Free CRRN Practice Test: 50 Questions With Explanations

This free CRRN practice test has 50 original, unofficial questions on adult rehabilitation nursing and U.S. care rules—not a full-length exam. Pick an answer, then open the explanation under the question; no signup.

Question 1 of 50

A 34-year-old man with a complete C6 spinal cord injury is lying flat in bed after lunch. His usual blood pressure is 96/60 mm Hg. He suddenly reports a pounding headache and a stuffy nose, and his face is flushed and damp. His blood pressure is now 164/98 mm Hg, and his pulse is 54 beats/min. What should the nurse do first?

A. Raise the head of the bed to a sitting position and lower his legs if possible.
B. Press over his lower abdomen to help empty his bladder.
C. Lower the head of the bed and raise his legs.
D. Recheck his blood pressure in 15 minutes to confirm the trend.

Show answer and explanation

Answer: A. His systolic pressure is 68 mm Hg above his usual baseline, and his injury is above T6. That is autonomic dysreflexia until proven otherwise; the adult threshold is a rise of more than 20 mm Hg over the person's usual systolic pressure. The first move is positional: sit him up and, if possible, lower his legs so blood pools below the injury. Then loosen anything tight, check pressure every 1–2 minutes, and look for the trigger, starting with the bladder. Because his systolic pressure is already at least 150 mm Hg, consider the prescribed rapid-onset, short-duration antihypertensive before catheterization, and check for recent phosphodiesterase-5 (PDE5) inhibitor use before any nitrate. Get urgent clinical assistance while treating the episode.

Why not the others:

B. Pressing on the bladder (Credé) or tapping over it can make dysreflexia worse. Check the urinary drainage system and follow the catheter and blood-pressure steps in the AD protocol instead.
C. This is how you treat low blood pressure. It keeps his pressure high.
D. Waiting 15 minutes delays an emergency. The guideline calls for checks every 1–2 minutes.

Domain II: Functional Health Patterns · Topic: Autonomic dysreflexia: first action

Source: Consortium for Spinal Cord Medicine / Paralyzed Veterans of America, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2020), Recommendations 2.1, 2.6–2.8, 2.10–2.14, 2.16–2.17.

Question 2 of 50

An inpatient rehabilitation facility (IRF) checks new admissions against Medicare's compliance threshold, often called the 60% rule. Based on the admitting diagnosis alone, which admission falls under one of the rule's listed conditions?

A. A 74-year-old after a single total knee replacement, BMI 31
B. A 68-year-old after surgical repair of a hip fracture
C. A 70-year-old with general deconditioning after pneumonia
D. A 79-year-old after an elective single hip replacement, BMI 29

Show answer and explanation

Answer: B. The regulation's list includes fracture of the femur (hip fracture). Joint replacement counts only when it is bilateral, when BMI is 50 or higher, or when the patient is 85 or older. The rule also lets some patients count through a qualifying comorbidity, but this question asks about the admitting diagnosis alone.

Why not the others:

A. A single knee replacement at age 74 with BMI 31 meets none of the joint-replacement conditions.
C. Deconditioning after pneumonia is not one of the listed conditions.
D. Same problem as A: single joint, under 85, BMI under 50.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: IRF compliance threshold (60% rule)

Source: 42 CFR 412.29, Classification criteria for IRF payment (eCFR), §412.29(b)(1)–(2), especially (b)(2)(iv) and (xiii).

Question 3 of 50

During the admission assessment in an IRF, a patient stands up from the edge of the bed. The nurse keeps a hand on the patient's hip for steadying (contact guard) the whole time but lifts none of the patient's weight. This reflects the patient's baseline ability before benefiting from the facility's services. How should sit-to-stand be coded on the Section GG scale?

A. 06 Independent
B. 05 Setup or clean-up assistance
C. 03 Partial/moderate assistance
D. 04 Supervision or touching assistance

Show answer and explanation

Answer: D. Code 04 covers verbal cues, touching or steadying, and contact guard assistance, whether given throughout the activity or now and then. The helper here steadies but never lifts.

Why not the others:

A. 06 means no helper assistance at all.
B. 05 is help given only before or after the activity, not during it.
C. 03 requires the helper to lift, hold, or support the trunk or limbs, providing less than half the effort.

Domain II: Functional Health Patterns · Topic: Section GG: supervision or touching assistance

Source: CMS, IRF-PAI Version 4.2, Section GG coding definitions (effective October 1, 2024), Section GG, printed pp. 10–12: six-point assistance scale; CMS, IRF-PAI Quarterly Q&As, consolidated June 2025, GG0130/GG0170, Question 10 (edited June 2025), printed pp. 18–19.

Question 4 of 50

A nurse uses the Neuman Systems Model with an adult patient (the client system) recovering from a stroke. The patient and his wife argue repeatedly about who will take over the household roles he used to handle. How is this stressor classified?

A. Intrapersonal
B. Extrapersonal
C. Interpersonal
D. A line of resistance

Show answer and explanation

Answer: C. Interpersonal stressors arise between the client and people close to him, such as family members and role expectations. The conflict with his wife fits that description.

Why not the others:

A. Intrapersonal stressors arise within the person, such as his own pain or fear.
B. Extrapersonal stressors come from further outside the client system, such as institutional rules or social policies.
D. Lines of resistance are protective structures in the model, not a type of stressor.

Domain I: Nursing Models and Theories · Topic: Neuman Systems Model: types of stressors

Source: Neuman Systems Model: official overview presentation, revised June 2025, Slide 7, Stressors (June 2025 revision).

Question 5 of 50

A patient with an indwelling urinary catheter is moving to a wheelchair for therapy. The drainage bag has been hooked on the push handle, above bladder level. Urine is flowing, and the patient has no symptoms. What should the nurse do?

A. Leave the bag where it is and empty it more often.
B. Move the bag below bladder level, keeping it off the floor.
C. Set the bag on the floor beside the wheelchair.
D. Disconnect the tubing and attach a new bag lower on the chair.

Show answer and explanation

Answer: B. CDC's CAUTI guideline says to keep the collecting bag below the level of the bladder at all times, and not to rest it on the floor.

Why not the others:

A. Emptying more often does not fix a bag positioned above the bladder.
C. The guideline says not to rest the bag on the floor.
D. Disconnecting breaks the closed drainage system, which the guideline says to maintain.

Domain II: Functional Health Patterns · Topic: Urinary drainage bag position

Source: CDC, CAUTI Guideline (2009) Summary of Recommendations, III.A, III.B.2.

Question 6 of 50

On a hospital rehab unit, an alert adult who has decision-making capacity declines a recommended nonemergency procedure after the nurse explains its purpose and risks. His daughter asks the staff to go ahead anyway. What is the nurse's best action?

A. Ask the daughter to sign consent in his place.
B. Go ahead, because the family and team agree it would help.
C. Tell the patient that refusing may mean discharge from the unit.
D. Respect the refusal, make sure he understands the consequences, notify the provider, and document the discussion.

Show answer and explanation

Answer: D. Under the federal hospital patients' rights rule, a patient has the right to make informed decisions about care, including the right to request or refuse treatment. He has capacity and there is no emergency, so his decision stands. The nurse's job is to confirm he's informed, communicate with the provider, and document.

Why not the others:

A. His daughter cannot override his informed refusal by signing in his place.
B. Team or family agreement doesn't override a capable adult's refusal.
C. Threatening an unrelated loss to change his mind is coercion.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: Informed refusal

Source: 42 CFR 482.13, Condition of participation: Patient's rights (eCFR), §482.13(b)(2).

Question 7 of 50

A woman with a T4 spinal cord injury has an intrathecal baclofen pump. She missed her scheduled refill appointment, the pump has been alarming, and she now has a temperature of 38.9 °C (102 °F), new confusion, and much worse spasticity. What should the nurse do?

A. Give acetaminophen and recheck her temperature in 4 hours.
B. Send a urine culture and reassess on the next shift.
C. Treat this as possible baclofen withdrawal and arrange emergency evaluation now.
D. Increase passive range of motion to reduce her spasticity.

