CRRN Rehabilitation Registered Nurse Certification 4 — Questions and Answers
Question 1: A patient with a C4 complete spinal cord injury is most likely to require which form of respiratory support?
- Incentive spirometry only
- Mechanical ventilation, at least initially (Correct answer)
- Bipap therapy at night only
- No respiratory support, as breathing is above the injury
Correct answer: Mechanical ventilation, at least initially
C4 injuries affect the phrenic nerve (C3–C5) that drives diaphragm function, often necessitating mechanical ventilation because spontaneous breathing is severely impaired or absent.
Question 2: A patient with neurogenic bladder after SCI is being taught intermittent catheterization (CIC). The nurse should instruct the patient to catheterize every:
- 1–2 hours regardless of fluid intake
- 4–6 hours with a goal of volumes under 400–500 mL (Correct answer)
- 8–12 hours to reduce urethral trauma
- Only when feeling a strong urge to void
Correct answer: 4–6 hours with a goal of volumes under 400–500 mL
CIC every 4–6 hours maintains bladder volumes below 400–500 mL, which prevents overdistension, reduces infection risk, and protects upper urinary tract function.
Question 3: When caring for a patient in the subacute phase of a stroke, the CRRN observes shoulder subluxation on the hemiplegic side. The priority nursing action is:
- Apply a tightly bound sling at all times
- Position the arm with proper support and educate the patient and family on handling techniques (Correct answer)
- Massage the shoulder vigorously to stimulate muscle tone
- Restrict all use of the affected arm to prevent further injury
Correct answer: Position the arm with proper support and educate the patient and family on handling techniques
Proper positioning, arm support troughs, and education on safe handling prevent further subluxation and shoulder-hand syndrome without restricting therapeutic use of the limb.
Question 4: A CRRN is teaching a patient with a T6 SCI about bowel management. Which statement about a neurogenic bowel program is correct?
- Bowel care should occur at a random time each day to remain flexible.
- A consistent scheduled time after a meal is recommended to utilize the gastrocolic reflex. (Correct answer)
- High fluid intake should be avoided to prevent loose stools.
- Laxatives should be used daily regardless of bowel output.
Correct answer: A consistent scheduled time after a meal is recommended to utilize the gastrocolic reflex.
Scheduling bowel care 20–30 minutes after a meal exploits the gastrocolic reflex, which increases colonic peristalsis and facilitates more predictable and complete evacuation.
Question 5: Which outcome measure is specifically designed to assess ambulation ability and community mobility in patients with lower-limb impairment?
- Functional Independence Measure (FIM)
- 10-Meter Walk Test (10MWT) (Correct answer)
- Montreal Cognitive Assessment (MoCA)
- Hamilton Anxiety Rating Scale
Correct answer: 10-Meter Walk Test (10MWT)
The 10-Meter Walk Test measures walking speed over a short distance and is a reliable, sensitive indicator of gait speed changes and functional ambulation in rehabilitation populations.
Question 6: A patient with an acquired brain injury has difficulty with memory consolidation. Which nursing strategy best supports this patient's learning of new self-care skills?
- Provide all education in one comprehensive session
- Use errorless learning and spaced retrieval techniques with frequent repetition (Correct answer)
- Rely primarily on written handouts for the patient to review independently
- Delay all teaching until the patient demonstrates intact recall
Correct answer: Use errorless learning and spaced retrieval techniques with frequent repetition
Errorless learning prevents the reinforcement of incorrect responses, while spaced retrieval strengthens long-term memory retention in patients with memory impairment after brain injury.
Question 7: A CRRN is discharging a patient who will self-manage anticoagulation therapy after DVT. Which teaching point is the highest priority?
- Avoid all physical activity until anticoagulation is complete
- Report any unusual bleeding, bruising, or blood in urine or stool immediately (Correct answer)
- Take double doses if a scheduled dose is missed
- Discontinue medication when leg swelling resolves
Correct answer: Report any unusual bleeding, bruising, or blood in urine or stool immediately
Recognizing and promptly reporting signs of bleeding is the highest priority safety concern for patients on anticoagulation therapy, as hemorrhagic complications can be life-threatening.
CRRN Rehabilitation Registered Nurse Certification 4
A patient with a C4 complete spinal cord injury is most likely to require which form of respiratory support?