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CRRN practice questions

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Question 1Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient two days after total hip arthroplasty is learning to transfer from bed to chair. Which instruction best protects the surgical hip during the transfer?

  1. Bend forward past 90 degrees at the hip to reach the chair
  2. Keep the operative hip extended and avoid flexing it beyond 90 degrees Correct answer.
  3. Pivot on the operative leg while twisting the torso toward the chair
  4. Keep the operative leg internally rotated and crossed over the other leg

Explanation

Posterior hip precautions after total hip arthroplasty limit hip flexion beyond 90 degrees, internal rotation, and adduction to reduce dislocation risk. Keeping the hip extended during transfers and pivoting on the non-operative leg protects the prosthesis. Twisting and crossing the legs violate these precautions.

Question 2Rehabilitation Nursing Practice (content outline not enumerated in source)

Which bowel program component is most appropriate for a patient with an established upper motor neuron neurogenic bowel after spinal cord injury?

  1. Continuous bed rest to reduce colonic motility demands
  2. A high-fiber diet alone with no bowel regimen
  3. Unrestricted laxative use with no scheduled evacuation time
  4. A daily digital rectal stimulation schedule combined with a suppository Correct answer.

Explanation

Upper motor neuron neurogenic bowel produces a hyperreflexic bowel that responds to digital rectal stimulation and suppositories on a scheduled basis. A consistent evacuation time uses the gastrocolic reflex and prevents impaction and incontinence. Diet alone does not replace a structured program.

Question 3Rehabilitation Nursing Practice (content outline not enumerated in source)

During gait training, a patient with a recent stroke shows increased extensor tone in the involved lower extremity and circumducts the limb. Which intervention is most appropriate for the rehabilitation nurse to implement?

  1. Have the patient practice isolated resisted extension of the involved knee
  2. Apply a weighted cuff to the involved ankle to pull the limb through swing
  3. Use a straight cane on the involved side and practice slow, controlled steps Correct answer.
  4. Encourage quick ambulation to build endurance before addressing tone

Explanation

A cane held on the involved side widens the base of support and encourages weight shift while slow, controlled stepping reduces the extensor synergy that drives circumduction. Resistance training of the extensor pattern would reinforce the abnormal tone. Speed should not be increased before the pattern is controlled.

Question 4Rehabilitation Nursing Practice (content outline not enumerated in source)

A rehabilitation nurse is teaching a patient with rheumatoid arthritis about joint protection. Which statement by the patient indicates correct understanding?

  1. I should rest my hands only after pain becomes severe
  2. I should slide heavy objects across a counter instead of lifting them Correct answer.
  3. I should grip objects tightly to keep my fingers from getting stiff
  4. I should use my strongest joints for heavy tasks like carrying groceries

Explanation

Sliding rather than lifting reduces the load on inflamed joints and is a core joint protection principle. Larger, stronger joints should carry loads, and tight gripping increases deformity risk. Rest should be balanced with activity before pain escalates.

Question 5Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a T6 spinal cord injury reports a pounding headache and blurred vision during a bladder catheterization. The blood pressure is 178/104 mm Hg, higher than the baseline of 112/68 mm Hg. What is the nurse's first action?

  1. Place the patient flat and apply a cool cloth to the forehead
  2. Increase the bladder irrigation rate to flush the catheter
  3. Sit the patient upright and check the catheter for obstruction Correct answer.
  4. Administer a prescribed analgesic and document the episode

Explanation

These findings indicate autonomic dysreflexia, a medical emergency triggered by noxious stimuli below the injury level, most often a distended bladder. The immediate priority is sitting the patient upright to lower blood pressure while identifying and removing the trigger, such as a kinked or blocked catheter.

Question 6Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient who had a left hemisphere stroke has difficulty understanding spoken instructions. Which nursing approach best supports communication?

  1. Ask the patient to repeat each instruction back verbatim
  2. Speak louder and use longer, more detailed sentences
  3. Limit communication to written instructions only
  4. Use short phrases, gestures, and yes-or-no questions Correct answer.

