Stroke Certified Registered Nurse (SCRN) Exam — Questions and Answers

Question 1: Which pathophysiological process converts an ischemic infarct into a hemorrhagic transformation?

Reperfusion injury causing breakdown of damaged endothelium and BBB (Correct answer)
Hypertensive crisis causing de novo vessel rupture
Activation of the coagulation cascade within the infarct core
Vasogenic edema leading to vessel rupture

Correct answer: Reperfusion injury causing breakdown of damaged endothelium and BBB

Reperfusion of ischemia-damaged vessels causes blood to leak through the disrupted blood-brain barrier, resulting in hemorrhagic transformation, most commonly petechial (HI1/HI2) or parenchymal hematoma (PH1/PH2).

Question 2: Which finding in a stroke patient most urgently indicates elevated intracranial pressure (ICP)?

Temperature of 37.8°C
Complaint of headache rated 4/10
SpO2 of 94% on room air
Cushing's triad: bradycardia, hypertension, and irregular respirations (Correct answer)

Correct answer: Cushing's triad: bradycardia, hypertension, and irregular respirations

Cushing's triad is a late, ominous sign of severely elevated ICP and impending brainstem herniation requiring immediate intervention.

Question 3: What is the primary source of embolism in cardioembolic stroke associated with atrial fibrillation?

Mitral valve vegetation
Left atrial appendage thrombus (Correct answer)
Pulmonary vein thrombus
Left ventricular mural thrombus

Correct answer: Left atrial appendage thrombus

In atrial fibrillation, blood stasis in the left atrial appendage (LAA) promotes thrombus formation; embolization of LAA clots causes the majority of AF-related cardioembolic strokes.

Question 4: When documenting assessment findings in SCRN practice, which approach is MOST appropriate?

Summarize findings verbally without written documentation
Record objective findings, measurements, and professional observations factually (Correct answer)
Include only positive findings to maintain optimism
Use technical jargon that only experts can understand

Correct answer: Record objective findings, measurements, and professional observations factually

Assessment documentation must be objective, factual, and comprehensive. Recording measurements, observations, and findings without bias ensures that the documentation is useful for decision-making and withstands scrutiny.

Question 5: A stroke patient on warfarin has an INR of 3.2 and presents with acute ischemic stroke. Which reversal agent is recommended?

4-factor prothrombin complex concentrate (PCC) (Correct answer)
Vitamin K only
Fresh frozen plasma alone
Protamine sulfate

Correct answer: 4-factor prothrombin complex concentrate (PCC)

4-factor PCC rapidly reverses warfarin anticoagulation and is preferred over FFP alone due to faster onset and lower volume requirements.

Question 6: When performing dysphagia screening in an acute stroke patient, what is the safest initial step?

Offer soft foods to assess swallowing
Administer a 3-oz water swallow test immediately
Perform a modified barium swallow study within the first hour
Keep the patient NPO and use a validated bedside screening tool before any oral intake (Correct answer)

Correct answer: Keep the patient NPO and use a validated bedside screening tool before any oral intake

The patient should remain NPO until a validated bedside dysphagia screen is passed; aspiration pneumonia is a leading preventable complication of acute stroke.

Question 7: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting regular safety drills and exercises?

To satisfy insurance requirements only
To reduce daily workload
To evaluate employee performance reviews
To ensure personnel can respond effectively in emergencies (Correct answer)

Correct answer: To ensure personnel can respond effectively in emergencies

Regular safety drills ensure that all personnel are prepared to respond effectively during actual emergencies. Practice builds muscle memory, identifies gaps in emergency procedures, and improves overall response times.

Question 8: Which personal protective equipment (PPE) principle applies to ALL SCRN certified professionals regardless of their specific role?

PPE is optional if experienced in the field
PPE must be properly fitted, maintained, and replaced as needed (Correct answer)
Any PPE will provide adequate protection
PPE is only necessary during formal inspections

Correct answer: PPE must be properly fitted, maintained, and replaced as needed

Regardless of experience level or specific role, PPE must be properly fitted to the individual, regularly maintained in good condition, and replaced when worn or damaged. Improperly fitted or degraded PPE can provide a false sense of security.

Question 9: Which part of the brain is most commonly affected by a stroke?

The brainstem (Correct answer)
The liver
The lungs
The heart

Correct answer: The brainstem

The brainstem is a crucial part of the brain that connects the cerebrum with the spinal cord and controls many vital functions, including breathing, heart rate, and consciousness. A stroke affecting the brainstem can have severe and life-threatening consequences due to its role in these essential bodily processes. While other areas are also affected, the brainstem's role is critical.

Question 10: How should Stroke Certified Registered Nurse professionals handle technical procedures that have been updated or revised?

Wait for mandatory enforcement before changing
Only apply updates to new cases or projects
Continue using the original method if it still works
Review the updates, complete any required training, and implement the revised procedures (Correct answer)

Correct answer: Review the updates, complete any required training, and implement the revised procedures

When procedures are updated, professionals must review the changes, complete any required training to understand the rationale and new requirements, and implement the revised procedures in their practice. Continuing outdated methods risks non-compliance and suboptimal outcomes.

Question 11: Which FIM (Functional Independence Measure) score indicates complete independence requiring no helper?

Score of 7 (Correct answer)
Score of 5
Score of 6
Score of 4

Correct answer: Score of 7

A FIM score of 7 indicates complete independence — the patient performs the activity safely without any helper or assistive device concerns.

Question 12: Which cerebral artery supplies the lateral surface of the frontal and parietal lobes, including the primary motor cortex of the upper extremity?

Anterior cerebral artery
Posterior cerebral artery
Basilar artery
Middle cerebral artery (Correct answer)

Correct answer: Middle cerebral artery

The middle cerebral artery (MCA) supplies the lateral hemispheres including the motor and sensory cortex for the face, arm, and hand.

Question 13: In hemorrhagic stroke, perihematomal edema begins to develop most significantly at what time after the initial bleed?

24–72 hours (Correct answer)
5–7 days
Immediately (within 1 hour)
2–3 weeks

Correct answer: 24–72 hours

Perihematomal edema begins within hours but reaches its peak at 24–72 hours after ICH, driven by coagulation cascade activation, thrombin production, and BBB disruption.

Question 14: Which approach is MOST important for SCRN professionals when applying technical procedures?

Adhering to established protocols while adapting to specific conditions (Correct answer)
Following personal shortcuts developed through experience
Using the fastest method available regardless of standards
Applying the same technique in every situation without variation

Correct answer: Adhering to established protocols while adapting to specific conditions

Technical procedures require adherence to established protocols as a foundation, with professional judgment to adapt appropriately to specific conditions. This balance ensures both consistency and effectiveness.

Question 15: A patient with hemorrhagic stroke has been taking apixaban. Which reversal agent should the nurse anticipate administering?

Protamine sulfate
Idarucizumab
Andexanet alfa (Correct answer)
Fresh frozen plasma

Correct answer: Andexanet alfa

Andexanet alfa reverses factor Xa inhibitors such as apixaban and rivaroxaban by binding and sequestering the drug.

Question 16: Which intervention is CONTRAINDICATED in a patient receiving IV alteplase for acute ischemic stroke?

Continuous cardiac monitoring
Placing an arterial line for blood pressure monitoring
Frequent neurological checks every 15 minutes
Placing a nasogastric tube within the first 24 hours (Correct answer)

Correct answer: Placing a nasogastric tube within the first 24 hours

Invasive procedures such as nasogastric tube placement should be avoided for 24 hours after alteplase to minimize bleeding risk.

Question 17: Nimodipine is routinely administered after subarachnoid hemorrhage. Its primary mechanism of benefit is:

Prevention of hydrocephalus
Reduction of vasospasm-related cerebral ischemia by blocking calcium channels (Correct answer)
Systemic blood pressure reduction to prevent rebleeding
Antiepileptic prophylaxis

Correct answer: Reduction of vasospasm-related cerebral ischemia by blocking calcium channels

Nimodipine is a calcium channel blocker that reduces the severity of neurological deficits from vasospasm-induced ischemia following SAH.

Question 18: Which medication is used to rapidly lower blood pressure in a hypertensive emergency associated with acute ischemic stroke when tPA is indicated?

Labetalol or nicardipine (Correct answer)
Oral amlodipine
Hydralazine alone
Nitroprusside

Correct answer: Labetalol or nicardipine

Labetalol (IV bolus) and nicardipine (IV infusion) are preferred agents for acute BP management pre-tPA due to their controllable, titratable effects.

Question 19: A patient post-stroke develops a fever of 38.5°C on day 2. Why is aggressive fever management critical in acute stroke care?

Fever indicates successful reperfusion
High temperature improves collateral blood flow
Hyperthermia expands the ischemic penumbra and worsens neurological outcomes (Correct answer)
Fever increases the risk of hemorrhagic transformation only

Correct answer: Hyperthermia expands the ischemic penumbra and worsens neurological outcomes

Hyperthermia increases metabolic demand in vulnerable penumbral tissue, enlarging infarct size and worsening outcomes.

Question 20: When assessment results for a Stroke Certified Registered Nurse evaluation are inconclusive, the BEST practice is to:

Delay reporting until results are favorable
Report the results as definitive anyway
Conduct additional assessment using alternative methods (Correct answer)
Discard the results and start over completely

Correct answer: Conduct additional assessment using alternative methods

Inconclusive results require additional assessment using alternative methods to gather more data. This triangulation approach helps clarify findings without compromising the integrity of the assessment process.

Question 21: In hyperacute stroke care, what does a NIHSS score of 0 indicate?

Hemorrhagic conversion
Maximum stroke severity
Patient is comatose
No stroke deficits detected (Correct answer)

Correct answer: No stroke deficits detected

An NIHSS score of 0 indicates no neurological deficits on the scale's 42-point range from 0 (normal) to 42 (most severe).

Question 22: When a SCRN professional identifies a potential regulatory violation, the CORRECT first step is to:

Discuss it casually with coworkers
Wait to see if it resolves on its own
Address it only if directly affected
Document the violation and report it through proper channels (Correct answer)

Correct answer: Document the violation and report it through proper channels

Proper documentation and reporting through established channels is the correct first step when identifying a potential violation. This ensures accountability, creates a paper trail, and allows appropriate parties to investigate and resolve the issue.

