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

Question 1: A post-stroke patient in a skilled nursing facility develops a DVT in the paretic leg. Which action takes priority?

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

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 2: During IV tPA administration, a patient suddenly develops angioedema with tongue and lip swelling. What is the immediate nursing action?

Administer diphenhydramine and continue the infusion
Apply ice packs to the lips and continue monitoring
Stop the tPA infusion immediately and prepare to manage the airway (Correct answer)
Slow the infusion rate and observe

Correct answer: Stop the tPA infusion immediately and prepare to manage the airway

Orolingual angioedema is a life-threatening complication of alteplase; the infusion must be stopped immediately and airway management initiated.

Question 3: Which approach is MOST important for SCRN professionals when applying technical procedures?

Using the fastest method available regardless of standards
Following personal shortcuts developed through experience
Adhering to established protocols while adapting to specific conditions (Correct answer)
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 4: What is the PRIMARY reason for regulatory compliance in the Stroke Certified Registered Nurse profession?

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

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 5: 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
Nasogastric (NG) tube feeding (Correct answer)
Percutaneous endoscopic gastrostomy (PEG) tube placement within 24 hours
Continue NPO status indefinitely

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

Only apply updates to new cases or projects
Continue using the original method if it still works
Wait for mandatory enforcement before changing
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 7: Nimodipine is administered after subarachnoid hemorrhage primarily to prevent which complication?

Hydrocephalus
Seizures
Rebleeding
Cerebral vasospasm (Correct answer)

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

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

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

Reteplase
Alteplase (tPA) (Correct answer)
Streptokinase
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 10: During hyperacute stroke care, the head of the bed is typically positioned flat (0°) for which reason?

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

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 11: What is transient ischemic attack (TIA)?

A temporary blockage or reduced blood flow to the brain (Correct answer)
A heart attack
A permanent blockage of blood flow to the brain
A viral infection of the brain

Correct answer: A temporary blockage or reduced blood flow to the brain

A Transient Ischemic Attack (TIA), often called a 'mini-stroke,' occurs when blood flow to the brain is temporarily interrupted, causing stroke-like symptoms that typically last only a few minutes to an hour and resolve completely. Although symptoms are temporary, a TIA is a serious warning sign that a full-blown stroke may occur soon, necessitating immediate medical evaluation.

Question 12: What is the correct dose of IV alteplase (tPA) for acute ischemic stroke in adults?

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

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 13: A patient admitted with ischemic stroke has an LDL of 145 mg/dL. Per current stroke guidelines, what medication should be started during the acute hospitalization?

Ezetimibe monotherapy
High-intensity statin therapy (Correct answer)
Niacin supplementation
Fibrate therapy

Correct answer: High-intensity statin therapy

High-intensity statin therapy reduces recurrent stroke and cardiovascular events and should be initiated during acute hospitalization regardless of baseline LDL.

Question 14: Which neurotransmitter is primarily responsible for excitotoxic neuronal death in acute ischemia?

Dopamine
Serotonin
GABA
Glutamate (Correct answer)

Correct answer: Glutamate

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

Question 15: Which part of the brain is most commonly affected by a stroke?

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

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

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

Correct answer: Andexanet alfa

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

Question 17: Why is blood pressure management crucial in acute stroke care?

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

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 18: 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
Microvascular obstruction by activated leukocytes, platelets, and edematous endothelium (Correct answer)
Hyperperfusion syndrome causing arteriolar dilation
Persistent arterial vasospasm in large vessels

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 19: A stroke patient develops symptomatic cerebral edema. Which osmotic agent is commonly used to reduce intracranial pressure?

Dexamethasone
Mannitol (Correct answer)
Normal saline
Furosemide

Correct answer: Mannitol

Mannitol is an osmotic diuretic that creates an osmotic gradient to draw water from cerebral tissue, effectively reducing ICP.

Question 20: In a patient with large vessel occlusion (LVO), mechanical thrombectomy is recommended up to how many hours from last known well with favorable imaging?

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

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 21: 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?

Only if tPA was given first
Up to 6 hours, and up to 24 hours in selected patients with favorable imaging (Correct answer)
Within 3 hours of symptom onset only
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 22: 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?