Explanation

Receptive aphasia after left hemisphere stroke impairs comprehension, so short phrases, gestures, and simple closed questions reduce processing demands. Raising volume does not improve understanding, and repeating back is a verbal expression task that may be impaired.

Question 7Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient is being evaluated for a pressure injury risk on the sacrum. Which finding most strongly increases the risk of pressure injury at this site?

  1. A Braden scale score of 22
  2. Sensory impairment limiting the perception of pressure Correct answer.
  3. A body mass index in the normal range
  4. An ability to reposition independently every two hours

Explanation

Loss of sensation removes the protective feedback that prompts repositioning, allowing prolonged pressure over the sacrum and ischemia. Independent repositioning and a high Braden score indicate low risk. Body mass index in the normal range is not a pressure injury risk factor.

Question 8Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with Parkinson disease has difficulty initiating gait and freezes when approaching a doorway. Which strategy should the nurse teach?

  1. Stop walking and wait until the freezing resolves on its own
  2. Lean the trunk forward and take rapid short steps
  3. Hold the breath and push the hips backward before stepping
  4. Visualize stepping over a line on the floor to initiate movement Correct answer.

Explanation

Freezing of gait in Parkinson disease responds to external cues that bypass the impaired internal movement generation. Stepping over a visual cue such as a line or laser on the floor is a common and effective strategy. Leaning forward and rapid steps increase fall risk.

Question 9Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient recovering from a stroke has left-sided neglect. Which intervention best addresses this deficit during morning care?

  1. Turn the patient's head passively to the left during care
  2. Perform all grooming for the patient on the left side
  3. Cue the patient to scan and attend to the left side while grooming Correct answer.
  4. Place grooming items on the right side only

Explanation

Left-sided neglect reflects impaired attention to the contralesional side, so verbal and visual cueing to scan and use the left side during functional tasks is the appropriate rehabilitation approach. Doing the task for the patient or restricting items to one side reinforces neglect.

Question 10Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a new below-knee amputation is being taught about residual limb care. Which instruction is correct?

  1. Keep the limb elevated continuously to prevent edema
  2. Inspect the residual limb daily and wash it with mild soap and water Correct answer.
  3. Wrap the limb with an elastic bandage in a figure-eight pattern with firm distal pressure
  4. Apply lotion generously to soften the incision scar

Explanation

Daily inspection and gentle washing allow early detection of skin breakdown and keep the residual limb clean for prosthetic use. Bandaging should be applied with graduated pressure that is firmer distally, but a tight figure-eight can create a tourniquet effect if uneven. Lotion on a healing incision can promote maceration.

Question 11Rehabilitation Nursing Practice (content outline not enumerated in source)

Which finding in a patient with a C5 spinal cord injury indicates the need for immediate repositioning and reassessment?

  1. Warm, dry skin with capillary refill under three seconds
  2. A heart rate of 72 beats per minute with regular rhythm
  3. A sudden drop in oxygen saturation with a weak cough Correct answer.
  4. A request for a blanket because the room feels cool

Explanation

Patients with high cervical injuries have impaired cough and diaphragm-dominated breathing, so falling oxygen saturation with a weak cough suggests secretion retention or respiratory compromise. Immediate repositioning, airway assessment, and possible suctioning are indicated. The other findings are not emergent.

Question 12Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with multiple sclerosis reports new onset of double vision and increased fatigue over two days. Which nursing action is most appropriate?

  1. Reassure the patient that fatigue is expected and needs no evaluation
  2. Schedule the patient for a routine follow-up visit in two weeks
  3. Notify the provider of these new neurologic symptoms Correct answer.
  4. Encourage the patient to increase activity to build tolerance

Explanation

New diplopia with worsening fatigue may signal an acute multiple sclerosis exacerbation and warrants prompt provider notification. Fatigue management alone does not address new neurologic deficits, and delaying evaluation can allow progression.

Question 13Rehabilitation Nursing Practice (content outline not enumerated in source)

Which intervention best supports safe swallowing for a patient with dysphagia after a stroke?

