SCRN Exam Flashcards

Q: What is the SCRN exam pass rate?

ABNN reports a 71% overall SCRN pass rate over the past 5 years; 2024 data showed 932 passes out of 1,389 test takers. The exam uses a criterion-referenced scaled score with a passing point of 200, not a fixed percent correct. Results are not reported as a simple percentage because the raw cut score can vary by exam form.

Q: How many questions are on the SCRN exam?

The SCRN exam has 170 multiple-choice items: 150 scored questions and 20 unscored pretest questions, delivered over 3 hours (about 64 seconds per item). Pretest items are not labeled, so candidates should treat every question as if it counts toward the score.

Q: What does the SCRN exam cover?

The 2026 SCRN blueprint has five domains scored across 150 items: Anatomy/Physiology/Pathophysiology (28 items), Hyperacute Care (42), Acute Care (42), Post-acute Care (19), and Primary/Secondary Preventative Care (19). Hyperacute and Acute Care together make up 84 of the 150 scored items.

Q: Who is eligible to take the SCRN exam?

ABNN requires a current unrestricted RN license plus one year of full-time (2,080 hours) direct or indirect stroke nursing practice within the previous 3 years. Indirect practice can include stroke-focused supervision, education, research, consultation, or administration. International candidates may qualify with verified licensure equivalency.

Q: How long is SCRN certification valid?

SCRN certification is valid for 5 years and expires on December 31 of the fifth year after certification. Candidates may test only once per exam window and no more than three times in any 12-month period; a repeat attempt requires a new application and full fee.

Question 1

Last Known Well (LKW)

Accepted Answer

The last time the patient was confirmed at neurologic baseline, NOT the time symptoms were discovered. If a patient was normal at 2230 and woke aphasic at 0700, LKW is 2230. LKW drives thrombolytic and thrombectomy eligibility decisions.

Question 2

Code Stroke Activation Timing

Accepted Answer

Activate the stroke pathway as soon as a new focal deficit is suspected—not after imaging confirms ischemic stroke. Aspirin, oral intake, and routine admission tasks must not delay hemorrhage exclusion or reperfusion screening.

Question 3

BE-FAST Stroke Screen

Accepted Answer

Balance, Eyes, Face, Arm, Speech, Time. A normal face-arm-speech check does not make a patient safe: posterior circulation strokes can present with isolated imbalance, diplopia, or dysphagia and still be time-critical.

Question 4

Point-of-Care Glucose in Code Stroke

Accepted Answer

An immediate triage priority because severe hypoglycemia can mimic focal weakness, speech change, or altered mental status. Treat abnormal glucose and reassess the deficit before the team commits to thrombolytic therapy.

Question 5

Stroke Mimics

Accepted Answer

Nonvascular processes that resemble stroke: hypoglycemia, postictal (Todd) paralysis, complex migraine, infection, intoxication, and functional symptoms. Assess them rapidly without delaying stroke activation—treat as stroke until proven otherwise.

Question 6

NIH Stroke Scale (NIHSS)

Accepted Answer

A standardized scale that quantifies stroke severity and trends neurologic change. A low total can still miss disabling aphasia, visual loss, neglect, or posterior circulation danger, so bedside surveillance must supplement the number.

Question 7

Neurologic Baseline vs Normal

Accepted Answer

A meaningful neuro assessment compares the current exam to the documented baseline, not only to textbook normal. Worsening relative to that patient's baseline—even if still 'abnormal'—is the trend that triggers escalation.

Question 8

Cushing's Triad (Late ICP)

Accepted Answer

Widening pulse pressure (rising systolic, falling diastolic), bradycardia, and irregular respirations. A late, ominous sign of rising intracranial pressure—escalate immediately and prepare for urgent imaging and possible neurosurgical intervention.

Question 9

Deterioration Cues Requiring Escalation

Accepted Answer

New decreased consciousness, worsening NIHSS elements, severe headache, vomiting, seizure, pupillary change, or new focal deficit. Stop routine tasks, reassess ABCs/glucose/vitals, notify the stroke team, and prepare for imaging.

Question 10

Aphasia vs Dysarthria

Accepted Answer

Aphasia is impaired language processing (comprehension or expression), usually from dominant-hemisphere injury. Dysarthria is impaired speech motor output with intact language. Confusing them leads to inaccurate assessment and unsafe education.

Question 11

MCA (Middle Cerebral Artery) Stroke

Accepted Answer

Contralateral face and arm weakness greater than leg, gaze deviation, and sensory loss. Dominant hemisphere adds aphasia; nondominant adds neglect and anosognosia. Protect the ignored side and anticipate unsafe transfers.

Question 12

ACA (Anterior Cerebral Artery) Stroke

Accepted Answer

Contralateral leg weakness greater than arm, abulia (impaired initiation), frontal behavior change, and urinary symptoms. Do not mistake low initiation for refusal or noncompliance; assess transfer and toileting safety.

Question 13

PCA (Posterior Cerebral Artery) Stroke

Accepted Answer

Homonymous visual field loss, cortical blindness, thalamic sensory pain, and memory changes. Screen for visual neglect, reading difficulty, and unsafe ambulation related to the field cut.