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

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 23: 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)
Place all essential items on the patient's right side to promote use
Approach the patient only from the left side
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 24: Which laboratory value is most important to check BEFORE initiating IV alteplase in an acute ischemic stroke patient?

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

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 25: 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
Benedikt syndrome
Wallenberg (lateral medullary) syndrome (Correct answer)
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 26: What is the role of thrombolytic therapy in acute care for ischemic stroke?

To stabilize blood pressure
To decrease the risk of hemorrhagic stroke
To remove the blood clot causing the stroke (Correct answer)
To prevent future strokes

Correct answer: To remove the blood clot causing the stroke

Thrombolytic therapy, specifically with medications like tPA, is a cornerstone of acute care for ischemic stroke. Its role is to actively dissolve the blood clot that is blocking blood flow to a part of the brain. By removing the clot, it aims to restore circulation and salvage brain tissue that is at risk of permanent damage.

Question 27: A patient is transferred from the ICU to the stroke unit 48 hours after a large MCA infarct. Which complication requires ongoing prophylactic nursing intervention throughout hospitalization?

Hyperthyroidism
Polyuria
Deep vein thrombosis (DVT) (Correct answer)
Hyperkalemia

Correct answer: Deep vein thrombosis (DVT)

Immobility after stroke significantly increases DVT risk; prophylaxis with compression devices and pharmacological anticoagulation (when safe) must be maintained throughout the hospital stay.

Question 28: What is the maximum dose of IV alteplase for acute ischemic stroke treatment?

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

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

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

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

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

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

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

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 32: Which electrolyte disturbance is commonly managed pharmacologically after subarachnoid hemorrhage due to cerebral salt wasting or SIADH?

Hypernatremia
Hypophosphatemia
Hyperkalemia
Hyponatremia (Correct answer)

Correct answer: Hyponatremia

Hyponatremia is common post-SAH due to cerebral salt wasting or SIADH and is managed with hypertonic saline or fludrocortisone depending on the mechanism.

Question 33: A patient with acute ischemic stroke has a blood glucose of 42 mg/dL. What is the nurse's immediate intervention?

Proceed with tPA assessment without intervention
Administer oral glucose tablets
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 34: 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?

Moyamoya disease
Fibromuscular dysplasia
Cerebral amyloid angiopathy
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 35: Cerebral amyloid angiopathy (CAA) most commonly causes hemorrhage in which location?

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

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 36: A patient with ischemic stroke is found to have diabetes. Which antihypertensive class has additional benefit for secondary stroke prevention in diabetic patients?

Loop diuretics
Alpha-1 blockers
ACE inhibitors or ARBs (Correct answer)
Beta-blockers

Correct answer: ACE inhibitors or ARBs

ACE inhibitors and ARBs provide both blood pressure reduction and renoprotective benefits, and are preferred antihypertensives for diabetic stroke patients.

Question 37: Cytotoxic edema in the ischemic brain is primarily caused by:

Inflammatory cytokine-mediated endothelial disruption
Failure of Na⁺/K⁺-ATPase causing intracellular water accumulation (Correct answer)
Disruption of the blood-brain barrier allowing protein leakage
Increased hydrostatic pressure from arterial hypertension

Correct answer: Failure of Na⁺/K⁺-ATPase causing intracellular water accumulation

Cytotoxic edema results from energy failure and Na⁺/K⁺-ATPase pump dysfunction, causing sodium and water to accumulate within neurons and astrocytes without BBB breakdown.

Question 38: Which imaging modality is the gold standard for detecting acute hemorrhagic stroke in the emergency setting?

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

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 39: Which outcome measure is specifically designed to assess activity limitations in stroke survivors and is commonly used in post-acute research?

Stroke Impact Scale (SIS) (Correct answer)
Rankin Scale
NIHSS
GCS

Correct answer: Stroke Impact Scale (SIS)

The Stroke Impact Scale is a patient-reported outcome measure assessing multiple domains of stroke recovery including strength, memory, emotion, communication, and social participation.

Question 40: How frequently should ongoing assessments be conducted in Stroke Certified Registered Nurse practice?

Only when problems are reported
At regular intervals based on established protocols and as conditions change (Correct answer)
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 41: What is the role of speech therapy in post-acute stroke care?

