A 69-year-old man in the stroke clinic describes three episodes this week in which a gray shade came down over his right eye for about 5 minutes and then lifted. He had no weakness or speech problems. Which vessel is the MOST likely source of these episodes?

The right internal carotid artery, through emboli to its ophthalmic branch

The right posterior cerebral artery, through ischemia of the visual cortex

The basilar artery, through intermittent flow to both occipital lobes

The left internal carotid artery, through emboli to the left optic radiations

A 58-year-old woman developed right arm numbness and slurred speech at 09:00. Her husband says the symptoms disappeared completely by 09:20 and she went back to gardening. At 11:00 she developed right arm weakness and aphasia, and she arrives in the emergency department at 11:40. Which time should the nurse document as last known well?

11:00, because she had returned fully to baseline before the new symptoms

11:40, because that is when a clinician first confirmed her deficits

09:00, because the first symptoms mark the onset of this stroke event

09:20, because that is when the first set of symptoms was last present

A 67-year-old man is admitted to the stroke unit with a 22-mL left lobar ICH. He has had no clinical seizures and is alert. Which admission order should the nurse question?

Levetiracetam 500 mg IV every 12 hours for seizure prophylaxis

Neuro checks with GCS and pupil assessment every hour for 24 hours

Intermittent pneumatic compression devices to both legs on admission

Nicardipine infusion titrated to a systolic BP of about 140 mm Hg

A 70-year-old woman with atrial fibrillation and moderate mitral stenosis is being discharged from rehabilitation on warfarin. Which statement indicates a need for further teaching?

"I'll stop eating salads and broccoli completely so that the vitamin K won't affect my blood level."

"I'll check with the clinic before taking any new antibiotic, herbal product or pain medicine."

"If I forget a dose and remember the next day, I'll skip it and take my usual dose that day."

"I'll keep eating about the same amount of green vegetables each week and keep my INR appointments."

A 57-year-old man in the emergency department has sudden diplopia, vertigo, slurred speech and inability to sit upright without support; his limb strength is normal and his NIHSS is 2. A staff nurse suggests canceling the code stroke because the score is low. Which response by the stroke nurse is MOST accurate?

Posterior circulation strokes can be disabling or life-threatening even when the NIHSS is low

An NIHSS below 4 rules out a large-vessel occlusion, so the code stroke can be canceled

The NIHSS measures brainstem function precisely, so a score of 2 indicates a minor brainstem stroke

These symptoms are typical of an inner ear disorder and should be reassessed after meclizine

A daughter tells the ED nurse that her 77-year-old father seemed fine at breakfast at 07:30. She found him unable to speak at 10:40. On further questioning, she says she spoke with him on the phone at 09:15 and he chatted normally about his garden. Which time should the nurse document as last known well?

09:15, the last confirmed time he was at his neurological baseline

10:40, the time his daughter discovered that he was unable to speak

09:05, the midpoint between breakfast and the time he was discovered

07:30, the last time a family member saw him in person at baseline

A 46-year-old woman with a CTA-confirmed ruptured posterior communicating artery aneurysm is awaiting coiling. She reports severe headache and her blood pressure is 178/96 mm Hg. Which action is MOST appropriate?

Treat pain and start a titratable antihypertensive to keep systolic pressure below about 160

Give a large isotonic fluid bolus and then recheck her blood pressure in 1 hour

Allow her pressure to remain elevated to support perfusion until the vasospasm window begins

Start a vasopressor infusion to raise her mean arterial pressure and prevent early ischemia

A 68-year-old woman on the stroke unit with a history of post-stroke seizures begins having a generalized tonic-clonic seizure while a newly hired nurse is in the room. Which action by the new nurse requires the charge nurse to intervene?

Inserting a padded tongue blade between her teeth to keep her from biting her tongue

Noting the time the seizure began and observing which body parts are involved first

Turning her onto her side and moving the bedside table and IV pole away from the bed

Lowering the bed to its lowest position while keeping the padded side rails raised

Two months after a left MCA stroke, a 63-year-old man in outpatient rehabilitation catches the toes of his right foot when he walks and has nearly fallen twice. His right ankle can be moved passively to a neutral position. Which recommendation should the nurse anticipate from the physical therapist?

An ankle-foot orthosis that holds the ankle near neutral while he walks

A knee immobilizer worn during the day so that the right knee stays straight

A wheelchair for all distances until his right leg strength returns to normal

Soft slippers instead of shoes so that he can feel the floor with his toes

SCRN Exam

Free SCRN Practice Questions

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

Sections covered on the exam: Neurovascular Anatomy and Brain Structure, Stroke Types, Syndromes, Mimics and Pathophysiology, Hyperacute Triage, Assessment and Diagnostics, Thrombolysis, Thrombectomy and Hyperacute Ischemic Care, Hyperacute Hemorrhagic Care, Complications, Metrics and Disposition, Acute Assessment and Ischemic and Hemorrhagic Management, Acute Plan of Care, Psychosocial Care, Education and Early Rehabilitation, Primary and Secondary Stroke Prevention.