Question 14

Vertebrobasilar / Posterior Circulation Stroke

Accepted Answer

Dizziness, diplopia, dysarthria, dysphagia, ataxia, or depressed consciousness. Easily under-triaged because symptoms seem less dramatic than hemiplegia. Prioritize airway, swallow risk, and rapid escalation for decline.

Question 15

Basilar Artery Occlusion

Accepted Answer

A neurologic emergency that can progress to quadriplegia, coma, or locked-in syndrome. Subtle early symptoms (dysarthria, diplopia, decreased arousal) can precede catastrophic decline—treat new posterior signs as escalation findings.

Question 16

Lacunar Syndrome

Accepted Answer

Small deep-vessel stroke producing pure motor or sensorimotor deficits WITHOUT cortical signs (no aphasia, neglect, or visual field cut). Trend subtle changes; do not assume a small-appearing stroke is automatically low risk.

Question 17

Infarct Core vs Penumbra

Accepted Answer

The core is irreversibly injured tissue; the penumbra is impaired but potentially salvageable if circulation is restored in time. Saving the penumbra is the rationale for time-critical reperfusion therapy.

Question 18

Transient Ischemic Attack (TIA)

Accepted Answer

Transient focal ischemia whose symptoms resolve without persistent deficit. It is NOT reassuring—it signals unstable cerebrovascular risk requiring urgent evaluation and prompt secondary prevention, not discharge with reassurance alone.

Question 19

Noncontrast CT as the First Imaging Gate

Accepted Answer

Fast and widely available; its primary job is to exclude intracranial hemorrhage before thrombolytic therapy. A normal early CT does NOT rule out disabling ischemia—keep the stroke pathway moving rather than reassuring the patient.

Question 20

CT Angiography (CTA) in Acute Stroke

Accepted Answer

CTA from the aortic arch through the head identifies large-vessel occlusion and vascular anatomy, supporting thrombectomy routing or transfer. Nursing prep: IV access, contrast allergy screen, and rapid transport.

Question 21

CT Perfusion / Mismatch Imaging

Accepted Answer

Identifies infarct core versus salvageable tissue for selected patients with wake-up stroke, unknown onset, or later presentation—expanding reperfusion options beyond simple time windows.

Question 22

Door-to-Needle Goal

Accepted Answer

Target: Stroke / Get With The Guidelines tracks door-to-needle within 60 minutes for treated patients and brain imaging within ~20-25 minutes. The tested behavior is EMS prenotification, single-call activation, and direct-to-CT transport.

Question 23

IV Thrombolysis Time Window

Accepted Answer

Current acute ischemic stroke guidance supports IV alteplase or tenecteplase for eligible patients within the 4.5-hour window, with advanced-imaging selection for some later or unknown-onset cases. Local protocol sets the agent and dosing.

Question 24

Pre-Thrombolytic Nursing Data

Accepted Answer

Confirm last known well, dosing weight, glucose, baseline NIHSS, vitals, anticoagulant use and last dose, allergies, recent surgery/trauma, and IV access—run these in parallel with imaging, never sequentially after it.

Question 25

Thrombolytic Contraindication Red Flags

Accepted Answer

Hemorrhage on imaging, active internal bleeding, recent intracranial/spinal surgery or serious head trauma, severe uncontrolled hypertension, very low platelets, or anticoagulant-related coagulopathy. The nurse escalates these; the provider decides.

Question 26

Blood Pressure Before Thrombolysis

Accepted Answer

Severe hypertension must be lowered to the protocol threshold before IV thrombolysis can proceed, because elevated pressure increases hemorrhage risk. After treatment, follow ordered parameters and report excursions promptly.

Question 27

Post-Thrombolytic Deterioration Signs

Accepted Answer

Severe headache, vomiting, acute hypertension, worsening neurologic status, or tongue/lip swelling (angioedema). Stop the infusion if running, notify urgently, and prepare for airway management and emergent imaging.

Question 28

Large-Vessel Occlusion (LVO) Clues

Accepted Answer

Gaze deviation, dense hemiparesis, global aphasia, severe neglect, depressed consciousness, or a very high NIHSS. A modest NIHSS does not remove concern in posterior or aphasic strokes—activate the team and keep imaging moving.

Question 29

Mechanical Thrombectomy

Accepted Answer

Endovascular clot removal for selected large-vessel-occlusion patients. Current guidance broadens eligibility, so later arrival, wake-up stroke, or early ischemic change does not automatically end the thrombectomy conversation.

Question 30

Door-In-Door-Out (DIDO) Transfer

Accepted Answer

Hospitals without thrombectomy capability must prioritize rapid vascular imaging, telestroke or specialist input, and a fast door-in-door-out transfer for eligible LVO patients—bedside delays cost salvageable tissue.

Question 31

Post-Thrombectomy Nursing Surveillance

Accepted Answer

Neurologic trending, ordered blood pressure management, arterial access-site checks, distal pulse assessment, and bleeding surveillance. Escalate immediately for neurologic decline or access-site hematoma.