  1. Encourage the patient to talk during meals to stay alert
  2. Position the patient upright and tuck the chin slightly during swallows Correct answer.
  3. Offer large bites to shorten the length of the meal
  4. Provide thin liquids with a straw to speed intake

Explanation

An upright posture with a slight chin tuck narrows the airway entrance and protects against aspiration during swallowing. Straws and large bites increase the volume and speed of intake, raising aspiration risk. Talking during meals divides attention from swallowing.

Question 14Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient in inpatient rehabilitation has an indwelling urinary catheter that was placed during acute care. Which action best supports early catheter removal?

  1. Assess the ongoing indication and use a bladder scanner to guide removal Correct answer.
  2. Maintain the catheter until discharge to avoid incontinence
  3. Irrigate the catheter daily to prevent infection
  4. Clamp the catheter for several hours each day to build bladder tone

Explanation

Indwelling catheters should be removed as soon as the indication ends, and bladder scanning can confirm urinary retention without repeated catheterization. Daily review of necessity is central to preventing catheter-associated urinary tract infection. Clamping is not an evidence-based method to prepare for removal.

Question 15Rehabilitation Nursing Practice (content outline not enumerated in source)

During a therapy session, a patient with a traumatic brain injury becomes agitated and attempts to leave the gym. Which response is most appropriate?

  1. Send the patient to the room alone without follow-up
  2. Speak loudly to gain attention and insist on completing the session
  3. Physically restrain the patient until agitation resolves
  4. Reduce environmental stimulation and redirect the patient to a calm activity Correct answer.

Explanation

Agitation after traumatic brain injury is often triggered by overstimulation, fatigue, or confusion. Reducing noise and activity and redirecting to a calm, familiar task de-escalates behavior while preserving safety. Restraint and confrontation escalate agitation.

Question 16Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient is learning to use a walker after a fractured hip. Which instruction reflects correct walker technique?

  1. Move the walker forward, then step into it with the weaker leg first Correct answer.
  2. Lift the walker off the floor with each step to avoid noise
  3. Hold the walker with one hand and use the other hand for support
  4. Place the walker two arm lengths ahead before stepping

Explanation

The walker is advanced first, then the weaker leg steps forward while the arms bear weight, followed by the stronger leg. This sequence maximizes support for the weaker limb. The walker should be placed a short distance ahead, kept on the floor, and held with both hands.

Question 17Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with chronic obstructive pulmonary disease is participating in endurance training. Which approach best supports activity tolerance?

  1. Encourage rapid, shallow breathing during exercise
  2. Schedule exercise after meals to use postprandial energy
  3. Use pursed-lip breathing and pace activities with rest periods Correct answer.
  4. Limit fluids to reduce breathlessness during exercise

Explanation

Pursed-lip breathing prolongs expiration and reduces air trapping, and pacing with planned rest periods conserves energy for patients with airflow limitation. Rapid shallow breathing increases dead-space ventilation and dyspnea. Exercise immediately after meals and fluid restriction are not appropriate strategies.

Question 18Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient who is one day after a total knee arthroplasty has a cold, pale foot with decreased sensation and severe pain unrelieved by analgesia. What is the priority nursing action?

  1. Notify the provider immediately and prepare for possible compartment pressure assessment Correct answer.
  2. Elevate the leg above heart level and encourage ankle pumps
  3. Administer the next scheduled opioid and document the pain
  4. Apply warm compresses to the foot and reassess in one hour

Explanation

The combination of severe unrelieved pain, pallor, coolness, and sensory change suggests compromised perfusion or compartment syndrome, which requires immediate provider notification and pressure assessment. Warm compresses and elevation can worsen ischemia, and additional analgesia masks the warning sign.

Question 19Rehabilitation Nursing Practice (content outline not enumerated in source)

A rehabilitation nurse is developing a plan to prevent falls for a patient with impaired balance. Which intervention is most effective?

