Free CRRN Exam Flashcards

Restore and maintain maximum functional independence and quality of life for people with disability or chronic illness. The nurse promotes adaptation and self-management rather than doing tasks for the patient.

An 18-item tool (13 motor, 5 cognitive) scored 1-7. Score 1 = total assistance; 7 = complete independence; 6 = modified independence; 5 = supervision; below 5 indicates the patient needs physical help. Tracks functional change over the rehab stay.

A FIM score of 7 means complete independence; 6 means independence with a device or extra time. The break between 5 (supervision/setup) and 4 (minimal contact assist) marks the transition from independent to dependent for that task.

A medical emergency in spinal cord injury at T6 or above: a noxious stimulus below the injury triggers severe hypertension, pounding headache, bradycardia, flushing/sweating above and pallor below the lesion. Untreated it causes stroke or seizure.

Sit the patient upright and lower the legs to drop blood pressure, loosen tight clothing/devices, then find and remove the trigger (most often a distended bladder, then bowel impaction, then skin). Treat the cause before giving antihypertensives.

Bladder distension (kinked catheter, full bladder) is the most frequent cause, followed by bowel impaction, then skin issues (pressure injury, ingrown nail, tight clothing). Identifying and removing the noxious stimulus is the definitive treatment.

C4: diaphragm function variable, often ventilator-dependent, dependent for ADLs. C6: wrist extension allows tenodesis grasp, enabling some independent self-feeding, grooming, and pressure relief with adaptive equipment. Function increases as the level descends.

Complete (ASIA A) = no motor or sensory function in the lowest sacral segments (S4-S5). Incomplete (ASIA B-D) = some preserved function below the level, including sacral sparing, which carries a better prognosis for recovery.

Temporary loss of all reflexes, flaccid paralysis, and sensation below the SCI level immediately after injury. It resolves over days to weeks; return of reflexes (e.g., bulbocavernosus) signals its end and allows true injury level assessment.

Describes cognitive recovery after traumatic brain injury across levels I-X (or VIII). Level IV is confused-agitated (manage environment, ensure safety); higher levels show purposeful behavior. It guides interventions and family expectations.

Standardized assessment quantifying stroke severity (consciousness, language, motor, sensory, neglect). Higher scores indicate greater deficit and worse prognosis; serial scoring detects neurologic change requiring escalation.

Left-hemisphere stroke: right-sided weakness, aphasia, slow/cautious behavior. Right-hemisphere stroke: left-sided weakness, spatial-perceptual deficits, neglect, impulsivity and poor safety judgment requiring closer supervision.

Failure to attend to the affected side (often left, from right-hemisphere stroke). The patient ignores stimuli, food, and limbs on that side, increasing injury risk. Intervention includes cueing to scan and approaching from the unaffected side initially.

Expressive (Broca) aphasia: comprehension intact, output effortful and limited; use yes/no questions and patience. Receptive (Wernicke) aphasia: fluent but meaningless speech with poor comprehension; use gestures and simple cues.

After stroke, screen swallowing before oral intake. Sit upright 90 degrees, use chin-tuck, small bites, thickened liquids as ordered, and have suction available. Aspiration pneumonia is a leading preventable post-stroke complication.

The nervous system's ability to reorganize and form new connections in response to repetitive, task-specific practice. It is the physiologic basis for rehabilitation gains and supports intensive, meaningful, repeated functional training.

Dress the affected (weaker) extremity first and undress it last. This minimizes strain and pain on the limb with limited range of motion and makes the task achievable with one functional arm.

Reposition at least every 2 hours, use pressure-redistribution surfaces, inspect skin (especially over bony prominences and insensate areas), manage moisture, and teach independent weight shifts. Insensate SCI patients cannot feel early ischemia.

Predicts pressure-injury risk via sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Lower scores mean higher risk; immobile and insensate rehab patients are inherently high risk and need a proactive plan.

Spastic (reflex/upper motor neuron, injury above the conus) empties on reflex with small capacity; flaccid (lower motor neuron) overdistends and overflows. Management (timed voiding, intermittent catheterization) depends on the type.

Clean intermittent catheterization on a schedule is preferred over an indwelling catheter for many neurogenic bladders because it lowers infection risk, preserves bladder tone, and supports independence and dignity.

A consistent bowel program (timing tied to the gastrocolic reflex, adequate fluid and fiber, scheduled stimulation) prevents impaction and incontinence and reduces autonomic dysreflexia risk in SCI. Routine and consistency are essential.

Common with prolonged bedrest and SCI; a drop of about 20 mmHg systolic or 10 mmHg diastolic on standing causes dizziness and falls. Manage with gradual position change, compression garments, abdominal binders, and adequate hydration.

Immobility and SCI greatly increase venous thromboembolism risk. Prevention includes prophylactic anticoagulation, mechanical compression, range-of-motion, and surveillance for unilateral limb swelling, warmth, or new dyspnea (possible PE).

