SCRN study guide, planned around the testing window

For a 60-hour review, dividing the hours by each section's share of items gives about:

• Hyperacute care, 42 items: 17 hours
• Acute care, 42 items: 17 hours
• Stroke pathophysiology, 28 items: 11 hours
• Post-acute care, 19 items: 7 to 8 hours
• Prevention, 19 items: 7 to 8 hours

Shift hours toward what your own job does not cover. An ED or interventional nurse usually needs the rehab and prevention sections more than the hyperacute one; a rehab nurse, the reverse. The counts and their source: exam facts.

The exam windows are February 1–28, May 1–31 and September 1–30, and the application has to be in weeks before each one (January 7, April 1 and August 5, 2027 for 2027). A workable sequence:

1. Weeks 1–2: vascular anatomy and syndromes. Everything later builds on knowing which artery causes which deficit.
2. Weeks 3–5: hyperacute care. Learn the blood pressure thresholds and the treatment windows as a table, then practice NIHSS scoring rules.
3. Weeks 6–7: acute care, with hemorrhagic stroke and complications as separate study blocks.
4. Week 8: post-acute care and prevention together.
5. Week 9: the 60-item practice test in one sitting, then the section quizzes for whatever scored lowest.
6. Week 10: review the guideline changes below. Book the exam day early in the window, since a window cannot be extended.

Submit the application at the start of week 1, not at the end, so an audit request does not collide with the deadline.

AHA/ASA replaced two guidelines in 2026: early management of acute ischemic stroke (January) and adult stroke rehabilitation (August). Older review books and question banks were written before both. Check any key that turns on these points:

• Tenecteplase now sits at the same recommendation level as alteplase for eligible patients within 4.5 hours; the FDA label for stroke, approved in March 2025, reads 3 hours.
• Thrombectomy for a large core (ASPECTS 3–5) in selected patients is now a class 1 recommendation, and so is thrombectomy for basilar occlusion.
• Thrombectomy for distal or non-dominant medium-vessel occlusions is classed as no benefit after the 2025 ESCAPE-MeVO and DISTAL trials; a dominant proximal M2 occlusion within 6 hours is still a reasonable case.
• After successful thrombectomy, pushing systolic pressure below 140 mm Hg is classed as harmful.
• A non-disabling minor stroke gets dual antiplatelet therapy, not a lytic (already in the 2019 update; older books may predate it).
• Tight glucose control (80–130 mg/dL) is not recommended; 140–180 is the range (also carried over from the 2019 update).
• Anticoagulation after a cardioembolic stroke can start early in selected patients rather than after a fixed delay.
• Andexanet is no longer sold in the US (withdrawn in December 2025), so 4-factor PCC is the factor Xa reversal answer.

Details by section: hyperacute care, acute care, prevention.

• Waiting on labs before a lytic. Unless a bleeding disorder or anticoagulant use is suspected, glucose is the only result needed before thrombolysis; platelets and coagulation tests should not delay it (AHA/ASA acute ischemic stroke guideline).
• Reading a quality measure as a treatment window. The Joint Commission's STK-4 counts thrombolysis within 3 hours for patients who arrive within 2 hours; the treatment window itself is 4.5 hours.
• Calling the yearly pass data first-time rates. ABNN's figures include everyone who tested (pass rate).
• Choosing the answer that fits your own unit's protocol. A local order set that differs from the guideline is a weak basis for an answer.

The candidate handbook lists suggested materials without endorsing any of them (handbook, p. 18): the AANN Comprehensive Review for Stroke Nursing, AANN's self-paced SCRN review course and live review webinar, the AANN Core Curriculum for Neuroscience Nursing, the SCRN Self-Assessment Examination, Morrison's Fast Facts for Stroke Care Nursing, Hickey and Strayer's Clinical Practice of Neurological and Neurosurgical Nursing (8th edition) and the AHA/ASA guidelines.

Read the guidelines last and newest-first: a book printed before 2026 can be right on anatomy and wrong on a blood pressure target. For the look of a real item, see the board's sample questions.