BARKLEY SCRN STROKE CERTIFICATION PRACTICE EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Acute Stroke Assessment and Stabilization
Ischemic Stroke Pathophysiology and Management
Hemorrhagic Stroke Management
Neurovascular Anatomy and Clinical Syndromes
Secondary Prevention and Risk Factor Modification
Post-Stroke Complications and Rehabilitation
Pharmacology and Thrombolytic Therapy
Ethical, Legal, and Professional Standards in Stroke Care
Quality Improvement and Systems of Care
Introduction
This comprehensive examination is designed to rigorously assess the knowledge and clinical decision-making skills
essential for the Stroke Certified Registered Nurse (SCRN). The exam covers foundational neurovascular science,
acute and chronic management strategies, and complex patient scenarios. Through a blend of theoretical
questions and realistic case studies, candidates will demonstrate their ability to synthesize information, prioritize
interventions, and apply evidence-based guidelines in the fast-paced stroke care environment. This assessment
emphasizes the application of specialized knowledge to improve patient outcomes, ensuring the test-taker is
prepared to lead and excel in the multidisciplinary stroke team.
,SECTION ONE: QUESTIONS 1-100
1. A 68-year-old patient presents with acute onset of right-sided weakness and expressive aphasia. The patient's
last known well (LKW) time was 2.5 hours ago. The patient is a candidate for IV alteplase. Which of the following
would be an absolute contraindication to its administration?
A. History of a seizure at the time of symptom onset
B. A blood glucose level of 85 mg/dL
C. Current use of an oral anticoagulant with an INR of 1.1
D. A baseline NIHSS score of 22
🟢A
🔴 RATIONALE: Seizure at symptom onset is a relative, not absolute, contraindication unless the diagnosis of
stroke is in question. An INR of 1.1 is within the acceptable range for thrombolysis. A baseline NIHSS of 22 is
not a contraindication. The absolute contraindication listed is the use of an oral anticoagulant only if the INR is
>1.7.
2. A patient is suspected of having an acute ischemic stroke. Which of the following is the most important factor
in determining a patient's eligibility for mechanical thrombectomy?
A. The patient's baseline level of consciousness
B. The patient's age and premorbid functional status
,C. The presence of a large vessel occlusion (LVO) on vascular imaging
D. The patient's blood pressure on arrival
🟢C
🔴 RATIONALE: The presence of a large vessel occlusion (LVO) is the primary target for mechanical
thrombectomy. While other factors like age and NIHSS are considered, the key determining factor for the
procedure's anatomical feasibility is the identification of an LVO.
3. A nurse is caring for a patient with a subarachnoid hemorrhage (SAH) from a ruptured aneurysm. The patient
is on nimodipine. What is the primary purpose of this medication in this patient population?
A. To reduce blood pressure to prevent re-bleeding
B. To prevent delayed cerebral ischemia (DCI) by improving collateral circulation
C. To reduce cerebral edema and intracranial pressure
D. To prevent seizures in the acute phase of SAH
🟢B
🔴 RATIONALE: Nimodipine is a calcium channel blocker that has been shown to improve outcomes in SAH
patients by reducing the incidence and severity of delayed cerebral ischemia (DCI), likely through its
vasodilatory effects on cerebral vessels.
, 4. Which of the following assessment findings is most concerning for a patient who has just received IV
alteplase for an acute ischemic stroke?
A. Mild headache
B. Blood pressure of 150/90 mmHg
C. Sudden onset of severe nausea
D. Gingival bleeding
🟢D
🔴 RATIONALE: Gingival bleeding is a sign of systemic fibrinolysis and is a potential precursor to more serious
bleeding, such as intracranial hemorrhage. While a headache and nausea can be common, the presence of any
bleeding, even minor, requires immediate reassessment and notification of the provider.
5. A patient presents with a left homonymous hemianopsia, left-sided neglect, and a left facial droop. The
patient is right-handed. Which cerebral artery is most likely involved?
