2026 APEX NIH STROKE SCALE ALL TEST GROUPS
A-F (6 PATIENTS) REAL EXAM QUESTIONS &
VERIFIED ANSWERS INSTANT DIGITAL DOWNLOAD
159 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
2026 APEX NIH STROKE SCALE ALL TEST GROUPS A-F (6 PATIENTS) REAL EXAM QUESTIONS &
VERIFIED ANSWERS INSTANT DIGITAL DOWNLOAD. It contains 159 carefully selected questions that reflect
the most current exam content and testing strategies. Each question is accompanied by a correct answer and a
detailed rationale that explains the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 159 Questions
Foundations - Application - 2026 APEX NIH Stroke Scale ALL Groups A-f 6 Patients REAL & Instant Digital
Download Neurology / Stroke Assessment Graduate / Advanced Clinical Neuroscience
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
2026 APEX NIH Stroke Scale 1-27 Nihss, Score, Stroke, Right, Aphasia
ALL Groups A-f 6 Patients
REAL & Instant Digital
Download Neurology / Stroke
Assessment Graduate /
Advanced Clinical
Neuroscience
Score 28-54 Nihss, Stroke, Right, Visual, Aphasia
Stroke 55-81 Nihss, Score, Right, Likely, Language
Right 82-108 Nihss, Stroke, Score, Scoring, Aphasia
Aphasia 109-135 Score, Nihss, Stroke, Finding, Motor
Likely 136-159 Nihss, Score, Stroke, Right, Hemispheric
TOTAL 159 All questions include answers and detailed rationales
,Section A - 2026 APEX NIH Stroke Scale ALL Groups A-f 6
Patients REAL & Instant Digital Download Neurology /
Stroke Assessment Graduate / Advanced Clinical
Neuroscience
Q1.
A patient with acute left MCA syndrome scores 2 on item 1a (LOC) because they only
respond to repeated painful stimulation. On item 1b (LOC questions), they are unable to
answer either question correctly. How should the examiner score item 1b, and what is the
critical implication for the total NIHSS?
A. Score 2; the total NIHSS is artificially B. Score 2; the total NIHSS is valid as the
inflated by the LOC, potentially patient's aphasia is a direct result of the
overestimating stroke severity stroke
C. Score 1; the patient's inability to answer D. Score 0; the patient is untestable, so the
is due to reduced consciousness, not item is not scored, and the total NIHSS is
aphasia, and the total NIHSS reflects unaffected
cortical dysfunction
Correct: B - Score 2; the total NIHSS is valid as the patient's aphasia is a direct result of
the stroke
Rationale:Item 1b is scored based on the patient's response to verbal commands, regardless
of the cause. If the patient cannot answer due to stupor or aphasia, they receive 2 points.
This is not an overestimation; the NIHSS is designed to capture the overall neurological
deficit. Option B is correct because the score is valid and reflects the severity of the stroke.
Q2.
In the NIHSS, item 9 (best language) requires the patient to describe a picture, name
objects, and read sentences. A patient with fluent, paraphasic speech but severe
comprehension deficit scores 2. How does this score differentiate from a score of 3, and
what clinical syndrome does this pattern most likely represent?
A. Score 2 indicates global aphasia; score 3 B. Score 2 indicates severe aphasia with
indicates mutism; pattern suggests large left intact reading; score 3 indicates inability to
hemispheric infarct follow commands; pattern suggests
Wernicke's aphasia
C. Score 2 indicates severe aphasia with all D. Score 2 indicates moderate aphasia;
components impaired; score 3 indicates score 3 indicates severe aphasia; pattern
mute or global aphasia; pattern suggests suggests Broca's aphasia
Wernicke's aphasia
Correct: C - Score 2 indicates severe aphasia with all components impaired; score 3
indicates mute or global aphasia; pattern suggests Wernicke's aphasia
Page 3
, Section A - 2026 APEX NIH Stroke Scale ALL Groups A-f 6 Patients REAL & Instant Digital Download Neurology / Stroke Assessment Graduate
/ Advanced Clinical Neuroscience
Rationale: Item 9 scores 2 for severe aphasia where all components (naming, repetition,
reading) are impaired but the patient is not mute. A score of 3 is reserved for mutism or global
aphasia. Fluent paraphasic speech with poor comprehension is classic for Wernicke's
aphasia, typically from a posterior left MCA/STA territory infarct.
Q3.
A patient with a right hemispheric stroke has left-sided visual neglect. On item 11
(extinction and inattention), the examiner tests bilateral simultaneous stimulation. The
patient extinguishes the left visual stimulus but correctly identifies left tactile and auditory
stimuli. What score is given, and what does this pattern indicate about the lesion?
A. Score 1; extinction in one modality B. Score 2; extinction in more than one
indicates a parietal lesion modality indicates a large frontoparietal
lesion
C. Score 1; extinction in visual modality only D. