SCRN STROKE NURSE EXAM 2026 |
COMPREHENSIVE TEST BANK | QUESTIONS AND
ANSWER AND EXPLAINED RATIONALS ON
ANATOMY, PHYSIOLOGY, AND
PATHOPHYSIOLOGY
1. Which cerebral artery territory is most characteristically associated with predominant
contralateral leg weakness?
A) Anterior cerebral artery
B) Middle cerebral artery
C) Posterior cerebral artery
D) Superior cerebellar artery
Correct Answer: Anterior cerebral artery
Rationale: The anterior cerebral artery supplies the medial frontal and parietal regions,
including the motor and sensory areas representing the contralateral lower extremity.
Therefore, ACA infarction commonly produces leg-predominant weakness and sensory loss.
MCA infarction more often produces face and upper-extremity deficits, particularly when the
lateral cerebral cortex is affected.
2. A lesion involving the dominant middle cerebral artery most commonly produces which
additional deficit?
A) Ipsilateral limb ataxia
B) Expressive or receptive aphasia
C) Isolated bilateral blindness
D) Contralateral hearing loss
Correct Answer: Expressive or receptive aphasia
Rationale: The dominant hemisphere, usually the left hemisphere, contains cortical language
networks supplied substantially by the MCA. Infarction can therefore produce aphasia,
depending on the affected cortical region. MCA strokes may also cause contralateral face
and arm weakness, sensory deficits, gaze deviation, and visual-field abnormalities.
3. What is the primary significance of the ischemic penumbra?
,A) It represents permanently infarcted tissue.
B) It consists exclusively of hemorrhagic tissue.
C) It contains dysfunctional but potentially salvageable tissue.
D) It represents tissue unaffected by reduced perfusion.
Correct Answer: It contains dysfunctional but potentially salvageable tissue.
Rationale: The ischemic penumbra surrounds the infarct core and has impaired function
because of reduced perfusion but remains potentially viable. Rapid reperfusion can preserve
some of this tissue. The distinction between infarct core and penumbra is central to time-
sensitive stroke treatment and selected imaging-based treatment decisions.
4. Which mechanism is most directly responsible for neuronal injury during cerebral
ischemia?
A) Reduced catecholamine release
B) Increased cerebrospinal-fluid production
C) Decreased intracellular calcium
D) Excitotoxicity with calcium influx
Correct Answer: Excitotoxicity with calcium influx
Rationale: Ischemia reduces ATP production and disrupts cellular ion pumps. Excess
extracellular glutamate stimulates receptors that promote intracellular calcium
accumulation, initiating enzymatic and mitochondrial injury. This excitotoxic cascade
contributes to neuronal death and helps explain why rapid restoration of cerebral perfusion
is critical.
5. Occlusion of the posterior inferior cerebellar artery is classically associated with which
syndrome?
A) Wallenberg syndrome
B) Gerstmann syndrome
C) Weber syndrome
D) Korsakoff syndrome
Correct Answer: Wallenberg syndrome
Rationale: Wallenberg syndrome results from infarction of the lateral medulla, most
commonly involving the PICA territory. Findings may include ipsilateral facial sensory loss,
contralateral body sensory loss, dysphagia, hoarseness, vertigo, ataxia, and Horner
syndrome. Recognizing this pattern helps localize posterior-circulation stroke.
,6. Which finding most strongly suggests a stroke mimic rather than an acute ischemic
stroke?
A) Sudden unilateral facial droop
B) Abrupt aphasia
C) Progressive focal deficit with documented onset
D) Hypoglycemia associated with neurologic deficits
Correct Answer: Hypoglycemia associated with neurologic deficits
Rationale: Hypoglycemia can produce focal neurologic findings that closely resemble stroke.
Blood glucose is therefore checked rapidly during suspected stroke evaluation. Correcting
hypoglycemia may resolve the neurologic deficits, distinguishing the mimic from persistent
cerebral ischemia.
7. Which structure is primarily responsible for coordinating balance, posture, and fine
motor control?
A) Cerebellum
B) Hippocampus
C) Thalamus
D) Hypothalamus
Correct Answer: Cerebellum
Rationale: The cerebellum coordinates movement, balance, posture, and motor learning
rather than initiating voluntary movement directly. Cerebellar stroke can cause ataxia,
dysmetria, vertigo, and gait disturbance. Large cerebellar infarctions can also cause
dangerous posterior-fossa swelling and brainstem compression.