Show answer and explanation

Answer: C. The drug's boxed warning lists high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity after abrupt interruption of intrathecal baclofen. In rare cases this has progressed to rhabdomyolysis, multiple organ failure, and death. The warning names people with SCI at T6 or above as a group at special risk. A missed refill plus an alarming pump plus these signs needs urgent evaluation.

Why not the others:

A. Treating the fever alone delays care for a possibly life-threatening withdrawal.
B. Infection is possible, but waiting a shift to reassess is too slow for this picture.
D. Stretching doesn't address the cause and wastes time.

Domain II: Functional Health Patterns · Topic: Intrathecal baclofen withdrawal

Source: Gablofen (intrathecal baclofen), manufacturer prescribing information (May 2021), Boxed warning; §§5.4–5.5; §17 Patient Counseling Information.

Question 8 of 50

A patient will go home using clean intermittent catheterization, with his wife helping. After two teaching sessions, she says, "I've watched you do it twice. I've got it." What is the best next step before discharge?

A. Have her perform the procedure while the nurse watches and coaches.
B. Give her a written handout and a video link.
C. Ask her to rate her confidence from 1 to 10.
D. Schedule a home health visit so a nurse can teach her at home.

Show answer and explanation

Answer: A. AHRQ describes the show-me method as the way to confirm that someone can actually follow specific instructions. Watching twice isn't the same as doing it. CDC's CAUTI guideline also says that only properly trained people, including family members, should be given responsibility for catheter care.

Why not the others:

B. Handouts support teaching but don't confirm she can do the procedure.
C. Confidence doesn't show skill.
D. This pushes verification past discharge when it can be done now.

Domain III: The Function of the Rehabilitation Team and Transitions of Care · Topic: Verifying caregiver skill before discharge (show-me)

Source: AHRQ, Teach-Back (TeamSTEPPS tool, based on Health Literacy Universal Precautions Toolkit Tool 5), Teach-back and show-me; CDC, CAUTI Guideline (2009) Summary of Recommendations, II.B, II.D.

Question 9 of 50

A man with a C7 spinal cord injury takes oxybutynin for neurogenic bladder. Before a summer discharge, he asks what to watch for in hot weather. Which teaching is most accurate?

A. Sweating below his injury will cool him normally, so he doesn't need extra precautions.
B. He should skip his oxybutynin on hot days to avoid overheating.
C. His injury and oxybutynin can both interfere with temperature control, so he should stay in cool places, drink cool fluids, and wear light clothing.
D. A heavy blanket in hot weather will keep his skin temperature steady.

Show answer and explanation

Answer: C. The Consortium guideline warns that people with SCI at or above T6 are at risk of overheating in hot environments. It lists oxybutynin among drugs that can disrupt temperature regulation. Prevention includes air-conditioned settings, cool fluids, light clothing, and water spray or a fan.

Why not the others:

A. Sweating below the injury may not work normally after SCI, so this isn't safe to assume.
B. Stopping a prescribed medicine is a decision for the prescriber, not a heat-day rule.
D. Heavy covering traps heat.

Domain II: Functional Health Patterns · Topic: Heat risk with SCI and anticholinergics

Source: Consortium for Spinal Cord Medicine / Paralyzed Veterans of America, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2020), Recs 8.2.1, 8.2.3, 8.2.4.

Question 10 of 50

Four months after a traumatic brain injury, a man follows his morning routine on the rehab unit without prompts. He is oriented in familiar settings and is learning new tasks, but he insists he can drive home, and he steps away from his walker without checking his balance. Which Rancho Los Amigos level best fits?

A. Level V: Confused, inappropriate, non-agitated
B. Level VII: Automatic, appropriate
C. Level IV: Confused, agitated
D. Level VIII: Purposeful, appropriate

Show answer and explanation

Answer: B. Level VII describes someone who does a familiar routine automatically, carries over new learning, and is only superficially aware of their deficits. Judgment and safety awareness are still poor, so they need at least minimal supervision.

Why not the others:

A. At level V, memory is severely impaired and new learning is difficult.
C. Level IV is marked by agitation and bizarre, non-purposeful behavior.
D. At level VIII, the person is starting to recognize specific impairments. He doesn't.

Domain II: Functional Health Patterns · Topic: Rancho Los Amigos: level VII

Source: Rancho Los Amigos Scale, revised level descriptions reproduced by Centre for Neuro Skills, Levels IV, V, VII, and VIII.

Question 11 of 50

During the first week of a Medicare-covered inpatient rehabilitation facility stay, how often must a rehabilitation physician see the patient face to face?

A. Every day of the stay
B. At least 3 days during the week
C. Once a week, at the team conference
D. Only at admission and discharge

Show answer and explanation

Answer: B. The regulation requires face-to-face visits on at least 3 days per week to assess the patient medically and functionally and adjust treatment. During the first week, these visits are by a rehabilitation physician. Beginning in the second week, a nonphysician practitioner with appropriate inpatient rehabilitation training and experience may perform one of the three weekly visits when permitted by state scope-of-practice requirements.

Why not the others:

A. Daily visits aren't the regulatory minimum.
C. Weekly doesn't meet the 3-days-a-week standard.
D. Admission and discharge alone fall far short.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: IRF rehabilitation physician supervision

Source: 42 CFR 412.622, Basis of payment (eCFR), §412.622(a)(3)(iv), including the second-week nonphysician-practitioner exception.

Question 12 of 50

Six weeks after a spinal cord injury, a woman tells the nurse she has felt down most days for several weeks and no longer enjoys the visits she used to look forward to. What is the most appropriate response?

A. Acknowledge her feelings and arrange an evaluation with the team's psychologist or counselor, because ongoing depression is treatable.
B. Reassure her that this is a normal stage of grief that will pass on its own.
C. Encourage her to focus on therapy so she has less time to dwell on it.
D. Plan to revisit her mood after discharge, once she is back in familiar surroundings.

Show answer and explanation

Answer: A. Down days are normal after SCI. Low mood that keeps going for weeks is different: the MSKTC factsheet notes that continuing depression makes adjustment harder, that people should talk to a professional, and that depression is treatable with medication and counseling. Psychologists, counselors, and social workers are the right team members for this.

Why not the others:

B. There's no one set path through adjustment, and weeks of low mood shouldn't be waved off as a stage.
C. Distraction doesn't treat depression.
D. Waiting delays treatment.

Domain II: Functional Health Patterns · Topic: Ongoing low mood after SCI

Source: MSKTC, Adjusting to Life After Spinal Cord Injury (2022), Difficulty with adjustment; Who can I talk to.

Question 13 of 50

A patient with a complete T6 spinal cord injury has an upper motor neuron (reflexic) bowel. Which approach fits this type of bowel?

A. Manual removal of stool as the main method, keeping stool firm
B. Bearing down (Valsalva) as the main method
C. Waiting for spontaneous bowel movements instead of using a schedule
D. A consistent schedule, using a suppository or digital stimulation to trigger reflex emptying

Show answer and explanation

Answer: D. With an injury above the conus, the defecation reflex still works but the sphincter stays tight and the person may not feel fullness. The program triggers the reflex at a planned time, using a suppository or gentle digital stimulation to relax the sphincter. The bowel program is individualized; at T6, monitor for autonomic dysreflexia during bowel care.

Why not the others:

A. This is the typical main approach for an areflexic bowel. Manual evacuation can also be an adjunct in reflexic bowel care, such as removing stool before a rectal medication; it is not exclusive to areflexic bowel.
B. Bearing down isn't the primary method for a reflexic bowel.
C. Without a schedule, reflex emptying happens at unplanned times.

Domain II: Functional Health Patterns · Topic: Upper motor neuron (reflexic) bowel program

Source: Paralyzed Veterans of America, Neurogenic Bowel Dysfunction: A Guide for People with Spinal Cord Injury (2024), Reflexic neurogenic bowel dysfunction; reflexic bowel program; glossary: manual evacuation, printed pp. 6, 9–10, 26; Consortium for Spinal Cord Medicine / Paralyzed Veterans of America, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2020), Recommendations 2.24–2.28: bowel triggers and AD precautions.

