CRRN Certified Rehabilitation Registered Nurse — Questions and Answers

Question 1: 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
Sit the patient upright and identify the triggering stimulus (Correct answer)
Apply a cooling blanket to reduce fever
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 2: When educating a patient with a new stroke about dysphagia precautions, which food consistency is typically SAFEST to introduce first?

Thin liquids such as water
Regular solids cut into small pieces
Nectar-thick liquids (Correct answer)
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 3: A rehabilitation nurse is assessing a patient who had a right-hemisphere stroke. Which deficit is MOST characteristic of right-hemisphere damage?

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

Correct answer: Left-sided neglect and impulsive behavior

Right-hemisphere strokes commonly cause left-sided neglect, poor safety judgment, and impulsive behavior, while left-hemisphere strokes more commonly cause aphasia.

Question 4: A patient with a complete C5 spinal cord injury is being taught tenodesis grasp. What is the functional goal of this technique?

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

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 5: 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?

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

Correct answer: Stage 4

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

Question 6: 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)
Placing an indwelling Foley catheter until the patient regains consciousness
Using external condom catheters overnight only

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

Barthel Index
Functional Independence Measure (FIM) (Correct answer)
Glasgow Coma Scale (GCS)
Berg Balance Scale

Correct 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.

Question 8: 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 9: 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?

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

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

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
It blocks opioid receptors to produce analgesia

Correct answer: It modulates calcium channel activity to reduce neuropathic pain transmission

Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels in the dorsal horn, reducing neuropathic pain signal transmission.

Question 11: A rehabilitation nurse notes that a patient with incomplete SCI ambulates with a steppage gait pattern. Which nerve root level deficit BEST explains this finding?

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

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

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

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 13: 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?

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

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

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

Question 14: A patient with rheumatoid arthritis asks about joint protection principles during ADL training. Which instruction reflects correct joint protection technique?

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

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 15: A patient with a spinal cord injury at L1 reports difficulty initiating urination. Urodynamic testing reveals detrusor areflexia. Which bladder management strategy is MOST appropriate?

Indwelling Foley catheter long-term
Triggered reflex voiding using suprapubic tapping
Clean intermittent catheterization (CIC) program (Correct answer)
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 16: Which nutritional marker is the BEST indicator of a rehabilitation patient's long-term protein nutritional status?

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

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

Apply a wet-to-dry dressing and change every 4 hours
Reposition the patient off the area and implement a pressure redistribution surface (Correct answer)
Obtain a wound culture before initiating any treatment
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 18: 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?

Increased spasticity in the lower extremities
Localized warmth, swelling, and decreased range of motion below the injury (Correct answer)
Elevated serum creatinine and BUN
Sudden onset of leg pain with positive Homans' sign

Correct 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.

Question 19: Which bowel program schedule is MOST consistent with evidence-based rehabilitation nursing practice for a patient with upper motor neuron (spastic) neurogenic bowel?

Bowel care every other day using digital stimulation and suppositories at a consistent time (Correct answer)
As-needed laxatives based on patient complaint of constipation
High-fiber diet alone without scheduled bowel care
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 20: 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?

Every 2 hours
Every 30 minutes
Once per hour
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 21: A patient receiving baclofen for spasticity following SCI reports sudden onset of hallucinations, confusion, and fever. What complication should the nurse suspect first?

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

Correct answer: Abrupt baclofen withdrawal syndrome

Abrupt baclofen withdrawal can cause life-threatening symptoms including hallucinations, agitation, hyperthermia, and seizures; the baclofen should be restarted immediately.

CRRN Certified Rehabilitation Registered Nurse

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?

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