (NRS) for pain assessment, a patient with aphasia rates their pain as 0 but grimaces and guards during movement. What should the nurse do?

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

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

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

Question 31: 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 32: 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
Measure blood glucose every morning
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

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 33: A patient's laryngeal and pharyngeal weakness on the left side is accompanied by dysphagia. Which positioning approach among the following is MOST suitable to lower the risk of aspiration?

Chin tuck.
Chin tuck with head turn (to right).
Head turn (to right).
Head turn (to left). (Correct answer)

Correct answer: Head turn (to left).

For dysphagia caused by unilateral pharyngeal weakness, turning the head towards the weaker side (in this case, the left) helps to close off the weaker side of the pharynx. This maneuver directs the food bolus down the stronger, unaffected side, thereby reducing the risk of aspiration. This compensatory strategy improves swallowing safety.

Question 34: What are the three PRIMARY variables that should be taken into account while conducting a pretransfer assessment?

Weight, extension, and balance.
Safety awareness, strength, and cognition.
Strength and motivation.
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 35: A rehabilitation nurse notes that a patient's pain is consistently worse during morning physical therapy sessions and improves with rest and ice application. This pain pattern is most consistent with:

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

Correct answer: Musculoskeletal pain aggravated by mechanical loading

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

Question 36: 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 37: 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 uses illustrated facial expressions to represent pain intensity
It is designed exclusively for pediatric rehabilitation patients
It only measures acute pain following surgical procedures
It incorporates the impact of pain on the patient's ability to function (Correct answer)

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

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

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 39: 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
Stand-pivot transfer toward the weaker (right) side
Pivot transfer toward the stronger (left) side (Correct answer)
Two-person full lift transfer

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 40: 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?

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

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 41: 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?

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)
Single-use sterile catheters and sterile gloves required

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

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

Question 42: A patient in cardiac rehab has a resting blood pressure of 180/105 mmHg before the exercise session. What is the APPROPRIATE nursing action?

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

Correct answer: Withhold exercise and notify the physician

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

Question 43: A CRRN is teaching a patient with a T6 SCI about bowel management. Which statement about a neurogenic bowel program is correct?

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

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

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

Question 44: A patient with a diabetic foot ulcer has signs of wound infection. Which assessment finding BEST confirms local wound infection?

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

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

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

Question 45: When educating a patient with a new stroke about dysphagia precautions, which food consistency is typically SAFEST to introduce first?

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

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 46: 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:

Somatic pain
Neuropathic pain (Correct answer)
Inflammatory pain
Visceral 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 47: 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?

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

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

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

Correct answer: Gastrointestinal bleeding and peptic ulcer formation

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

Question 49: 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?

Administer IV labetalol immediately
Apply a cooling blanket to reduce fever
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 50: A patient with a TBI demonstrates impulsive behavior and poor safety awareness. Which nursing intervention best addresses this deficit?

Use consistent cueing, structured routines, and environmental modifications (Correct answer)
Administer sedatives before therapy sessions
Document the behavior and defer to psychiatry alone
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 51: 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)
Pale pink wound edges with no migration
Yellow fibrinous tissue covering >50% of the wound bed
Dry, dark eschar at the wound center

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

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

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

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

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

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

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 55: Which patient is at highest risk for developing heterotopic ossification (HO) after a spinal cord injury?

A 25-year-old with a complete T4 injury and spasticity (Correct answer)
A 40-year-old with peripheral neuropathy
A 65-year-old with an incomplete C6 injury
A 50-year-old with a lumbar disc herniation

Correct answer: A 25-year-old with a complete T4 injury and spasticity

Heterotopic ossification most commonly occurs in young patients with complete cervical or thoracic SCI who also exhibit spasticity, which is a recognized risk factor.

Question 56: A patient with stroke has urge urinary incontinence due to neurogenic detrusor overactivity. Which pharmacological intervention is most commonly used?

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

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

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

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 58: 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 has no cardiac risk and can resume immediately
Wait at least 6 months before any sexual activity
Sexual activity should be permanently avoided after MI

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 59: 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?