  1. Apply a bed alarm and keep the call light out of reach
  2. Use physical restraints during all unsupervised periods
  3. Review medications and schedule toileting and rounding proactively Correct answer.
  4. Keep the bed in the highest position to ease transfers

Explanation

Falls are multifactorial, and reviewing sedating or hypotension-inducing medications while proactively meeting toileting needs addresses common modifiable causes. Proactive rounding reduces the unassisted attempts that lead to falls. Restraints and inaccessible call lights increase risk and are not appropriate.

Question 20Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with an L1 spinal cord injury is learning intermittent catheterization. Which instruction is most accurate?

  1. Limit fluids to less than one liter daily to reduce catheterization frequency
  2. Catheterize every two hours regardless of fluid intake
  3. Catheterize on a schedule based on fluid intake and measured volumes Correct answer.
  4. Wait for bladder fullness and discomfort before catheterizing

Explanation

After spinal cord injury, intermittent catheterization is timed to keep bladder volumes within a safe range, typically determined by monitoring intake and catheterized volumes. A fixed two-hour schedule regardless of intake is impractical, and waiting for discomfort risks overdistension because sensation is impaired.

Question 21Rehabilitation Nursing Practice (content outline not enumerated in source)

During a dysphagia screening, a patient coughs and has a wet voice after swallowing a small amount of water. What is the most appropriate nursing action?

  1. Continue the screening with a larger volume to confirm the finding
  2. Stop oral intake and notify the provider for a swallowing evaluation Correct answer.
  3. Document the finding as normal and resume the regular diet
  4. Encourage the patient to drink quickly to clear the throat

Explanation

Coughing and a wet voice after swallowing suggest aspiration and are a failed screening. Oral intake should be withheld and a formal swallowing evaluation obtained to determine safe textures and strategies. Increasing volume or continuing the diet risks further aspiration.

Question 22Rehabilitation Nursing Practice (content outline not enumerated in source)

Which goal statement for a patient learning to transfer from wheelchair to bed is written in measurable, functional terms?

  1. Patient will be educated about transfer techniques
  2. Patient will demonstrate a stand-pivot transfer with standby assistance by day three Correct answer.
  3. Patient will feel more confident about transfers
  4. Patient will understand transfer safety before discharge

Explanation

A measurable goal specifies the activity, the level of assistance, and a timeframe. Demonstrating a stand-pivot transfer with standby assistance by day three meets these criteria and reflects functional performance. Goals using understand, feel, or be educated lack observable criteria.

Question 23Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a recent stroke has difficulty dressing the upper body. Which technique should the nurse teach?

  1. Dress both arms simultaneously to save time
  2. Dress the affected arm first and undress it last Correct answer.
  3. Dress the unaffected arm first and undress it last
  4. Dress the affected arm last and undress it first

Explanation

The standard rule for dressing after stroke is to put the affected limb into the garment first and remove it last, which allows the stronger arm to assist with pulling clothing over the weaker side. Reversing the sequence makes dressing harder and increases strain on the affected limb.

Question 24Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a new tracheostomy is participating in mobility training. Which precaution is most important before ambulation?

  1. Remove the speaking valve to reduce airway pressure
  2. Deflate the cuff to reduce airway resistance
  3. Ensure secure tube ties, suction equipment, and oxygen are available Correct answer.
  4. Disconnect the oxygen source to prevent entanglement

Explanation

Before mobilizing a patient with a tracheostomy, the nurse confirms the tube is secured, suction is immediately available, and oxygen is functioning to manage secretions or accidental decannulation during activity. Deflating the cuff or removing equipment risks airway compromise.

Question 25Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with severe rheumatoid arthritis and hand deformities wants to remain independent in the kitchen. Which recommendation best supports independence?

  1. Suggest gripping standard utensils tightly to maintain strength
  2. Advise the patient to avoid cooking and rely on others
  3. Recommend adaptive utensils with built-up handles and lightweight cookware Correct answer.
  4. Encourage the patient to prepare meals only when hands are most painful

Explanation

Adaptive utensils with built-up handles reduce grip force and joint stress, and lightweight cookware decreases load on small joints. These modifications preserve independence while protecting joints. Cooking during peak pain and tight gripping increase inflammation and deformity risk.