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

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

Wear an eye patch over the unaffected eye during activities
Avoid all driving permanently regardless of recovery
Request a lower bed to minimize fall risk from visual loss
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 43: What is the role of neuroprotective strategies in hyperacute care?

To enhance the recovery process
To treat existing neurological damage
To prevent complications during rehabilitation
To prevent further brain damage and improve outcomes (Correct answer)

Correct answer: To prevent further brain damage and improve outcomes

Neuroprotective strategies in hyperacute stroke care aim to protect brain cells from secondary injury following the initial stroke event. These strategies focus on minimizing damage to the penumbra, the area of brain tissue surrounding the core infarct that is at risk but not yet irreversibly damaged. By preserving this tissue, the goal is to limit the overall extent of brain injury and improve long-term functional outcomes.

Question 44: When performing dysphagia screening in an acute stroke patient, what is the safest initial step?

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

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

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

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

Stress incontinence
Urge incontinence (overactive bladder) (Correct answer)
Overflow incontinence
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 47: A patient with ischemic stroke develops elevated glucose of 210 mg/dL. What is the recommended glucose management approach?

Treat hyperglycemia with insulin to maintain glucose 140–180 mg/dL (Correct answer)
Allow permissive hyperglycemia up to 250 mg/dL
No glucose treatment required in acute stroke
Administer dextrose to avoid hypoglycemia

Correct answer: Treat hyperglycemia with insulin to maintain glucose 140–180 mg/dL

Hyperglycemia worsens stroke outcomes; AHA/ASA guidelines recommend treating glucose > 180 mg/dL and maintaining levels between 140–180 mg/dL.

Question 48: Which documentation practice BEST demonstrates regulatory compliance for SCRN certified professionals?

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

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

Hypointense signal on DWI with bright ADC
Hyperintense signal with corresponding ADC restriction (dark on ADC map) (Correct answer)
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 50: A patient who received IV tPA 2 hours ago requires urgent surgery for an unrelated emergency. What is the primary concern?

Risk of rebound hypertension
Potential for allergic reaction to anesthesia
Risk of stroke recurrence during surgery
Increased bleeding risk due to active fibrinolytic effect (Correct answer)

Correct answer: Increased bleeding risk due to active fibrinolytic effect

IV tPA has an active fibrinolytic effect for several hours, significantly increasing surgical bleeding risk and generally requiring delay of elective or semi-urgent procedures.

Question 51: 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
Butterfly hemorrhage pattern
Hypodense basal ganglia

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

Uncal herniation (Correct answer)
Subfalcine herniation
Tonsillar herniation
Central (transtentorial) 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 53: Which patient behavior after stroke best indicates readiness for inpatient rehabilitation transfer?

Patient denies disability and refuses therapy
Patient requires continuous IV medication titration
Patient is nonverbal with no response to commands
Patient tolerates 3 hours of therapy per day and is medically stable (Correct answer)

Correct answer: Patient tolerates 3 hours of therapy per day and is medically stable

Inpatient rehabilitation requires medical stability and ability to participate in at least 3 hours of therapy per day.

Question 54: A stroke patient's serum glucose is 280 mg/dL on admission. How does hyperglycemia affect acute stroke outcomes?

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

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

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

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 56: Which antiplatelet agent is recommended for secondary stroke prevention in patients with non-cardioembolic ischemic stroke?

Heparin
Aspirin
Clopidogrel or aspirin (Correct answer)
Warfarin

Correct answer: Clopidogrel or aspirin

AHA/ASA guidelines recommend aspirin or clopidogrel (or their combination for high-risk TIA/minor stroke) for secondary prevention of non-cardioembolic ischemic stroke.

Question 57: During the first 24 hours after IV alteplase, a patient's blood pressure must be maintained below which threshold?

160/90 mmHg
180/105 mmHg (Correct answer)
220/120 mmHg
185/110 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 58: 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?

21 days (Correct answer)
90 days
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 59: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting regular safety drills and exercises?

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

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

Report the issue without any preliminary assessment
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)

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

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

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

Mitral valve vegetation
Left atrial appendage thrombus (Correct answer)
Left ventricular mural thrombus
Pulmonary vein 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 63: In SCRN practice, what happens when regulations are updated or changed?