Global aphasia
Broca's aphasia (Correct answer)
Anomic aphasia
Wernicke's 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 60: A strong gag reaction means that:

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

Correct answer: pharyngeal muscles are constricting

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

Question 61: 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 use a ring cushion to protect my tailbone when sitting
I only need to check my skin weekly unless I feel pain
I will reposition every 2 hours in bed and perform weight shifts every 15–30 minutes in my wheelchair (Correct answer)

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

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

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 63: 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?

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

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

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

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

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

Correct answer: Digital rectal stimulation or insertion of a suppository to trigger the gastrocolic reflex

Digital rectal stimulation (DRS) or suppository insertion triggers the anorectal reflex in UMN neurogenic bowel, promoting coordinated reflex evacuation.

Question 66: What is a patient's best course of nursing action? experiencing physical and/or psychological distress after moving from one setting to another recently?

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

Correct answer: encourage pt's verbalization of feelings

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

Question 67: A patient with Guillain-Barré syndrome is in the recovery phase. Which nursing priority is MOST important during early mobilization?

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

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

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

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

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

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

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

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

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

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 72: 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
Take seizure medications only when feeling a seizure coming on
Never drive until seizure-free per state law guidelines (Correct answer)
Avoid all physical activity to prevent seizures

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 73: 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:

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

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

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

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

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

Question 75: 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)
Glasgow Coma Scale
Braden Scale (Correct answer)

Correct answer: Braden Scale

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

Question 76: 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?

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

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

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

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

Muscle pain from spasticity only
Sharp, well-localized pain at the stroke site in the brain
Pain limited to the shoulder and upper extremity
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 79: 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?

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

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

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

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

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

Question 81: A patient with diabetes and a neuropathic plantar foot ulcer is in wound rehabilitation. Which offloading device is considered the GOLD STANDARD for plantar foot ulcer healing?

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

Correct answer: Total contact cast (TCC)

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

Question 82: A patient with a hip replacement is being taught posterior hip precautions. Which instruction is correct?

Avoid hip flexion beyond 60° and all rotation for 12 months
Avoid hip abduction and keep legs together at all times
Avoid hip flexion beyond 90°, hip adduction past midline, and internal rotation (Correct answer)
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 83: In rehabilitation nursing, the term 'learned non-use' most accurately describes:

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

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

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

Question 84: Which scale is most widely used in rehabilitation settings to measure a patient's functional independence across motor and cognitive domains?

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

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

Vitamin D
Vitamin C (Correct answer)
Vitamin B12
Calcium

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

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

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

Improved quality of sleep and rest
Functional decline and development of depression (Correct answer)
Enhanced ability to perform activities of daily living
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 88: Which lab value change MOST warrants withholding cardiac rehabilitation exercise and notifying the physician?

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

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

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

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

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

Question 90: A patient with paraplegia develops a stage 3 pressure injury over the ischial tuberosity. Which factor is the PRIMARY cause of ischial pressure injuries in wheelchair users?

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

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

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

Question 91: A CRRN identifies that a patient with T4 SCI is experiencing autonomic dysreflexia. The patient's BP is 195/110 mmHg. Which is the PRIORITY intervention?

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

Correct answer: Sit the patient upright, loosen constrictive clothing, and identify/remove the noxious stimulus

The first priority in AD is sitting the patient upright (to lower BP via orthostasis) and identifying and removing the triggering noxious stimulus, such as bladder distension.

Question 92: A patient's sacral wound is being treated with negative pressure wound therapy (NPWT/wound VAC). Which assessment finding requires IMMEDIATE intervention?

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

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 93: 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
Maintain a moist wound environment to promote healing and granulation (Correct answer)
Apply hydrogen peroxide daily to reduce bacterial colonization

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

Functional Independence Measure (FIM) (Correct answer)
Visual Analog Scale
Glasgow Coma Scale
Modified Ashworth 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 95: 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)
Mild sternal discomfort with deep breathing
Fatigue with low-level activity
Minor incision site bruising

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

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

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

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

Question 97: A patient enrolled in Phase II cardiac rehabilitation after MI is exercising on a treadmill. Which heart rate finding is the THRESHOLD for stopping the session?

