STROKE SCA 411‑STROKE LATEST EXAM ||
ACTUAL EXAM 100 QUESTIONS CORRECT
VERIFIED AND DETAILED ANSWERS |ALREADY
GRADED A+ || 2026
Stroke Care & Cerebrovascular Disease (Neurology / SCA 411)
Prepare for the STROKE SCA 411‑STROKE exam with practice questions
covering ischemic and hemorrhagic stroke pathophysiology, stroke risk
factors and prevention strategies, acute stroke assessment (NIHSS, FAST),
diagnostic imaging (CT, CTA, MRI, perfusion studies), thrombolytic therapy
(tPA) administration protocols and contraindications, endovascular
thrombectomy, post‑stroke complications (cerebral edema, hemorrhagic
conversion, aspiration pneumonia), stroke rehabilitation and recovery,
secondary prevention (antiplatelet and anticoagulation therapies, carotid
intervention), nursing and multidisciplinary management, and stroke system
of care protocols. This study guide helps reinforce essential stroke care
knowledge and supports effective exam preparation for SCA 411. Designed
to improve clinical decision‑making and evidence‑based stroke management
skills while boosting confidence in treating acute and chronic stroke patients.
Suitable for medical students, neurology residents, stroke fellows, nursing
students, advanced practice providers, and healthcare professionals
specializing in cerebrovascular disease.
1. A patient suddenly develops right-sided weakness, facial droop, and
slurred speech. Which artery is most likely occluded?
A. Left middle cerebral artery (MCA)
B. Right middle cerebral artery
C. Left anterior cerebral artery
D. Basilar artery
,Correct Answer: A. Left middle cerebral artery (MCA) ✓
Rationale: Left MCA stroke causes right-sided motor and sensory deficits,
aphasia (if dominant hemisphere), and gaze deviation toward the left. Right
MCA causes left-sided weakness.
2. Which of the following is a contraindication to intravenous alteplase (tPA)
for acute ischemic stroke?
A. Systolic blood pressure 155 mm Hg
B. Onset of symptoms 2 hours ago
C. Head CT showing no hemorrhage
D. History of intracranial hemorrhage
Correct Answer: D. History of intracranial hemorrhage ✓
Rationale: Prior intracranial hemorrhage is an absolute contraindication to
tPA due to high risk of rebleeding. Symptom onset <3-4.5 hours and BP
<185/110 are inclusion criteria; no hemorrhage on CT is required.
3. A patient with a suspected stroke arrives at the emergency department 45
minutes after symptom onset. What is the priority diagnostic test?
A. Carotid ultrasound
B. Non-contrast head CT
C. Magnetic resonance angiography (MRA)
D. Lumbar puncture
Correct Answer: B. Non-contrast head CT ✓
Rationale: Non-contrast CT is rapid, widely available, and essential to rule
out intracranial hemorrhage before tPA administration. CTA and MRI may
follow but do not delay treatment.
4. The nurse is assessing a patient using the NIH Stroke Scale (NIHSS).
Which item is not part of the NIHSS?
A. Level of consciousness
B. Facial palsy
C. Glasgow Coma Scale eye response
D. Limb ataxia
Correct Answer: C. Glasgow Coma Scale eye response ✓
Rationale: NIHSS includes LOC (1a-1c), facial palsy, motor arm/leg, ataxia,
sensory, language, dysarthria, and extinction/inattention. GCS is a different
scale, not part of NIHSS.
,5. A patient with acute ischemic stroke has a blood pressure of 190/110 mm
Hg and is not a candidate for tPA. The nurse should:
A. Administer IV labetalol immediately to lower BP
B. Lower BP cautiously only if it exceeds 220/120 or there is end-organ
damage
C. Give oral hydralazine
D. Start a nitroglycerin drip
Correct Answer: B. Lower BP cautiously only if it exceeds 220/120 or
there is end-organ damage ✓
Rationale: In non-tPA ischemic stroke, permissive hypertension (allow BP
up to 220/120) maintains cerebral perfusion. Aggressive lowering can worsen
ischemia.
6. Which finding is most suggestive of a posterior circulation
(vertebrobasilar) stroke?
A. Pure motor hemiparesis
B. Vertigo, diplopia, and ataxia
C. Aphasia
D. Homonymous hemianopia
Correct Answer: B. Vertigo, diplopia, ataxia ✓
Rationale: Posterior circulation (brainstem, cerebellum, occipital lobe)
causes vertigo, nystagmus, diplopia, dysarthria, ataxia, and crossed findings.