Professionals must update their knowledge and practices to meet new requirements (Correct answer)
Previous certifications are automatically revoked
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 64: 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
Document it for the next safety audit
Continue working and report at end of shift
Immediately secure the area and report the hazard (Correct answer)

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

Prophylactic alteplase
IV heparin anticoagulation
Oral calcium channel blockers only
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 66: A patient 6 weeks post-stroke has right-sided hemiplegia and is learning to dress independently. The occupational therapist recommends dressing the affected side first. Why?

It follows the natural sequence of morning routine
It prevents contracture of the shoulder joint
It builds strength in the affected limb through repetition
It is easier to thread the affected arm/leg through clothing before mobility is limited (Correct answer)

Correct answer: It is easier to thread the affected arm/leg through clothing before mobility is limited

Dressing the affected side first allows easier garment placement when range of motion is less impaired by surrounding fabric.

Question 67: 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:

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

Correct answer: 15–30°

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

Question 68: A patient presents with bilateral leg weakness and urinary incontinence after a stroke. Which artery territory is most likely affected?

Middle cerebral artery
Posterior inferior cerebellar artery
Anterior cerebral artery (Correct answer)
Posterior cerebral artery

Correct answer: Anterior cerebral artery

The anterior cerebral artery (ACA) supplies the medial hemisphere including the leg area of the motor cortex; bilateral ACA involvement causes bilateral leg weakness and incontinence.

Question 69: Which risk management approach is MOST effective for SCRN professionals when evaluating potential workplace hazards?

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

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

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

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 71: Which factor most strongly predicts a successful return to driving after stroke?

Patient's self-reported confidence in driving
Absence of visual field defects and adequate cognitive function (Correct answer)
Time elapsed since stroke onset
Family support and transportation availability

Correct answer: Absence of visual field defects and adequate cognitive function

Intact visual fields and adequate cognitive function — especially attention and processing speed — are the strongest predictors of safe return to driving.

Question 72: When a SCRN professional encounters an unexpected result during a technical procedure, the FIRST action should be to:

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

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

Question 73: A stroke patient on warfarin has an INR of 3.2 and presents with acute ischemic stroke. Which reversal agent is recommended?

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

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

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

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 75: 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:

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

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

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

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

Within 2–4 hours
Within 2–4 weeks
Within 3–7 days (Correct answer)
Within 24–48 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 78: Which FIM (Functional Independence Measure) score indicates complete independence requiring no helper?

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

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

Applying a sling to keep the arm immobilized
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)

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 80: 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?

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

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

Document it for the next safety audit
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)

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 82: 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
Intracranial hemorrhage (Correct answer)
Mild sulcal effacement
Hypodensity involving less than one-third of the MCA territory

Correct answer: Intracranial hemorrhage

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

Question 83: What documentation is MOST critical to maintain for safety compliance in the Stroke Certified Registered Nurse field?

Employee vacation schedules
Incident reports, training records, and inspection logs (Correct answer)
Annual revenue reports
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 84: What documentation is MOST critical to maintain for safety compliance in the Stroke Certified Registered Nurse field?

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

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

Question 85: What is the significance of nutrition in post-acute stroke care?

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

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 86: 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
Aspirin for antiplatelet effect
Heparin infusion as acute bridging therapy (Correct answer)
CT imaging to rule out hemorrhage

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

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

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

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

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

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

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

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

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 91: Lacunar infarcts are most commonly caused by:

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

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

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

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 93: What is a key consideration in post-acute stroke care for elderly patients?

Address both stroke recovery and age-related health issues (Correct answer)
Provide only medication management
Limit therapy to mobility
Focus on speech therapy alone

Correct answer: Address both stroke recovery and age-related health issues

For elderly stroke patients, post-acute care must take a holistic approach, considering not only the stroke-related deficits but also pre-existing age-related health conditions. Older adults often have comorbidities, polypharmacy, and reduced physiological reserves, which can impact recovery and require integrated management. Addressing both aspects optimizes outcomes and prevents complications in this vulnerable population.

Question 94: A hyperacute stroke patient with known DOAC use taken within the last 48 hours presents within the tPA window. What is the appropriate action?