Question 14 of 50

A patient who is Deaf and uses American Sign Language is being discharged with a complicated new medication plan. Her adult son, who signs, offers to interpret, but she asks for a hospital-provided interpreter. There is no emergency. What should the nurse do?

A. Accept her son's offer, since he's already here and signs fluently.
B. Use written notes, which meet the hospital's obligation for any conversation.
C. Arrange a qualified sign language interpreter for the discharge teaching.
D. Have her son interpret the medication portion and use an interpreter for the rest.

Show answer and explanation

Answer: C. Under the ADA, the hospital is responsible for effective communication. The U.S. Department of Justice explains that outside an emergency, a provider can rely on an accompanying adult to interpret only when the patient requests it, the adult agrees, and it's appropriate. She asked for an interpreter, and complex treatment discussions often need a qualified interpreter.

Why not the others:

A. She didn't request her son, so relying on him isn't allowed here.
B. Notes can work for simple exchanges but aren't enough for complex, interactive teaching.
D. Splitting the conversation still relies on him without her request.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: ADA: effective communication

Source: U.S. Department of Justice, ADA Requirements: Effective Communication, Effective communication; qualified interpreters; use of accompanying adults or children as interpreters.

Question 15 of 50

A unit practice council reviews the Consortium for Spinal Cord Medicine autonomic dysreflexia guideline. On that guideline's evidence scale, which type of evidence ranks highest (Level I)?

A. Randomized controlled trials large enough to limit false results, or meta-analyses of such trials
B. Randomized controlled trials too small to reach the highest level
C. Cohort studies and case series
D. The guideline panel's opinion, based on experience and consensus

Show answer and explanation

Answer: A. The guideline's Table 1 defines Level I as adequately sized randomized controlled trials or meta-analyses of them. Many of its recommendations actually rest on Level V (panel opinion), which is why the strength rating matters when you apply them.

Why not the others:

B. Small RCTs are Level II.
C. Cohort studies and case series are Level III.
D. Panel opinion is Level V.

Domain I: Nursing Models and Theories · Topic: Levels of evidence

Source: Consortium for Spinal Cord Medicine / Paralyzed Veterans of America, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2020), Grading of the Recommendations, Table 1.

Question 16 of 50

A man with a T4 spinal cord injury sits up in a wheelchair for the first time. His blood pressure lying down was 112/70 mm Hg. Three minutes after sitting up it is 86/54 mm Hg, and he says he feels lightheaded. What should the nurse do first?

A. Recline him (tilt the chair back or return him to bed) and raise his legs, then recheck his blood pressure.
B. Keep him upright so his body can adjust, and recheck in 15 minutes.
C. Sit him more upright and lower his legs.
D. Take him to therapy as scheduled and report the reading at the end of the shift.

Show answer and explanation

Answer: A. His systolic pressure dropped 26 mm Hg (112 − 86) on moving upright. This meets the guideline's systolic criterion for orthostatic hypotension: a drop of at least 20 mm Hg within 3 minutes of moving upright. For symptomatic low pressure, lay him back and elevate his legs. Nonpharmacologic measures come first for prevention.

Why not the others:

B. He is symptomatic now; waiting risks fainting.
C. This is the positioning for autonomic dysreflexia, which is high blood pressure. It makes low pressure worse.
D. Delaying care and reporting is unsafe.

Domain II: Functional Health Patterns · Topic: Orthostatic hypotension after SCI

Question 17 of 50

On a patient's heel, the nurse finds intact skin with a persistent, non-blanchable maroon area. The area developed after prolonged heel pressure; assessment finds no traumatic or vascular cause. There is no open wound, blister, slough, or eschar. How is this classified under NPIAP staging?

A. Stage 1 pressure injury
B. Stage 2 pressure injury
C. Deep tissue pressure injury
D. Unstageable pressure injury

Show answer and explanation

Answer: C. A deep tissue pressure injury is intact or non-intact skin with a persistent, non-blanchable deep red, maroon, or purple area, or a blood-filled blister. It can evolve quickly, so it needs close watching and pressure off the area.

Why not the others:

A. Stage 1 color changes don't include purple or maroon; those suggest deep tissue injury.
B. Stage 2 is partial-thickness skin loss with exposed dermis, or a serum-filled blister.
D. Unstageable means full-thickness loss hidden by slough or eschar.

Domain II: Functional Health Patterns · Topic: Deep tissue pressure injury

Source: NPIAP, Pressure Injury Stages: official definitions, Pressure Injury; Stage 1, Stage 2, Unstageable, and Deep Tissue Pressure Injury definitions, pp. 1–2; AHRQ, Preventing Pressure Ulcers in Hospitals: individualized prevention care planning, §3.4.2: individualized prevention, heel pressure relief and monitoring.

Question 18 of 50

Last quarter, a rehab unit recorded 3 catheter-associated urinary tract infections (CAUTIs) across 1,200 urinary catheter-days. What is the CAUTI rate per 1,000 catheter-days? (These are practice numbers, not real data.)

A. 0.25
B. 2.5
C. 4.0
D. 25

Show answer and explanation

Answer: B. CDC's surveillance metric is the number of CAUTIs per 1,000 catheter-days. The math: 3 ÷ 1,200 × 1,000 = 2.5.

Why not the others:

A. This drops a factor of 10: 3 ÷ 1,200 × 100.
C. This doesn't come from the correct formula.
D. This multiplies by 10,000 instead of 1,000.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: CAUTI rate calculation

Source: CDC, CAUTI Guideline (2009) Summary of Recommendations, VI.B.

Question 19 of 50

An exam of a patient with a spinal cord injury shows light-touch sensation at S4–S5 and no voluntary anal contraction. No motor function is preserved more than three levels below the motor level on either side. Which ASIA Impairment Scale (AIS) grade applies?

A. AIS A
B. AIS C
C. AIS D
D. AIS B

Show answer and explanation

Answer: D. AIS B means sensory incomplete. This patient has sacral sensory sparing at S4–S5, no voluntary anal contraction, and no motor function more than three levels below the motor level on either side. AIS B does not mean that every muscle below the neurological level is inactive: limited motor preservation can coexist with this grade.

Why not the others:

A. AIS A requires no sensory or motor function at S4–S5. This patient has sacral sensation.
B. AIS C requires motor-incomplete status: voluntary anal contraction, or sacral sensory sparing plus motor function more than three levels below the motor level on either side. Fewer than half of key muscles below the single neurological level must have strength of 3 or higher. This stem does not establish motor-incomplete status.
C. AIS D also requires motor-incomplete status, with at least half of key muscles below the single neurological level graded 3 or higher. The patient does not meet the motor-incomplete criterion.

Domain II: Functional Health Patterns · Topic: ASIA Impairment Scale

Source: ASIA/ISCoS, International Standards for Neurological Classification of Spinal Cord Injury worksheet (revision April 2026), Reverse side: ASIA Impairment Scale definitions and motor-incomplete rule (April 2026 revision).

Question 20 of 50

A woman with paraplegia tells the team her top goal is to make her own lunch when she gets home. Which goal best reflects a patient-centered, interdisciplinary plan?

A. Physical therapy will increase her standing tolerance to 10 minutes.
B. By discharge, she will prepare a simple cold lunch from her wheelchair, in a kitchen set up like hers at home, with no more than supervision.
C. The team will teach kitchen safety in two occupational therapy sessions.
D. She will be independent in all household tasks before discharge.

Show answer and explanation

Answer: B. Good goals are measurable, achievable, and written into the shared care plan so every discipline works toward them. This one starts from her stated priority, names the task, the setting, the level of help, and a timeframe.

Why not the others:

A. This is a single-discipline goal that isn't tied to what she asked for.
C. This describes a team action, not a result for her.
D. This is broad, hard to measure, and may not be achievable.

Domain III: The Function of the Rehabilitation Team and Transitions of Care · Topic: A shared, patient-centered goal

Source: American Nurses Association, The Nursing Process, Outcomes / Planning.