Question 23: A patient with a posterior cerebral artery stroke is most likely to present with which primary deficit?

Ipsilateral facial palsy with contralateral hemiplegia
Global aphasia
Contralateral homonymous hemianopia (Correct answer)
Contralateral arm and face weakness

Correct answer: Contralateral homonymous hemianopia

The PCA supplies the occipital lobe (primary visual cortex); PCA stroke classically causes contralateral homonymous hemianopia, often with macular sparing.

Question 24: When conducting a risk assessment for SCRN operations, which factor should receive the HIGHEST priority?

Convenience for daily operations
Cost of implementing safety measures
Probability and severity of potential harm (Correct answer)
Time required for safety training

Correct answer: Probability and severity of potential harm

The probability and severity of potential harm are the primary factors in risk assessment. While cost and convenience are considerations, they should never override the assessment of how likely an incident is and how severe its consequences could be.

Question 25: How frequently should ongoing assessments be conducted in Stroke Certified Registered Nurse practice?

At regular intervals based on established protocols and as conditions change (Correct answer)
Only when problems are reported
Once annually regardless of circumstances
Only when required by external auditors

Correct answer: At regular intervals based on established protocols and as conditions change

Ongoing assessments should follow established protocols for regular intervals and also be conducted when conditions change. This balanced approach ensures continuous monitoring while remaining responsive to new developments.

Question 26: Which sign on non-contrast CT is associated with a proximal MCA occlusion in hyperacute ischemic stroke?

Hyperdense MCA sign (Correct answer)
Diffuse sulcal effacement
Hypodense basal ganglia
Butterfly hemorrhage pattern

Correct answer: Hyperdense MCA sign

The hyperdense MCA sign represents acute thrombus within the middle cerebral artery and indicates proximal occlusion requiring emergent intervention.

Question 27: In SCRN practice, what happens when regulations are updated or changed?

Previous certifications are automatically revoked
Professionals must update their knowledge and practices to meet new requirements (Correct answer)
Existing professionals are permanently grandfathered in
Changes apply only to new professionals entering the field

Correct answer: Professionals must update their knowledge and practices to meet new requirements

When regulations change, all professionals must update their knowledge and practices to comply with new requirements. While transition periods may exist, compliance with current regulations is mandatory for all practitioners regardless of when they were certified.

Question 28: Which post-stroke complication is most commonly associated with shoulder pain in the hemiplegic upper extremity?

Glenohumeral subluxation (Correct answer)
Bicipital tendonitis
Acromioclavicular joint arthritis
Rotator cuff tear from overuse

Correct answer: Glenohumeral subluxation

Glenohumeral subluxation, caused by loss of muscle tone supporting the shoulder joint, is the most common cause of hemiplegic shoulder pain.

Question 29: Which cerebrovascular condition is characterized by thickening of small artery walls due to hyaline material replacing smooth muscle, predisposing to both ischemic lacunar strokes and intracerebral hemorrhage?

Cerebral amyloid angiopathy
Moyamoya disease
Fibromuscular dysplasia
Lipohyalinosis (Correct answer)

Correct answer: Lipohyalinosis

Lipohyalinosis is chronic hypertension-induced degeneration of small penetrating arteries (< 400 µm), replacing smooth muscle with lipid-laden macrophages and hyaline, causing both lacunar infarcts and ICH.

Question 30: In Stroke Certified Registered Nurse practice, what is the CORRECT sequence when performing a technical procedure?

Document, execute, then plan
Plan, prepare, execute, verify, and document (Correct answer)
Execute immediately and document only if issues arise
Execute, then plan and review

Correct answer: Plan, prepare, execute, verify, and document

The correct sequence follows a systematic approach: plan the procedure, prepare necessary resources, execute according to standards, verify results meet specifications, and document the process and outcomes. This ensures quality and accountability.

Question 31: A post-stroke patient in a skilled nursing facility refuses morning care and says 'there's no point.' The nurse's best first response is:

Document the refusal and respect the patient's autonomy
Sit with the patient, use open-ended questions, and explore the statement (Correct answer)
Notify the physician and request a psychiatric consult immediately
Remind the patient of their therapy schedule to refocus attention

Correct answer: Sit with the patient, use open-ended questions, and explore the statement

A therapeutic communication approach — sitting with the patient and exploring hopeless statements — assesses for suicidality and depression before escalating.

Question 32: Which temperature management strategy is recommended in the hyperacute phase of ischemic stroke?

Allow mild hyperthermia up to 38.5°C to improve cerebral metabolism
Temperature has no impact on acute stroke outcomes
Treat fever aggressively with antipyretics to maintain normothermia (≤37.5°C) (Correct answer)
Induce mild hypothermia to 35°C with cooling blankets

Correct answer: Treat fever aggressively with antipyretics to maintain normothermia (≤37.5°C)

Hyperthermia worsens ischemic brain injury, so fever should be treated aggressively with antipyretics to maintain a temperature ≤37.5°C.

Question 33: What documentation is MOST critical to maintain for safety compliance in the Stroke Certified Registered Nurse field?

Employee vacation schedules
Annual revenue reports
Incident reports, training records, and inspection logs (Correct answer)
Client marketing preferences

Correct answer: Incident reports, training records, and inspection logs

Incident reports, training records, and inspection logs are essential safety documentation. They demonstrate compliance with safety regulations, track training completion, and provide evidence of systematic hazard management.

Question 34: What is the goal of hyperacute care for hemorrhagic stroke?

To perform diagnostic imaging only
To begin rehabilitation immediately
To immediately remove the clot
To stabilize the patient and control bleeding (Correct answer)

Correct answer: To stabilize the patient and control bleeding

Hemorrhagic stroke involves bleeding into the brain, rather than a clot. Therefore, the immediate goal in hyperacute care is to stabilize the patient's condition and control or stop the bleeding. This often involves managing blood pressure, reversing anticoagulation if applicable, and sometimes surgical intervention to relieve pressure or stop the hemorrhage.

Question 35: A stroke patient in inpatient rehabilitation is experiencing learned non-use of the affected arm. Which intervention best addresses this?

Constraint-induced movement therapy (CIMT) (Correct answer)
Passive range-of-motion exercises only
Sling immobilization of the unaffected arm
Botulinum toxin injection to the affected arm

Correct answer: Constraint-induced movement therapy (CIMT)

CIMT restrains the unaffected limb to force use of the affected arm, directly counteracting learned non-use.

Question 36: What is the importance of early rehabilitation after acute stroke care?

To reduce pain from the stroke
To prevent further neurological damage
To start the process of recovery as soon as possible (Correct answer)
To assist in the healing of brain tissue

Correct answer: To start the process of recovery as soon as possible

Early rehabilitation, often starting within 24-48 hours after stroke onset and medical stabilization, is crucial for optimizing recovery. It helps to prevent secondary complications like muscle atrophy or contractures, promotes neuroplasticity, and allows patients to begin relearning lost functions. Initiating therapy early capitalizes on the brain's heightened capacity for recovery in the acute phase.

Question 37: What is the role of neuroimaging in acute care?

To locate the stroke and determine treatment (Correct answer)
To assess long-term recovery
To monitor patient vitals
To evaluate the brain's electrical activity

Correct answer: To locate the stroke and determine treatment

Neuroimaging, primarily CT scans and sometimes MRI, is indispensable in acute stroke care for rapidly diagnosing the type of stroke (ischemic vs. hemorrhagic) and pinpointing its location and extent. This information is critical for guiding immediate treatment decisions, such as whether to administer thrombolytics or consider surgical intervention. Accurate imaging ensures appropriate and timely care.

Question 38: What is one of the immediate goals in hyperacute care for stroke patients?

To stabilize the patient and restore blood flow (Correct answer)
To start physical therapy
To schedule a follow-up consultation
To perform invasive surgery

Correct answer: To stabilize the patient and restore blood flow

The immediate goals in hyperacute stroke care are paramount for patient survival and minimizing disability. Stabilizing the patient involves managing vital signs and preventing secondary brain injury. For ischemic stroke, restoring blood flow to the brain via thrombolytics or thrombectomy is critical to salvage brain tissue within the narrow therapeutic window.

Question 39: Which neurological scale is used at the bedside to quantify stroke severity and guide acute treatment decisions?

NIH Stroke Scale (NIHSS) (Correct answer)
Modified Rankin Scale (mRS)
Hunt and Hess Scale
Glasgow Coma Scale (GCS)

Correct answer: NIH Stroke Scale (NIHSS)

The NIHSS provides a standardized, reproducible measure of acute stroke deficits and is used to determine tPA eligibility and monitor response to treatment.

Question 40: During hyperacute stroke, a patient's oxygen saturation drops to 93%. What is the nurse's priority intervention?

Apply supplemental oxygen to maintain SpO2 ≥94% (Correct answer)
Administer IV dexamethasone
Elevate head of bed to 90 degrees
Prepare for immediate intubation

Correct answer: Apply supplemental oxygen to maintain SpO2 ≥94%

Supplemental oxygen should be provided to maintain SpO2 ≥94%, as hypoxia worsens ischemic brain injury.

Question 41: What is the PRIMARY reason for regulatory compliance in the Stroke Certified Registered Nurse profession?

To protect public safety, ensure quality standards, and maintain professional integrity (Correct answer)
To avoid penalties and fines only
To create additional paperwork for documentation
To justify higher service fees

Correct answer: To protect public safety, ensure quality standards, and maintain professional integrity

Regulatory compliance serves the broader purpose of protecting public safety, ensuring consistent quality standards, and maintaining the integrity of the profession. While avoiding penalties is a benefit, the primary motivation is safeguarding the public interest.

Question 42: How should Stroke Certified Registered Nurse professionals handle technical procedures that have been updated or revised?

Wait for mandatory enforcement before changing
Review the updates, complete any required training, and implement the revised procedures (Correct answer)
Continue using the original method if it still works
Only apply updates to new cases or projects

Correct answer: Review the updates, complete any required training, and implement the revised procedures

Question 43: Cerebral autoregulation maintains constant cerebral blood flow across which range of mean arterial pressure (MAP)?