Withhold all reperfusion therapy
IV tPA is generally contraindicated; proceed with thrombectomy if LVO present (Correct answer)
Administer tPA at full dose after reversal agent
Administer tPA at half the standard dose

Correct answer: IV tPA is generally contraindicated; proceed with thrombectomy if LVO present

DOACs taken within 48 hours are a contraindication to IV tPA; mechanical thrombectomy remains an option if LVO is confirmed on imaging.

Question 95: When a SCRN professional identifies a potential regulatory violation, the CORRECT first step is to:

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

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

Question 96: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting regular safety drills and exercises?

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

Correct answer: To ensure personnel can respond effectively in emergencies

Question 97: A patient with aphasia after stroke is frustrated during speech therapy. What is the most therapeutic nursing response?

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

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 98: What is ischemic stroke?

A stroke caused by an infection
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

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

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

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 100: What role does physical therapy play in post-acute stroke care?

To improve cognitive abilities
To help with regaining physical function such as strength and balance (Correct answer)
To control blood pressure
To assist with emotional recovery

Correct answer: To help with regaining physical function such as strength and balance

Physical therapy (PT) is fundamental in post-acute stroke care, focusing on restoring motor function and mobility. Therapists work with patients on exercises to improve muscle strength, coordination, balance, and gait. The goal is to help patients relearn how to move, walk, and perform daily activities safely and independently, maximizing their physical capabilities.

Question 101: In hyperacute stroke care, what does a NIHSS score of 0 indicate?

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

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

< 180/105 mmHg (Correct answer)
< 200/110 mmHg
< 160/100 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 103: Which assessment finding indicates successful reperfusion after mechanical thrombectomy?

Improvement in neurological deficits and TICI 2b/3 reperfusion on angiogram (Correct answer)
Stable CT scan without hemorrhage
Persistent NIHSS score of 18
Blood pressure within normal limits

Correct answer: Improvement in neurological deficits and TICI 2b/3 reperfusion on angiogram

Successful reperfusion is defined angiographically as TICI grade 2b or 3 and clinically as improvement in neurological deficits.

Question 104: In SCRN practice, what happens when regulations are updated or changed?

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

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

Question 105: 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
Review the updates, complete any required training, and implement the revised procedures (Correct answer)
Continue using the original method if it still works

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

Question 106: 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?

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

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

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

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 108: 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:

Within the first 90 days (Correct answer)
Risk remains constant over 5 years
At the 1-year mark
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 109: What is the role of oxygen therapy in acute stroke care?

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

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 110: What medication is commonly used for acute stroke patients to prevent complications?

Antiplatelet drugs (Correct answer)
Anticoagulants
Blood pressure medication
Sedatives

Correct answer: Antiplatelet drugs

Antiplatelet drugs, such as aspirin, are commonly used for acute ischemic stroke patients (after ruling out hemorrhage) to prevent further clot formation and reduce the risk of early recurrent stroke. They work by inhibiting platelet aggregation, making the blood less likely to clot. This helps to maintain blood flow and prevent worsening of the ischemic event.

Question 111: Which cranial nerve is responsible for the gag reflex and is commonly affected in lateral medullary (Wallenberg) syndrome?

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

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 112: Which medication is specifically used to reverse dabigatran (a direct thrombin inhibitor) in acute hemorrhagic stroke?

Protamine sulfate
Andexanet alfa
Vitamin K
Idarucizumab (Praxbind) (Correct answer)

Correct answer: Idarucizumab (Praxbind)

Idarucizumab is a specific reversal agent for dabigatran, binding it with high affinity and rapidly neutralizing its anticoagulant effect.

Question 113: Which antiepileptic drug is most commonly used as prophylaxis or treatment for seizures in the early post-stroke period?

Carbamazepine
Levetiracetam (Correct answer)
Valproic acid
Phenobarbital

Correct answer: Levetiracetam

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

Question 114: What are the main causes of ischemic stroke?

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

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

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

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 116: What is hemorrhagic stroke?

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

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

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

Correct answer: Probability and severity of potential harm

Question 118: Which standardized tool is recommended to screen for post-stroke depression in the post-acute setting?

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

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

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

Deep vein thrombosis
Atrial fibrillation recurrence
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 121: 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)
Depend on colleagues to share updates informally
Check regulations only during certification renewal

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 122: The blood-brain barrier (BBB) is primarily maintained by which cell type?

