A 58-year-old man with a new right transtibial amputation is independent in transfers and dressing but has never inspected his residual limb or performed limb care. He is cognitively intact and eager to learn. According to Orem's self-care deficit theory, which nursing system BEST fits his current needs?

Supportive-educative nursing system

Health-deviation self-care nursing system

Partly compensatory nursing system

Wholly compensatory nursing system

A 69-year-old with Parkinson disease takes carbidopa-levodopa three times daily. His wife reports that his tremor and stiffness worsen after his lunch, which usually includes a large serving of meat. Which teaching is MOST appropriate?

Take the dose 30 to 60 minutes before meals and spread protein through the day

Add a vitamin B6 supplement to each dose to boost levodopa action

Skip the midday dose on days he eats a high-protein lunch

Take each dose with the lunch meal to reduce nausea and improve its absorption

The wife of a 58-year-old man with a traumatic brain injury (Rancho Level VI) has visited daily for 6 weeks while working full time. She says she is not sleeping, has stopped seeing friends, and cries in the car. Which nursing action is MOST appropriate?

Assess her caregiver burden with a validated tool and explore respite and support resources.

Suggest that she limit her visits so that her husband learns to be more independent in rehabilitation.

Reassure her that the stress will lessen once her husband is discharged and settled at home.

Refer her husband to the neuropsychologist to evaluate how her distress is affecting his recovery.

A 59-year-old man 5 weeks after an ischemic stroke has the following findings: loud snoring and pauses in breathing observed by night staff; falls asleep during afternoon therapy; BMI 33; blood pressure poorly controlled on three medications. Which action should the nurse take?

Report the findings and advocate for an evaluation with polysomnography.

Schedule his therapy sessions only in the mornings when he is most alert.

Elevate the head of the bed to 15 degrees and recheck him after one week.

Request a sedative at bedtime so that his nighttime sleep is uninterrupted.

An IRF case manager explains to a new nurse how Medicare determines payment for each admission under the IRF prospective payment system. Which set of factors places a patient into a case-mix group?

Impairment category, admission motor and cognitive scores, and age

Total therapy minutes delivered, number of disciplines, and length of stay

Primary diagnosis, number of nursing hours, and discharge destination

Comorbidity count, number of physician visits, and admission source

A 67-year-old who had a right hemisphere stroke repeatedly tries to stand from his wheelchair without locking the brakes and states he has no problems with his left side. Which nursing approach is MOST appropriate?

Provide close supervision and short, concrete cues for each safety step

Give a detailed verbal explanation of the fall risks before each transfer attempt

Reduce supervision since his speech and language are fully intact

Allow him to learn from the consequences of unsafe transfer attempts

An 80-year-old woman admitted after a stroke comes from a culture in which her eldest son traditionally makes medical decisions. She is alert and has decision-making capacity. The son asks the team to discuss her prognosis only with him. What should the nurse do FIRST?

Ask the patient privately how she would like information shared and decisions made.

Ask the ethics committee to decide who should receive information about her prognosis.

Explain to the son that the law requires all information be given only to the patient.

Agree to the son's request because it reflects the family's cultural practice.

A 28-year-old man at Rancho Level VII after a traumatic brain injury sleeps fitfully at night, naps for hours in the afternoon, and is drowsy in morning therapy. Which nursing intervention is BEST to restore his sleep-wake cycle?

Keep a consistent daytime schedule with morning light exposure and limited daytime naps.

Let him sleep as long as he wants during the day so that he can recover.

Request a bedtime benzodiazepine to consolidate his nighttime sleep and improve his morning alertness.

Schedule his vital signs and therapies during the night when he is awake.

A therapist at a skilled nursing facility suggests adding more daily therapy minutes for a 78-year-old Medicare Part A resident with a stroke so that the facility will be paid more. The nurse case manager knows that under the Patient-Driven Payment Model, payment is driven MOSTLY by which factor?

The resident's clinical characteristics across five case-mix components

The length of the resident's preceding acute hospital stay and the discharge diagnosis

The total number of therapy minutes the resident receives during the 7-day look-back period

The number of therapy disciplines treating the resident during each calendar week

CRRN Exam

Free CRRN Practice Questions

10 sample questions for the CRRN Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Nursing Models and Theories, The Function of the Rehabilitation Team and Transitions of Care, Legislative, Economic, Ethical, and Legal Issues.