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

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

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

Question 98: A rehabilitation nurse notices that a certified nursing assistant is completing all of a patient's ADLs rather than allowing the patient to perform them independently. The nurse should:

File a formal complaint with the facility administrator immediately
Allow the CNA to continue since it saves time and prevents patient fatigue
Redirect the CNA by explaining that patient participation in ADLs is a core therapeutic goal in rehabilitation (Correct answer)
Perform the ADLs with the CNA to model the correct approach

Correct answer: Redirect the CNA by explaining that patient participation in ADLs is a core therapeutic goal in rehabilitation

In rehabilitation, performing ADLs is therapeutic; the nurse must educate all team members that allowing patient participation — even if slower — supports functional recovery.

Question 99: A patient with a hip fracture after total hip replacement (posterior approach) asks which movement to avoid. The nurse correctly identifies:

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

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

RICE protocol with complete rest for another 4 weeks
Proprioceptive and balance training to restore neuromuscular control (Correct answer)
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 101: A patient in rehabilitation is using a fentanyl transdermal patch for chronic pain management. Which instruction is most important for the nurse to include in patient education?

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

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

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

Question 102: The rehabilitation nurse is a member of an interdisciplinary team (IDT). Which statement best distinguishes an interdisciplinary team from a multidisciplinary team?

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

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 103: 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 104: In rehabilitation, the nurse's role in family education is best described as:

Teaching caregiving skills and home safety modifications to support the patient's successful community reintegration (Correct answer)
Reserving family education exclusively for discharge day to ensure information recency
Limiting family involvement to prevent patient dependency on caregivers
Providing all medical information only to the designated legal next of kin

Correct answer: Teaching caregiving skills and home safety modifications to support the patient's successful community reintegration

Family education throughout the rehabilitation stay builds caregiver competency, addresses home modification needs, and improves outcomes for community reintegration.

Question 105: Which principle guides the rehabilitation nurse when setting goals with a patient who has a newly acquired disability?

Long-term goals should always aim for full pre-injury functional status
Goals should be set primarily by the interdisciplinary team based on clinical findings
Short-term goals should focus exclusively on preventing medical complications
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 106: The patient exhibits signs of extreme anxiety throughout the initial interview and health history, including fidgeting, licking lips, and shaking. What is the BEST reaction out of the following?

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

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

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

Question 107: 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 6–8 (nothing to very, very light)
RPE 17–19 (very hard to extremely hard)
RPE 20 (maximum exertion)
RPE 11–14 (fairly light to somewhat hard) (Correct answer)

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

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

Question 108: 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)
The patient's insurance coverage for catheter supplies
Whether the patient has a caregiver available at all times
The distance from the patient's home to the outpatient clinic

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

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

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 110: 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?

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

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

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

Correct answer: Prealbumin (transthyretin)

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

Question 112: 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
Verbal counting or rhythmic auditory cues (Correct answer)
Asking the patient to walk faster to build momentum
Dimming room lights to reduce visual distraction

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 113: 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
Apply a cooling blanket for fever management
Sit the patient upright and identify the noxious stimulus (Correct answer)
Administer IV morphine for pain relief

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 114: 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?

Administer a PRN anxiolytic
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

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

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

Correct answer: Bladder distension or bowel impaction

Bladder distension is the most common trigger of autonomic dysreflexia in SCI at or above T6, causing uncontrolled sympathetic discharge below the injury level.

Question 116: A patient receiving baclofen for spasticity following SCI reports sudden onset of hallucinations, confusion, and fever. What complication should the nurse suspect first?

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

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

Low-air-loss or alternating pressure mattress system (Correct answer)
Donut cushion placed under bony prominences
Standard hospital mattress with a thin foam overlay
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 118: A patient with an implantable cardioverter-defibrillator (ICD) is enrolled in cardiac rehabilitation. Which safety parameter is MOST important to establish before exercise?