Aphasia and pure motor are anterior circulation.
7. A patient with a stroke has difficulty swallowing. Before oral intake, the
nurse should:
A. Place the patient on a pureed diet
B. Request a speech therapy swallowing evaluation
C. Start IV fluids only
D. Thicken all liquids to honey consistency
Correct Answer: B. Request a speech therapy swallowing evaluation ✓
Rationale: A formal bedside swallowing evaluation (by speech therapist)
determines aspiration risk and safe diet texture. Empirical thickening or
pureeing may be incorrect.
8. Which medication is most commonly used for secondary prevention of
ischemic stroke in a patient with nonvalvular atrial fibrillation?
A. Aspirin
, B. Clopidogrel
C. Warfarin (target INR 2-3) or direct oral anticoagulant (DOAC)
D. Dipyridamole
Correct Answer: C. Warfarin (target INR 2-3) or direct oral
anticoagulant (DOAC) ✓
Rationale: AF-related stroke prevention requires anticoagulation (warfarin or
DOAC). Antiplatelet agents (aspirin, clopidogrel) are less effective for
cardiogenic emboli.
9. A patient receiving tPA for ischemic stroke suddenly becomes more
lethargic and has a new severe headache. The nurse should first:
A. Administer acetaminophen
B. Stop the tPA infusion and stat head CT
C. Increase the tPA infusion rate
D. Give IV mannitol
Correct Answer: B. Stop the tPA infusion and stat head CT ✓
Rationale: Sudden neurologic deterioration + headache in a tPA patient
suggests intracranial hemorrhage. Stop tPA immediately and obtain emergent
CT.
10. Which of the following is a modifiable risk factor for stroke?
A. Age
B. Male sex
C. Hypertension
D. Family history
Correct Answer: C. Hypertension ✓
Rationale: Hypertension is the most important modifiable risk factor. Age,
sex, and family history are nonmodifiable.
11. A patient with a right hemispheric stroke ignores the left side of their
body and denies weakness despite obvious left hemiparesis. This is called:
A. Aphasia
B. Apraxia
C. Anosognosia (hemineglect)
D. Agnosia
Correct Answer: C. Anosognosia (hemineglect) ✓
Rationale: Right hemisphere stroke commonly causes left hemineglect and
ACTUAL EXAM 100 QUESTIONS CORRECT
VERIFIED AND DETAILED ANSWERS |ALREADY
GRADED A+ || 2026
Stroke Care & Cerebrovascular Disease (Neurology / SCA 411)
Prepare for the STROKE SCA 411‑STROKE exam with practice questions
covering ischemic and hemorrhagic stroke pathophysiology, stroke risk
factors and prevention strategies, acute stroke assessment (NIHSS, FAST),
diagnostic imaging (CT, CTA, MRI, perfusion studies), thrombolytic therapy
(tPA) administration protocols and contraindications, endovascular
thrombectomy, post‑stroke complications (cerebral edema, hemorrhagic
conversion, aspiration pneumonia), stroke rehabilitation and recovery,
secondary prevention (antiplatelet and anticoagulation therapies, carotid
intervention), nursing and multidisciplinary management, and stroke system
of care protocols. This study guide helps reinforce essential stroke care
knowledge and supports effective exam preparation for SCA 411. Designed
to improve clinical decision‑making and evidence‑based stroke management
skills while boosting confidence in treating acute and chronic stroke patients.
Suitable for medical students, neurology residents, stroke fellows, nursing
students, advanced practice providers, and healthcare professionals
specializing in cerebrovascular disease.
1. A patient suddenly develops right-sided weakness, facial droop, and
slurred speech. Which artery is most likely occluded?
A. Left middle cerebral artery (MCA)
B. Right middle cerebral artery
C. Left anterior cerebral artery
D. Basilar artery
,Correct Answer: A. Left middle cerebral artery (MCA) ✓
Rationale: Left MCA stroke causes right-sided motor and sensory deficits,
aphasia (if dominant hemisphere), and gaze deviation toward the left. Right
MCA causes left-sided weakness.
2. Which of the following is a contraindication to intravenous alteplase (tPA)
for acute ischemic stroke?
A. Systolic blood pressure 155 mm Hg
B. Onset of symptoms 2 hours ago
C. Head CT showing no hemorrhage
D. History of intracranial hemorrhage
Correct Answer: D. History of intracranial hemorrhage ✓
Rationale: Prior intracranial hemorrhage is an absolute contraindication to
tPA due to high risk of rebleeding. Symptom onset <3-4.5 hours and BP
<185/110 are inclusion criteria; no hemorrhage on CT is required.
