Certified Rehabilitation Registered Nurse (CRRN) — Questions and Answers

Question 1: A patient recovering from a right hemisphere stroke demonstrates left-sided spatial neglect. Which nursing intervention is most appropriate?

Patch the left eye to eliminate visual input from that side
Approach and place items on the left side to encourage awareness (Correct answer)
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 2: Which nutritional parameter is most useful for monitoring a rehabilitation patient's short-term protein status?

Hemoglobin A1c
Total cholesterol
Serum albumin
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 3: When communicating with a patient who has expressive aphasia, which approach is most effective?

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

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

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

Correct answer: PAINAD Scale

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

Question 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?

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

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

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

Question 6: A patient with heel pressure injuries is being positioned in bed. Which position is BEST to protect the heels?

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

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

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

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

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

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

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 10: 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?

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

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

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

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

Question 12: A patient with a rotator cuff repair is at 6 weeks post-surgery. Which activity is APPROPRIATE at this stage?

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

Correct answer: Pendulum exercises and passive ROM within prescribed limits

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

Question 13: A patient with an implantable cardioverter-defibrillator (ICD) is enrolled in cardiac rehabilitation. Which safety parameter is MOST important to establish before exercise?

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

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

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

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

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

Question 15: As opposed to bilevel positive airway pressure (BPAP), which of the following conditions is typically treated with continuous positive airway pressure (CPAP)?

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

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

refle
medulla (Correct answer)
hypothalamus
sacral

Correct answer: medulla

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

Question 17: 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?

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

Correct answer: L4-L5 (dorsiflexors)

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

Question 18: What is a typical adverse reaction to hyperosmotic tube feedings?

fatigue
diarrhea (Correct answer)
hypotension
dysphagia

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

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

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

Digital rectal stimulation or insertion of a suppository to trigger the gastrocolic reflex (Correct answer)
Manual disimpaction every morning
High-volume tap water enema twice daily
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 21: Which class of medication is considered first-line pharmacological treatment for neuropathic pain in rehabilitation patients?

Non-steroidal anti-inflammatory drugs (NSAIDs)
Anticonvulsants (gabapentinoids) (Correct answer)
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 22: A 35-year-old MS patient experiences chronic constipation but only infrequent fecal incontinence. What intervention is MOST appropriate from the list below?

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

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 23: 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
Administer IV morphine for pain relief
Apply a cooling blanket for fever management
Sit the patient upright and identify the noxious stimulus (Correct answer)

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

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

Question 24: A four-year-old girl who was born with a ventriculoperitoneal shunt and myelomeningocele at L3 underwent postnatal surgery to close the lesion on her back. The MOST suitable objective for a physical therapy program is which of the following?

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

Correct answer: Functional ambulation with orthotics, crutches.

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

Question 25: A CRRN is staging a wound with slough covering 70% of the wound bed. The visible tissue appears to reach subcutaneous fat. Which pressure injury stage is CORRECT?

Stage 4
Stage 1
Stage 2
Unstageable (Correct answer)

Correct answer: Unstageable

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

Question 26: 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)
Any reading above 120/80 mmHg
Diastolic above 90 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 27: A patient who sustained a stroke 6 months ago reports feeling hopeless and has lost interest in therapy activities. Which standardized tool is MOST appropriate for screening for post-stroke depression?

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

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

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

Question 28: When educating a patient with a new stroke about dysphagia precautions, which food consistency is typically SAFEST to introduce first?

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

Correct answer: Nectar-thick liquids

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

Question 29: A rehabilitation nurse is performing a Braden Scale assessment. Which subscale DIRECTLY assesses the patient's level of physical activity?

Nutrition
Friction and Shear
Moisture
Activity (Correct answer)

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

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

Correct answer: group home

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

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).

Questions

35 min

Time Limit

70%

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