CRRN Certified Rehabilitation Registered Nurse 4 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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 4
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?