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

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

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

Question 119: 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
Chronic constipation requiring daily enemas
Predictable bowel evacuation every 1–2 days without incontinence episodes (Correct answer)

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 120: 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
Exclude the family from care sessions to allow independent practice
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

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 121: 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:

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

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

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

Correct answer: Every 15–20 minutes

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

Question 123: 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
Long-term skilled nursing facility placement due to residual deficits
Home health therapy and outpatient stroke support group to maintain function and social participation (Correct answer)
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 124: A patient 3 days post-total hip arthroplasty (posterior approach) asks to cross their legs while sitting. What is the correct nursing response?

Allow it if the patient is comfortable and pain-free
Instruct the patient to avoid crossing the legs to prevent hip dislocation (Correct answer)
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 125: A rehabilitation nurse is caring for a patient with lateral epicondylitis (tennis elbow). Which activity modification is MOST appropriate?

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

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

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

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

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

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 128: 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
Only when feeling a strong urge to void
4–6 hours with a goal of volumes under 400–500 mL (Correct answer)
8–12 hours to reduce urethral trauma

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

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

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 130: 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°
Arm positioned across the chest in a sling at all times
Shoulder internally rotated with forearm pronated

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

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

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 132: 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?

Triggered reflex voiding using suprapubic tapping
Clean intermittent catheterization (CIC) program (Correct answer)
Indwelling Foley catheter long-term
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 133: When teaching weight-bearing precautions after a femur fracture, the CRRN distinguishes 'toe-touch weight bearing' (TTWB). Which description is CORRECT?

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

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

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

Question 134: A rehabilitation patient with chronic low back pain asks about biofeedback therapy. The nurse correctly explains that biofeedback helps manage pain by:

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
Using guided imagery to create a relaxation response that permanently eliminates pain
Administering subliminal auditory cues to block pain perception during therapy

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

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

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

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)
Speak in a louder voice to ensure comprehension

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

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

Question 137: A rehabilitation patient prescribed methadone for chronic pain management requires close monitoring because methadone:

Is approved only for opioid use disorder and not for pain
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

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 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?

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

Correct answer: Continuous passive motion (CPM) combined with active ROM exercises

CPM combined with active ROM exercises promotes early joint mobility, reduces adhesion formation, and helps achieve the 90-degree flexion discharge benchmark.

Question 139: Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?

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

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 140: 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)
Provide all education in one comprehensive session
Rely primarily on written handouts for the patient to review independently
Delay all teaching until the patient demonstrates intact recall

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 141: 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?

Beneficence
Nonmaleficence
Justice
Autonomy (Correct answer)

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

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

Correct answer: Systolic 20 mmHg above baseline

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

Question 143: A rehabilitation patient with a T6 spinal cord injury suddenly reports a severe pounding headache and diaphoresis above the level of injury along with worsening pain. The nurse's priority action is to:

Administer a PRN analgesic immediately
Notify dietary services about a potential food sensitivity
Assess for and eliminate the triggering stimulus for autonomic dysreflexia (Correct answer)
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 144: A patient with COPD is learning pursed-lip breathing in pulmonary rehabilitation. What is the PRIMARY purpose of this technique?

Strengthen the diaphragm through resistance
Increase the respiratory rate to improve oxygenation
Slow exhalation to reduce air trapping and dynamic hyperinflation (Correct answer)
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 145: A patient with SCI begins an intermittent catheterization (IC) program. Which teaching point is MOST important regarding catheter frequency?

Catheterize once daily before sleep
Catheterize only when the patient feels urgency
Catheterize every 4–6 hours to keep bladder volume below 400–500 mL (Correct answer)
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 146: A patient with TBI at Rancho Level IV is agitated and pulling at tubes. Which nursing intervention is MOST appropriate?

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

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

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

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 148: 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 149: A patient with complete C7 tetraplegia will be discharged home. Which functional skill should the CRRN prioritize in the discharge plan?

