APEX NIH Stroke Scale Group A Patients 1-6 (Complete)
Verified Answers - 2026/2027 Edition - Aligned with APEX Innovations Certification Standards
Total Questions: 50 Format: Multiple Choice (A-D) Rating: Rated A+
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis | 75% Scenario-Based | 20% Direct Recall | 5% Interpretation
Domain 1: Level of Consciousness - Items 1a, 1b, 1c (Q1-Q10)
Q1: According to NIHSS scoring criteria for Item 1a (Level of Consciousness), what score is assigned to a patient
who is alert and responsive to the examiner?
A. A) 0 [CORRECT]
B. B) 1
C. C) 2
D. D) 3
Correct Answer: A
Rationale: The correct answer is A. Per NIHSS Item 1a criteria, a score of 0 indicates the patient is alert, keenly responsive, and fully
oriented. A score of 1 indicates lethargy, score 2 requires vigorous or repeated stimulation, and score 3 indicates unresponsiveness.
APEX 2026/2027 standards confirm that alertness without any diminished arousal is scored as 0.
Q2: A patient requires vigorous and repeated stimulation to arouse, and when stimulated, the patient only moans
briefly before becoming unresponsive again. What is the correct NIHSS score for Item 1a?
A. A) 0
B. B) 1
C. C) 2 [CORRECT]
D. D) 3
Correct Answer: C
Rationale: The correct answer is C. NIHSS Item 1a defines a score of 2 as requiring vigorous or repeated stimulation to make the
patient move. The patient's brief moaning response followed by re-unresponsiveness indicates score 2 rather than 3 (completely
unresponsive/reflexive only). This distinction is a common certification error emphasized in APEX 2026/2027 training materials.
Q3: A stroke patient is intubated and cannot speak. On cognitive assessment, the patient follows all commands
appropriately, nods correctly to yes/no questions, and tracks the examiner visually. When the nurse asks 'What month
is it?' and 'How old are you?' the patient cannot verbalize a response. What is the correct NIHSS score for Item 1b
(LOC Questions)?
A. A) 0 [CORRECT]
B. B) 1
C. C) 2
D. D) UN
Correct Answer: A
APEX NIH Stroke Scale Group A Exam | Page 1
, Rationale: The correct answer is A. Per NIHSS scoring rules for intubated patients on Item 1b, if the patient cannot speak due to
intubation but cognition is clearly intact (follows commands, appropriate nonverbal responses), the score should be 0. This is a
frequent certification error where examiners incorrectly score intubated patients as 1 or UN. APEX 2026/2027 standards explicitly
state that intubation alone does not warrant a non-zero score if cognition is intact.
Q4: A patient correctly states the current month but is unable to recall their age. What NIHSS score should be
assigned for Item 1b (LOC Questions)?
A. A) 0
B. B) 1 [CORRECT]
C. C) 2
D. D) UN
Correct Answer: B
Rationale: The correct answer is B. NIHSS Item 1b uses two questions: 'What month is it?' and 'How old are you?' A score of 0
requires both correct, score 1 means one correct answer, and score 2 means neither is correct. Since the patient answered the month
correctly but not the age, the score is 1. APEX 2026/2027 certification exams commonly test this one-correct/one-incorrect scenario.
Q5: A patient appears drowsy but opens eyes spontaneously and responds to verbal questions, though responses are
slightly slow. What is the appropriate NIHSS score for Item 1a?
A. A) 0
B. B) 1 [CORRECT]
C. C) 2
D. D) 3
Correct Answer: B
Rationale: The correct answer is B. NIHSS Item 1a score of 1 indicates the patient is not fully alert but is arousable by minor
stimulation and can sustain attention briefly. Drowsiness with spontaneous eye opening and slowed but present verbal responses
matches the lethargic category. Score 0 requires full alertness, and score 2 requires vigorous stimulation, per APEX 2026/2027
guidelines.
Q6: When assessing Item 1c (LOC Commands), which two commands must the examiner ask the patient to perform?
A. A) Squeeze the examiner's hand and stick out the tongue
B. B) Open and close eyes and grip and release the non-paretic hand [CORRECT]
C. C) Raise both arms above the head and wiggle the toes
D. D) Say the patient's name and follow the examiner's finger
Correct Answer: B
Rationale: The correct answer is B. NIHSS Item 1c specifically requires the examiner to ask the patient to open and close the eyes and
to grip and release the hand. The hand used should be the non-paretic hand. The other options describe assessment techniques not
specified for Item 1c. APEX 2026/2027 certification emphasizes using the exact NIHSS-prescribed commands.
Q7: A patient is completely unresponsive to any stimulus, including noxious stimuli. There is no verbal response, no
eye opening, and no purposeful movement. What NIHSS score is assigned for Item 1a?