70–120 mmHg
100–200 mmHg
50–150 mmHg (Correct answer)
40–60 mmHg

Correct answer: 50–150 mmHg

Normal cerebral autoregulation maintains constant cerebral blood flow when MAP ranges from approximately 50–150 mmHg; outside this range, CBF becomes pressure-passive.

Question 44: What is the use of sedatives in acute stroke care?

To reduce agitation and promote comfort (Correct answer)
To treat headaches caused by the stroke
To prevent seizures
To stabilize vital signs

Correct answer: To reduce agitation and promote comfort

Sedatives may be used in acute stroke care to manage agitation, anxiety, or delirium, which can be common in critically ill patients. Reducing agitation helps to decrease metabolic demand on the brain, prevent self-harm, and facilitate necessary medical procedures or monitoring. Promoting comfort also contributes to overall patient well-being during a stressful event.

Question 45: When a SCRN professional encounters an unexpected result during a technical procedure, the FIRST action should be to:

Repeat the procedure from the beginning immediately
Continue the procedure and address it later
Stop, assess the situation, and determine whether to proceed or seek guidance (Correct answer)
Report the issue without any preliminary assessment

Correct answer: Stop, assess the situation, and determine whether to proceed or seek guidance

Stopping to assess the situation when unexpected results occur is critical. This allows the professional to evaluate whether it is safe and appropriate to continue, and to determine if additional guidance or resources are needed.

Question 46: Which assessment method provides the MOST reliable data for SCRN professionals making critical decisions?

Informal verbal feedback alone
Standardized tools combined with professional observation (Correct answer)
Single-source data from one stakeholder
Social media reviews and testimonials

Correct answer: Standardized tools combined with professional observation

Combining standardized assessment tools with professional observation provides the most reliable and comprehensive data. Standardized tools ensure consistency and validity, while professional observation captures nuances that tools might miss.

Question 47: What role does monitoring intracranial pressure play in acute stroke care?

To prevent seizures in the patient
To manage brain swelling and prevent further injury (Correct answer)
To track the patient's temperature
To monitor the brain's electrical activity

Correct answer: To manage brain swelling and prevent further injury

Intracranial pressure (ICP) monitoring is vital in acute stroke care, especially in severe cases or hemorrhagic strokes, because brain swelling (edema) is a common and dangerous complication. Elevated ICP can compress brain tissue, reduce cerebral blood flow, and lead to further neurological damage or herniation. Monitoring allows for timely interventions to reduce pressure and protect the brain.

Question 48: A patient declines IV tPA after being informed of risks and benefits. What is the nurse's appropriate response?

Document the refusal, ensure the patient has decision-making capacity, and explore alternative therapies (Correct answer)
Discharge the patient immediately
Administer tPA while the patient is distracted
Override the refusal and administer tPA as ordered

Correct answer: Document the refusal, ensure the patient has decision-making capacity, and explore alternative therapies

A patient with decision-making capacity has the right to refuse treatment; the nurse must document the refusal, assess capacity, and explore alternatives such as thrombectomy.

Question 49: In Stroke Certified Registered Nurse practice, what is the FIRST step when a safety hazard is identified in the workplace?

Continue working and report at end of shift
Document it for the next safety audit
Immediately secure the area and report the hazard (Correct answer)
Wait for a supervisor to notice the issue

Correct answer: Immediately secure the area and report the hazard

When a safety hazard is identified, the immediate priority is to secure the area to prevent injury and report the hazard through proper channels. Delaying action increases the risk of incidents.

Question 50: A home health nurse assesses a stroke survivor 4 weeks post-discharge and finds the patient sitting alone, not participating in hobbies, and expressing hopelessness. Which intervention is the priority?

Refer to outpatient speech therapy
Increase home health visit frequency
Encourage the patient to exercise daily
Conduct depression screening and notify the provider (Correct answer)

Correct answer: Conduct depression screening and notify the provider

Symptoms of hopelessness and social withdrawal suggest post-stroke depression, which requires formal screening and timely provider notification for treatment.

Question 51: Which symptom pattern is most consistent with a posterior circulation (vertebrobasilar) stroke?

Expressive aphasia with right hemiplegia
Vertigo, diplopia, and ataxia (Correct answer)
Neglect and left-sided weakness
Unilateral arm weakness and facial droop

Correct answer: Vertigo, diplopia, and ataxia

Posterior circulation strokes commonly present with vertigo, diplopia, dysphagia, and cerebellar ataxia due to brainstem and cerebellar involvement.

Question 52: What is the role of occupational therapy in post-acute care?

To reduce physical pain
To improve memory and cognitive function
To focus on emotional recovery
To help regain independence in daily activities (Correct answer)

Correct answer: To help regain independence in daily activities

Occupational therapy (OT) in post-acute care focuses on helping stroke survivors regain the skills needed for daily living activities (ADLs) and instrumental ADLs (IADLs). This includes tasks like dressing, bathing, eating, cooking, and managing finances. OTs adapt environments and teach compensatory strategies to maximize independence and participation in meaningful activities, improving overall quality of life.

Question 53: Which assessment method provides the MOST reliable data for SCRN professionals making critical decisions?

Social media reviews and testimonials
Single-source data from one stakeholder
Informal verbal feedback alone
Standardized tools combined with professional observation (Correct answer)

Correct answer: Standardized tools combined with professional observation

Question 54: When educating a family about stroke recurrence risk, the nurse correctly states that the highest risk period for a second stroke after a TIA or minor stroke is:

Risk remains constant over 5 years
At the 1-year mark
Within the first 90 days (Correct answer)
Between 6 and 12 months

Correct answer: Within the first 90 days

The risk of stroke after TIA or minor stroke is highest in the first 90 days, with the greatest risk in the first 48 hours.

Question 55: During the first 24 hours after IV alteplase, a patient's blood pressure must be maintained below which threshold?

185/110 mmHg
220/120 mmHg
180/105 mmHg (Correct answer)
160/90 mmHg

Correct answer: 180/105 mmHg

After alteplase administration, blood pressure must be kept below 180/105 mmHg for at least 24 hours to minimize the risk of hemorrhagic transformation.

Question 56: Post-stroke depression affects approximately what percentage of stroke survivors?

5–10%
55–65%
30–40% (Correct answer)
15–20%

Correct answer: 30–40%

Post-stroke depression occurs in approximately 30–40% of stroke survivors and significantly impairs rehabilitation outcomes.

Question 57: A stroke patient has loss of pain and temperature sensation on the right side of the face and left side of the body. This crossed sensory pattern localizes the lesion to the:

Right lateral medulla (Correct answer)
Left internal capsule
Right thalamus
Left pons

Correct answer: Right lateral medulla

In the lateral medulla, the ipsilateral trigeminal nucleus (face sensation) and the contralateral spinothalamic tract (body sensation) are adjacent; lateral medullary infarct produces crossed hemianesthesia.

Question 58: Which nursing intervention best prevents post-stroke shoulder-hand syndrome (complex regional pain syndrome type 1)?

Applying ice to the hand twice daily
Restricting arm movement until spasticity resolves
Gentle ROM, proper positioning, and avoiding trauma to the hand (Correct answer)
Applying a sling to keep the arm immobilized

Correct answer: Gentle ROM, proper positioning, and avoiding trauma to the hand

Preventing joint trauma, maintaining joint mobility with gentle ROM, and proper positioning prevent the cascade that leads to shoulder-hand syndrome.

Question 59: A patient with acute ischemic stroke has a serum sodium of 126 mEq/L on day 3. The most likely cause in the stroke population is:

Medication-induced diuresis
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Correct answer)
Hyperaldosteronism
Diabetes insipidus

Correct answer: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

SIADH is the most common cause of hyponatremia following stroke due to inappropriate ADH release from hypothalamic disruption.

Question 60: When a SCRN professional encounters an unexpected result during a technical procedure, the FIRST action should be to:

Continue the procedure and address it later
Report the issue without any preliminary assessment
Repeat the procedure from the beginning immediately
Stop, assess the situation, and determine whether to proceed or seek guidance (Correct answer)

Correct answer: Stop, assess the situation, and determine whether to proceed or seek guidance

Question 61: What is a stroke?

A blood clot that forms in the heart
A heart attack
A sudden increase in blood pressure
A disruption of blood supply to the brain (Correct answer)

Correct answer: A disruption of blood supply to the brain

A stroke, also known as a cerebrovascular accident (CVA), occurs when the blood flow to a part of the brain is interrupted or severely reduced. This deprives brain tissue of oxygen and nutrients, causing brain cells to die within minutes. This disruption can be due to a blocked artery (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke).

Question 62: What imaging technique is typically used in hyperacute care for stroke diagnosis?

X-ray
MRI
CT scan (Correct answer)
Ultrasound

Correct answer: CT scan

A CT scan is the imaging technique of choice in hyperacute stroke care due to its rapid availability and ability to quickly differentiate between ischemic and hemorrhagic stroke. This distinction is critical because treatment strategies differ significantly (e.g., tPA for ischemic vs. blood pressure control for hemorrhagic). While MRI provides more detailed images, it takes longer and is not typically the first-line diagnostic tool in the immediate hyperacute phase.

Question 63: Which medication is the preferred first-line agent to rapidly lower blood pressure prior to tPA eligibility in acute ischemic stroke?

Metoprolol PO
Labetalol IV or nicardipine IV (Correct answer)
Hydralazine PO
Nitroprusside infusion

Correct answer: Labetalol IV or nicardipine IV

Labetalol IV boluses or nicardipine infusion are first-line agents for rapid, controlled BP reduction before tPA in acute ischemic stroke.

Question 64: A stroke patient is found to have atrial fibrillation. Which anticoagulant is NOT appropriate for acute use in the hyperacute phase?

IV tPA if eligible
Heparin infusion as acute bridging therapy (Correct answer)
CT imaging to rule out hemorrhage
Aspirin for antiplatelet effect

Correct answer: Heparin infusion as acute bridging therapy

Full anticoagulation with heparin is generally avoided in the hyperacute phase due to increased risk of hemorrhagic transformation.