Question 21 of 50

At admission to inpatient rehab, a patient's daughter brings in pill bottles, an over-the-counter sleep aid, and two herbal supplements. Some items don't match the transfer medication list. What should the nurse do?

A. Follow the transfer list only, since it came from the hospital.
B. Throw away the supplements and over-the-counter products.
C. Review every item with the patient, including how she actually takes each one, and report discrepancies to the prescriber or pharmacist.
D. Start all the home products so her routine isn't disrupted.

Show answer and explanation

Answer: C. AHRQ's brown bag review asks patients to bring every prescription, over-the-counter product, vitamin, supplement, and herbal product, and to talk through how they actually take each one. That's how list errors and missing medicines surface. The nurse helps reconcile the list and works with the prescriber or pharmacist to resolve discrepancies; changes to medication orders require the appropriate authorized clinician.

Why not the others:

A. The transfer list may be the thing that's wrong.
B. Discarding products loses information the team needs.
D. Starting everything could cause duplicates or interactions.

Domain II: Functional Health Patterns · Topic: Brown bag medication review

Source: AHRQ, Conduct Brown Bag Medicine Reviews: Tool 8, Overview; Actions.

Question 22 of 50

A patient who is incontinent has diffuse, shiny, red, weepy skin in the perineal folds and on the inner thighs. The area isn't over a bony prominence and isn't related to a device. How should this be described?

A. Moisture-associated skin damage (incontinence-associated dermatitis), not a pressure injury stage
B. Stage 2 pressure injury
C. Stage 1 pressure injury
D. Deep tissue pressure injury

Show answer and explanation

Answer: A. NPIAP's Stage 2 definition says it should not be used for moisture-associated skin damage, including incontinence-associated dermatitis. Pressure injuries usually sit over a bony prominence or relate to a device, and neither applies here.

Why not the others:

B. Stage 2 explicitly excludes moisture damage.
C. Stage 1 is localized non-blanchable redness of intact skin from pressure.
D. DTPI is a persistent deep red, maroon, or purple area from pressure and shear.

Domain II: Functional Health Patterns · Topic: Moisture damage vs. pressure injury

Source: NPIAP, Pressure Injury Stages: official definitions, Stage 2 definition excludes incontinence-associated dermatitis; pp. 1–2.

Question 23 of 50

An adult patient with decision-making capacity tells the nurse, "Don't discuss my condition with my sister." Later, the sister calls and asks how the patient is doing. What should the nurse do?

A. Share general progress, since relatives can receive updates.
B. Share details if the sister verifies the patient's date of birth.
C. Ask the sister to come in so the information can be shared in person.
D. Decline to share information, consistent with the patient's objection.

Show answer and explanation

Answer: D. HIPAA lets providers share information with family involved in care when the patient has the opportunity to agree or object. This patient objected.

Why not the others:

A. Being related doesn't override the patient's objection.
B. Verifying identity doesn't create permission.
C. The setting of the conversation doesn't change the patient's wishes.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: HIPAA: patient objects to family disclosure

Source: HHS, Summary of the HIPAA Privacy Rule, Permitted Uses and Disclosures (3): Opportunity to Agree or Object.

Question 24 of 50

A man with expressive (nonfluent) aphasia understands well but struggles to find words. The nurse needs to know whether he wants to shower before or after breakfast. Which approach works best?

A. Ask, "What would you like to do this morning?" and wait for a full answer.
B. Ask a choice question, "Shower first, or breakfast first?", while pointing to each, and give him time to answer.
C. Finish his sentence for him as soon as you can guess the word.
D. Speak louder and repeat the open question.

Show answer and explanation

Answer: B. Choice and yes/no questions, backed by gestures, let him answer without having to produce every word. Give him time, and don't speak for him unless you need to and he agrees.

Why not the others:

A. Open questions put the most strain on word-finding.
C. Speaking for him takes away his chance to communicate.
D. Aphasia isn't a hearing problem, so volume doesn't help.

Domain II: Functional Health Patterns · Topic: Asking questions with expressive aphasia

Source: ASHA-linked consumer aphasia guidance: communication tips (CHSA), Tips for Communicating: Talking tips 6–8; Listening tips 1, 3–4, 6; NIDCD, Aphasia: family communication guidance, How is aphasia treated? Family communication recommendations.

Question 25 of 50

Two nurses plan to lift a cooperative 150-lb patient from bed to chair by hand. His ability to assist varies with fatigue. One says, "With his help, that's about 35 pounds each, so we're under the safe limit." What is the most accurate response?

A. That's right. NIOSH set 35 lb per caregiver as the safe limit for any patient lift.
B. That's right, as long as they bend their knees and keep their backs straight.
C. A weight estimate alone does not make this lift safe. Reassess his assistance and use the devices required by the unit's safe-patient-handling plan.
D. Add a third nurse so each person lifts less than 35 lb.

Show answer and explanation

Answer: C. NIOSH's safe-patient-handling curriculum calls for assistive devices when a patient's assistance is unpredictable, not just when a weight threshold is exceeded. The estimate assumes a steady contribution he may not make. Assess his assistance before the transfer rather than treating 35 lb as a universal safe limit.

Why not the others:

A. The curriculum does not declare every lift at or below 35 lb per caregiver safe; unpredictable assistance also calls for an assistive device.
B. Body mechanics alone don't make a manual lift safe.
D. More people still means manual lifting, and the per-person math rests on the same flawed assumption.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: Safe patient handling: the 35-lb figure

Source: NIOSH, Safe Patient Handling Training for Schools of Nursing, Publication 2009-127, Appendix B, Patient’s Level of Assistance and pre-task assessment, printed p. 38.

Question 26 of 50

For a bed-to-chair transfer, a patient provides some of the effort, but two staff members are needed to complete it safely. How is this coded on the Section GG scale?

A. 03 Partial/moderate assistance
B. 02 Substantial/maximal assistance
C. 04 Supervision or touching assistance
D. 01 Dependent

Show answer and explanation

Answer: D. Code 01 applies when the helper does all the effort, or when two or more helpers are needed to complete the activity. The patient's partial effort doesn't change that.

Why not the others:

A. 03 assumes one helper doing less than half the effort.
B. 02 assumes one helper doing more than half the effort.
C. 04 is cues or steadying only.

Domain II: Functional Health Patterns · Topic: Section GG: two helpers

Source: CMS, IRF-PAI Version 4.2, Section GG coding definitions (effective October 1, 2024), Section GG, printed pp. 10–12: 01 Dependent; two or more required helpers.

Question 27 of 50

Which statement is a patient outcome, rather than a nursing intervention, in a rehab care plan?

A. "The patient will transfer from bed to wheelchair with supervision only by May 14."
B. "The nurse will help the patient with transfers three times a day."
C. "The nurse will teach the patient safe transfer technique."
D. "Staff will place the wheelchair on the patient's stronger side."

Show answer and explanation

Answer: A. In the nursing process, outcomes are measurable, achievable goals for the patient. This one names the task, the level of help, and a date.

Why not the others:

B. This describes what the nurse does.
C. This is teaching, a nursing action.
D. This is a staff action.

Domain I: Nursing Models and Theories · Topic: Outcome vs. intervention

Source: American Nurses Association, The Nursing Process, Outcomes / Planning.

Question 28 of 50

A patient with a cauda equina injury has a lower motor neuron (areflexic) bowel and frequent stool leakage. Which change best fits this type of bowel?

A. Rely on digital stimulation to trigger a reflex bowel movement.
B. Use manual removal of stool on a regular schedule and aim for firm, formed stool that is easy to pass.
C. Keep stool as soft and loose as possible.
D. Move the program to once a week to reduce handling.

Show answer and explanation

Answer: B. An injury at or below the conus can wipe out the defecation reflex and leave the sphincter relaxed. That's why programs rely on manual removal, often more frequently, and on keeping stool firm and formed, but easy to pass, to limit leakage.

Why not the others:

A. Stimulation works by triggering a reflex that this bowel type lacks.
C. Loose stool worsens leakage with a relaxed sphincter.
D. Less frequent emptying lets stool build up and leak.