Question 1 · Nursing Models and Theories
A 58-year-old man with a new right transtibial amputation is independent in transfers and dressing but has never inspected his residual limb or performed limb care. He is cognitively intact and eager to learn. According to Orem's self-care deficit theory, which nursing system BEST fits his current needs?
- A.Health-deviation self-care nursing system
- B.Supportive-educative nursing system
- C.Partly compensatory nursing system
- D.Wholly compensatory nursing system
Show answer and explanation
Answer: B. Supportive-educative nursing system
The supportive-educative nursing system applies when the patient can perform self-care but needs teaching, guidance, and support to do it, which matches a capable, motivated man who simply lacks knowledge of limb care. A partly compensatory system is used when nurse and patient share the performance of care, and a wholly compensatory system is used when the patient cannot perform self-care at all. Health deviation is one of Orem's categories of self-care requisites, not one of her three nursing systems.
Question 2 · Nursing Models and Theories
A 69-year-old with Parkinson disease takes carbidopa-levodopa three times daily. His wife reports that his tremor and stiffness worsen after his lunch, which usually includes a large serving of meat. Which teaching is MOST appropriate?
- A.Add a vitamin B6 supplement to each dose to boost levodopa action
- B.Take the dose 30 to 60 minutes before meals and spread protein through the day
- C.Skip the midday dose on days he eats a high-protein lunch
- D.Take each dose with the lunch meal to reduce nausea and improve its absorption
Show answer and explanation
Answer: B. Take the dose 30 to 60 minutes before meals and spread protein through the day
Dietary amino acids compete with levodopa for intestinal absorption and transport into the brain, so taking doses before meals and spreading protein across the day reduces motor fluctuations. Taking it with a heavy protein meal causes the problem described. Pyridoxine interferes mainly with levodopa given without carbidopa and is not a strategy to boost it, and skipping doses increases rigidity and risk of complications.
Question 3 · Nursing Models and Theories
The wife of a 58-year-old man with a traumatic brain injury (Rancho Level VI) has visited daily for 6 weeks while working full time. She says she is not sleeping, has stopped seeing friends, and cries in the car. Which nursing action is MOST appropriate?
- A.Assess her caregiver burden with a validated tool and explore respite and support resources.
- B.Suggest that she limit her visits so that her husband learns to be more independent in rehabilitation.
- C.Reassure her that the stress will lessen once her husband is discharged and settled at home.
- D.Refer her husband to the neuropsychologist to evaluate how her distress is affecting his recovery.
Show answer and explanation
Answer: A. Assess her caregiver burden with a validated tool and explore respite and support resources.
Sleep disturbance, social withdrawal and tearfulness are signs of caregiver strain; a structured assessment such as the Caregiver Strain Index or Zarit Burden Interview guides referral to respite, support groups and social work. Strain typically increases rather than decreases after discharge, so reassurance is false. Telling her to visit less without assessment ignores her needs, and the neuropsychology referral targets the patient rather than the caregiver.
Question 4 · Nursing Models and Theories
A 59-year-old man 5 weeks after an ischemic stroke has the following findings: loud snoring and pauses in breathing observed by night staff; falls asleep during afternoon therapy; BMI 33; blood pressure poorly controlled on three medications. Which action should the nurse take?
- A.Schedule his therapy sessions only in the mornings when he is most alert.
- B.Elevate the head of the bed to 15 degrees and recheck him after one week.
- C.Request a sedative at bedtime so that his nighttime sleep is uninterrupted.
- D.Report the findings and advocate for an evaluation with polysomnography.
Show answer and explanation
Answer: D. Report the findings and advocate for an evaluation with polysomnography.
Obstructive sleep apnea is very common after stroke and is linked to poor functional recovery, resistant hypertension and recurrent stroke; witnessed apneas, snoring and daytime sleepiness warrant a sleep study and treatment such as CPAP. Rescheduling therapy only works around the problem, sedatives can worsen apnea, and positioning alone with a delay does not address a likely treatable disorder.
Question 5 · Legislative, Economic, Ethical, and Legal Issues
An IRF case manager explains to a new nurse how Medicare determines payment for each admission under the IRF prospective payment system. Which set of factors places a patient into a case-mix group?
- A.Total therapy minutes delivered, number of disciplines, and length of stay
- B.Impairment category, admission motor and cognitive scores, and age
- C.Primary diagnosis, number of nursing hours, and discharge destination
- D.Comorbidity count, number of physician visits, and admission source
Show answer and explanation
Answer: B. Impairment category, admission motor and cognitive scores, and age
Under the IRF PPS, patients are classified into case-mix groups by rehabilitation impairment category, functional motor and cognitive scores from Section GG admission items, and age, with comorbidity tiers adjusting payment further. Therapy minutes and length of stay do not set the group, and discharge destination and physician visit counts are not classification variables.
