CRRN Exam Flashcards

Q: What is the CRRN exam structure in 2026?

The CRRN exam has 175 multiple-choice questions (scored plus unscored pretest items) with a 3-hour time limit. It is administered by the Rehabilitation Nursing Certification Board (RNCB) in partnership with the Association of Rehabilitation Nurses (ARN) via computer-based testing at PSI or Prometric centers using a criterion-referenced scaled passing score.

Q: What does the CRRN exam cover?

The content outline covers Rehabilitation Nursing Practice (25%), Neuro-Rehabilitation (25%), Functional Assessment and Patient Education (20%), Psychosocial and Pain Management (15%), and Continuity of Care and Regulatory Compliance (15%). Neuro-rehab emphasizes stroke, traumatic brain injury, spinal cord injury, and autonomic dysreflexia.

Q: Who is eligible for the CRRN certification?

Eligibility requires a current unrestricted RN license in the U.S. or Canada, at least 2 years of practice as a registered nurse, and a minimum of 1 year of rehabilitation nursing experience within the past 5 years (or the alternative continuing-education pathway in rehabilitation nursing).

Q: What is the CRRN exam pass rate?

RNCB estimates an approximately 70% first-time pass rate. Candidates with active rehabilitation nursing experience and study focused on functional assessment tools, spinal cord injury levels, and CMS/CARF regulatory requirements tend to perform best.

Q: How long is the CRRN credential valid?

The CRRN credential is valid for 5 years. Recertification can be achieved through approved continuing education hours in rehabilitation nursing topics or by retaking the examination, with specific requirements detailed in the RNCB recertification handbook.

Question 1

Goal of rehabilitation nursing

Accepted Answer

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.

Question 2

Functional Independence Measure (FIM)

Accepted Answer

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.

Question 3

FIM scoring key thresholds

Accepted Answer

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.

Question 4

Autonomic dysreflexia

Accepted Answer

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.

Question 5

Autonomic dysreflexia first actions

Accepted Answer

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.

Question 6

Common autonomic dysreflexia triggers

Accepted Answer

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.

Question 7

Spinal cord injury level C4 vs C6

Accepted Answer

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.

Question 8

Complete vs incomplete SCI (ASIA)

Accepted Answer

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.

Question 9

Spinal shock

Accepted Answer

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.

Question 10

Rancho Los Amigos Scale

Accepted Answer

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.

Question 11

NIH Stroke Scale (NIHSS)

Accepted Answer

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.

Question 12

Left vs right hemisphere stroke deficits

Accepted Answer

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.

Question 13

Hemispatial neglect

Accepted Answer

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.

Question 14

Expressive vs receptive aphasia

Accepted Answer

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.

Question 15

Dysphagia and aspiration precautions

Accepted Answer

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.

Question 16

Neuroplasticity

Accepted Answer

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.

Question 17

Dressing the patient with hemiplegia

Accepted Answer

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.

Question 18

Pressure injury prevention in rehab

Accepted Answer

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.

Question 19

Braden Scale in rehabilitation

Accepted Answer

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.

Question 20

Neurogenic bladder types

Accepted Answer

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.

Question 21

Intermittent catheterization rationale

Accepted Answer

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.

Question 22

Neurogenic bowel program

Accepted Answer

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.

Question 23

Orthostatic hypotension in rehab

Accepted Answer

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.

Question 24

DVT prevention after immobility/SCI

Accepted Answer

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).

Question 25

Heterotopic ossification

Accepted Answer

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.

Question 26

Spasticity vs contracture

Accepted Answer

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.

Question 27

Focal spasticity management

Accepted Answer

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.

Question 28

Isometric exercise indication

Accepted Answer

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.

Question 29

Range-of-motion exercise types

Accepted Answer

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.

Question 30

Parkinson disease gait freezing cueing

Accepted Answer

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.

Question 31

Fall risk assessment

Accepted Answer

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.

Question 32

Transfer and assistive device safety

Accepted Answer

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.

Question 33

Cane and walker measurement

Accepted Answer

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.

Question 34

Wheelchair fit essentials

Accepted Answer

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.

Question 35

Teaching the cognitively impaired patient

Accepted Answer

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.

Question 36

Learning readiness

Accepted Answer

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.

Question 37

Teach-back method

Accepted Answer

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.

Question 38

Health literacy in rehab education

Accepted Answer

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.

Question 39

Stages of adjustment to disability

Accepted Answer

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.

Question 40

Depression screening after disability

Accepted Answer

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.

Question 41

Body image and sexuality after injury

Accepted Answer

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.

Question 42

Caregiver role strain

Accepted Answer

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.

Question 43

Community reintegration

Accepted Answer

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.

Question 44

WHO analgesic ladder

Accepted Answer

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.

Question 45

Neuropathic pain in rehabilitation

Accepted Answer

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.

Question 46

Non-pharmacologic pain strategies

Accepted Answer

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.

Question 47

Interdisciplinary team conference

Accepted Answer

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.

Question 48

Discharge planning starts at admission

Accepted Answer

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.

Question 49

Home accessibility assessment

Accepted Answer

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.

Question 50

CMS inpatient rehab requirements (3-hour and 60% rules)

Accepted Answer

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.

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