Free SCRN Exam Questions That Helps Candidates Pass

Comprehensive and Detailed Explanation:

The correct answer is A because a history of gastrointestinal ulceration is classified as a relative contraindication (exclusion criterion) for intravenous alteplase within guidelines. However, a remote, healed ulcer without active bleeding over several years carries a lower risk of hemorrhage, meaning the multidisciplinary team can proceed with thrombolysis if the neurological deficit is severe and disabling, weighing the benefit against potential bleeding risks. Option B is incorrect because remote healed ulcers are relative, not absolute, contraindications. Option C is incorrect because surgical intervention is completely unnecessary. Option D is incorrect because gastrointestinal bleeding history must always be carefully screened during hyperacute evaluations. SCRN nurses master complex screening criteria to ensure patient safety during rapid hyperacute evaluations.

Comprehensive and Detailed Explanation:

The correct answer is A because guidelines mandate that a patient's blood pressure must be maintained at or below 185/110 mmHg prior to the initiation of intravenous alteplase to minimize the risk of symptomatic intracerebral hemorrhage. Because the patient's blood pressure is 190/106 mmHg, intravenous antihypertensives such as labetalol or nicardipine must be administered and blood pressure successfully reduced below the threshold before thrombolysis can be safely started. Option B is incorrect because giving tPA with blood pressure above 185/110 mmHg is a major protocol violation and increases bleeding risk. Option C is incorrect because waiting 24 hours wastes the therapeutic window. Option D is incorrect because craniotomy is not indicated for acute blood pressure elevation. SCRN nurses actively manage blood pressure protocols during hyperacute evaluations.

Comprehensive and Detailed Explanation:

The correct answer is A because a rapid drop in consciousness, accompanied by unilateral pupil dilation (blown pupil) and sluggish reactivity due to compression of the third cranial nerve, along with abnormal motor posturing, are classic hallmark signs of uncal (transtentorial) brain herniation. This medical emergency arises from severe mass effect caused by massive cerebral edema and dangerously elevated intracranial pressure following a large stroke. Option B is incorrect because benign positional vertigo causes brief, episodic spinning sensations without altering consciousness or causing pupil asymmetry. Option C is incorrect because transient ischemic attacks resolve quickly and do not cause progressive coma or pupillary changes. Option D is incorrect because dementia evolves gradually over months or years rather than presenting as an acute, life-threatening neurological catastrophe. SCRN nurses must maintain constant vigilance, perform rigorous serial neurological checks, and immediately report signs of herniation for emergency medical and surgical intervention.

Comprehensive and Detailed Explanation:

The correct answer is A because the patient presents within the crucial 4.5-hour therapeutic window for intravenous alteplase, has a non-diagnostic head CT for hemorrhage, and maintains blood pressure well below the exclusion threshold of 185/110 mmHg. Given the focal neurological deficits suggesting a large vessel occlusion, immediate administration of intravenous thrombolysis combined with concurrent evaluation for mechanical endovascular thrombectomy represents the gold standard of hyperacute care. Option B is incorrect because a "wait and watch" approach wastes critical penumbral tissue and violates the fundamental rule that "time is brain." Option C is incorrect because aggressively lowering blood pressure below normal parameters before reperfusion can precipitate hypoperfusion and expand the ischemic core. Option D is incorrect because waiting for advanced perfusion imaging when non-contrast CT is already negative and the patient is within the window creates dangerous treatment delays. SCRN nurses facilitate rapid-response workflows to optimize door-to-needle metrics and maximize functional recovery.

Comprehensive and Detailed Explanation:

The correct answer is A because atrial fibrillation causes blood stasis within the atria, predisposing patients to the formation of cardioembolic thrombi that can travel to cerebral vessels. Direct oral anticoagulants (DOACs) such as apixaban inhibit specific clotting factors, providing superior protection against cardioembolic strokes compared to antiplatelet agents like aspirin, which target platelet aggregation rather than stasis-induced clots. Option B is incorrect because DOACs do not lower blood pressure. Option C is incorrect because anticoagulants prevent new clot formation rather than dissolving existing atherosclerotic plaque. Option D is incorrect because aspirin is a cornerstone antiplatelet therapy for non-cardioembolic vascular disease. SCRN nurses educate patients on the specific rationale for anticoagulation to promote long-term adherence.