ABNN SCRNFree Stroke Certified Registered Nurse practice test

Correct answer: A. Administer prescribed intravenous antihypertensive agents to achieve a controlled, gradual blood pressure reduction

In intracerebral hemorrhage, rapidly controlling elevated blood pressure is essential to limit hematoma expansion and prevent further bleeding. Intravenous antihypertensive agents allow precise, titratable blood pressure reduction during the hyperacute phase. The therapeutic goal is reducing blood pressure safely without compromising cerebral perfusion pressure. Oral antihypertensives act too slowly and are not suitable for immediate management in this acute setting. Trendelenburg positioning (head-down) is contraindicated in intracerebral hemorrhage because it increases intracranial pressure and worsens cerebral edema. Elevating the head of the bed to 30 degrees is the standard recommendation to promote venous drainage. Valsalva maneuvers raise intrathoracic pressure and can impede cerebral venous return, potentially increasing intracranial pressure — they are contraindicated in patients with intracranial hemorrhage.

Correct answer: C. International Normalized Ratio (INR)

The International Normalized Ratio (INR) must be checked before administering thrombolytic therapy such as IV alteplase because it reflects coagulation status. An INR greater than 1.7 — as seen in patients on warfarin — indicates impaired clotting and significantly increases the risk of hemorrhagic complications, rendering thrombolysis unsafe. Serum creatinine assesses renal function but does not directly determine thrombolytic eligibility. WBC count can signal infection or systemic inflammation but has no bearing on the acute stroke treatment decision. TSH evaluates thyroid function, which is not relevant in the hyperacute stroke evaluation.

Correct answer: B. Implement strict blood pressure control

Tight blood pressure management is the cornerstone of pre-operative care in subarachnoid hemorrhage. Hypertensive surges increase transmural pressure across the aneurysm wall and raise the risk of re-rupture. Maintaining blood pressure within the prescribed target range reduces this risk until the aneurysm is secured. Anticoagulant therapy is contraindicated because it promotes further bleeding. Early mobilization is inappropriate before aneurysm repair, as physical exertion can precipitate dangerous blood pressure elevations and re-bleeding. A high-sodium diet contributes to fluid retention and elevated blood pressure, which can further threaten the unsecured aneurysm.

Correct answer: C. Maintain close supervision and place visual cues in the environment to reinforce safety limits

Stroke-related impulsivity frequently stems from impaired insight and executive dysfunction, leaving patients unable to recognize their own limitations. Continuous supervision paired with environmental cues — such as floor markers, consistent room layouts, and posted reminders — establishes external boundaries that compensate for diminished self-regulation and reduce fall and injury risk. Verbal reminders alone are often ineffective when cognitive or attentional deficits are present; repetition without tangible environmental support rarely changes behavior. Encouraging independent mobility decisions presumes a level of judgment the patient may not yet have, potentially leading to unsafe actions. A low-stimulation environment may help with agitation but does not directly counteract impulsive behavior during mobility and self-care activities.

Correct answer: D. Encourage her to use alternative communication methods such as writing or picture boards to reduce frustration

Expressive aphasia and dysarthria are common post-stroke deficits that can cause social withdrawal and significant emotional distress. Introducing augmentative communication strategies — such as writing, gesture boards, or picture symbols — empowers the patient to convey her thoughts and needs, reduces frustration, and helps maintain meaningful engagement with caregivers and loved ones. Preserving the patient's communicative autonomy is fundamental to psychosocial recovery. Speech therapy referral is an important long-term component of care but does not provide an immediate solution for the patient's current frustration and isolation. One-on-one conversations can promote rapport, but without expressive supports, they may still be distressing for the patient. Having family interpret the patient's needs, while sometimes necessary, can inadvertently reduce autonomy and deepen feelings of helplessness.

Correct answer: A. Administer intravenous vitamin K together with fresh frozen plasma

In a patient with warfarin-associated intracerebral hemorrhage, urgent anticoagulation reversal is necessary to halt ongoing bleeding. Intravenous vitamin K restores synthesis of vitamin K-dependent clotting factors inhibited by warfarin, while fresh frozen plasma supplies these factors directly for immediate effect — making the combination a rapid and effective reversal strategy. Heparin and low-molecular-weight heparin would intensify hemorrhage and are absolutely contraindicated. Aspirin impairs platelet aggregation and would further hinder clot formation, worsening the bleeding.

Correct answer: C. Intracerebral hemorrhage

In a patient with recent ischemic stroke who is on anticoagulation for atrial fibrillation, hemorrhagic transformation of the infarct is a critical complication to consider when acute hemodynamic instability and declining consciousness occur together. Hemorrhagic conversion increases intracranial pressure, which can produce the cardiovascular and neurological changes observed here. Emergent neuroimaging is essential. Septic shock can mimic these hemodynamic changes but typically evolves more gradually and is accompanied by signs of infection. Pulmonary embolism classically presents with acute dyspnea and pleuritic chest pain, features not described in this scenario. Myocardial infarction may cause hypotension and altered consciousness but usually involves chest pain and specific ECG changes.

Correct answer: D. High-intensity statin therapy

High-intensity statin therapy is strongly recommended at discharge for patients who have experienced an ischemic stroke or TIA with a history of hyperlipidemia. Statins reduce LDL cholesterol, stabilize atherosclerotic plaques, attenuate vascular inflammation, and lower the risk of recurrent cerebrovascular and cardiovascular events. The GWTG-Stroke program tracks statin prescription at discharge as a core quality measure. Low-dose aspirin is an antiplatelet agent for stroke prevention but does not target lipid levels. Antihypertensive medications manage blood pressure, which is a separate risk factor. Anticoagulant therapy is indicated for conditions such as atrial fibrillation but is not used for lipid management.

Correct answer: A. Implement early mobilization and initiate venous thromboembolism (VTE) prophylaxis

Early mobilization is a foundational stroke care intervention to reduce DVT risk by promoting venous blood flow. Concurrent VTE prophylaxis — using sequential compression devices and, when not contraindicated, pharmacologic agents such as low-molecular-weight heparin — provides additional mechanical and chemical protection against clot formation. Guidelines call for individualized strategies based on the patient's mobility level and bleeding risk. Active range-of-motion exercises alone are beneficial but insufficient in the early post-stroke period when patients may have significant motor deficits. Formal VTE prophylaxis and assisted mobilization are more effective. Adequate hydration reduces dehydration-related clotting risk but cannot substitute for mobilization and prophylaxis as a primary DVT prevention strategy. Leg elevation may reduce edema but does not prevent thrombosis and can worsen venous stasis if movement is absent.

Correct answer: B. Acknowledge her emotional reactions, offer reassurance, and coordinate involvement of a counselor or psychologist to support coping

Emotional lability — sometimes called pseudobulbar affect — is a recognized consequence of stroke, especially following left-hemispheric injury due to that hemisphere's involvement in language and emotional modulation. The intense, often disproportionate emotional responses can interfere with rehabilitation and cause significant distress. Validating the patient's experience while arranging psychological support is the most effective first-line response, giving the patient coping tools that are neurologically tailored. Although cognitive reassessment and medication review are valid long-term considerations, they do not address the patient's immediate distress. Journaling and mindfulness may serve as adjuncts but should not replace direct psychological support when emotional lability is impairing rehabilitation participation.