Question 65: After IV tPA administration, how frequently should neurological assessments and blood pressure be monitored in the first 2 hours?

Every 15 minutes (Correct answer)
Every 5 minutes
Every hour
Every 30 minutes

Correct answer: Every 15 minutes

During tPA infusion and for the first 2 hours after, neurological checks and BP should be performed every 15 minutes to detect hemorrhagic complications early.

Question 66: A patient is eligible for mechanical thrombectomy. What is the recommended door-to-puncture time goal at thrombectomy-capable stroke centers?

90 minutes or less (Correct answer)
30 minutes or less
60 minutes or less
120 minutes or less

Correct answer: 90 minutes or less

The AHA/ASA recommends a door-to-puncture time of 90 minutes or less for mechanical thrombectomy at capable centers.

Question 67: A post-stroke patient in a skilled nursing facility develops a DVT in the paretic leg. Which action takes priority?

Initiate anticoagulation therapy per provider order (Correct answer)
Apply pneumatic compression to the affected limb
Apply warm compresses and elevate the limb
Increase ambulation to promote circulation

Correct answer: Initiate anticoagulation therapy per provider order

Confirmed DVT requires prompt anticoagulation to prevent pulmonary embolism; compression and massage are contraindicated on an active thrombus.

Question 68: Which type of cerebral herniation occurs when the uncus of the temporal lobe displaces through the tentorium cerebelli, compressing cranial nerve III?

Tonsillar herniation
Central (transtentorial) herniation
Uncal herniation (Correct answer)
Subfalcine herniation

Correct answer: Uncal herniation

Uncal herniation occurs when the medial temporal lobe (uncus) herniates over the tentorial edge, compressing CN III and causing ipsilateral pupil dilation and contralateral hemiparesis.

Question 69: What is the significance of early intervention in stroke management?

It only treats the symptoms
Early intervention helps restore blood flow and prevent brain damage (Correct answer)
It has no impact on recovery
It may worsen the condition

Correct answer: Early intervention helps restore blood flow and prevent brain damage

Time is critical in stroke management, often summarized as 'time is brain.' Early intervention, particularly within the first few hours of symptom onset, allows for treatments like thrombolytic drugs (tPA) or mechanical thrombectomy to restore blood flow to the affected brain area. This rapid action can significantly limit the extent of brain damage, improve patient outcomes, and reduce long-term disability.

Question 70: When assessment results for a Stroke Certified Registered Nurse evaluation are inconclusive, the BEST practice is to:

Discard the results and start over completely
Conduct additional assessment using alternative methods (Correct answer)
Report the results as definitive anyway
Delay reporting until results are favorable

Correct answer: Conduct additional assessment using alternative methods

Question 71: What is the role of the blood-brain barrier in stroke?

It has no role in stroke management
It allows all substances to pass into the brain
It increases the risk of stroke
It prevents the passage of harmful substances but limits drug access in stroke (Correct answer)

Correct answer: It prevents the passage of harmful substances but limits drug access in stroke

The blood-brain barrier (BBB) is a highly selective semipermeable membrane that protects the brain from circulating toxins and pathogens while allowing essential nutrients to pass. In stroke, while it helps protect against further damage from systemic substances, its integrity can be compromised. It also poses a challenge by limiting the delivery of therapeutic drugs to the affected brain tissue, making treatment more complex.

Question 72: Why is monitoring of vital signs critical in hyperacute care?

To determine when rehabilitation should begin
To prevent patient discomfort
To monitor for complications and stabilize the patient (Correct answer)
To prepare the patient for discharge

Correct answer: To monitor for complications and stabilize the patient

In hyperacute stroke care, frequent monitoring of vital signs is crucial for detecting rapid changes in a patient's condition. It allows healthcare providers to identify potential complications like increased intracranial pressure, blood pressure fluctuations, or respiratory distress early. Prompt detection enables timely interventions to stabilize the patient and prevent further neurological damage.

Question 73: What is the significance of nutrition in post-acute stroke care?

It is not necessary for stroke patients
It has little to no impact on recovery
It supports brain recovery and overall health (Correct answer)
It only addresses weight loss

Correct answer: It supports brain recovery and overall health

Optimal nutrition is crucial in post-acute stroke care because it directly supports the brain's recovery processes and the body's overall healing. Adequate nutrients are essential for neuroplasticity, reducing inflammation, and preventing complications like malnutrition, which can significantly hinder rehabilitation progress. Therefore, a well-managed nutritional plan plays a vital role in improving patient outcomes and accelerating recovery after a stroke.

Question 74: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting regular safety drills and exercises?

To evaluate employee performance reviews
To satisfy insurance requirements only
To ensure personnel can respond effectively in emergencies (Correct answer)
To reduce daily workload

Correct answer: To ensure personnel can respond effectively in emergencies

Question 75: What is the BEST way for a Stroke Certified Registered Nurse professional to stay current with regulatory changes?

Actively monitor regulatory bodies, attend continuing education, and participate in professional associations (Correct answer)
Rely solely on employer notifications
Check regulations only during certification renewal
Depend on colleagues to share updates informally

Correct answer: Actively monitor regulatory bodies, attend continuing education, and participate in professional associations

Staying current requires a multi-faceted approach: monitoring regulatory agencies directly, attending relevant continuing education programs, and participating in professional associations that disseminate regulatory updates.

Question 76: Which clinical finding in an acute stroke patient suggests hemorrhagic transformation of an ischemic infarct?

Sudden neurological deterioration, new severe headache, and rising blood pressure (Correct answer)
Resolution of aphasia
Stable NIHSS score over 48 hours
Gradual improvement in motor strength over 24 hours

Correct answer: Sudden neurological deterioration, new severe headache, and rising blood pressure

Hemorrhagic transformation typically presents with abrupt neurological worsening, severe headache, and hypertension as blood extravasates into the infarct zone.

Question 77: What is ischemic stroke?

A stroke due to reduced blood flow caused by a clot (Correct answer)
A stroke due to a sudden drop in blood pressure
A stroke caused by a ruptured blood vessel
A stroke caused by an infection

Correct answer: A stroke due to reduced blood flow caused by a clot

Ischemic stroke is the most common type of stroke, occurring when a blood clot blocks or narrows an artery that supplies blood to the brain. This blockage prevents oxygen and nutrients from reaching brain cells, leading to their damage or death. The clot can form in the brain's arteries (thrombotic) or travel from elsewhere in the body (embolic).

Question 78: What is the maximum dose of IV alteplase for acute ischemic stroke treatment?

0.9 mg/kg, max 90 mg (Correct answer)
0.6 mg/kg, max 60 mg
0.9 mg/kg, max 100 mg
1.2 mg/kg, max 120 mg

Correct answer: 0.9 mg/kg, max 90 mg

The standard dose of IV alteplase is 0.9 mg/kg with a maximum total dose of 90 mg.

Question 79: Which pathological process is responsible for the 'no-reflow' phenomenon seen after cerebral ischemia-reperfusion?

Re-occlusion of the previously occluded artery by fresh thrombus
Persistent arterial vasospasm in large vessels
Hyperperfusion syndrome causing arteriolar dilation
Microvascular obstruction by activated leukocytes, platelets, and edematous endothelium (Correct answer)

Correct answer: Microvascular obstruction by activated leukocytes, platelets, and edematous endothelium

No-reflow results from microvascular obstruction by adherent leukocytes and platelets, endothelial swelling, and perivascular edema preventing restoration of perfusion despite large vessel recanalization.

Question 80: In a patient with subarachnoid hemorrhage, cerebral vasospasm most commonly occurs at which time interval after the initial bleed?

Immediately (within 6 hours)
24–48 hours
3–4 weeks
4–14 days (Correct answer)

Correct answer: 4–14 days

Cerebral vasospasm after SAH typically peaks between days 4–14, with the highest risk around days 7–10, due to oxyhemoglobin degradation products irritating vessel walls.

Question 81: A stroke patient with homonymous hemianopia is being discharged home. Which safety teaching is most important?

Avoid all driving permanently regardless of recovery
Request a lower bed to minimize fall risk from visual loss
Wear an eye patch over the unaffected eye during activities
Scan toward the blind side when walking and in traffic (Correct answer)

Correct answer: Scan toward the blind side when walking and in traffic

Teaching the patient to consciously scan toward the affected visual field compensates for the deficit and is the highest-priority safety strategy.

Question 82: Which regulatory requirement is UNIVERSAL across all Stroke Certified Registered Nurse practice settings?

Limiting services to local jurisdictions only
Maintaining current certification and meeting continuing education requirements (Correct answer)
Using specific proprietary software systems
Working exclusively during business hours

Correct answer: Maintaining current certification and meeting continuing education requirements

Maintaining current certification and meeting continuing education requirements is a universal regulatory requirement. Regardless of practice setting, professionals must keep their credentials current and demonstrate ongoing competency through continuing education.

Question 83: A stroke patient with dysphagia fails a bedside swallow screen. Which nutritional strategy is most appropriate for the short term?

Total parenteral nutrition (TPN) via central line
Continue NPO status indefinitely
Percutaneous endoscopic gastrostomy (PEG) tube placement within 24 hours
Nasogastric (NG) tube feeding (Correct answer)

Correct answer: Nasogastric (NG) tube feeding

Nasogastric tube feeding is the first-line enteral route for short-term nutritional support in stroke patients who fail dysphagia screening.

Question 84: Which factor MOST significantly affects the quality of technical outcomes in SCRN practice?

The brand of equipment being used
The practitioner's training, preparation, and attention to detail (Correct answer)
The speed at which procedures are completed
The time of day the procedure is performed

Correct answer: The practitioner's training, preparation, and attention to detail

The quality of technical outcomes depends primarily on the practitioner's level of training, thorough preparation, and careful attention to detail. While equipment matters, the professional's competence is the most significant factor.

Question 85: A patient with acute stroke is NPO pending swallow evaluation. Which IV fluid is contraindicated due to risk of cerebral edema?

Hypertonic saline (3% NaCl)
Lactated Ringer's solution
Normal saline (0.9% NaCl)
Hypotonic fluids (e.g., 0.45% NaCl) (Correct answer)

Correct answer: Hypotonic fluids (e.g., 0.45% NaCl)

Hypotonic fluids are contraindicated in stroke because they can worsen cerebral edema by promoting fluid shift into brain tissue.