Question 26Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient in inpatient rehabilitation has a stage 2 pressure injury over the coccyx. Which nursing measure is most appropriate for promoting healing at this site?

  1. Keep the head of the bed elevated at 45 degrees or more during meals
  2. Apply a doughnut-shaped cushion when the patient sits
  3. Massage the reddened tissue around the wound twice daily
  4. Reposition the patient at least every two hours while in bed Correct answer.

Explanation

Scheduled repositioning at least every two hours relieves sustained pressure over the sacrum and coccyx, which is the essential mechanical intervention for healing a stage 2 injury. Massage over or near a pressure injury is contraindicated because it further damages compromised tissue, and doughnut cushions concentrate pressure at the wound margins. Elevating the head of the bed increases shear and pressure on the coccyx.

Question 27Rehabilitation Nursing Practice (content outline not enumerated in source)

A rehabilitation nurse is teaching a patient with a new colostomy how to care for the stoma before discharge. Which statement by the patient indicates correct understanding?

  1. I should avoid looking at the stoma until it heals completely
  2. I will cleanse the stoma with hydrogen peroxide each time I change the pouch
  3. I will cut the pouch opening to fit snugly around the stoma Correct answer.
  4. I should expect the stoma to be pale and dry between pouch changes

Explanation

The pouch opening must be cut to fit closely around the stoma so that stool does not contact and excoriate the surrounding skin. A healthy stoma is moist and beefy red, not pale and dry, and hydrogen peroxide is too irritating for stoma cleansing. Patients are taught to inspect the stoma and surrounding skin at every change.

Question 28Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a spinal cord injury above T6 reports a sudden pounding headache and blurred vision. The nurse notes profuse sweating and a blood pressure of 190/110 mm Hg. Which action should the nurse take first?

  1. Administer a prescribed oral antihypertensive and recheck in 30 minutes
  2. Place the patient in a sitting position and check for bladder distention Correct answer.
  3. Obtain a urine specimen for culture and await the results
  4. Apply a cool cloth to the forehead and dim the room lights

Explanation

These findings indicate autonomic dysreflexia, a medical emergency triggered by a noxious stimulus below the injury level, most often bladder distention. The immediate priority is to sit the patient upright to lower blood pressure and to identify and remove the triggering stimulus. Antihypertensives are used only if positioning and stimulus removal do not resolve the crisis.

Question 29Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient who had a stroke three weeks ago is beginning constraint-induced movement therapy for the affected upper extremity. Which finding would require the nurse to contact the therapist before the session?

  1. The patient reports mild fatigue after morning care
  2. The patient's blood pressure is 138/84 mm Hg before therapy
  3. The patient's affected shoulder shows new pain and limited passive range of motion Correct answer.
  4. The patient needs verbal cues to sequence dressing tasks

Explanation

New shoulder pain with limited passive range of motion suggests a shoulder subluxation or soft tissue injury, which must be evaluated before intensive use of the affected arm. Constraint-induced therapy is demanding, and an injured shoulder can be further damaged by forced use. Mild fatigue, need for cueing, and a stable blood pressure are not contraindications.

Question 30Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with an above-knee amputation has a rigid dressing in place. Which assessment finding most urgently requires notifying the surgeon?

  1. Absence of palpable popliteal pulse and cool distal skin Correct answer.
  2. Serosanguineous drainage staining the distal dressing
  3. Mild swelling at the proximal edge of the dressing
  4. Complaint of a dull ache at the incision line

Explanation

With a rigid dressing, the limb cannot be directly observed, so absent distal pulses and cool skin suggest the dressing is acting as a tourniquet and compromising perfusion. This requires immediate notification to prevent ischemia. Small amounts of serosanguineous drainage and mild aching are expected after amputation.

Question 31Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with moderate cognitive impairment after a traumatic brain injury is learning to brush teeth. Which teaching approach best promotes carryover of the skill?