Domain II: Functional Health Patterns · Topic: Lower motor neuron (areflexic) bowel program

Source: Paralyzed Veterans of America, Neurogenic Bowel Dysfunction: A Guide for People with Spinal Cord Injury (2024), Areflexic neurogenic bowel dysfunction and areflexic program, printed pp. 6, 11–12; glossary, p. 26.

Question 29 of 50

On admission to a hospital-based rehab unit, a man says he completed a living will last year and keeps it at home. What is the best response?

A. "Rehab patients don't need advance directives, since you're not critically ill."
B. "Only directives written with the hospital's attorney are valid here."
C. "You have the right to have your advance directive followed. Could someone bring a copy so it's in your record?"
D. "Please write a new one today, because older ones expire."

Show answer and explanation

Answer: C. The federal patients' rights rule gives hospital patients the right to formulate advance directives and to have staff comply with them, in line with Medicare's advance directive requirements. Getting a copy into the record makes that possible. What makes a directive valid is set by state law, so the facility's process handles questions about the document itself.

Why not the others:

A. The right doesn't depend on how sick he is.
B. This invents a requirement that isn't in the rule.
D. This invents a blanket expiration rule.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: Advance directives on admission

Source: 42 CFR 482.13, Condition of participation: Patient's rights (eCFR), §482.13(b)(3).

Question 30 of 50

A man with C5 tetraplegia says, "I'll never be independent again. I can't do anything for myself." Which response best supports his adjustment?

A. "You're right that you'll depend on others, so let your family make these decisions."
B. "With enough therapy, you'll probably do everything on your own again."
C. "Try not to think about independence right now."
D. "Independence can mean being in control: directing your own care and making your own decisions. Let's practice how you'll instruct your helpers."

Show answer and explanation

Answer: D. The MSKTC factsheet reframes independence as being in control of your life, which includes making decisions, directing personal care, and speaking up in decisions that affect you. That's something he can do fully even with high physical dependence.

Why not the others:

A. Handing his decisions to family undermines the control he still has.
B. This promises a recovery no one can guarantee.
C. Avoiding the topic doesn't help him adjust.

Domain II: Functional Health Patterns · Topic: Independence as self-direction

Source: MSKTC, Adjusting to Life After Spinal Cord Injury (2022), How can I be independent if I have to rely on others for help?.

Question 31 of 50

A man with a T2 spinal cord injury has autonomic dysreflexia. He is sitting up, his clothing is loosened, and his bladder was just drained by catheter. His blood pressure is still 172/96 mm Hg (baseline 100/62). What is the nurse's best next action?

A. Lay him flat and check his rectum for stool right away, without anesthetic jelly.
B. Because his systolic pressure is 150 or higher, get and give the prescribed rapid-onset, short-acting antihypertensive, then check for stool impaction using lidocaine jelly.
C. Recheck his blood pressure in 30 minutes.
D. Irrigate the new catheter with 60 mL of cold saline.

Show answer and explanation

Answer: B. After the bladder, fecal impaction is the next suspect. The guideline advises strongly considering drug treatment before laying him down for a rectal check when systolic pressure stays at 150 or higher, and using lidocaine jelly and waiting a few minutes before checking, because the exam itself can worsen dysreflexia. Medication is given per provider order. Check for recent PDE5-inhibitor use before any nitrate; if the rectal examination worsens AD, stop and treat the blood-pressure rise.

Why not the others:

A. Lying flat and an unanesthetized rectal exam can drive pressure higher.
C. The guideline calls for checks every 1–2 minutes during an episode.
D. If irrigation is needed to check a catheter, it's a small volume (10–15 mL) at body temperature. Cold, large volumes can worsen dysreflexia.

Domain II: Functional Health Patterns · Topic: Autonomic dysreflexia that persists

Question 32 of 50

An IRF nurse calls the skilled nursing facility that will receive a patient tomorrow. The receiving nurse asks about the patient's skin condition and bowel program. Under HIPAA, what applies?

A. The information can be shared for treatment without the patient's written authorization.
B. The patient must sign a written authorization first.
C. Only the diagnosis can be shared, not care details.
D. The information can be shared only after the patient arrives at the new facility.

Show answer and explanation

Answer: A. HIPAA permits disclosures for treatment, which includes coordinating care and referral between providers, without written authorization. The minimum necessary standard doesn't apply to disclosures to a provider for treatment. Exceptions exist, for example psychotherapy notes or a restriction the facility has agreed to.

Why not the others:

B. Treatment disclosures don't need a signed authorization.
C. Care details are exactly what treatment coordination needs.
D. Sharing in advance is part of coordinating the transfer.

Domain III: The Function of the Rehabilitation Team and Transitions of Care · Topic: Sharing information at a care transition

Source: HHS, Summary of the HIPAA Privacy Rule, Permitted Uses and Disclosures (2); Minimum Necessary.

Question 33 of 50

A patient's assessment finds no sleep apnea, uncontrolled pain, or medication cause for his poor sleep. He naps from 4 to 6 p.m., goes to bed at a different time each night, and drinks cola with dinner. Which teaching best supports better sleep?

A. Nap longer in the afternoon to make up for lost sleep.
B. Stay up later until he feels exhausted.
C. Keep the same bedtime and wake time every day, avoid late-afternoon naps, and skip caffeine in the evening.
D. Keep the TV on low so the room isn't too quiet.

Show answer and explanation

Answer: C. NHLBI's healthy sleep habits include going to bed and waking at the same time every day and avoiding caffeine, which can last up to 8 hours. For people who have trouble falling asleep at night, NHLBI advises limiting naps or taking them earlier in the afternoon.

Why not the others:

A. Late naps make it harder to fall asleep at night.
B. An irregular schedule disrupts the body clock.
D. NHLBI advises a quiet, dark bedroom without TV distraction.

Domain II: Functional Health Patterns · Topic: Sleep habits

Source: NHLBI, Healthy Sleep Habits, Healthy sleep habits: regular schedule, caffeine, bedroom environment and naps.

Question 34 of 50

On a short-staffed night, a staff member suggests restraining a calm, confused patient in bed so she won't wander while everyone is busy. She isn't a danger to herself or others right now. What is the nurse's best response?

A. Get a PRN restraint order so staff can use restraints when needed.
B. Apply the restraint and check her every 2 hours.
C. Ask the family for permission to restrain her.
D. Decline, because restraint can't be used for staff convenience, and arrange individualized, less restrictive measures such as closer observation and reorientation.

Show answer and explanation

Answer: D. The hospital patients' rights rule says patients have the right to be free from restraint imposed for coercion, discipline, convenience, or retaliation. Restraint is allowed only to ensure immediate physical safety and must end as soon as possible. Orders can never be standing or PRN.

Why not the others:

A. Restraint orders may never be written PRN.
B. Monitoring doesn't make a convenience restraint lawful.
C. Family permission doesn't change why the restraint is being used.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: Restraint for staff convenience

Source: 42 CFR 482.13, Condition of participation: Patient's rights (eCFR), §482.13(e), (e)(6); RNCB, CRRN Examination Candidate Handbook (updated February 2026), CRRN content outline, Domain IV Task 4 (restraint and alternatives).

Question 35 of 50

A patient with moderate traumatic brain injury keeps missing therapy sessions, even though he understands why they matter. Which strategy is most likely to get him there?

A. Set up a phone alarm and a written daily schedule, and practice using them with him.
B. Assign daily memory drills to strengthen his recall.
C. Remind him that missing sessions could delay his discharge.
D. Stop scheduling sessions until his memory improves.

Show answer and explanation

Answer: A. The MSKTC memory factsheet says compensatory strategies, like alarms, calendars, and notes, are the best way to work around memory problems after moderate to severe TBI. Practice using an aid in the actual daily routine; cognitive rehabilitation can help the patient learn which strategies fit and how to use them.

Why not the others:

B. Standalone drills do not directly cue the missed appointment or teach him to use an everyday reminder. This does not mean all memory rehabilitation is ineffective.
C. The problem is remembering, not motivation.
D. This withholds therapy instead of solving the problem.