Question 86: What is the correct dose of IV alteplase (tPA) for acute ischemic stroke in adults?

0.9 mg/kg IV all as a bolus over 2 minutes
0.6 mg/kg IV over 30 minutes
1.0 mg/kg IV (max 100 mg) bolus
0.9 mg/kg IV (max 90 mg), 10% bolus then 90% over 60 minutes (Correct answer)

Correct answer: 0.9 mg/kg IV (max 90 mg), 10% bolus then 90% over 60 minutes

The standard dose is 0.9 mg/kg (max 90 mg) with 10% given as an IV bolus and the remaining 90% infused over 60 minutes.

Question 87: Which medication is contraindicated within 24 hours of IV alteplase administration?

Osmotic diuretics
Antiepileptics
Antihypertensives
Anticoagulants and antiplatelet agents (Correct answer)

Correct answer: Anticoagulants and antiplatelet agents

Anticoagulants and antiplatelet agents are contraindicated for 24 hours after tPA to reduce the risk of hemorrhagic transformation.

Question 88: How frequently should ongoing assessments be conducted in Stroke Certified Registered Nurse practice?

Only when problems are reported
Once annually regardless of circumstances
Only when required by external auditors
At regular intervals based on established protocols and as conditions change (Correct answer)

Correct answer: At regular intervals based on established protocols and as conditions change

Question 89: What role does calibration play in maintaining technical accuracy for Stroke Certified Registered Nurse professionals?

It only matters during formal inspections
It is an optional best practice for advanced professionals
It is only necessary for new equipment
It ensures instruments and methods produce accurate, consistent results over time (Correct answer)

Correct answer: It ensures instruments and methods produce accurate, consistent results over time

Regular calibration ensures that instruments, tools, and methods continue to produce accurate and consistent results over time. Without calibration, measurement drift and equipment wear can lead to unreliable outcomes.

Question 90: Which NIHSS item specifically assesses the patient's level of consciousness responsiveness?

Item 5 – Motor Arm
Item 2 – Best Gaze
Item 1a – Level of Consciousness (Correct answer)
Item 9 – Best Language

Correct answer: Item 1a – Level of Consciousness

NIHSS Item 1a assesses level of consciousness responsiveness, scored 0 (alert) to 3 (responds only with reflex).

Question 91: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting an initial assessment?

To generate documentation for billing purposes
To fulfill administrative paperwork requirements
To demonstrate the assessor's expertise
To establish a baseline and identify needs for appropriate action (Correct answer)

Correct answer: To establish a baseline and identify needs for appropriate action

The initial assessment establishes a baseline of current conditions and identifies specific needs. This foundational information guides all subsequent decisions, planning, and interventions.

Question 92: In a patient with large vessel occlusion (LVO), mechanical thrombectomy is recommended up to how many hours from last known well with favorable imaging?

24 hours (Correct answer)
6 hours
12 hours
48 hours

Correct answer: 24 hours

Based on DAWN and DEFUSE-3 trials, mechanical thrombectomy can be performed up to 24 hours in selected patients with favorable perfusion imaging.

Question 93: A stroke survivor is being discharged to home with dysphagia. Which instruction is most important for the caregiver?

Offer thin liquids to ensure adequate hydration
Position the patient upright at 90° during all meals (Correct answer)
Allow the patient to self-pace without supervision
Avoid pureed foods as they reduce oral motor strength

Correct answer: Position the patient upright at 90° during all meals

An upright 90° position during meals uses gravity to assist safe swallowing and minimizes aspiration risk.

Question 94: A patient with a posterior circulation stroke presents with vertigo, ipsilateral facial numbness, and contralateral limb ataxia. This constellation suggests involvement of which artery?

Middle cerebral artery (MCA)
Basilar artery tip
Anterior cerebral artery (ACA)
Posterior inferior cerebellar artery (PICA) (Correct answer)

Correct answer: Posterior inferior cerebellar artery (PICA)

PICA occlusion causes Wallenberg (lateral medullary) syndrome, characterized by ipsilateral facial and contralateral body sensory loss, vertigo, dysphagia, and ataxia.

Question 95: Which cranial nerve is responsible for the gag reflex and is commonly affected in lateral medullary (Wallenberg) syndrome?

CN XII (hypoglossal)
CN XI (accessory)
CN VII (facial)
CN IX (glossopharyngeal) and CN X (vagus) (Correct answer)

Correct answer: CN IX (glossopharyngeal) and CN X (vagus)

CN IX and CN X nuclei in the lateral medulla mediate the gag reflex; lateral medullary infarcts damage these nuclei, causing dysphagia and absent gag reflex.

Question 96: What is a common treatment in hyperacute care for ischemic stroke?

Use of sedatives
Anticoagulants
Thrombolytic therapy (tPA) (Correct answer)
Surgical removal of the clot

Correct answer: Thrombolytic therapy (tPA)

For ischemic stroke, which is caused by a blood clot blocking blood flow to the brain, thrombolytic therapy (tPA) is a primary treatment in hyperacute care. This medication works by dissolving the clot, thereby restoring crucial blood flow. Administered within a narrow time window, tPA aims to minimize brain damage and improve patient outcomes.

Question 97: A patient receiving IV tPA suddenly develops severe headache and hypertension. What is the nurse's immediate priority action?

Stop the tPA infusion and notify the physician immediately (Correct answer)
Administer analgesics and continue monitoring
Increase the infusion rate to complete the dose faster
Slow the infusion rate and reassess in 15 minutes

Correct answer: Stop the tPA infusion and notify the physician immediately

Sudden severe headache and hypertension during tPA infusion are warning signs of symptomatic intracranial hemorrhage requiring immediate cessation of tPA.

Question 98: In SCRN practice, what happens when regulations are updated or changed?

Changes apply only to new professionals entering the field
Professionals must update their knowledge and practices to meet new requirements (Correct answer)
Previous certifications are automatically revoked
Existing professionals are permanently grandfathered in

Correct answer: Professionals must update their knowledge and practices to meet new requirements

Question 99: A stroke patient is being discharged on apixaban for newly diagnosed atrial fibrillation. The SCRN's education should emphasize which critical point?

Grapefruit juice enhances apixaban's effectiveness
Take apixaban only when symptomatic palpitations occur
Never miss a dose, avoid NSAIDs, and report unusual bleeding immediately (Correct answer)
Apixaban requires routine INR monitoring every week

Correct answer: Never miss a dose, avoid NSAIDs, and report unusual bleeding immediately

Consistent dosing adherence, avoidance of NSAIDs that increase bleeding risk, and prompt reporting of bleeding signs are essential for safe DOAC therapy.

Question 100: A post-stroke patient is prescribed aspirin and clopidogrel for dual antiplatelet therapy after a minor ischemic stroke. How long should dual therapy typically continue according to current guidelines?

90 days
21 days (Correct answer)
Indefinitely
6 months

Correct answer: 21 days

Current AHA/ASA guidelines recommend dual antiplatelet therapy for 21 days after minor ischemic stroke or high-risk TIA, then single antiplatelet therapy.

Question 101: Which risk management approach is MOST effective for SCRN professionals when evaluating potential workplace hazards?

Relying solely on historical accident data
Proactive hazard identification and assessment (Correct answer)
Delegating all safety decisions to management
Reactive analysis after incidents occur

Correct answer: Proactive hazard identification and assessment

Proactive hazard identification and assessment allows professionals to identify and mitigate risks before incidents occur, which is far more effective than reactive approaches that only address problems after they happen.

Question 102: In Stroke Certified Registered Nurse practice, what is the CORRECT sequence when performing a technical procedure?

Document, execute, then plan
Execute, then plan and review
Execute immediately and document only if issues arise
Plan, prepare, execute, verify, and document (Correct answer)

Correct answer: Plan, prepare, execute, verify, and document

Question 103: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting an initial assessment?

To fulfill administrative paperwork requirements
To establish a baseline and identify needs for appropriate action (Correct answer)
To generate documentation for billing purposes
To demonstrate the assessor's expertise

Correct answer: To establish a baseline and identify needs for appropriate action

The initial assessment establishes a baseline of current conditions and identifies specific needs. This foundational information guides all subsequent decisions, planning, and interventions.

Question 104: In a patient with suspected large vessel occlusion, which clinical finding most strongly suggests the need for emergent CT angiography?

NIHSS of 2 with mild facial droop only
Transient symptoms that have fully resolved
Isolated headache without focal deficits
NIHSS ≥6 with gaze deviation or dense hemiplegia (Correct answer)

Correct answer: NIHSS ≥6 with gaze deviation or dense hemiplegia

An NIHSS ≥6 with gaze deviation or dense hemiplegia suggests large vessel occlusion (LVO), warranting emergent CTA to identify thrombectomy candidacy.

Question 105: What is the role of speech therapy in post-acute stroke care?

To improve speech and swallowing abilities (Correct answer)
To assist with mobility
To control blood sugar levels
To monitor heart function

Correct answer: To improve speech and swallowing abilities

Speech therapy (or speech-language pathology) is crucial in post-acute stroke care for addressing communication and swallowing difficulties. Stroke can cause aphasia (language impairment), dysarthria (speech muscle weakness), and dysphagia (swallowing difficulties). Therapists work to improve speech clarity, language comprehension, expression, and safe swallowing techniques, essential for nutrition and social interaction.

Question 106: Which neurotransmitter is primarily responsible for excitotoxic neuronal death in acute ischemia?

Glutamate (Correct answer)
Serotonin
GABA
Dopamine

Correct answer: Glutamate

Massive glutamate release during ischemia activates NMDA and AMPA receptors, causing calcium influx and triggering excitotoxic neuronal death.

Question 107: In a stroke patient, which finding on diffusion-weighted MRI (DWI) indicates irreversible infarction?