Question 1 · Neurovascular Anatomy and Brain Structure
A 69-year-old man in the stroke clinic describes three episodes this week in which a gray shade came down over his right eye for about 5 minutes and then lifted. He had no weakness or speech problems. Which vessel is the MOST likely source of these episodes?
- A.The right posterior cerebral artery, through ischemia of the visual cortex
- B.The basilar artery, through intermittent flow to both occipital lobes
- C.The left internal carotid artery, through emboli to the left optic radiations
- D.The right internal carotid artery, through emboli to its ophthalmic branch
Show answer and explanation
Answer: D. The right internal carotid artery, through emboli to its ophthalmic branch
Transient monocular vision loss (amaurosis fugax) is a retinal TIA from emboli entering the ophthalmic artery, the first intracranial branch of the ipsilateral internal carotid, so the right eye points to the right carotid. Lesions of the optic radiations, occipital cortex or posterior cerebral artery produce homonymous field defects in both eyes, not monocular loss, and basilar ischemia typically affects both visual fields.
Question 2 · Hyperacute Triage, Assessment and Diagnostics
A 58-year-old woman developed right arm numbness and slurred speech at 09:00. Her husband says the symptoms disappeared completely by 09:20 and she went back to gardening. At 11:00 she developed right arm weakness and aphasia, and she arrives in the emergency department at 11:40. Which time should the nurse document as last known well?
- A.11:00, because she had returned fully to baseline before the new symptoms
- B.11:40, because that is when a clinician first confirmed her deficits
- C.09:00, because the first symptoms mark the onset of this stroke event
- D.09:20, because that is when the first set of symptoms was last present
Show answer and explanation
Answer: A. 11:00, because she had returned fully to baseline before the new symptoms
When deficits resolve completely and the patient returns to baseline, the last known well clock resets to the onset of the new symptoms, here 11:00. If her symptoms had only improved without full resolution, 09:00 would remain the LKW. The time symptoms resolved and the arrival time are never the LKW.
Question 3 · Hyperacute Hemorrhagic Care, Complications, Metrics and Disposition
A 77-year-old man is brought to the emergency department after his daughter found him vomiting and unsteady. Noncontrast CT and the initial examination produce the following findings.
Finding Result
GCS Eye 3, verbal 4, motor 5
Hematoma location Left cerebellar hemisphere
ABC/2 volume 12 mL
Intraventricular blood None
Medications Amlodipine, aspirin
Based on the case, what is this patient's ICH score?
- A.1
- B.4
- C.3
- D.2
Show answer and explanation
Answer: D. 2
GCS is 3 + 4 + 5 = 12, which falls in the 5-12 band for 1 point. The volume of 12 mL is below 30 mL (0 points), there is no IVH (0), the cerebellar location is infratentorial (1 point), and age 77 is below 80 (0), so the total is 1 + 1 = 2. A total of 1 misses the infratentorial point, and 3 or 4 wrongly add points for volume, IVH or age.
Question 4 · Acute Assessment and Ischemic and Hemorrhagic Management
A 67-year-old man is admitted to the stroke unit with a 22-mL left lobar ICH. He has had no clinical seizures and is alert. Which admission order should the nurse question?
- A.Neuro checks with GCS and pupil assessment every hour for 24 hours
- B.Intermittent pneumatic compression devices to both legs on admission
- C.Nicardipine infusion titrated to a systolic BP of about 140 mm Hg
- D.Levetiracetam 500 mg IV every 12 hours for seizure prophylaxis
Show answer and explanation
Answer: D. Levetiracetam 500 mg IV every 12 hours for seizure prophylaxis
Prophylactic antiseizure medication is not recommended after ICH in a patient who has not had a seizure; clinical seizures are treated, and EEG is used when consciousness is unexplained. Pneumatic compression on admission, a systolic target near 140 mm Hg and hourly neuro checks are all consistent with guideline-based ICH care.
Question 5 · Acute Plan of Care, Psychosocial Care, Education and Early Rehabilitation
A 70-year-old woman with atrial fibrillation and moderate mitral stenosis is being discharged from rehabilitation on warfarin. Which statement indicates a need for further teaching?
- A."I'll check with the clinic before taking any new antibiotic, herbal product or pain medicine."
- B."If I forget a dose and remember the next day, I'll skip it and take my usual dose that day."
- C."I'll keep eating about the same amount of green vegetables each week and keep my INR appointments."
- D."I'll stop eating salads and broccoli completely so that the vitamin K won't affect my blood level."
Show answer and explanation
Answer: D. "I'll stop eating salads and broccoli completely so that the vitamin K won't affect my blood level."
Warfarin diet teaching is about a consistent vitamin K intake, not avoiding leafy greens; eliminating them abruptly makes the INR rise and become unstable. Steady weekly intake with regular INR checks, checking new drugs and supplements for interactions, and skipping rather than doubling a dose remembered the next day are all correct.
Question 6 · Neurovascular Anatomy and Brain Structure
A 57-year-old man in the emergency department has sudden diplopia, vertigo, slurred speech and inability to sit upright without support; his limb strength is normal and his NIHSS is 2. A staff nurse suggests canceling the code stroke because the score is low. Which response by the stroke nurse is MOST accurate?