Oligodendrocytes
Neurons
Microglia
Astrocyte end-feet and tight junction endothelial cells (Correct answer)

Correct answer: Astrocyte end-feet and tight junction endothelial cells

Tight junctions between cerebral endothelial cells, supported by astrocyte end-feet, pericytes, and the basement membrane, form the structural basis of the BBB.

Question 123: What is the primary goal of post-acute care in stroke patients?

To control blood pressure
To prevent recurrence of stroke
To help regain independence and improve functionality (Correct answer)
To prepare the patient for discharge

Correct answer: To help regain independence and improve functionality

The primary goal of post-acute care for stroke patients is to maximize their functional recovery and help them regain as much independence as possible in daily life. This is achieved through comprehensive rehabilitation therapies (physical, occupational, speech) designed to address specific deficits and improve mobility, communication, cognitive abilities, and self-care skills.

Question 124: During the hyperacute stroke window, glucose should be monitored because hyperglycemia worsens outcomes. What blood glucose level is generally recommended to treat in acute ischemic stroke?

Greater than 250 mg/dL
Greater than 140 mg/dL
Greater than 200 mg/dL
Greater than 180 mg/dL (Correct answer)

Correct answer: Greater than 180 mg/dL

Blood glucose above 180 mg/dL should be treated in acute ischemic stroke as hyperglycemia worsens infarct size and outcomes.

Question 125: The Modified Rankin Scale (mRS) score of 3 is best described as:

No symptoms at all
Moderate disability requiring some help but able to walk without assistance (Correct answer)
Slight disability but able to carry out all usual duties and activities
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 126: A stroke patient in inpatient rehabilitation is experiencing learned non-use of the affected arm. Which intervention best addresses this?

Passive range-of-motion exercises only
Sling immobilization of the unaffected arm
Constraint-induced movement therapy (CIMT) (Correct answer)
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 127: Which regulatory requirement is UNIVERSAL across all Stroke Certified Registered Nurse practice settings?

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

Correct answer: Maintaining current certification and meeting continuing education requirements

Question 128: Which factor MOST significantly affects the quality of technical outcomes in SCRN practice?

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)
The brand of equipment being used

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

Conduct additional assessment using alternative methods (Correct answer)
Delay reporting until results are favorable
Report the results as definitive anyway
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 130: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting an initial assessment?

To generate documentation for billing purposes
To demonstrate the assessor's expertise
To fulfill administrative paperwork requirements
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 131: What is the role of the stroke nurse during CT imaging for a hyperacute stroke patient?

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

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 132: 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)
Remind the patient of their therapy schedule to refocus attention
Notify the physician and request a psychiatric consult immediately

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

NIH Stroke Scale (NIHSS) (Correct answer)
Hunt and Hess Scale
Modified Rankin Scale (mRS)
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 134: 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 prevents the passage of harmful substances but limits drug access in stroke (Correct answer)
It increases the risk of stroke

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 135: What defines acute care in stroke management?

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

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

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

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

Question 137: What is hyperacute care?

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

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

Increase the infusion rate to complete the dose faster
Administer analgesics and continue monitoring
Stop the tPA infusion and notify the physician immediately (Correct answer)
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 139: Which post-stroke complication is the leading cause of death in the first month after stroke?

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

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

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

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 141: A patient arrives with acute ischemic stroke symptoms. Which blood pressure target is recommended BEFORE IV tPA administration if BP is elevated?

Below 140/80 mmHg
Below 185/110 mmHg (Correct answer)
Below 160/90 mmHg
Below 200/120 mmHg

Correct answer: Below 185/110 mmHg

Blood pressure must be below 185/110 mmHg before IV tPA can be safely administered to reduce hemorrhagic transformation risk.

Question 142: During cerebral ischemia, the ischemic penumbra is best defined as:

Irreversibly infarcted tissue at the stroke core
Hypoperfused but potentially viable tissue surrounding the infarct core (Correct answer)
The zone of reactive hyperemia following reperfusion
Necrotic tissue resulting from hemorrhagic transformation

Correct answer: Hypoperfused but potentially viable tissue surrounding the infarct core

The ischemic penumbra is electrically silent but metabolically viable tissue surrounding the infarct core that can be salvaged with timely reperfusion.