Hyperintense signal with corresponding ADC restriction (dark on ADC map) (Correct answer)
Hypointense signal on DWI with bright ADC
Hyperintense signal with elevated ADC values
No DWI change within 24 hours of symptom onset

Correct answer: Hyperintense signal with corresponding ADC restriction (dark on ADC map)

Restricted diffusion (bright DWI, dark ADC map) indicates cytotoxic edema from acute ischemia, reflecting irreversible neuronal injury within minutes to hours of onset.

Question 108: What are the main causes of ischemic stroke?

Stress and dehydration
Severe headaches
High blood pressure and infections
Fatty deposits and blood clots (Correct answer)

Correct answer: Fatty deposits and blood clots

The primary causes of ischemic stroke are atherosclerosis, which involves the buildup of fatty deposits (plaque) in the arteries, and the formation of blood clots. These plaques can narrow arteries, reducing blood flow, or rupture, leading to clot formation that blocks the vessel. Clots can also travel from other parts of the body, such as the heart, to the brain.

Question 109: A patient with aphasia after stroke is frustrated during speech therapy. What is the most therapeutic nursing response?

Allow extra time and use augmentative communication supports (Correct answer)
Recommend deferring speech therapy until the patient is emotionally ready
Complete sentences for the patient to reduce frustration
Speak loudly and slowly to help comprehension

Correct answer: Allow extra time and use augmentative communication supports

Allowing extra response time and using AAC tools (picture boards, apps) respects the patient's effort and supports communication without fostering dependence.

Question 110: When documenting assessment findings in SCRN practice, which approach is MOST appropriate?

Use technical jargon that only experts can understand
Record objective findings, measurements, and professional observations factually (Correct answer)
Include only positive findings to maintain optimism
Summarize findings verbally without written documentation

Correct answer: Record objective findings, measurements, and professional observations factually

Question 111: During hyperacute stroke care, the head of the bed is typically positioned flat (0°) for which reason?

To reduce intracranial pressure
To maximize cerebral perfusion pressure in the ischemic penumbra (Correct answer)
To facilitate IV access
To prevent aspiration pneumonia

Correct answer: To maximize cerebral perfusion pressure in the ischemic penumbra

Flat positioning improves cerebral perfusion to the ischemic penumbra, though it is contraindicated if the patient has elevated ICP or aspiration risk.

Question 112: In Stroke Certified Registered Nurse practice, what is the FIRST step when a safety hazard is identified in the workplace?

Wait for a supervisor to notice the issue
Continue working and report at end of shift
Immediately secure the area and report the hazard (Correct answer)
Document it for the next safety audit

Correct answer: Immediately secure the area and report the hazard

When a safety hazard is identified, the immediate priority is to secure the area to prevent injury and report the hazard through proper channels. Delaying action increases the risk of incidents.

Question 113: What role does the carotid artery play in stroke risk?

It supplies blood to the lungs
It supplies blood to the kidneys
It carries oxygen to the heart
It supplies blood to the brain, and blockage increases stroke risk (Correct answer)

Correct answer: It supplies blood to the brain, and blockage increases stroke risk

The carotid arteries are major blood vessels located on each side of the neck that supply a significant portion of the blood to the brain. Atherosclerosis, or the buildup of plaque in these arteries, can narrow them (carotid artery stenosis) or lead to the formation of blood clots. This severely increases the risk of an ischemic stroke by impeding blood flow to the brain.

Question 114: Which post-stroke complication is the leading cause of death in the first month after stroke?

Aspiration pneumonia (Correct answer)
Deep vein thrombosis
Recurrent ischemic stroke
Hemorrhagic transformation

Correct answer: Aspiration pneumonia

Aspiration pneumonia is the most common cause of death in the early post-stroke period due to dysphagia and impaired protective reflexes.

Question 115: A patient with a right hemispheric stroke demonstrates left-sided neglect. Which nursing strategy best addresses this deficit?

Place essential items in the patient's left visual field and encourage scanning to the left (Correct answer)
Approach the patient only from the left side
Place all essential items on the patient's right side to promote use
Restrict activities requiring bilateral visual attention

Correct answer: Place essential items in the patient's left visual field and encourage scanning to the left

Rehabilitation for hemispatial neglect involves placing stimuli in the neglected field and training the patient to consciously scan toward the affected side.

Question 116: A nurse is educating a post-stroke patient on secondary prevention. Which lifestyle modification has the greatest evidence for stroke risk reduction?

Blood pressure control (Correct answer)
Regular aerobic exercise
Adopting a Mediterranean diet
Smoking cessation

Correct answer: Blood pressure control

Hypertension is the single most modifiable risk factor for stroke recurrence, making blood pressure control the highest-priority secondary prevention measure.

Question 117: Which circle of Willis variant increases the risk of ischemic stroke when the ipsilateral internal carotid artery is occluded?

Persistent trigeminal artery
Absent or hypoplastic anterior communicating artery (Correct answer)
Duplicate basilar artery
Bilateral fetal posterior cerebral arteries

Correct answer: Absent or hypoplastic anterior communicating artery

An absent or hypoplastic anterior communicating artery prevents collateral blood flow from the contralateral hemisphere when the ipsilateral ICA is occluded, increasing infarct risk.

Question 118: Which imaging modality is the gold standard for detecting acute hemorrhagic stroke in the emergency setting?

MRI with diffusion-weighted imaging
CT angiography
Carotid duplex ultrasound
Non-contrast CT of the head (Correct answer)

Correct answer: Non-contrast CT of the head

Non-contrast CT of the head rapidly identifies acute hemorrhage and is the gold standard first-line neuroimaging in emergency stroke evaluation.

Question 119: A patient receiving IV alteplase for acute ischemic stroke develops sudden severe headache and hypertension. What is the priority action?

Stop the infusion and obtain emergent CT head (Correct answer)
Administer antihypertensive medication and continue infusion
Slow the infusion rate and monitor closely
Administer fresh frozen plasma immediately

Correct answer: Stop the infusion and obtain emergent CT head

Sudden severe headache and hypertension during tPA infusion suggest hemorrhagic transformation, requiring immediate cessation and emergent CT imaging.

Question 120: The Modified Rankin Scale (mRS) score of 3 is best described as:

Slight disability but able to carry out all usual duties and activities
No symptoms at all
Moderate disability requiring some help but able to walk without assistance (Correct answer)
Moderately severe disability requiring constant nursing care

Correct answer: Moderate disability requiring some help but able to walk without assistance

An mRS score of 3 indicates moderate disability: the patient requires some help with daily activities but is able to walk without assistance.

Question 121: Which of the following is a relative contraindication to IV tPA in acute ischemic stroke?

NIHSS score of 8
Blood pressure of 170/100 after two doses of labetalol
Onset of symptoms 3.5 hours ago
Major surgery within the past 14 days (Correct answer)

Correct answer: Major surgery within the past 14 days

Major surgery within 14 days is a relative contraindication to tPA due to the risk of serious bleeding at the surgical site.

Question 122: A nurse is preparing a patient for mechanical thrombectomy. The patient's NIHSS score is 18 and CT angiography confirms large vessel occlusion. What time window is generally accepted for thrombectomy in eligible patients?

Within 3 hours of symptom onset only
Up to 6 hours, and up to 24 hours in selected patients with favorable imaging (Correct answer)
Only if tPA was given first
Within 1 hour of symptom onset

Correct answer: Up to 6 hours, and up to 24 hours in selected patients with favorable imaging

Current guidelines support thrombectomy up to 6 hours for standard eligibility and up to 24 hours for selected patients with perfusion imaging mismatch.

Question 123: Which medication is used to treat symptomatic cerebral hypoperfusion (vasospasm) after subarachnoid hemorrhage in addition to nimodipine?

Prophylactic alteplase
Oral calcium channel blockers only
IV heparin anticoagulation
Induced hypertension with vasopressors (Triple-H therapy) (Correct answer)

Correct answer: Induced hypertension with vasopressors (Triple-H therapy)

Triple-H therapy (hypertension, hemodilution, hypervolemia) using vasopressors is used to augment cerebral perfusion during symptomatic vasospasm.

Question 124: What is the BEST way for a Stroke Certified Registered Nurse professional to stay current with regulatory changes?

Rely solely on employer notifications
Actively monitor regulatory bodies, attend continuing education, and participate in professional associations (Correct answer)
Check regulations only during certification renewal
Depend on colleagues to share updates informally

Correct answer: Actively monitor regulatory bodies, attend continuing education, and participate in professional associations

Question 125: What defines acute care in stroke management?

Immediate interventions to stabilize the patient's condition (Correct answer)
Ongoing rehabilitation therapy
Long-term follow-up care
Supportive care during rehabilitation

Correct answer: Immediate interventions to stabilize the patient's condition

Acute care in stroke management refers to the critical period immediately following stroke onset, typically within the first few hours to days. During this phase, the focus is on rapid diagnosis, stabilizing the patient's medical condition, and implementing time-sensitive treatments to minimize brain damage and prevent complications. This includes interventions like thrombolysis or blood pressure management.

Question 126: A patient with subarachnoid hemorrhage (SAH) from a ruptured aneurysm is at high risk for which serious delayed complication between days 4–14?

Hyperthyroidism
Hyponatremia from SIADH only
Pulmonary embolism
Cerebral vasospasm causing delayed ischemic neurological deficit (DIND) (Correct answer)

Correct answer: Cerebral vasospasm causing delayed ischemic neurological deficit (DIND)

Cerebral vasospasm peaks between days 4 and 14 after SAH and can cause delayed ischemic injury; nimodipine is given prophylactically to reduce this risk.

Question 127: Why is blood pressure management crucial in acute stroke care?

To prevent further bleeding and brain injury (Correct answer)
To reduce stress on the heart
To reduce pain from the stroke
To increase the blood flow to the kidneys

Correct answer: To prevent further bleeding and brain injury

Blood pressure management is critical in acute stroke care, though the specific targets vary depending on stroke type. In hemorrhagic stroke, aggressive blood pressure control is essential to prevent further bleeding. In ischemic stroke, blood pressure is carefully managed to ensure adequate cerebral perfusion while avoiding excessively high pressures that could lead to hemorrhagic transformation or edema.

Question 128: Which documentation practice BEST demonstrates regulatory compliance for SCRN certified professionals?