- A.An NIHSS below 4 rules out a large-vessel occlusion, so the code stroke can be canceled
- B.The NIHSS measures brainstem function precisely, so a score of 2 indicates a minor brainstem stroke
- C.These symptoms are typical of an inner ear disorder and should be reassessed after meclizine
- D.Posterior circulation strokes can be disabling or life-threatening even when the NIHSS is low
Show answer and explanation
Answer: D. Posterior circulation strokes can be disabling or life-threatening even when the NIHSS is low
The NIHSS weights limb strength, language and neglect and captures vertigo, diplopia, truncal ataxia and dysphagia poorly, so a vertebrobasilar stroke can score very low despite a basilar or vertebral occlusion. A low score does not exclude a large-vessel occlusion, sudden diplopia with dysarthria and truncal ataxia is not a benign inner ear picture, and the scale is not a precise measure of brainstem function.
Question 7 · Hyperacute Triage, Assessment and Diagnostics
A daughter tells the ED nurse that her 77-year-old father seemed fine at breakfast at 07:30. She found him unable to speak at 10:40. On further questioning, she says she spoke with him on the phone at 09:15 and he chatted normally about his garden. Which time should the nurse document as last known well?
- A.10:40, the time his daughter discovered that he was unable to speak
- B.09:05, the midpoint between breakfast and the time he was discovered
- C.07:30, the last time a family member saw him in person at baseline
- D.09:15, the last confirmed time he was at his neurological baseline
Show answer and explanation
Answer: D. 09:15, the last confirmed time he was at his neurological baseline
Last known well is the last time the patient was confirmed to be at baseline, and a reliable specific observation such as a normal phone conversation counts, making 09:15 the LKW. The time of discovery is never the LKW unless he was normal at that moment. Using the earlier breakfast time could wrongly remove him from a treatment window, and midpoints are not used for LKW in this situation.
Question 8 · Hyperacute Hemorrhagic Care, Complications, Metrics and Disposition
A 46-year-old woman with a CTA-confirmed ruptured posterior communicating artery aneurysm is awaiting coiling. She reports severe headache and her blood pressure is 178/96 mm Hg. Which action is MOST appropriate?
- A.Give a large isotonic fluid bolus and then recheck her blood pressure in 1 hour
- B.Allow her pressure to remain elevated to support perfusion until the vasospasm window begins
- C.Start a vasopressor infusion to raise her mean arterial pressure and prevent early ischemia
- D.Treat pain and start a titratable antihypertensive to keep systolic pressure below about 160
Show answer and explanation
Answer: D. Treat pain and start a titratable antihypertensive to keep systolic pressure below about 160
Before the aneurysm is secured, rebleeding risk is highest, and blood pressure is commonly kept below about 160 systolic (some protocols lower) with pain control and a titratable agent. Permissive hypertension and vasopressors raise rebleeding risk in an unsecured aneurysm, and a fluid bolus does nothing to reduce pressure on the aneurysm wall.
Question 9 · Acute Assessment and Ischemic and Hemorrhagic Management
A 68-year-old woman on the stroke unit with a history of post-stroke seizures begins having a generalized tonic-clonic seizure while a newly hired nurse is in the room. Which action by the new nurse requires the charge nurse to intervene?
- A.Inserting a padded tongue blade between her teeth to keep her from biting her tongue
- B.Noting the time the seizure began and observing which body parts are involved first
- C.Turning her onto her side and moving the bedside table and IV pole away from the bed
- D.Lowering the bed to its lowest position while keeping the padded side rails raised
Show answer and explanation
Answer: A. Inserting a padded tongue blade between her teeth to keep her from biting her tongue
Nothing should be placed in the mouth during a seizure, because it can break teeth, injure the mouth or obstruct the airway, and the tongue cannot be swallowed. Side-lying positioning to drain secretions, clearing nearby objects, timing and describing the seizure, and a low bed with padded rails are correct seizure precautions.
Question 10 · Acute Plan of Care, Psychosocial Care, Education and Early Rehabilitation
Two months after a left MCA stroke, a 63-year-old man in outpatient rehabilitation catches the toes of his right foot when he walks and has nearly fallen twice. His right ankle can be moved passively to a neutral position. Which recommendation should the nurse anticipate from the physical therapist?
- A.A knee immobilizer worn during the day so that the right knee stays straight
- B.A wheelchair for all distances until his right leg strength returns to normal
- C.An ankle-foot orthosis that holds the ankle near neutral while he walks
- D.Soft slippers instead of shoes so that he can feel the floor with his toes
Show answer and explanation
Answer: C. An ankle-foot orthosis that holds the ankle near neutral while he walks
Foot drop from weak ankle dorsiflexors makes the toes catch during swing, and an ankle-foot orthosis that holds the ankle near neutral improves foot clearance and safety when the ankle can reach neutral. A knee immobilizer does not lift the foot, giving up walking promotes deconditioning, and slippers increase the risk of tripping.

Finding	Result
GCS	Eye 3, verbal 4, motor 5
Hematoma location	Left cerebellar hemisphere
ABC/2 volume	12 mL
Intraventricular blood	None
Medications	Amlodipine, aspirin

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