Domain II: Functional Health Patterns · Topic: Memory aids after TBI

Source: MSKTC, Memory and Moderate to Severe Traumatic Brain Injury (revised 2025), Prospective Memory; What Can You Do to Help Your Memory? (2025 revision).

Question 36 of 50

A rehab unit's infection committee proposes routine antimicrobial bladder irrigation for every patient with an indwelling catheter, to prevent CAUTI. Based on CDC's CAUTI guideline, what is the best response?

A. Support it, because irrigation keeps catheters from blocking.
B. Oppose it. CDC doesn't recommend routine antimicrobial bladder irrigation.
C. Support it only for patients with spinal cord injury.
D. Replace it with routine antiseptic cleaning of the area around the urethra.

Show answer and explanation

Answer: B. The guideline says routine bladder irrigation with antimicrobials isn't recommended, and that irrigation in general isn't recommended unless obstruction is expected. A committee's job is to match unit policy to that evidence. A patient-specific order for a treatment that's actually indicated is a separate matter.

Why not the others:

A. Irrigation is reserved for when obstruction is anticipated, not routine use.
C. The guideline doesn't carve out SCI for routine antimicrobial irrigation.
D. The guideline also advises against antiseptic periurethral cleaning while the catheter is in; routine hygiene is enough.

Domain I: Nursing Models and Theories · Topic: Using CDC evidence to judge a practice proposal

Source: CDC, CAUTI Guideline (2009) Summary of Recommendations, III.G, III.H, III.I.

Question 37 of 50

A man with a T4 spinal cord injury asks about resuming sex with his partner. He uses sildenafil for erections. Which teaching is most important?

A. Sexual activity doesn't affect blood pressure after spinal cord injury.
B. If a headache starts, keep going; symptoms usually fade on their own.
C. Sildenafil prevents autonomic dysreflexia.
D. Sexual activity can trigger autonomic dysreflexia. If symptoms start, stop, sit up, check blood pressure, and tell any emergency clinician he took sildenafil, because nitrate treatment may not be safe.

Show answer and explanation

Answer: D. With an injury at or above T6, sexual activity can provoke dysreflexia. The guideline says to stop stimulation and follow the dysreflexia plan if symptoms occur. Clinicians must ask about PDE5 inhibitors like sildenafil before giving nitrates, because the combination can cause a severe drop in blood pressure.

Why not the others:

A. Blood pressure rises more during sex for people with injuries at T6 and above.
B. Continuing stimulation keeps the trigger going.
C. Sildenafil doesn't prevent dysreflexia, and it can complicate treatment.

Domain II: Functional Health Patterns · Topic: Sexual activity and autonomic dysreflexia

Source: Consortium for Spinal Cord Medicine / Paralyzed Veterans of America, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2020), Recs 2.14, 3.1, 3.5, 3.8.

Question 38 of 50

A woman with paraplegia wants to go back to her office job but doesn't know what accommodations she might need. Which referral fits best?

A. Apply for disability benefits first, since returning to work is unlikely.
B. Wait a year after discharge before exploring work.
C. Refer her to her state vocational rehabilitation agency and share the Job Accommodation Network (JAN) as an accommodations resource.
D. Ask her employer to decide what she can do.

Show answer and explanation

Answer: C. The MSKTC factsheet points people to JAN for guidance on workplace accommodations and notes that state vocational rehabilitation agencies can help with returning to work. The CRRN outline lists vocational rehabilitation counselors among the professional resources for community reintegration.

Why not the others:

A. This assumes an outcome she hasn't chosen.
B. Delay isn't needed to start planning.
D. The employer can help identify job demands and accommodations, but should not make this decision alone or replace the patient's own goals and rehabilitation planning.

Domain III: The Function of the Rehabilitation Team and Transitions of Care · Topic: Returning to work

Source: MSKTC, Adjusting to Life After Spinal Cord Injury (2022), Use resources to make your life better; RNCB, CRRN Examination Candidate Handbook (updated February 2026), CRRN content outline, Domain III Task 2.

Question 39 of 50

A man with a new spinal cord injury and reduced sensation is getting ready for discharge. Which statement shows he understands skin checks?

A. "I'll check my skin every morning and at bedtime, with a mirror or my attendant, looking for changes."
B. "I'll check my skin once a week when I shower."
C. "If it doesn't hurt, there's no problem."
D. "I'll only check if I notice a red spot."

Show answer and explanation

Answer: A. The MSKTC skin care guidance says to check the skin, or have an attendant or caregiver check it, at least twice a day, in the morning and at bedtime. With reduced sensation, he can't rely on pain to warn him.

Why not the others:

B. Once a week isn't enough.
C. Reduced sensation means damage may not hurt.
D. Waiting to notice a spot defeats the purpose of routine checks.

Domain II: Functional Health Patterns · Topic: Skin checks after SCI

Source: MSKTC / UW SCI Model System, Skin Care & Pressure Sores Part 2: Preventing Pressure Sores, What do I need to know?.

Question 40 of 50

An IRF admission is being reviewed. The plan includes 3 hours a day of speech-language pathology only, 5 days a week. Which Medicare coverage requirement does this plan fail to meet?

A. Therapy must start within 7 days of admission.
B. The patient must need more than one therapy discipline, and one must be physical or occupational therapy.
C. Speech-language pathology doesn't count as therapy in an IRF.
D. Therapy must be 3 hours a day, 7 days a week.

Show answer and explanation

Answer: B. Medicare requires active, ongoing intervention from multiple therapy disciplines (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics), one of which must be physical or occupational therapy. Speech-language pathology counts toward intensity, but it can't be the only discipline.

Why not the others:

A. The current regulation says therapy must begin within 36 hours from midnight of the admission day, not 7 days. Effective October 1, 2026, the final rule expressly requires all required therapy treatments and/or evaluations to begin within that interval.
C. Speech-language pathology is one of the listed disciplines.
D. The usual standard is at least 3 hours a day, at least 5 days a week, or 15 hours over 7 days in documented cases.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: IRF therapy requirements

Source: 42 CFR 412.622, Basis of payment (eCFR), §412.622(a)(3); CMS, FY 2027 IRF PPS final rule (published August 3, 2026; effective October 1, 2026), Summary and Dates; §412.622(a)(3)(ii), effective October 1, 2026.

Question 41 of 50

Two months after a traumatic brain injury, a woman says she tries to do all her errands in one morning and then crashes for the rest of the day. She has no new medical symptoms. What is the best advice?

A. Push through the fatigue to build stamina.
B. Stay in bed until the fatigue goes away.
C. Spread tasks out and take short breaks through the day, instead of doing everything at once.
D. Save the hardest tasks for late in the day, when she's most tired.

Show answer and explanation

Answer: C. The MSKTC fatigue guidance recommends regular rest breaks, avoiding over-scheduling, and stopping an activity before getting tired. Plan demanding tasks for a time when she is fresher rather than doing everything at once. Fatigue that is getting worse is a reason to discuss possible medical causes and medications with her provider.

Why not the others:

A. Overdoing it is a trigger for fatigue.
B. Prolonged bed rest isn't the recommended approach.
D. This schedules demanding work for her worst time.

Domain II: Functional Health Patterns · Topic: Pacing fatigue after TBI

Source: MSKTC, Fatigue and Traumatic Brain Injury, What can be done to decrease fatigue?.

Question 42 of 50

A woman recovering from hip fracture surgery can tolerate only about 45 minutes of therapy a day, and the team doesn't expect that to increase soon. Her family asks about admission to an inpatient rehabilitation facility. What is the most appropriate step?

A. Admit her to the IRF and increase therapy to 3 hours on day one.
B. Admit her to the IRF, because hip fracture is a qualifying condition.
C. Hold off on any discharge decision until she can tolerate 3 hours.
D. Work with the case manager and team to consider a setting that matches her current tolerance, since IRF care requires an intensive therapy program she can take part in and benefit from.