Question 143: In Stroke Certified Registered Nurse, what is the PRIMARY purpose of conducting an initial assessment?

To generate documentation for billing purposes
To establish a baseline and identify needs for appropriate action (Correct answer)
To fulfill administrative paperwork requirements
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 144: During hyperacute stroke, a patient's oxygen saturation drops to 93%. What is the nurse's priority intervention?

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

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

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

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

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

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

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

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

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

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

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

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

Question 150: A stroke survivor is being discharged to home with dysphagia. Which instruction is most important for the caregiver?

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

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

55–65%
5–10%
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 152: 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 increase cerebral perfusion pressure
To reduce cerebral metabolic rate
To limit hematoma expansion and improve outcomes (Correct answer)
To prevent vasospasm

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

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

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

Question 154: Which clinical finding in an acute stroke patient suggests hemorrhagic transformation of an ischemic infarct?

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

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 155: A patient develops seizures 12 hours after an ischemic stroke. Which nursing intervention takes priority?

Restrain the patient to prevent injury
Administer an antiepileptic drug as ordered and protect the airway (Correct answer)
Increase the IV fluid rate
Perform a 12-lead ECG immediately

Correct answer: Administer an antiepileptic drug as ordered and protect the airway

Seizure management priorities are airway protection and prompt administration of ordered antiepileptics to terminate the seizure and prevent recurrence.

Question 156: When assessment results for a Stroke Certified Registered Nurse evaluation are inconclusive, the BEST practice is to:

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

Correct answer: Conduct additional assessment using alternative methods

Question 157: 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 fresh frozen plasma immediately
Slow the infusion rate and monitor closely
Administer antihypertensive medication and continue infusion

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 158: What is the role of neuroimaging in acute care?

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

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

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

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

Question 160: Cerebral autoregulation maintains constant cerebral blood flow across which range of mean arterial pressure (MAP)?

70–120 mmHg
40–60 mmHg
50–150 mmHg (Correct answer)
100–200 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 161: A patient recovering from a right hemispheric stroke demonstrates left-sided neglect. Which rehabilitation strategy is evidence-based?

Patching the patient's right eye to force left-field attention
Avoiding stimulation from the left side entirely
Placing all essential items on the patient's right side only
Prism adaptation therapy (Correct answer)

Correct answer: Prism adaptation therapy

Prism adaptation therapy shifts the patient's spatial reference frame and has evidence for reducing hemispatial neglect.

Question 162: A patient presents with pure motor hemiplegia affecting the face, arm, and leg equally with no cortical signs. Which location is the infarct most likely in?

Cortex of the middle cerebral artery territory
Posterior limb of the internal capsule (Correct answer)
Thalamus
Occipital lobe

Correct answer: Posterior limb of the internal capsule

A lacunar infarct in the posterior limb of the internal capsule, where corticospinal fibers are densely packed, causes pure motor hemiplegia affecting face, arm, and leg equally without cortical (aphasia, neglect, visual) signs.

Question 163: 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 hour
Every 5 minutes
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 164: Nimodipine is routinely administered after subarachnoid hemorrhage. Its primary mechanism of benefit is:

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

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

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

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 166: 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?

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

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 167: A SCRN is reviewing a post-stroke patient's home medication list and notes the patient is taking warfarin for atrial fibrillation. The INR today is 1.4. What is the appropriate interpretation?

No action is needed as the INR is within normal lab range
The INR is therapeutic for stroke prevention in AF
The INR is subtherapeutic and requires dose adjustment (Correct answer)
The INR is supratherapeutic and warfarin should be held

Correct answer: The INR is subtherapeutic and requires dose adjustment

The therapeutic INR range for stroke prevention in atrial fibrillation is 2.0–3.0; an INR of 1.4 is subtherapeutic and warrants a dose adjustment.

Question 168: A patient with acute stroke is NPO pending swallow evaluation. Which IV fluid is contraindicated due to risk of cerebral edema?

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

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

To determine when rehabilitation should begin
To monitor for complications and stabilize the patient (Correct answer)
To prevent patient discomfort
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 170: 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:

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

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 171: How does early administration of tPA affect patient outcomes?

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

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.

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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