Filing documents only when audited
Relying on memory for routine procedures
Keeping informal handwritten notes
Maintaining organized, dated, and signed records of all activities, training, and incidents (Correct answer)

Correct answer: Maintaining organized, dated, and signed records of all activities, training, and incidents

Organized, dated, and signed records demonstrate systematic compliance with regulatory requirements. Proper documentation serves as evidence during audits, protects against liability, and shows a pattern of consistent adherence to standards.

Question 129: Which area of the internal capsule carries fibers controlling contralateral upper extremity movement?

Retrolenticular limb
Genu
Anterior limb
Posterior limb (posterior one-third) (Correct answer)

Correct answer: Posterior limb (posterior one-third)

Corticospinal fibers controlling the contralateral arm travel in the posterior limb of the internal capsule; the face is at the genu and the leg is most posterior.

Question 130: What is hyperacute care?

Care provided after a stroke, before any rehabilitation
Care for patients before any diagnostic tests
Immediate care to stabilize and prevent further neurological damage (Correct answer)
Long-term care for stroke patients

Correct answer: Immediate care to stabilize and prevent further neurological damage

Hyperacute care refers to the critical and immediate medical management provided to stroke patients within the first few hours of symptom onset. The primary goal is to stabilize the patient, rapidly diagnose the type of stroke, and initiate treatments like thrombolysis or thrombectomy to restore blood flow or control bleeding. This minimizes brain damage and improves recovery prospects.

Question 131: Which of the following laboratory values is MOST important to obtain before administering IV tPA in a patient on anticoagulation?

Serum sodium and potassium
Troponin and BNP
INR and aPTT (Correct answer)
Hemoglobin and hematocrit

Correct answer: INR and aPTT

INR and aPTT must be checked to rule out therapeutic anticoagulation, as an INR >1.7 is a contraindication to IV tPA.

Question 132: Which antiepileptic drug is most commonly used as prophylaxis or treatment for seizures in the early post-stroke period?

Phenobarbital
Levetiracetam (Correct answer)
Carbamazepine
Valproic acid

Correct answer: Levetiracetam

Levetiracetam is widely used for post-stroke seizure management due to its favorable side-effect profile and minimal drug interactions.

Question 133: Nimodipine is administered after subarachnoid hemorrhage primarily to prevent which complication?

Cerebral vasospasm (Correct answer)
Hydrocephalus
Seizures
Rebleeding

Correct answer: Cerebral vasospasm

Nimodipine, a calcium channel blocker, is administered for 21 days after SAH to reduce the incidence and severity of cerebral vasospasm.

Question 134: Cerebral amyloid angiopathy (CAA) most commonly causes hemorrhage in which location?

Basal ganglia and thalamus
Pons
Lobar (cortical and subcortical) regions (Correct answer)
Cerebellum

Correct answer: Lobar (cortical and subcortical) regions

CAA results from amyloid-beta deposition in cortical and leptomeningeal vessels, predisposing elderly patients to lobar hemorrhages in parietal, occipital, and frontal regions.

Question 135: What is the MOST important factor to consider when selecting assessment tools for SCRN certification work?

Personal familiarity with the tool
How quickly the tool can be administered
The cost of the assessment tool
Validity, reliability, and appropriateness for the specific context (Correct answer)

Correct answer: Validity, reliability, and appropriateness for the specific context

Assessment tools must be valid (measuring what they claim to measure), reliable (producing consistent results), and appropriate for the specific context and population. These psychometric properties ensure the quality of assessment outcomes.

Question 136: A patient with ischemic stroke is receiving IV alteplase. After 30 minutes, the nurse notes a blood pressure of 195/108 mmHg. What is the priority action?

Notify the physician and document the reading
Administer labetalol or nicardipine to lower BP below 180/105 mmHg (Correct answer)
Stop the alteplase infusion immediately
Increase IV fluid rate to dilute the medication

Correct answer: Administer labetalol or nicardipine to lower BP below 180/105 mmHg

During IV alteplase infusion, BP must be maintained below 180/105 mmHg; antihypertensives such as labetalol or nicardipine should be given promptly.

Question 137: Which mechanism accounts for the majority of hemorrhagic strokes in elderly hypertensive patients?

Cerebral amyloid angiopathy
Rupture of a saccular (berry) aneurysm
Arteriovenous malformation rupture
Hypertensive lipohyalinosis with vessel rupture (Correct answer)

Correct answer: Hypertensive lipohyalinosis with vessel rupture

Chronic hypertension causes lipohyalinosis of small penetrating vessels, making them prone to rupture and causing intracerebral hemorrhage, typically in the basal ganglia, thalamus, pons, or cerebellum.

Question 138: A patient with ischemic stroke secondary to carotid artery stenosis is started on dual antiplatelet therapy. Which combination is most commonly used short-term?

Aspirin plus clopidogrel (Correct answer)
Aspirin plus warfarin
Clopidogrel plus ticagrelor
Aspirin plus heparin

Correct answer: Aspirin plus clopidogrel

Short-term dual antiplatelet therapy with aspirin plus clopidogrel is recommended for high-risk TIA or minor stroke to reduce early recurrent events.

Question 139: Why is cognitive rehabilitation important in post-acute care?

It helps manage blood pressure
It helps improve cognitive functions such as memory and attention (Correct answer)
It helps improve speech
It focuses on physical mobility

Correct answer: It helps improve cognitive functions such as memory and attention

Cognitive rehabilitation is a vital component of post-acute stroke care because stroke can significantly impair cognitive functions like memory, attention, problem-solving, and executive function. Therapy focuses on strategies and exercises to improve these abilities, helping patients to better manage daily tasks, return to work, or engage in social activities, thereby enhancing their quality of life.

Question 140: A nurse is caring for a patient with a large hemispheric ischemic stroke. To reduce the risk of malignant cerebral edema, the head of the bed should be maintained at:

Flat (0°)
60–90°
15–30° (Correct answer)
45°

Correct answer: 15–30°

Head-of-bed elevation at 15–30° optimizes cerebral venous drainage and ICP without compromising cerebral perfusion pressure.

Question 141: A stroke patient's serum glucose is 280 mg/dL on admission. How does hyperglycemia affect acute stroke outcomes?

It reduces hemorrhagic transformation risk
It has no significant effect on stroke outcomes
It is neuroprotective by providing extra fuel to ischemic neurons
It worsens infarct size by promoting lactic acidosis and cerebral edema (Correct answer)

Correct answer: It worsens infarct size by promoting lactic acidosis and cerebral edema

Hyperglycemia promotes anaerobic metabolism, lactic acidosis, and cerebral edema, all of which expand the ischemic injury.

Question 142: Which regulatory requirement is UNIVERSAL across all Stroke Certified Registered Nurse practice settings?

Using specific proprietary software systems
Maintaining current certification and meeting continuing education requirements (Correct answer)
Limiting services to local jurisdictions only
Working exclusively during business hours

Correct answer: Maintaining current certification and meeting continuing education requirements

Question 143: What is hemorrhagic stroke?

A stroke caused by a clot
A stroke from an allergic reaction
A stroke caused by bleeding in the brain (Correct answer)
A stroke due to low blood sugar

Correct answer: A stroke caused by bleeding in the brain

A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. This bleeding directly damages brain cells and increases pressure on the brain, further impairing function. It is often associated with high blood pressure, aneurysms, or arteriovenous malformations (AVMs).

Question 144: What is the target blood pressure goal during IV alteplase infusion for acute ischemic stroke?

< 160/100 mmHg
< 180/105 mmHg (Correct answer)
< 200/110 mmHg
< 140/90 mmHg

Correct answer: < 180/105 mmHg

Blood pressure must be maintained below 180/105 mmHg during and for 24 hours after IV alteplase to minimize hemorrhagic risk.

Question 145: A patient with acute ischemic stroke suddenly develops worsening neurological deficits and a MAP drop to 55 mmHg during hospitalization. What is the most likely cause?

Hyperperfusion syndrome
Benign fatigue from rehabilitation
Stroke-related cardiac arrhythmia causing hemodynamic compromise (Correct answer)
Cerebral vasospasm

Correct answer: Stroke-related cardiac arrhythmia causing hemodynamic compromise

Stroke patients are prone to cardiac arrhythmias and neurogenic cardiac dysfunction, which can precipitate hemodynamic instability and secondary neurological deterioration.

Question 146: A 58-year-old patient develops sudden onset diplopia, dysphagia, and ipsilateral facial numbness with contralateral body numbness. Which syndrome does this represent?

Weber syndrome
Wallenberg (lateral medullary) syndrome (Correct answer)
Benedikt syndrome
Millard-Gubler syndrome

Correct answer: Wallenberg (lateral medullary) syndrome

Wallenberg syndrome results from posterior inferior cerebellar artery occlusion causing ipsilateral facial and contralateral body pain/temperature loss, dysphagia, dysarthria, and Horner syndrome.

Question 147: A patient with ischemic stroke secondary to atrial fibrillation is started on anticoagulation. Which drug class is preferred for long-term secondary prevention?

Aspirin plus clopidogrel
Direct oral anticoagulants (DOACs) (Correct answer)
Unfractionated heparin
Low molecular weight heparin

Correct answer: Direct oral anticoagulants (DOACs)

DOACs (e.g., apixaban, rivaroxaban) are preferred over warfarin for secondary prevention in non-valvular atrial fibrillation-related ischemic stroke due to superior safety profiles.

Question 148: A stroke patient in home health has a Barthel Index score of 60. What does this indicate?

Fully independent in all ADLs
Minimal dependence with only supervision needed
Moderate dependence requiring significant assistance (Correct answer)
Total dependence in all activities

Correct answer: Moderate dependence requiring significant assistance

A Barthel Index score of 60 out of 100 reflects moderate dependence, meaning the patient requires significant assistance with many ADLs.

Question 149: What documentation is MOST critical to maintain for safety compliance in the Stroke Certified Registered Nurse field?

Incident reports, training records, and inspection logs (Correct answer)
Annual revenue reports
Client marketing preferences
Employee vacation schedules

Correct answer: Incident reports, training records, and inspection logs

Question 150: What is the role of the stroke nurse during CT imaging for a hyperacute stroke patient?