  1. Break the task into short steps and guide practice at the same time each day Correct answer.
  2. Provide a written handout with step-by-step instructions to review alone
  3. Demonstrate the task once and then observe the patient perform it
  4. Ask a family member to perform the task so the patient can watch

Explanation

Patients with impaired cognition learn best through task breakdown, repetition, and consistent routines that reduce demands on memory and attention. Guided practice at a consistent time uses procedural learning, which is often preserved after brain injury. Written handouts and single demonstrations rely on memory functions that are impaired.

Question 32Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with heart failure is participating in an inpatient cardiac rehabilitation program. Which finding during exercise should cause the nurse to stop the session?

  1. Systolic blood pressure rising from 118 to 132 mm Hg
  2. Respiratory rate of 20 breaths per minute
  3. Report of new chest pressure with diaphoresis Correct answer.
  4. Heart rate rising from 72 to 98 beats per minute

Explanation

New chest pressure with diaphoresis during exercise suggests myocardial ischemia and is an absolute indication to stop activity and report immediately. A modest rise in heart rate, a modest rise in systolic pressure, and a respiratory rate of 20 are normal physiologic responses to exercise.

Question 33Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient recovering from a stroke has unilateral neglect of the left side. Which intervention is most appropriate to incorporate into morning care?

  1. Approach the patient only from the right side to avoid startling
  2. Perform all left-sided hygiene tasks for the patient to save energy
  3. Keep the left arm restrained near the body during activities
  4. Place the meal tray and personal items on the left side and cue the patient to scan left Correct answer.

Explanation

Placing items on the neglected side and repeatedly cueing the patient to scan toward that side promotes awareness and is a core intervention for unilateral neglect. Approaching only from the intact side and performing care for the patient reinforce the neglect, and restraining the limb worsens learned nonuse.

Question 34Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a T4 spinal cord injury is being taught to prevent orthostatic hypotension during early mobilization. Which instruction is most helpful?

  1. Sit up gradually with the head elevated and dangle the legs before standing Correct answer.
  2. Drink less fluid in the morning to reduce blood pressure drops
  3. Avoid wearing elastic compression stockings during transfers
  4. Remain flat in bed until the blood pressure stabilizes

Explanation

Gradual position changes with progressive head elevation and leg dangling allow baroreceptor adaptation and reduce orthostatic symptoms. Adequate hydration and compression stockings support venous return and blood pressure, and prolonged bed rest worsens deconditioning.

Question 35Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with severe osteoarthritis of both hips is learning to use a raised toilet seat and long-handled equipment. Which principle best guides these recommendations?

  1. Joint protection through energy conservation and reduced hip flexion Correct answer.
  2. Strengthening the hip extensors through repeated squatting
  3. Increasing range of motion by stretching into pain
  4. Reducing reliance on assistive devices over time

Explanation

Raised seating and long-handled equipment limit hip flexion and force across arthritic joints, which is the essence of joint protection. Activities that push joints into pain or repeated squatting increase joint stress and are not recommended for severe osteoarthritis.

Question 36Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with multiple sclerosis has bladder urgency and frequency. Which self-management strategy should the nurse teach first?

  1. Schedule voiding at set intervals before the urge occurs Correct answer.
  2. Drink a large volume of fluid rapidly once daily
  3. Delay voiding as long as possible to strengthen the bladder
  4. Restrict all fluids after the evening meal only

Explanation

Timed voiding on a schedule that anticipates the urge helps retrain the bladder and reduce incontinent episodes. Adequate daytime hydration is important, and delaying voiding or rapidly consuming large volumes worsens urgency. Restricting evening fluids alone does not address daytime frequency.

Question 37Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient who is two days after total hip arthroplasty is being taught precautions before discharge. Which instruction is correct?

  1. Use a raised toilet seat and avoid bending the hip past 90 degrees Correct answer.
  2. Bend forward past 90 degrees to pick up items from the floor
  3. Cross the legs at the knees when sitting for long periods
  4. Turn the feet inward when rolling over in bed

Explanation

After total hip arthroplasty, the posterior approach precautions limit hip flexion beyond 90 degrees, adduction, and internal rotation to prevent dislocation. A raised toilet seat keeps the hip within safe limits. Crossing the legs, bending forward past 90 degrees, and turning the feet inward all violate these precautions.