3. A patient with a suspected stroke arrives at the emergency department 45
minutes after symptom onset. What is the priority diagnostic test?
A. Carotid ultrasound
B. Non-contrast head CT
C. Magnetic resonance angiography (MRA)
D. Lumbar puncture
Correct Answer: B. Non-contrast head CT ✓
Rationale: Non-contrast CT is rapid, widely available, and essential to rule
out intracranial hemorrhage before tPA administration. CTA and MRI may
follow but do not delay treatment.
4. The nurse is assessing a patient using the NIH Stroke Scale (NIHSS).
Which item is not part of the NIHSS?
A. Level of consciousness
B. Facial palsy
C. Glasgow Coma Scale eye response
D. Limb ataxia
Correct Answer: C. Glasgow Coma Scale eye response ✓
Rationale: NIHSS includes LOC (1a-1c), facial palsy, motor arm/leg, ataxia,
sensory, language, dysarthria, and extinction/inattention. GCS is a different
scale, not part of NIHSS.
,5. A patient with acute ischemic stroke has a blood pressure of 190/110 mm
Hg and is not a candidate for tPA. The nurse should:
A. Administer IV labetalol immediately to lower BP
B. Lower BP cautiously only if it exceeds 220/120 or there is end-organ
damage
C. Give oral hydralazine
D. Start a nitroglycerin drip
Correct Answer: B. Lower BP cautiously only if it exceeds 220/120 or
there is end-organ damage ✓
Rationale: In non-tPA ischemic stroke, permissive hypertension (allow BP
up to 220/120) maintains cerebral perfusion. Aggressive lowering can worsen
ischemia.
6. Which finding is most suggestive of a posterior circulation
(vertebrobasilar) stroke?
A. Pure motor hemiparesis
B. Vertigo, diplopia, and ataxia
C. Aphasia
D. Homonymous hemianopia
Correct Answer: B. Vertigo, diplopia, ataxia ✓
Rationale: Posterior circulation (brainstem, cerebellum, occipital lobe)
causes vertigo, nystagmus, diplopia, dysarthria, ataxia, and crossed findings.
Aphasia and pure motor are anterior circulation.
7. A patient with a stroke has difficulty swallowing. Before oral intake, the
nurse should:
A. Place the patient on a pureed diet
B. Request a speech therapy swallowing evaluation
C. Start IV fluids only
D. Thicken all liquids to honey consistency
Correct Answer: B. Request a speech therapy swallowing evaluation ✓
Rationale: A formal bedside swallowing evaluation (by speech therapist)
determines aspiration risk and safe diet texture. Empirical thickening or
pureeing may be incorrect.
8. Which medication is most commonly used for secondary prevention of
ischemic stroke in a patient with nonvalvular atrial fibrillation?
A. Aspirin
, B. Clopidogrel
C. Warfarin (target INR 2-3) or direct oral anticoagulant (DOAC)
D. Dipyridamole
Correct Answer: C. Warfarin (target INR 2-3) or direct oral
anticoagulant (DOAC) ✓
Rationale: AF-related stroke prevention requires anticoagulation (warfarin or
DOAC). Antiplatelet agents (aspirin, clopidogrel) are less effective for
cardiogenic emboli.
9. A patient receiving tPA for ischemic stroke suddenly becomes more
lethargic and has a new severe headache. The nurse should first:
A. Administer acetaminophen
B. Stop the tPA infusion and stat head CT
C. Increase the tPA infusion rate
D. Give IV mannitol
Correct Answer: B. Stop the tPA infusion and stat head CT ✓
Rationale: Sudden neurologic deterioration + headache in a tPA patient
suggests intracranial hemorrhage. Stop tPA immediately and obtain emergent
CT.
10. Which of the following is a modifiable risk factor for stroke?
A. Age
B. Male sex
C. Hypertension
D. Family history
Correct Answer: C. Hypertension ✓
Rationale: Hypertension is the most important modifiable risk factor. Age,
sex, and family history are nonmodifiable.
11. A patient with a right hemispheric stroke ignores the left side of their
body and denies weakness despite obvious left hemiparesis. This is called:
A. Aphasia
B. Apraxia
C. Anosognosia (hemineglect)
D. Agnosia
Correct Answer: C. Anosognosia (hemineglect) ✓
Rationale: Right hemisphere stroke commonly causes left hemineglect and