8. Which stroke mechanism is most strongly associated with atrial fibrillation?
A) Lacunar infarction
B) Cardioembolic ischemic stroke
C) Watershed infarction
D) Venous sinus thrombosis
Correct Answer: Cardioembolic ischemic stroke
Rationale: Atrial fibrillation promotes blood stasis in the atria, particularly the left atrial
appendage, allowing thrombus formation. Emboli can subsequently travel through the
, arterial circulation to the cerebral vessels. Cardioembolic strokes may involve large arterial
territories and can have a higher risk of hemorrhagic transformation.
9. Which feature distinguishes transient ischemic attack from completed ischemic stroke in
the modern tissue-based definition?
A) Presence of severe hypertension
B) Presence of aphasia
C) Absence of persistent infarction on appropriate brain imaging
D) Duration exceeding 24 hours
Correct Answer: Absence of persistent infarction on appropriate brain imaging
Rationale: TIA is defined by transient neurologic dysfunction caused by focal ischemia
without acute infarction, rather than simply by symptom duration. A brief episode can still
produce infarction and therefore qualify as ischemic stroke. This tissue-based approach is
clinically important for determining urgency of evaluation and prevention.
10. Which process best describes neuroplasticity after stroke?
A) Permanent neuronal inactivity
B) Destruction of all surrounding neurons
C) Progressive cerebral hemorrhage
D) Reorganization of neural networks to support recovery
Correct Answer: Reorganization of neural networks to support recovery
Rationale: Neuroplasticity refers to the nervous system's ability to reorganize structurally and
functionally after injury. Surviving neural networks can strengthen alternative pathways and
adapt to lost functions. Rehabilitation uses repetitive, meaningful activity to encourage
beneficial neuroplastic changes.
11. Which vascular territory most commonly causes contralateral homonymous
hemianopia when the primary visual cortex is affected?
A) Posterior cerebral artery
B) Anterior cerebral artery
C) Anterior choroidal artery
D) Middle meningeal artery
Correct Answer: Posterior cerebral artery
COMPREHENSIVE TEST BANK | QUESTIONS AND
ANSWER AND EXPLAINED RATIONALS ON
ANATOMY, PHYSIOLOGY, AND
PATHOPHYSIOLOGY
1. Which cerebral artery territory is most characteristically associated with predominant
contralateral leg weakness?
A) Anterior cerebral artery
B) Middle cerebral artery
C) Posterior cerebral artery
D) Superior cerebellar artery
Correct Answer: Anterior cerebral artery
Rationale: The anterior cerebral artery supplies the medial frontal and parietal regions,
including the motor and sensory areas representing the contralateral lower extremity.
Therefore, ACA infarction commonly produces leg-predominant weakness and sensory loss.
MCA infarction more often produces face and upper-extremity deficits, particularly when the
lateral cerebral cortex is affected.
2. A lesion involving the dominant middle cerebral artery most commonly produces which
additional deficit?
A) Ipsilateral limb ataxia
B) Expressive or receptive aphasia
C) Isolated bilateral blindness
D) Contralateral hearing loss
Correct Answer: Expressive or receptive aphasia
Rationale: The dominant hemisphere, usually the left hemisphere, contains cortical language
networks supplied substantially by the MCA. Infarction can therefore produce aphasia,
depending on the affected cortical region. MCA strokes may also cause contralateral face
and arm weakness, sensory deficits, gaze deviation, and visual-field abnormalities.
3. What is the primary significance of the ischemic penumbra?
,A) It represents permanently infarcted tissue.
B) It consists exclusively of hemorrhagic tissue.
C) It contains dysfunctional but potentially salvageable tissue.
D) It represents tissue unaffected by reduced perfusion.
Correct Answer: It contains dysfunctional but potentially salvageable tissue.
Rationale: The ischemic penumbra surrounds the infarct core and has impaired function
because of reduced perfusion but remains potentially viable. Rapid reperfusion can preserve
some of this tissue. The distinction between infarct core and penumbra is central to time-
sensitive stroke treatment and selected imaging-based treatment decisions.
4. Which mechanism is most directly responsible for neuronal injury during cerebral
ischemia?
