Certified Rehabilitation Registered Nurse Flashcards

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?

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.

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

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.

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

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.

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

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.

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

Answer: Stage 4

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

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?

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.

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

Answer: Functional Independence Measure (FIM)

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

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

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.

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?

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.

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

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.

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?

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.

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

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.

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

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

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

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

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.

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?

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.

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

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.

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

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.

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

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

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

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

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.

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?

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.