A. Right Middle Cerebral Artery (MCA)
B. Left Middle Cerebral Artery (MCA)
C. Right Posterior Cerebral Artery (PCA)
D. Anterior Cerebral Artery (ACA)
🟢A
ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Acute Stroke Assessment and Stabilization
Ischemic Stroke Pathophysiology and Management
Hemorrhagic Stroke Management
Neurovascular Anatomy and Clinical Syndromes
Secondary Prevention and Risk Factor Modification
Post-Stroke Complications and Rehabilitation
Pharmacology and Thrombolytic Therapy
Ethical, Legal, and Professional Standards in Stroke Care
Quality Improvement and Systems of Care
Introduction
This comprehensive examination is designed to rigorously assess the knowledge and clinical decision-making skills
essential for the Stroke Certified Registered Nurse (SCRN). The exam covers foundational neurovascular science,
acute and chronic management strategies, and complex patient scenarios. Through a blend of theoretical
questions and realistic case studies, candidates will demonstrate their ability to synthesize information, prioritize
interventions, and apply evidence-based guidelines in the fast-paced stroke care environment. This assessment
emphasizes the application of specialized knowledge to improve patient outcomes, ensuring the test-taker is
prepared to lead and excel in the multidisciplinary stroke team.
,SECTION ONE: QUESTIONS 1-100
1. A 68-year-old patient presents with acute onset of right-sided weakness and expressive aphasia. The patient's
last known well (LKW) time was 2.5 hours ago. The patient is a candidate for IV alteplase. Which of the following
would be an absolute contraindication to its administration?
A. History of a seizure at the time of symptom onset
B. A blood glucose level of 85 mg/dL
C. Current use of an oral anticoagulant with an INR of 1.1
D. A baseline NIHSS score of 22
🟢A
🔴 RATIONALE: Seizure at symptom onset is a relative, not absolute, contraindication unless the diagnosis of
stroke is in question. An INR of 1.1 is within the acceptable range for thrombolysis. A baseline NIHSS of 22 is
not a contraindication. The absolute contraindication listed is the use of an oral anticoagulant only if the INR is
>1.7.
2. A patient is suspected of having an acute ischemic stroke. Which of the following is the most important factor
in determining a patient's eligibility for mechanical thrombectomy?
A. The patient's baseline level of consciousness
B. The patient's age and premorbid functional status
,C. The presence of a large vessel occlusion (LVO) on vascular imaging
D. The patient's blood pressure on arrival
🟢C
🔴 RATIONALE: The presence of a large vessel occlusion (LVO) is the primary target for mechanical
thrombectomy. While other factors like age and NIHSS are considered, the key determining factor for the
procedure's anatomical feasibility is the identification of an LVO.
3. A nurse is caring for a patient with a subarachnoid hemorrhage (SAH) from a ruptured aneurysm. The patient
is on nimodipine. What is the primary purpose of this medication in this patient population?
A. To reduce blood pressure to prevent re-bleeding
B. To prevent delayed cerebral ischemia (DCI) by improving collateral circulation
C. To reduce cerebral edema and intracranial pressure
D. To prevent seizures in the acute phase of SAH
🟢B
🔴 RATIONALE: Nimodipine is a calcium channel blocker that has been shown to improve outcomes in SAH
patients by reducing the incidence and severity of delayed cerebral ischemia (DCI), likely through its
vasodilatory effects on cerebral vessels.
, 4. Which of the following assessment findings is most concerning for a patient who has just received IV
alteplase for an acute ischemic stroke?
A. Mild headache
B. Blood pressure of 150/90 mmHg
C. Sudden onset of severe nausea
D. Gingival bleeding
🟢D
🔴 RATIONALE: Gingival bleeding is a sign of systemic fibrinolysis and is a potential precursor to more serious
bleeding, such as intracranial hemorrhage. While a headache and nausea can be common, the presence of any
bleeding, even minor, requires immediate reassessment and notification of the provider.
5. A patient presents with a left homonymous hemianopsia, left-sided neglect, and a left facial droop. The
patient is right-handed. Which cerebral artery is most likely involved?
A. Right Middle Cerebral Artery (MCA)
B. Left Middle Cerebral Artery (MCA)
C. Right Posterior Cerebral Artery (PCA)
D. Anterior Cerebral Artery (ACA)
🟢A