Question 38Rehabilitation Nursing Practice (content outline not enumerated in source)

A rehabilitation nurse is caring for a patient with a new tracheostomy who is beginning to eat. Which action is most important before the first meal?

  1. Ensure the cuff is inflated or the patient is using a speaking valve as prescribed, and suction as needed Correct answer.
  2. Provide thin liquids first to test the swallow
  3. Remove the tracheostomy tube during meals to reduce resistance
  4. Deflate the cuff fully and leave it deflated during the meal

Explanation

Airway protection during eating depends on cuff management as prescribed and on clearing secretions before the meal. Suctioning before eating reduces aspiration risk. Removing the tube is unsafe, and thin liquids are the most aspiration-prone consistency, not a starting point.

Question 39Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient in rehabilitation has a stage 3 pressure injury with tunneling on the ischium and is on bed rest. Which nursing action is most important to support healing?

  1. Pack the tunnel tightly to prevent dead space
  2. Clean the wound with alcohol each shift
  3. Leave the wound open to air to dry the tissue
  4. Maintain a moist wound bed and reposition off the ischium Correct answer.

Explanation

A moist wound bed supports granulation, and pressure relief over the ischium is essential because continued pressure prevents healing. Tunnels are loosely packed, not tightly, to avoid trapping drainage and damaging tissue. Alcohol and air drying damage new tissue.

Question 40Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with amyotrophic lateral sclerosis reports increasing difficulty with speech that is slurred and effortful. Which intervention should the nurse anticipate?

  1. Refer to speech-language pathology for augmentative communication evaluation Correct answer.
  2. Tell the patient to avoid speaking until energy returns
  3. Encourage the patient to speak louder to strengthen muscles
  4. Restrict conversation to short yes-or-no questions

Explanation

In ALS, dysarthria progresses as bulbar muscles weaken, and augmentative and alternative communication should be introduced early while the patient can still participate in decision-making. Strengthening exercises do not reverse motor neuron degeneration, and restricting communication causes isolation and loss of autonomy.

Question 41Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a recent stroke has left-sided weakness and is learning to transfer from bed to wheelchair with a slide board. Which action indicates correct technique?

  1. Stand and pivot on the weak leg to reach the chair
  2. Position the wheelchair parallel to the bed on the weak side
  3. Place the wheelchair at a 90-degree angle to the bed on the strong side
  4. Lock the wheelchair brakes and place the board under the strong-side hip Correct answer.

Explanation

A slide board transfer requires locked brakes, a board positioned securely under the hip, and movement toward the stronger side. The wheelchair is placed parallel and close to the bed, and the patient slides rather than standing on the weak leg.

Question 42Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with chronic low back pain is participating in a rehabilitation program. Which instruction best reflects proper body mechanics for lifting a light object from the floor?

  1. Hold the object at arm's length to keep it away from the body
  2. Squat with the load close to the body and lift using the legs Correct answer.
  3. Bend at the waist with straight knees and reach for the object
  4. Twist the trunk while lifting to place the object on a table

Explanation

Squatting with the load held close to the body uses the stronger leg muscles and keeps the spine in a safer alignment. Bending at the waist, twisting while lifting, and holding loads away from the body increase spinal load and injury risk.

Question 43Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a recent stroke has severe dysphagia and a new percutaneous endoscopic gastrostomy tube. Which nursing action is most important before the first feeding?

  1. Check the residual volume and discard it routinely before each feeding
  2. Verify tube placement and confirm the prescribed feeding plan Correct answer.
  3. Flush the tube with a small amount of sterile water and begin formula immediately
  4. Position the patient flat and infuse the formula rapidly

Explanation

Before the first feeding, tube placement must be verified and the prescribed formula, rate, and method confirmed. Feedings are given with the head of the bed elevated, and routine residual checks with discarding are no longer recommended because they can lead to unnecessary interruptions and electrolyte loss.

Question 44Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a brain injury has difficulty with attention and becomes easily distracted during therapy. Which environmental modification best supports participation?

