CRRN Certified Rehabilitation Registered Nurse 3 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
CRRN Certified Rehabilitation Registered Nurse 3
A patient 3 days post-total hip arthroplasty (posterior approach) asks to cross their legs while sitting.
What is the correct nursing response?