Section IV is small on the exam but wide in scope: choosing the right level of rehab, managing the problems that slow recovery, and preparing the patient and family for life after discharge.
ABNN's outline for post-acute care (handbook, p. 20), in practice:
Team plan of care: physical, occupational and speech therapy, neuropsychology, social work, the primary care handoff
Goals of rehabilitation: function and participation, measured with standard scales
Levels of care: inpatient rehabilitation facility, skilled nursing facility, home health, outpatient and early supported discharge
Rehab problems: spasticity, shoulder pain, falls, bladder and bowel, fatigue, mood, cognition and communication
Education and medications: warning signs, adherence, caregiver training
Community resources: support groups, transport, return to driving and work
12 post-acute care questions
0 of 12 attempted · 0 correct · 0 missed
Post-acute Care · 19 items
A stroke survivor's arm and leg spasticity has suddenly worsened over 2 days without new neurological deficits. The nurse should FIRST assess for
Answer and why, all 4 options
A sudden rise in spasticity with no new deficit is often driven by a painful stimulus such as infection, constipation, a pressure injury or an ingrown nail; treating it usually brings tone back down.
Stretching is the basis of spasticity care; pausing it would raise tone and contracture risk.
Raising the dose before looking for a cause treats the symptom, adds sedation and weakness, and misses the trigger.
A new stroke presents with new focal deficits; tone change alone, over 2 days, does not fit and is outside any lytic window.
Item 419550
Post-acute Care · 19 items
Which intervention can reduce early inferior subluxation of the flaccid hemiplegic shoulder?
Answer and why, all 4 options
Range above 90 degrees without proper scapular rotation can impinge and injure the shoulder; motion is kept within a protected range.
An unsupported flaccid arm is pulled down by gravity, which stretches the capsule and worsens subluxation; it is supported with a sling or tray.
Electrical stimulation of the supraspinatus and deltoid in the flaccid phase can help hold the humeral head in place and reduce early subluxation.
Overhead pulleys force uncontrolled elevation of a weak shoulder and are linked to hemiplegic shoulder pain; they are avoided.
Item 419640
Post-acute Care · 19 items
A patient receiving constraint-induced movement therapy needs an objective, timed measure of task performance with the paretic arm. Which tool is MOST appropriate?
Answer and why, all 4 options
The Berg scale measures standing and sitting balance and fall risk, not arm function.
The Ashworth scale grades tone during passive movement; it does not measure what the arm can do.
The TUG measures mobility and fall risk during rising, walking and turning; it does not test the arm.
The Wolf Motor Function Test times and rates upper-limb tasks and was developed to measure change during constraint-induced movement therapy.
Item 419817
Post-acute Care · 19 items
A patient who now walks independently at home wants to resume grocery shopping and using public transportation. Which training approach is BEST?
Answer and why, all 4 options
Virtual training can add practice but does not replace real outings when the goal is community participation.
Community walking needs curbs, crowds, distance and dual tasks that a hallway cannot copy; graded practice in real places builds the skill and the confidence.
Written advice alone does not build the motor and attention skills that community mobility requires.
A quiet, level hallway does not train the demands of stores and buses, so the skill may not carry over.
Item 419833
Post-acute Care · 19 items
A stroke survivor has sudden episodes of crying that do not match their mood and stop within a minute. The SCRN recognizes this as
Answer and why, all 4 options
Sudden, brief crying or laughing that does not match the person's feelings is pseudobulbar affect, caused by damage to pathways that control emotional expression.
Depression is a lasting low mood with loss of interest; crying in depression matches the mood rather than coming and going in a minute.
Panic attacks bring fear, palpitations and breathlessness; isolated crying spells without anxiety do not fit.
Temporal seizures can cause emotional auras, but they come with altered awareness or automatisms, not repeated crying with intact awareness.
Item 1876565
Post-acute Care · 19 items
A stroke survivor with right hemiparesis and a right homonymous hemianopia is going home. Which home change BEST reduces the risk of falls?
Answer and why, all 4 options
A bed at the right height eases transfers, but the bigger risk in this home is tripping on unseen obstacles while walking.
Removing trip hazards and adding grab bars directly reduce falls for a person with one-sided weakness and a right visual field cut that hides obstacles.
Lever handles help a weak hand open doors, which supports independence but not fall prevention.
An alert device shortens the time lying on the floor after a fall; it does not prevent the fall.
Item 1876637
Post-acute Care · 19 items
The spouse of a patient with chronic nonfluent aphasia asks how to help communication at home. The nurse's BEST recommendation is to
Answer and why, all 4 options
Avoiding conversation isolates the patient and removes everyday practice, which is a key part of recovery.
Finishing sentences takes away practice and can put the wrong words in the person's mouth; partners are taught to wait and support.
Aphasia is not a hearing problem; raising the voice does not help, although short, simple sentences do.
Training the partner in strategies such as yes/no questions, gestures, writing key words and giving time improves conversation for people with chronic aphasia.