Abnormal bone formation in soft tissue around joints after SCI, TBI, or burns. Signs: warmth, swelling, decreased range of motion, low-grade fever. Early recognition and gentle ROM help preserve joint mobility.

Spasticity is velocity-dependent increased muscle tone from an upper motor neuron lesion. Contracture is fixed shortening of muscle/connective tissue from prolonged immobility. Untreated spasticity and poor positioning lead to contractures.

Botulinum toxin injection targets specific overactive muscles, reducing tone locally without the sedation and generalized weakness of oral antispasticity drugs. It is paired with stretching, splinting, and therapy.

Muscle contraction without joint movement, used to maintain strength when a joint is immobilized (cast, brace, traction). It preserves muscle without stressing the protected joint, supporting later functional recovery.

Passive ROM is performed by the nurse for patients who cannot move the joint (prevents contracture). Active and active-assisted ROM build or maintain strength. Choice depends on the patient's available motor function.

Visual cues (floor lines, a laser pointer, stepping over an object) and rhythmic auditory cues bypass impaired basal ganglia circuitry and are the most effective strategies to initiate movement when a patient freezes.

Use a validated tool (e.g., Morse Fall Scale) considering fall history, gait, mental status, IV/tethers, and assistive-device use. Rehab patients relearning mobility are high risk; the plan must balance safety with promoting independence.

Match the device and assistance level to the patient's weight-bearing status and balance; lock wheelchair brakes, use a gait belt, and guard on the affected side. Improper transfer technique is a common source of patient and staff injury.

A properly fitted cane/walker places the hand grip at wrist crease height with about 20-30 degrees of elbow flexion. A cane is held on the unaffected side and advanced with the affected leg. Wrong height impairs stability and gait.

Proper seat width, depth, and back height plus a pressure-redistribution cushion prevent skin breakdown and promote function. A poorly fitted chair causes pressure injury, poor posture, and reduced independence.

For short-term memory deficits, use short, simple, consistent steps; repetition; cueing; and frequent return demonstration in the same routine and environment. Long lectures and varied instructions impair carryover.

Effective teaching requires the patient to be physiologically and emotionally ready (pain controlled, not fatigued, beyond denial). Assess readiness first; teaching during acute distress or grief is ineffective and may need to be rescheduled.

Have the patient or caregiver explain or demonstrate the skill in their own words to confirm understanding, rather than asking 'do you understand?' Closes knowledge gaps before discharge and reduces readmission.

Many patients have limited health literacy; use plain language, visuals, small chunks, and confirm understanding. Match materials to literacy level so adaptive-equipment and self-care instructions are actually usable at home.

Adaptation is not linear; patients may move through shock, denial, anger, depression, and adjustment at their own pace. The nurse supports the patient where they are rather than forcing acceptance, and screens for prolonged maladaptive responses.

Post-stroke and SCI depression is common and underrecognized; it impairs participation and outcomes. Use a validated tool (e.g., PHQ-9), monitor for hopelessness and suicidal ideation, and ensure timely treatment referral.

Altered body image and sexual function are legitimate rehab concerns. The nurse addresses them openly and nonjudgmentally (e.g., the PLISSIT model) because unaddressed concerns impede psychosocial adjustment and relationships.

Family caregivers face physical, emotional, and financial burden that threatens the discharge plan. Assess caregiver capacity, provide training and respite resources, and include the caregiver as a partner from admission.

The ultimate rehab outcome: resuming roles at home, work, and in the community. The plan addresses transportation, accessibility, vocational/educational return, and social participation, not just physical mobility.

Stepwise pain management: non-opioids (step 1), then weak opioids (step 2), then strong opioids (step 3), with adjuvants at every step. Used to escalate or de-escalate analgesia rationally in rehabilitation pain care.

Burning, shooting, or electric pain (e.g., below an SCI level or post-stroke) often responds poorly to opioids alone. Adjuvants such as anticonvulsants and certain antidepressants are first-line; assess with a neuropathic-specific approach.

TENS, positioning, heat/cold, relaxation, and graded activity complement medication and reduce reliance on opioids. They support function-focused rehab goals and are integrated into the multimodal pain plan.

Regular team meetings (nursing, PT, OT, SLP, physician, case management, patient/family) set and update functional goals and the discharge plan. The rehab nurse coordinates care 24/7 and communicates patient status across the team.

Effective discharge planning begins on day one with assessment of home environment, caregiver support, equipment needs, and follow-up. Delaying it risks unsafe discharge, readmission, and unmet functional goals.

Evaluate entrances, stairs, doorway width, bathroom safety (grab bars, raised seat), and floor surfaces against the patient's mobility level. Recommendations must match the patient's actual function and equipment for a safe transition home.

An inpatient rehabilitation facility patient must generally tolerate intensive therapy (about 3 hours/day, 5 days/week) and 60% of admissions must meet qualifying conditions. CARF accreditation and accurate documentation support compliance.