Independent manual wheelchair propulsion on all surfaces (Correct answer)
Independent driving without adaptive equipment
Full independent transfers without any equipment
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 150: Which complication is a rehabilitation nurse most vigilant for in a patient who is post-stroke and has been prescribed subcutaneous heparin for DVT prophylaxis?

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

Correct answer: Heparin-induced thrombocytopenia (HIT)

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

Question 151: 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
Use wrist extension as the primary propulsion force
Use short, rapid push strokes to maximize speed
Propel with a long, smooth arc keeping hands below the pushrim top (Correct answer)

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

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

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

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

Question 153: A patient post-lumbar laminectomy is ready for discharge. Which activity is MOST important to include in discharge teaching?

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

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 154: 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)
Achieve complete elimination of all pain through psychological techniques alone
Replace all pharmacological pain management with psychological interventions
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 155: A CRRN is teaching a patient with MS about bladder dysfunction. Which bladder problem is MOST common in MS?

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

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

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

Question 156: Which bladder management strategy is most appropriate for a patient with a complete T10 spinal cord injury who has a flaccid neurogenic bladder?

Credé maneuver every 4 hours
Triggered voiding with suprapubic tapping
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 157: 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
Anger
Bargaining (Correct answer)
Acceptance

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 158: 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 159: As opposed to bilevel positive airway pressure (BPAP), which of the following conditions is typically treated with continuous positive airway pressure (CPAP)?

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

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

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 161: 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
Deferring all advocacy to the social worker
Limiting family involvement to prevent conflicting opinions
Ensuring the patient's goals and preferences are communicated and integrated into the care plan (Correct answer)

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

Directly destroying peripheral pain receptors at the skin surface
Increasing systemic cortisol release to suppress inflammation
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 163: A patient who underwent total hip arthroplasty (THA) via posterior approach is being educated on hip precautions. Which movement is CONTRAINDICATED?

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

Correct answer: Hip flexion beyond 90 degrees

After posterior approach THA, hip flexion beyond 90 degrees risks posterior dislocation of the prosthetic joint and must be strictly avoided.

Question 164: Which test is used primarily to determine a patient's risk of falling while the CRRN is evaluating their functional ability?

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

Correct answer: Timed Up and Go (TUG).

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

Question 165: When conducting a discharge planning assessment for a stroke patient returning home with a spouse as caregiver, the rehabilitation nurse should prioritize:

Scheduling outpatient therapy before assessing the home environment
Arranging nursing home placement if any ADL assistance is needed
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 166: 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
Broca's aphasia
Left hemispatial neglect and impaired spatial awareness (Correct answer)

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

hypotension
diarrhea (Correct answer)
dysphagia
fatigue

Correct answer: diarrhea

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

Question 168: A patient with a C4 complete spinal cord injury is most likely to require which form of respiratory support?

Mechanical ventilation, at least initially (Correct answer)
Bipap therapy at night only
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 169: A patient post-prostatectomy has stress urinary incontinence. Which non-pharmacological intervention is the FIRST LINE treatment?

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

Correct answer: Pelvic floor muscle training (Kegel exercises)

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

Question 170: 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?

After the morning stiffness period has resolved, typically mid-morning (Correct answer)
Late evening when joints are most rested
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 171: When teaching a patient with limited mobility about skin inspection, which tool is MOST helpful for visualizing posterior body surfaces independently?

Skin pH meter
Pulse oximeter
Long-handled mirror (Correct answer)
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 172: When using the Braden Scale to assess a patient's pressure injury risk, which subscale score of '1' indicates the GREATEST risk?

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

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 173: 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:

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

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

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

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

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

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

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

Question 176: A pulmonary rehabilitation patient asks about the benefits of respiratory muscle training. Which response by the CRRN is MOST accurate?

It is only beneficial in patients on mechanical ventilation
It increases FEV1 to normal levels in most patients
Respiratory muscle training cures COPD by reversing airway obstruction
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.

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).

175

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180 min

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