Show answer and explanation

Answer: D. IRF coverage requires that the patient can reasonably be expected to take part in and benefit from an intensive program, generally 3 hours a day at least 5 days a week, or 15 hours in a week in documented cases. Even if she receives 45 minutes on all 7 days, that is 5.25 hours for the week (45 × 7 ÷ 60). The case manager and team are the right people to match her to another level of care.

Why not the others:

A. Forcing intensity she can't tolerate is unsafe and doesn't meet the requirement.
B. A qualifying condition for the 60% rule doesn't establish that this patient meets IRF medical-necessity criteria.
C. Holding her in place delays care that fits her now.

Domain III: The Function of the Rehabilitation Team and Transitions of Care · Topic: Matching the level of care

Source: 42 CFR 412.622, Basis of payment (eCFR), §412.622(a)(3)(ii)–(iii); RNCB, CRRN Examination Candidate Handbook (updated February 2026), CRRN content outline, Domain III Task 2 (levels of care).

Question 43 of 50

Since October 1, 2019, which functional data does Medicare use to assign IRF patients to case-mix groups (CMGs) for payment?

A. Items from the Quality Indicators section of the IRF-PAI (Section GG)
B. The FIM instrument
C. The Barthel Index
D. Therapy minutes billed in the first week

Show answer and explanation

Answer: A. CMS removed the FIM instrument and its function modifiers from the IRF-PAI for discharges starting October 1, 2019. It now uses data items from the Quality Indicators section (Section GG) to assign case-mix groups.

Why not the others:

B. FIM was removed from the IRF-PAI for those discharges.
C. The Barthel Index isn't part of the IRF-PAI.
D. CMGs are based on patient assessment data, not billed minutes.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: FIM vs. Section GG in IRF payment

Source: CMS, FY 2019 IRF PPS Final Rule fact sheet, Removal of FIM Instrument and Refinements to the Case Mix Classification System.

Question 44 of 50

A man with aphasia after a stroke sits with his family in a noisy lounge with the TV on. His wife speaks loudly and talks about him as if he isn't there. What should the nurse teach?

A. Speak louder so he can follow the conversation.
B. Turn off the TV or move somewhere quieter, use a normal volume and short sentences, and include him directly in the conversation and decisions.
C. Keep conversations short so family matters don't upset him.
D. Communicate through written notes only.

Show answer and explanation

Answer: B. Aphasia guidance recommends cutting background noise, keeping communication simple but at an adult level, using a normal volume, and involving the person in conversations and family decisions rather than talking around him.

Why not the others:

A. Louder isn't clearer; aphasia isn't hearing loss.
C. Shielding him from family matters leaves him out.
D. Writing can help, but using it alone ignores gestures, speech, and other modes.

Domain II: Functional Health Patterns · Topic: Teaching family communication with aphasia

Source: NIDCD, Aphasia: family communication guidance, How is aphasia treated? Family communication recommendations; ASHA-linked consumer aphasia guidance: communication tips (CHSA), Tips for Communicating: Talking tips 2–3, 5, 9.

Question 45 of 50

After reviewing a new home medication schedule, an alert patient who communicates clearly says, "That all makes sense." Which question best checks understanding?

A. "Do you have any questions?"
B. "Do you feel comfortable managing these on your own?"
C. "Tell me in your own words how you'll take these medicines once you're home."
D. "Would you like another copy of the schedule?"

Show answer and explanation

Answer: C. Teach-back asks the patient to explain, in their own words, what they need to know or do. It checks how well the nurse explained things, not the patient's intelligence. If there's a gap, re-explain and check again.

Why not the others:

A. Patients often say no even when they've misunderstood.
B. This checks confidence, not understanding.
D. Giving materials doesn't check understanding.

Domain II: Functional Health Patterns · Topic: Teach-back

Source: AHRQ, Teach-Back (TeamSTEPPS tool, based on Health Literacy Universal Precautions Toolkit Tool 5), Teach-back definition and examples, including demonstration before discharge.

Question 46 of 50

A rehab unit's CAUTI rate has gone up. Which quality-improvement change does CDC's CAUTI guideline support?

A. Change every indwelling catheter and drainage bag on a fixed 2-week schedule.
B. Screen all catheterized patients for bacteria in the urine without symptoms.
C. Clean the area around the urethra with an antiseptic every shift.
D. Start a daily review of whether each catheter is still needed, with a nurse-directed removal protocol.

Show answer and explanation

Answer: D. The guideline names alert or reminder systems and nurse-directed removal protocols as effective quality-improvement strategies, with daily review of the continued need for each catheter.

Why not the others:

A. Changing catheters or bags at fixed intervals isn't recommended.
B. Routine screening for asymptomatic bacteriuria isn't recommended.
C. Antiseptic periurethral cleaning while the catheter is in isn't recommended.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: CAUTI quality improvement

Source: CDC, CAUTI Guideline (2009) Summary of Recommendations, IV.A, III.E, III.G, VI.C.

Question 47 of 50

A unit tests a new discharge-teaching checklist with one nurse for one week. The team then compares completion data with what they predicted and summarizes what they learned. Which PDSA step is this?

A. Plan
B. Do
C. Study
D. Act

Show answer and explanation

Answer: C. In IHI's Model for Improvement, Study is when the team completes the analysis, compares results with predictions, and summarizes what it learned.

Why not the others:

A. Plan sets up the test and the predictions.
B. Do carries out the test and records problems.
D. Act decides what to change and plans the next test.

Domain IV: Legislative, Economic, Ethical, and Legal Issues · Topic: PDSA cycle steps

Source: IHI, Model for Improvement: Testing Changes (PDSA), PDSA steps.

Question 48 of 50

The team's care plan says a patient needs minimal assistance for transfers. On evening shifts, the nurse repeatedly sees the patient transfer safely with supervision only. What should the nurse do?

A. Share the observation with the team so the shared plan and goals can be re-evaluated and updated.
B. Start using supervision only on her shift without telling the team.
C. Keep giving minimal assistance and not mention it.
D. Tell the patient he can transfer alone at night from now on.

Show answer and explanation

Answer: A. Assessment data and goals live in the shared care plan so every discipline works from the same information. New observations should go back to the team so the plan can be evaluated and changed together.

Why not the others:

B. Changing the plan on one shift alone splits the team.
C. Withholding useful data keeps the plan out of date.
D. This skips the team and jumps past supervision to no help at all.

Domain III: The Function of the Rehabilitation Team and Transitions of Care · Topic: Keeping the shared plan current

Source: American Nurses Association, The Nursing Process, Outcomes / Planning; RNCB, CRRN Examination Candidate Handbook (updated February 2026), CRRN content outline, Domain III Tasks 1–2.

Question 49 of 50

A man with a spinal cord injury and his wife, who provides most of his daily care, both say they're exhausted and arguing about who does what at home. What is the nurse's best action?

A. Tell his wife that caregiving is part of marriage and she will adjust.
B. Suggest he keep his needs to himself to reduce her stress.
C. Advise the couple to avoid discussing care until things calm down.
D. Help them talk through roles and decisions together, and refer them to the social worker or a counselor who works with couples and families.

Show answer and explanation

Answer: D. The MSKTC factsheet notes that changing family roles are stressful after SCI, that making decisions together and communicating openly help reduce stress, and that counselors, psychologists, and social workers can help couples and families.

Why not the others:

A. This dismisses a real strain on both of them.
B. Hiding needs creates safety and health risks.
C. Avoiding the topic lets the conflict grow.

Domain II: Functional Health Patterns · Topic: Caregiver strain and changing roles

Source: MSKTC, Adjusting to Life After Spinal Cord Injury (2022), Does family life change after SCI?; Do you feel like you are a burden?.

Question 50 of 50

A man with a C6 spinal cord injury returns from two hours at an outdoor event on a hot day. His temperature is 38.3 °C (101 °F), his skin is hot and dry, and he has no other new symptoms. He is alert, can swallow safely, and has no fluid restriction. What should the nurse do first?

A. Cover him with a blanket so his temperature doesn't swing.
B. Move him to a cool, air-conditioned room, give cool fluids, and use tepid water on his skin as needed.
C. Encourage exercise to help him sweat.
D. Offer a hot shower to help him relax.