  1. Conduct therapy in a busy gym to build tolerance to distraction
  2. Schedule therapy immediately after a long, stimulating activity
  3. Allow the television to remain on for background stimulation
  4. Provide a quiet room with minimal noise and one task at a time Correct answer.

Explanation

Reducing competing stimuli and presenting one task at a time conserves attention and supports learning in patients with impaired attention after brain injury. Busy environments and background media increase distraction and fatigue.

Question 45Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a spinal cord injury at C6 is being taught to perform pressure relief in a wheelchair. Which technique is appropriate?

  1. Perform a full push-up from the wheels every 15 minutes
  2. Lean side to side or forward every 15 to 30 minutes Correct answer.
  3. Shift weight once every four hours
  4. Remain in one position until discomfort occurs

Explanation

Patients with tetraplegia who cannot perform push-ups use lateral or forward leans to relieve ischial pressure at least every 15 to 30 minutes. Waiting for discomfort is unsafe because sensation is impaired, and four-hour intervals are far too long to prevent pressure injury.

Question 46Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with rheumatoid arthritis reports morning stiffness lasting more than an hour. Which recommendation best supports function?

  1. Apply ice packs to the hands before morning activities
  2. Perform vigorous range-of-motion exercises before getting out of bed
  3. Take a warm shower and perform gentle range of motion after stiffness subsides Correct answer.
  4. Restrict all activity until the stiffness resolves completely

Explanation

Warmth and gentle movement after morning stiffness eases symptoms and preserves function, whereas vigorous exercise during acute stiffness increases pain and joint stress. Complete rest leads to deconditioning, and cold application is not the preferred first measure for morning stiffness.

Question 47Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient who is one day after a laminectomy is being taught to logroll. Which instruction is correct?

  1. Pull up using the bedside rail while twisting the trunk
  2. Sit up by bending forward at the waist
  3. Turn by twisting the shoulders first, then the hips
  4. Keep the spine aligned and turn the shoulders and hips together Correct answer.

Explanation

Logrolling maintains spinal alignment by moving the shoulders and hips as a unit, which protects the surgical site and reduces strain. Twisting the trunk, bending forward at the waist, and pulling up with twisting all stress the spine.

Question 48Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a recent stroke has impulsivity and poor safety awareness during mobility. Which nursing action is most appropriate?

  1. Provide close supervision and consistent verbal cues during mobility Correct answer.
  2. Allow independent ambulation to build confidence
  3. Remove the call light to prevent the patient from using it
  4. Place the bed in the highest position for easier transfers

Explanation

Close supervision and consistent cues compensate for impaired judgment and reduce fall risk while the patient relearns mobility. Independent ambulation, removing the call light, and raising the bed all increase the risk of injury.

Question 49Rehabilitation Nursing Practice (content outline not enumerated in source)

A rehabilitation nurse is teaching a patient with chronic obstructive pulmonary disease to use pursed-lip breathing during activity. Which instruction is correct?

  1. Inhale quickly through the mouth and hold the breath
  2. Inhale through the nose and exhale slowly through pursed lips Correct answer.
  3. Breathe rapidly to increase oxygen intake during activity
  4. Exhale forcefully through the mouth with wide-open lips

Explanation

Pursed-lip breathing slows exhalation, prevents airway collapse, and reduces air trapping during activity. Quick mouth inhalation, forceful exhalation, and rapid breathing increase dyspnea and air trapping.

Question 50Rehabilitation Nursing Practice (content outline not enumerated in source)

A patient with a recent stroke has a new prescription for a wheelchair. Which assessment is most important before the wheelchair is ordered?

  1. The patient's ability to propel the wheelchair with both arms
  2. The patient's insurance coverage for the device
  3. The patient's preferred color and style of wheelchair
  4. Seat width, seat depth, and pressure-relief needs Correct answer.

Explanation

Proper wheelchair prescription depends on accurate measurement of seat width, depth, and height and on pressure-relief needs to prevent injury and support posture. Color and insurance are administrative, and propulsion ability is assessed after fitting rather than determining the dimensions.