A) Reduced catecholamine release
B) Increased cerebrospinal-fluid production
C) Decreased intracellular calcium
D) Excitotoxicity with calcium influx
Correct Answer: Excitotoxicity with calcium influx
Rationale: Ischemia reduces ATP production and disrupts cellular ion pumps. Excess
extracellular glutamate stimulates receptors that promote intracellular calcium
accumulation, initiating enzymatic and mitochondrial injury. This excitotoxic cascade
contributes to neuronal death and helps explain why rapid restoration of cerebral perfusion
is critical.
5. Occlusion of the posterior inferior cerebellar artery is classically associated with which
syndrome?
A) Wallenberg syndrome
B) Gerstmann syndrome
C) Weber syndrome
D) Korsakoff syndrome
Correct Answer: Wallenberg syndrome
Rationale: Wallenberg syndrome results from infarction of the lateral medulla, most
commonly involving the PICA territory. Findings may include ipsilateral facial sensory loss,
contralateral body sensory loss, dysphagia, hoarseness, vertigo, ataxia, and Horner
syndrome. Recognizing this pattern helps localize posterior-circulation stroke.
,6. Which finding most strongly suggests a stroke mimic rather than an acute ischemic
stroke?
A) Sudden unilateral facial droop
B) Abrupt aphasia
C) Progressive focal deficit with documented onset
D) Hypoglycemia associated with neurologic deficits
Correct Answer: Hypoglycemia associated with neurologic deficits
Rationale: Hypoglycemia can produce focal neurologic findings that closely resemble stroke.
Blood glucose is therefore checked rapidly during suspected stroke evaluation. Correcting
hypoglycemia may resolve the neurologic deficits, distinguishing the mimic from persistent
cerebral ischemia.
7. Which structure is primarily responsible for coordinating balance, posture, and fine
motor control?
A) Cerebellum
B) Hippocampus
C) Thalamus
D) Hypothalamus
Correct Answer: Cerebellum
Rationale: The cerebellum coordinates movement, balance, posture, and motor learning
rather than initiating voluntary movement directly. Cerebellar stroke can cause ataxia,
dysmetria, vertigo, and gait disturbance. Large cerebellar infarctions can also cause
dangerous posterior-fossa swelling and brainstem compression.
8. Which stroke mechanism is most strongly associated with atrial fibrillation?
A) Lacunar infarction
B) Cardioembolic ischemic stroke
C) Watershed infarction
D) Venous sinus thrombosis
Correct Answer: Cardioembolic ischemic stroke
Rationale: Atrial fibrillation promotes blood stasis in the atria, particularly the left atrial
appendage, allowing thrombus formation. Emboli can subsequently travel through the
, arterial circulation to the cerebral vessels. Cardioembolic strokes may involve large arterial
territories and can have a higher risk of hemorrhagic transformation.
9. Which feature distinguishes transient ischemic attack from completed ischemic stroke in
the modern tissue-based definition?
A) Presence of severe hypertension
B) Presence of aphasia
C) Absence of persistent infarction on appropriate brain imaging
D) Duration exceeding 24 hours
Correct Answer: Absence of persistent infarction on appropriate brain imaging
Rationale: TIA is defined by transient neurologic dysfunction caused by focal ischemia
without acute infarction, rather than simply by symptom duration. A brief episode can still
produce infarction and therefore qualify as ischemic stroke. This tissue-based approach is
clinically important for determining urgency of evaluation and prevention.
10. Which process best describes neuroplasticity after stroke?
A) Permanent neuronal inactivity
B) Destruction of all surrounding neurons
C) Progressive cerebral hemorrhage
D) Reorganization of neural networks to support recovery
Correct Answer: Reorganization of neural networks to support recovery
Rationale: Neuroplasticity refers to the nervous system's ability to reorganize structurally and
functionally after injury. Surviving neural networks can strengthen alternative pathways and
adapt to lost functions. Rehabilitation uses repetitive, meaningful activity to encourage
beneficial neuroplastic changes.
11. Which vascular territory most commonly causes contralateral homonymous
hemianopia when the primary visual cortex is affected?
A) Posterior cerebral artery
B) Anterior cerebral artery
C) Anterior choroidal artery
D) Middle meningeal artery
Correct Answer: Posterior cerebral artery