Show answer and explanation

Answer: B. The guideline defines hyperthermia as a core temperature above 37.8 °C (100 °F) and flags people with SCI at or above T6 as at risk in hot environments. Treatment is cooling: a cooler, preferably air-conditioned setting, cool drinks, tepid water, and rest. Start cooling and reassess promptly, but also evaluate the elevated temperature for other causes, including infection; heat exposure does not by itself establish neurogenic hyperthermia.

Why not the others:

A. Covering him traps heat.
C. Exercise adds heat, and his ability to sweat may be impaired.
D. Heat exposure makes it worse.

Domain II: Functional Health Patterns · Topic: Overheating after SCI

Score your practice test

Count one point for each correct answer, out of 50; unanswered questions earn no points. Then tally by domain using the question numbers below. Your percentage is correct answers ÷ 50 × 100, not correct answers divided by questions attempted.

Score your practice test
Domain	Official weight	Questions in this set	Your correct
I. Nursing Models and Theories	8%	4, 15, 27, 36	___ / 4
II. Functional Health Patterns	53%	1, 3, 5, 7, 9, 10, 12, 13, 16, 17, 19, 21, 22, 24, 26, 28, 30, 31, 33, 35, 37, 39, 41, 44, 45, 49, 50	___ / 27
III. The Function of the Rehabilitation Team and Transitions of Care	12%	8, 20, 32, 38, 42, 48	___ / 6
IV. Legislative, Economic, Ethical, and Legal Issues	27%	2, 6, 11, 14, 18, 23, 25, 29, 34, 40, 43, 46, 47	___ / 13
Total	100%	50	___ / 50

Your number is a result on these 50 questions. It isn't a CRRN scaled score, and it doesn't predict whether you'll pass. The domain counts are small, too: in Domain I, one miss moves you 25 percentage points. Treat the tally as a map of what to reread, not a measure of your ability.

What to do with your misses:

Read each explanation, including the "why not" lines. For each miss, identify the gap: a threshold you didn't know (like the rise of more than 20 mm Hg above baseline used to recognize autonomic dysreflexia in an adult with SCI), a rule you hadn't seen (like the IRF requirement for physical or occupational therapy), or a distractor that described the right action for the wrong problem.
Wait a day or two, then retry only the questions you missed, without opening the explanations first.
If most of your misses were in Domain IV, give it real study time. It's 27% of the scored exam, and it covers regulation, reimbursement, ethics, safety, and quality work.

How this set compares with the real CRRN exam

How this set compares with the real CRRN exam
Row label	This practice test	Official CRRN exam
Questions	50 original questions	175: 150 scored and 25 unscored pretest questions mixed in
Time	Self-paced	3 hours
Result	Number correct on this set	Scaled score; 500 is the passing standard
Explanations	Under every question	None during the exam
Question writer	Castleport Test Prep Editorial Team	Rehabilitation Nursing Certification Board (RNCB)

Source for the official column: RNCB, CRRN Examination Candidate Handbook, updated February 2026, pp. 13–16.

The handbook does not specify a single raw number of correct answers needed to pass across all exam forms. It uses several versions of the exam and adjusts for their difficulty through a process called equating, then converts raw scores to a common scale. That's why a percentage on any practice test can't be translated into a CRRN result.

How the 50 questions were split. We multiplied each official domain weight by 50 (4, 26.5, 6, 13.5) and allocated whole questions that add up to 50: 4, 27, 6, and 13. We assigned the tied extra question to Domain II. The sample percentages are 8%, 54%, 12%, and 26%—close to, but not identical to, the official weights. The weights come from RNCB; the allocation is ours. RNCB publishes percentages, not a guaranteed number of questions from each domain on any single form.

Pace. The real exam gives you 180 minutes for 175 questions, which works out to about 61.7 seconds per question (180 × 60 ÷ 175). At that pace, these 50 questions take about 51½ minutes. For timed practice, set a timer for 51 minutes and 26 seconds.

When you can test. The CRRN is given only in June and December. The February 2026 handbook lists June 1–30 and December 1–30, with application deadlines of April 15 and October 15 respectively. Late applications are accepted through May 1 and November 1 with a $100 late fee. For the December 2026 window, that means October 15, 2026, or November 1 with the late fee. Read the official dates and application instructions.

Want RNCB's own sample questions?

The candidate handbook includes 15 official sample questions with an answer key, on printed pages 23–26 of the February 2026 handbook. They illustrate the question format; use current clinical and regulatory sources for care rules rather than treating a sample item as a clinical guideline. They don't come with explanations, and they aren't a scored practice exam. None of the questions on this page reproduce them.

FIM or Section GG? Know both words

CMS removed the Functional Independence Measure (FIM) instrument from the IRF Patient Assessment Instrument (IRF-PAI) for discharges on or after October 1, 2019. Section GG records self-care and mobility with assistance codes from 06 (independent) down to 01 (dependent), plus separate codes for activities not attempted. CMS also uses Section GG items in payment classification (CMS final-rule fact sheet; IRF-PAI Version 4.2, Section GG).

RNCB's current handbook still includes a sample question worded in FIM assist levels. So be ready for both vocabularies. Questions 3, 26, and 43 above use Section GG.

Version boundary. These coding questions use the Section GG definitions in IRF-PAI Version 4.2 and CMS's June 2025 admission-coding clarification. CMS lists Version 4.4 as effective October 1, 2026; it is not yet the effective version on this page's September 23 check date. Use the version applicable to the assessment date (CMS version notices).

Common questions

Are these real CRRN exam questions? No. Every question here was written by the Castleport Test Prep Editorial Team for practice. None are recalled, leaked, or copied from the exam or from RNCB's samples. RNCB states in the handbook that it doesn't sponsor or endorse any review course or preparation material.

Is this a full-length practice exam? No. It's 50 questions, about 29% of the 175 you'll see on test day. It samples all four domains in approximately the official proportions, but it can't cover every topic in the outline.

What do I need to be eligible for the CRRN? A current, unrestricted RN license in the US, a US territory, or Canada, plus either two years of rehabilitation nursing practice as an RN within the five years preceding the examination, or one year of rehabilitation nursing practice plus one year of advanced study in nursing beyond the baccalaureate within the five years preceding the examination (handbook, p. 4). The handbook requires the eligibility criteria to be met when you apply. RNCB decides eligibility, so confirm your situation with them.

Sources and how we checked this page

Official exam facts come from the RNCB CRRN Examination Candidate Handbook, updated February 2026: eligibility (p. 4), dates and deadlines (p. 5), scoring and scaled scores (pp. 13–14), exam format and domain weights (p. 16), content outline (pp. 16–23), and sample questions (pp. 23–26). The domain labels and weights also match RNCB's separately published 2022 CRRN Exam Content Outline.

The teaching behind each answer comes from the clinical guideline, regulation, drug label, or agency guidance linked in that question's explanation, with the section or recommendation number. The CRRN outline tells us which topics belong on the test. It doesn't prove a clinical or legal answer is right, so each explanation cites the source that does.

Last verified: September 23, 2026. We checked the handbook facts listed above and the specific clinical, assessment, safety, and regulatory passages cited with the questions. U.S. regulatory answers describe rules in force on that date unless a future effective date is stated. Source verification does not establish exam-score validity or professional clinical review.

These hypothetical scenarios were developed with AI-assisted drafting and source checking. This page has not been reviewed by a CRRN-certified nurse, and source checking isn't the same as professional clinical review. Use your facility's policies and your prescribers' orders in real patient care. Editorial standards

Written by the Castleport Test Prep Editorial Team. How we verify exam claims · Independence policy · Report an error

Castleport Test Prep is an independent exam prep publisher. It is not affiliated with, endorsed by, or approved by the Rehabilitation Nursing Certification Board (RNCB) or the Association of Rehabilitation Nurses (ARN). CRRN and other exam and credential names are used to identify their subjects; trademarks belong to their respective owners. These are original, unofficial practice questions, not actual exam questions. Practice results don't predict an exam score and don't guarantee certification.