Question 32

Blood Pressure in Acute Ischemic Stroke (No Reperfusion)

Accepted Answer

Avoid aggressive normalization because cerebral perfusion may be pressure-dependent. Do not chase a normal outpatient BP in the first hours unless above the protocol threshold or another emergency exists.

Question 33

Inpatient Glucose Target After Stroke

Accepted Answer

Avoid both hyperglycemia and hypoglycemia; many inpatient protocols target roughly 140-180 mg/dL. Guidance cautions against intensive control to 80-130 mg/dL because it adds severe hypoglycemia risk without improving outcome.

Question 34

Fever Management After Stroke

Accepted Answer

Elevated temperature can worsen neurologic injury. Report and treat fever per protocol with normothermia measures and evaluate for infection or other causes—do not treat post-stroke fever as benign.

Question 35

Dysphagia Screening Before Oral Intake

Accepted Answer

All stroke patients need swallowing safety assessed before any oral food, fluids, or medications because silent aspiration is common. Keep NPO until a swallow screen clears the patient.

Question 36

VTE Prophylaxis After Stroke

Accepted Answer

Immobile stroke patients are at venous thromboembolism risk. Eligible patients should receive prophylaxis or have a documented reason for none—a tracked Joint Commission STK quality measure.

Question 37

Intracerebral Hemorrhage (ICH) Priorities

Accepted Answer

Airway, neurologic trend, smooth sustained BP control to limit hematoma expansion, rapid anticoagulant reversal by drug type, hematoma-expansion surveillance, and neurosurgical readiness.

Question 38

Warfarin-Associated ICH Reversal

Accepted Answer

Reversal commonly involves vitamin K plus 4-factor prothrombin complex concentrate. Dabigatran and factor Xa inhibitors have specific reversal strategies. The nurse escalates immediately rather than independently selecting the agent.

Question 39

Subarachnoid Hemorrhage (SAH) Presentation

Accepted Answer

Thunderclap (sudden, worst-ever) headache, meningeal signs, vomiting, photophobia, syncope, or collapse—even when focal weakness is limited. Suspect aneurysmal SAH and escalate urgently.

Question 40

Nimodipine in Aneurysmal SAH

Accepted Answer

Enteral nimodipine is given when ordered to improve outcomes related to delayed cerebral ischemia. Monitor for hypotension after doses and communicate if a dose is held or not tolerated.

Question 41

Rebleeding Prevention Before Aneurysm Securement

Accepted Answer

Before the aneurysm is secured, prevent rebleeding by controlling pain, nausea, agitation, and severe blood pressure elevations while avoiding hypotension. Sudden re-deterioration suggests rebleeding—escalate at once.

Question 42

Cerebellar Stroke Deterioration Risk

Accepted Answer

Cerebellar infarction or hemorrhage can worsen from edema and obstructive hydrocephalus even when early limb strength is preserved. Trend headache, vomiting, and arousal; prevent falls.

Question 43

Early Rehabilitation Timing

Accepted Answer

Formal interdisciplinary rehab assessment begins in the hospital once the patient is medically stable, but high-dose very early mobilization within the first 24 hours of onset can be unsafe—progress activity to neurologic and hemodynamic stability.

Question 44

Neuroplasticity

Accepted Answer

The nervous system's experience-dependent ability to reorganize after injury. Nurses support it by protecting sleep, nutrition, oxygenation, glucose, mood, skin, and participation in safe task-specific practice.

Question 45

Preventable Post-Stroke Complications

Accepted Answer

Aspiration, falls, pressure injury, venous thromboembolism, shoulder injury, delirium, depression, and medication-related bleeding. SCRN items often link a syndrome to its downstream risk (neglect to falls, brainstem to aspiration).

Question 46

Secondary Prevention Is Mechanism-Driven

Accepted Answer

The plan depends on cause: non-cardioembolic, cardioembolic, large-artery, small-vessel, cryptogenic, or hemorrhagic stroke do not use the same regimen. Ask what caused the stroke before choosing therapy.

Question 47

Atrial Fibrillation and Stroke Prevention

Accepted Answer

AF-related (cardioembolic) stroke is usually prevented with anticoagulation, NOT antiplatelet monotherapy. Discharge teaching must reinforce anticoagulant purpose, adherence, bleeding precautions, and follow-up.

Question 48

Dual Antiplatelet Therapy (DAPT) Is Time-Limited

Accepted Answer

DAPT is not a long-term default. It is reserved for selected high-risk scenarios (e.g., early minor stroke or high-risk TIA) as a prescribed short course—teach patients not to continue it indefinitely on their own.

Question 49

Teach-Back Method

Accepted Answer

Asking the patient or caregiver to explain or demonstrate the plan in their own words. It tests how clearly the team taught, not the patient's intelligence, and outperforms asking 'Do you understand?'—essential with aphasia or low health literacy.

Question 50

Joint Commission STK-8 Stroke Education

Accepted Answer

Core discharge education elements: activate EMS for symptoms, follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs/symptoms—adapted to the patient's deficits and health literacy.

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