Question 6 · Nursing Models and Theories
A 39-year-old woman with a long-standing T8 spinal cord injury has managed her bowel program successfully for years. During one week of very little sleep while caring for her sick child, she becomes fatigued and more vulnerable, but she has had no bowel accidents or skin changes yet. In Neuman's systems model, the sleep loss MOST directly affects which structure?
- A.Lines of resistance
- B.Flexible line of defense
- C.Basic core energy structure
- D.Normal line of defense
Show answer and explanation
Answer: B. Flexible line of defense
Neuman describes the flexible line of defense as the outer, changeable buffer that protects the usual state of wellness, and she names sleep loss and poor nutrition as factors that can quickly weaken it. The normal line of defense is the person's usual stable level of wellness built over time, which is what was breached once the buffer failed. Lines of resistance and the basic core are inner structures that come into play only after stressors get through.
Question 7 · Nursing Models and Theories
A 67-year-old who had a right hemisphere stroke repeatedly tries to stand from his wheelchair without locking the brakes and states he has no problems with his left side. Which nursing approach is MOST appropriate?
- A.Give a detailed verbal explanation of the fall risks before each transfer attempt
- B.Reduce supervision since his speech and language are fully intact
- C.Provide close supervision and short, concrete cues for each safety step
- D.Allow him to learn from the consequences of unsafe transfer attempts
Show answer and explanation
Answer: C. Provide close supervision and short, concrete cues for each safety step
Right hemisphere stroke often causes impulsivity, poor judgment, and anosognosia, so close supervision with short, concrete cues and consistent routines is needed for safety. Long explanations are not effective because the person tends to overestimate his abilities. Allowing unsafe trials risks falls, and intact language does not mean intact judgment or awareness.
Question 8 · Nursing Models and Theories
An 80-year-old woman admitted after a stroke comes from a culture in which her eldest son traditionally makes medical decisions. She is alert and has decision-making capacity. The son asks the team to discuss her prognosis only with him. What should the nurse do FIRST?
- A.Ask the ethics committee to decide who should receive information about her prognosis.
- B.Explain to the son that the law requires all information be given only to the patient.
- C.Agree to the son's request because it reflects the family's cultural practice.
- D.Ask the patient privately how she would like information shared and decisions made.
Show answer and explanation
Answer: D. Ask the patient privately how she would like information shared and decisions made.
Respecting both autonomy and culture starts by asking a capable patient how she wants information and decision-making handled; she may choose to defer to her son, and that choice is valid if it is hers. Agreeing without asking her assumes her wishes, insisting that information go only to her ignores culturally appropriate preferences, and an ethics consult is premature before asking the patient.
Question 9 · Nursing Models and Theories
A 28-year-old man at Rancho Level VII after a traumatic brain injury sleeps fitfully at night, naps for hours in the afternoon, and is drowsy in morning therapy. Which nursing intervention is BEST to restore his sleep-wake cycle?
- A.Let him sleep as long as he wants during the day so that he can recover.
- B.Keep a consistent daytime schedule with morning light exposure and limited daytime naps.
- C.Request a bedtime benzodiazepine to consolidate his nighttime sleep and improve his morning alertness.
- D.Schedule his vital signs and therapies during the night when he is awake.
Show answer and explanation
Answer: B. Keep a consistent daytime schedule with morning light exposure and limited daytime naps.
Sleep-wake disturbance is common after TBI; a structured routine, bright light in the morning, daytime activity and limiting naps help reset circadian rhythm, and nonpharmacologic measures come first. Benzodiazepines can impair cognition and recovery after brain injury, unlimited daytime sleep reinforces the reversed cycle, and nighttime care further disrupts sleep.
Question 10 · Legislative, Economic, Ethical, and Legal Issues
A therapist at a skilled nursing facility suggests adding more daily therapy minutes for a 78-year-old Medicare Part A resident with a stroke so that the facility will be paid more. The nurse case manager knows that under the Patient-Driven Payment Model, payment is driven MOSTLY by which factor?
- A.The resident's clinical characteristics across five case-mix components
- B.The length of the resident's preceding acute hospital stay and the discharge diagnosis
- C.The total number of therapy minutes the resident receives during the 7-day look-back period
- D.The number of therapy disciplines treating the resident during each calendar week
Show answer and explanation
Answer: A. The resident's clinical characteristics across five case-mix components
The SNF Patient-Driven Payment Model classifies residents by clinical characteristics into five case-mix-adjusted components: physical therapy, occupational therapy, speech-language pathology, nursing, and non-therapy ancillary services. It replaced the older system in which therapy minutes drove payment, so adding minutes does not raise payment. Discipline count and prior hospital stay length are not classification drivers.

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