Item 1876728
Post-acute Care · 19 items
A stroke survivor lives 2 hours from the outpatient rehab center and has no reliable transport. To continue therapy after discharge, the SCRN suggests
Answer and why, all 4 options
Unsupervised printed exercises lack progression and feedback, so adherence and gains are lower than with guided therapy.
Ending therapy because of distance gives up continued recovery; other delivery options exist.
Telerehabilitation delivers supervised therapy by video and gives results comparable to in-person therapy for many goals, removing the transport barrier.
A facility stay for a transport problem is a higher level of care than needed and takes the patient out of the home.
Item 1876778
Post-acute Care · 19 items
A patient 1 year after a stroke has severe generalized lower-limb spasticity that limits self-care despite maximally tolerated oral baclofen and repeated focal botulinum toxin injections. The MOST appropriate next step is
Answer and why, all 4 options
Spasticity that limits self-care despite maximal therapy calls for escalation, not acceptance.
Tizanidine is started low and titrated because of sedation, hypotension and liver toxicity, and adding a second oral drug rarely controls severe generalized spasticity.
Phenol nerve blocks treat focal spasticity in a few muscle groups; they are not suited to widespread spasticity and can cause dysesthesia.
Severe, generalized spasticity that resists oral drugs and focal injections is the indication for an intrathecal baclofen test dose before a pump is placed.
Item 1981169
Post-acute Care · 19 items
A patient with left neglect after a right hemisphere stroke is now in inpatient rehab. To promote recovery of attention, the SCRN should
Answer and why, all 4 options
Visual scanning training, with cues to turn the head and eyes toward the neglected side, is the core rehab approach for neglect.
Ignoring the neglected side lets the deficit become fixed; recovery depends on repeated attention to it.
Placing everything on the intact side is an older safety habit; in rehab it reinforces inattention to the left instead of retraining it.
Working from the intact side may ease care in the first days, but in rehab it removes the cues that draw attention leftward.
Item 1876725
Post-acute Care · 19 items
A patient 3 months after a stroke walks with a cane but catches the right toes during swing phase. Lower-leg tone is only mildly increased. Which intervention BEST improves gait safety?
Answer and why, all 4 options
Baclofen treats spasticity, which is only mild here; the problem is weakness, and high doses add sedation and more weakness.
A wheelchair gives up walking the patient can already do and speeds deconditioning; the fix is to make walking safe.
Catching the toes in swing is foot drop from weak dorsiflexion; an ankle-foot orthosis holds the foot up through swing, improves walking and lowers fall risk (peroneal functional electrical stimulation is the alternative).
Locking the knee straight makes the leg functionally longer, so the foot clears the floor even less and the gait becomes a hip hike.
Item 1981163
Post-acute Care · 19 items
Six weeks after a stroke, a patient at home reports overwhelming afternoon fatigue that stops them finishing the home exercise program. The nurse's BEST advice is to
Answer and why, all 4 options
Pausing exercise loses rehabilitation gains; graded activity is part of fatigue management.
Post-stroke fatigue is common and is managed with energy conservation: schedule harder tasks when energy is higher and break activity up with planned rest.
No drug, including fluoxetine, has shown benefit for post-stroke fatigue; depression is screened for separately.
Bed rest deconditions the patient and tends to make fatigue worse; post-stroke fatigue can persist for months.
Item 1981226
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Choosing the rehab setting
Medicare draws these lines:
Inpatient rehabilitation facility: for a patient who can take part in intensive therapy, generally 3 hours a day at least 5 days a week, with face-to-face visits by a rehabilitation physician at least 3 days a week (Medicare Benefit Policy Manual, ch. 1, §110). The AHA/ASA rehabilitation guidelines prefer it to a nursing facility for patients who qualify.
Skilled nursing facility: lower-intensity therapy for patients who cannot yet tolerate that load.
Home health and outpatient therapy: for patients safe at home, including early supported discharge after a mild or moderate stroke.
Functional scoring in IRFs moved from the FIM to Section GG items of the patient assessment instrument in October 2019; older review material may still teach the FIM as the federal standard.
Rehab answers that changed
Fluoxetine does not speed motor recovery in patients without depression; large trials after the FLAME study found no benefit and more fractures, and the 2026 acute ischemic stroke guideline classes it as no benefit for that purpose. Depression itself is screened for and treated.
Overhead pulleys for the hemiplegic shoulder are discouraged because they provoke pain and injury (AHA/ASA rehab guideline, 2026).
Very early, high-dose mobilization in the first 24 hours worsened outcomes in the AVERT trial; rehab starts once the patient is medically stable.
Botulinum toxin is the treatment for spasticity limited to a few muscle groups.
Caregivers are part of the plan, not an afterthought: training before discharge is a recommendation, not a courtesy.
Before and after this section
Early rehab referral and the first mobilization start in acute care; the medicines a survivor takes for years, and how to teach them, are stroke prevention.
Know what each common scale measures: global disability, daily activities, muscle tone, arm function. Items more often ask what a score means than how to compute it.
Is a rehab nurse at a disadvantage on this exam?
No, but the balance is uneven: post-acute care is 19 items, while hyperacute and acute care together hold more than half. A rehab nurse should spend most study time on those two.