A. A) 1
B. B) 2
C. C) 3 [CORRECT]
D. D) UN
Correct Answer: C
APEX NIH Stroke Scale Group A Exam | Page 2
Verified Answers - 2026/2027 Edition - Aligned with APEX Innovations Certification Standards
Total Questions: 50 Format: Multiple Choice (A-D) Rating: Rated A+
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis | 75% Scenario-Based | 20% Direct Recall | 5% Interpretation
Domain 1: Level of Consciousness - Items 1a, 1b, 1c (Q1-Q10)
Q1: According to NIHSS scoring criteria for Item 1a (Level of Consciousness), what score is assigned to a patient
who is alert and responsive to the examiner?
A. A) 0 [CORRECT]
B. B) 1
C. C) 2
D. D) 3
Correct Answer: A
Rationale: The correct answer is A. Per NIHSS Item 1a criteria, a score of 0 indicates the patient is alert, keenly responsive, and fully
oriented. A score of 1 indicates lethargy, score 2 requires vigorous or repeated stimulation, and score 3 indicates unresponsiveness.
APEX 2026/2027 standards confirm that alertness without any diminished arousal is scored as 0.
Q2: A patient requires vigorous and repeated stimulation to arouse, and when stimulated, the patient only moans
briefly before becoming unresponsive again. What is the correct NIHSS score for Item 1a?
A. A) 0
B. B) 1
C. C) 2 [CORRECT]
D. D) 3
Correct Answer: C
Rationale: The correct answer is C. NIHSS Item 1a defines a score of 2 as requiring vigorous or repeated stimulation to make the
patient move. The patient's brief moaning response followed by re-unresponsiveness indicates score 2 rather than 3 (completely
unresponsive/reflexive only). This distinction is a common certification error emphasized in APEX 2026/2027 training materials.
Q3: A stroke patient is intubated and cannot speak. On cognitive assessment, the patient follows all commands
appropriately, nods correctly to yes/no questions, and tracks the examiner visually. When the nurse asks 'What month
is it?' and 'How old are you?' the patient cannot verbalize a response. What is the correct NIHSS score for Item 1b
(LOC Questions)?
A. A) 0 [CORRECT]
B. B) 1
C. C) 2
D. D) UN
Correct Answer: A
APEX NIH Stroke Scale Group A Exam | Page 1
, Rationale: The correct answer is A. Per NIHSS scoring rules for intubated patients on Item 1b, if the patient cannot speak due to
intubation but cognition is clearly intact (follows commands, appropriate nonverbal responses), the score should be 0. This is a
frequent certification error where examiners incorrectly score intubated patients as 1 or UN. APEX 2026/2027 standards explicitly
state that intubation alone does not warrant a non-zero score if cognition is intact.
Q4: A patient correctly states the current month but is unable to recall their age. What NIHSS score should be
assigned for Item 1b (LOC Questions)?
A. A) 0
B. B) 1 [CORRECT]
C. C) 2
D. D) UN
Correct Answer: B
Rationale: The correct answer is B. NIHSS Item 1b uses two questions: 'What month is it?' and 'How old are you?' A score of 0
requires both correct, score 1 means one correct answer, and score 2 means neither is correct. Since the patient answered the month
correctly but not the age, the score is 1. APEX 2026/2027 certification exams commonly test this one-correct/one-incorrect scenario.
Q5: A patient appears drowsy but opens eyes spontaneously and responds to verbal questions, though responses are
slightly slow. What is the appropriate NIHSS score for Item 1a?
A. A) 0
B. B) 1 [CORRECT]
C. C) 2
D. D) 3
Correct Answer: B
Rationale: The correct answer is B. NIHSS Item 1a score of 1 indicates the patient is not fully alert but is arousable by minor
stimulation and can sustain attention briefly. Drowsiness with spontaneous eye opening and slowed but present verbal responses
matches the lethargic category. Score 0 requires full alertness, and score 2 requires vigorous stimulation, per APEX 2026/2027
guidelines.
Q6: When assessing Item 1c (LOC Commands), which two commands must the examiner ask the patient to perform?
A. A) Squeeze the examiner's hand and stick out the tongue
B. B) Open and close eyes and grip and release the non-paretic hand [CORRECT]
C. C) Raise both arms above the head and wiggle the toes
D. D) Say the patient's name and follow the examiner's finger
Correct Answer: B
Rationale: The correct answer is B. NIHSS Item 1c specifically requires the examiner to ask the patient to open and close the eyes and
to grip and release the hand. The hand used should be the non-paretic hand. The other options describe assessment techniques not
specified for Item 1c. APEX 2026/2027 certification emphasizes using the exact NIHSS-prescribed commands.
Q7: A patient is completely unresponsive to any stimulus, including noxious stimuli. There is no verbal response, no
eye opening, and no purposeful movement. What NIHSS score is assigned for Item 1a?
A. A) 1
B. B) 2
C. C) 3 [CORRECT]
D. D) UN
Correct Answer: C
APEX NIH Stroke Scale Group A Exam | Page 2