Administer sedation for the scan
Document the scan results independently
Stay at the nursing station and await radiology report
Accompany the patient, monitor vitals, and ensure imaging is completed without delay (Correct answer)

Correct answer: Accompany the patient, monitor vitals, and ensure imaging is completed without delay

The stroke nurse accompanies the patient to CT, continuously monitors vitals and neurological status, and facilitates rapid turnaround to minimize delays.

Question 151: A patient with acute ischemic stroke presents within 3 hours of symptom onset. Which medication is the first-line thrombolytic therapy?

Reteplase
Streptokinase
Alteplase (tPA) (Correct answer)
Tenecteplase

Correct answer: Alteplase (tPA)

Alteplase (IV tPA) is the FDA-approved first-line thrombolytic for acute ischemic stroke within the 3–4.5 hour window.

Question 152: A post-stroke patient has urinary incontinence. The nurse recognizes that which type is most common after stroke?

Overflow incontinence
Stress incontinence
Urge incontinence (overactive bladder) (Correct answer)
Functional incontinence

Correct answer: Urge incontinence (overactive bladder)

Urge incontinence due to disrupted cortical inhibition of detrusor activity is the most common type of urinary incontinence following stroke.

Question 153: Which finding on CT imaging is an absolute contraindication to IV tPA in acute ischemic stroke?

Loss of gray-white differentiation in a small area
Hypodensity involving less than one-third of the MCA territory
Intracranial hemorrhage (Correct answer)
Mild sulcal effacement

Correct answer: Intracranial hemorrhage

Any intracranial hemorrhage visible on CT is an absolute contraindication to IV tPA administration.

Question 154: A nurse administers 10% of the alteplase dose as an IV bolus over 1 minute. What happens with the remaining 90%?

Infused over 30 minutes
Given as a second bolus after 30 minutes
Held and administered only if symptoms worsen
Infused over 60 minutes (Correct answer)

Correct answer: Infused over 60 minutes

Standard alteplase administration is 10% as an IV bolus over 1 minute and the remaining 90% infused over 60 minutes.

Question 155: A patient with acute ischemic stroke has a blood glucose of 42 mg/dL. What is the nurse's immediate intervention?

Administer oral glucose tablets
Proceed with tPA assessment without intervention
Administer IV dextrose (D50) and recheck glucose (Correct answer)
Hold all interventions and notify neurology

Correct answer: Administer IV dextrose (D50) and recheck glucose

Hypoglycemia (≤60 mg/dL) can mimic stroke and must be corrected immediately with IV dextrose before stroke workup proceeds.

Question 156: How does early administration of tPA affect patient outcomes?

It has no effect on outcomes
It may improve functional outcomes in ischemic stroke (Correct answer)
It worsens outcomes in hemorrhagic stroke
It reduces the risk of bleeding complications

Correct answer: It may improve functional outcomes in ischemic stroke

Early administration of tissue plasminogen activator (tPA) for eligible ischemic stroke patients is time-critical because it can dissolve the clot and restore blood flow to the brain. This re-perfusion, when achieved quickly, significantly increases the likelihood of improved functional outcomes and reduced disability. The benefit diminishes rapidly with time, highlighting the 'time is brain' principle.

Question 157: When a SCRN professional identifies a potential regulatory violation, the CORRECT first step is to:

Wait to see if it resolves on its own
Address it only if directly affected
Discuss it casually with coworkers
Document the violation and report it through proper channels (Correct answer)

Correct answer: Document the violation and report it through proper channels

Question 158: Which laboratory value is most important to check BEFORE initiating IV alteplase in an acute ischemic stroke patient?

Troponin I
Prothrombin time (PT) and INR (Correct answer)
Blood glucose level
Complete metabolic panel (CMP)

Correct answer: Prothrombin time (PT) and INR

Elevated INR (>1.7) is a contraindication to alteplase; checking PT/INR is critical to rule out coagulopathy before thrombolysis.

Question 159: What is post-acute care?

Care aimed at prevention of future strokes
The immediate care after a stroke
Care after stabilization, focused on recovery and rehabilitation (Correct answer)
Care only provided in the hospital

Correct answer: Care after stabilization, focused on recovery and rehabilitation

Post-acute care refers to the phase of stroke management that follows the immediate acute hospital stay, once the patient is medically stable. The primary focus shifts from life-saving interventions to intensive rehabilitation and recovery. This care can be provided in various settings, including inpatient rehabilitation facilities, skilled nursing facilities, or home health, tailored to individual needs.

Question 160: A stroke patient on heparin infusion for cardioembolic stroke has a PTT result of 220 seconds (therapeutic range: 60–100 seconds). What is the nurse's priority action?

Administer protamine sulfate immediately
Continue the infusion and recheck in 6 hours
Decrease the heparin rate per the protocol and notify the physician (Correct answer)
Stop the heparin and start warfarin

Correct answer: Decrease the heparin rate per the protocol and notify the physician

A supratherapeutic PTT increases hemorrhagic transformation risk; the heparin rate must be reduced per weight-based protocol and the physician notified.

Question 161: What is the primary goal of acute stroke care?

To immediately begin rehabilitation
To diagnose the cause of the stroke
To stabilize the patient's condition and prevent further damage (Correct answer)
To increase blood pressure

Correct answer: To stabilize the patient's condition and prevent further damage

The primary goal of acute stroke care is to rapidly assess, diagnose, and intervene to stabilize the patient and limit the extent of brain injury. This involves managing vital signs, addressing potential complications, and initiating specific treatments like thrombolytics for ischemic stroke or blood pressure control for hemorrhagic stroke. Early stabilization is crucial for improving long-term outcomes.

Question 162: A patient with hemorrhagic stroke is on a nicardipine infusion. The target systolic blood pressure is less than 140 mmHg per protocol. What is the primary rationale?

To reduce cerebral metabolic rate
To prevent vasospasm
To increase cerebral perfusion pressure
To limit hematoma expansion and improve outcomes (Correct answer)

Correct answer: To limit hematoma expansion and improve outcomes

Aggressive blood pressure lowering in intracerebral hemorrhage reduces ongoing hematoma expansion, which is a key driver of early neurological deterioration.

Question 163: A post-stroke patient with spastic foot drop is being evaluated for an ankle-foot orthosis (AFO). The nurse understands the primary goal of an AFO in this patient is to:

Improve gait safety by holding the foot in a neutral position (Correct answer)
Reduce lymphedema in the paretic limb
Stretch spastic calf muscles overnight
Prevent heterotopic ossification

Correct answer: Improve gait safety by holding the foot in a neutral position

An AFO holds the ankle in a neutral dorsiflexed position to prevent foot drop during the swing phase of gait, improving safety and efficiency.

Question 164: What is the role of oxygen therapy in acute stroke care?

To increase the patient's heart rate
To stabilize blood glucose levels
To increase oxygen supply to the brain (Correct answer)
To prevent a hemorrhagic stroke

Correct answer: To increase oxygen supply to the brain

Oxygen therapy in acute stroke care is administered to ensure adequate oxygenation, especially if the patient is hypoxic or has compromised respiratory function. Maintaining sufficient oxygen levels is crucial to support brain metabolism and prevent further damage to already vulnerable brain tissue. It helps to maximize oxygen delivery to the ischemic penumbra, the area of brain tissue at risk.

Question 165: Statins are recommended after ischemic stroke primarily because they reduce which risk factor?

Atrial fibrillation recurrence
Deep vein thrombosis
Blood pressure only
LDL cholesterol and recurrent stroke risk (Correct answer)

Correct answer: LDL cholesterol and recurrent stroke risk

High-intensity statin therapy lowers LDL cholesterol and has been shown to reduce recurrent ischemic stroke and cardiovascular events.

Question 166: A post-stroke patient in outpatient rehab has spasticity limiting elbow extension. Botulinum toxin is administered. What is the expected onset of effect?

Within 3–7 days (Correct answer)
Within 2–4 weeks
Within 24–48 hours
Within 2–4 hours

Correct answer: Within 3–7 days

Botulinum toxin typically begins reducing spasticity within 3–7 days, with peak effect at 4–6 weeks.

Question 167: Which ion flux occurs first during the depolarization phase of ischemic neuronal injury?

Chloride efflux
Magnesium influx
Potassium efflux
Sodium influx (Correct answer)

Correct answer: Sodium influx

During ischemic depolarization, failure of the Na⁺/K⁺-ATPase pump leads to massive sodium influx, followed by water entry and cytotoxic edema.

Question 168: Which factor MOST significantly affects the quality of technical outcomes in SCRN practice?

The brand of equipment being used
The speed at which procedures are completed
The time of day the procedure is performed
The practitioner's training, preparation, and attention to detail (Correct answer)

Correct answer: The practitioner's training, preparation, and attention to detail

Question 169: Which standardized tool is recommended to screen for post-stroke depression in the post-acute setting?

Montreal Cognitive Assessment (MoCA)
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
Mini-Mental State Examination (MMSE)
Berg Balance Scale

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a validated, widely used depression screening tool recommended for post-stroke populations.

Question 170: Lacunar infarcts are most commonly caused by:

Lipohyalinosis of small penetrating arteries (Correct answer)
Large artery atherosclerosis of the carotid bifurcation
Cardioembolism from atrial fibrillation
Venous thrombosis of the superior sagittal sinus

Correct answer: Lipohyalinosis of small penetrating arteries

Lacunar infarcts result from lipohyalinosis or microatheroma of small penetrating arteries (< 15 mm diameter), most commonly in the basal ganglia, thalamus, and internal capsule.

Question 171: Which documentation practice BEST demonstrates regulatory compliance for SCRN certified professionals?

Keeping informal handwritten notes
Maintaining organized, dated, and signed records of all activities, training, and incidents (Correct answer)
Relying on memory for routine procedures
Filing documents only when audited

Correct answer: Maintaining organized, dated, and signed records of all activities, training, and incidents

Stroke Certified Registered Nurse (SCRN) Exam

This exam certifies registered nurses who demonstrate specialized knowledge and expertise in the care of stroke patients, from prevention and acute management to rehabilitation and secondary prevention.

170

Questions

180 min

Time Limit

70%

To Pass

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