Certified Rehabilitation Registered Nurse MCQ Flashcards

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:

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.

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

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.

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

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.

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

Answer: Braden Scale

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

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:

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.

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

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.

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?

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.

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

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.

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

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

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

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

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.

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

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.

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

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.

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

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.

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?

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.

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

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

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

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

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.

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

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.

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

Answer: PAINAD (Pain Assessment in Advanced Dementia) scale

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

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

Answer: Universal cuff with utensil holder to compensate for absent grip

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

A patient with a hip replacement is being taught posterior hip precautions. Which instruction is 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.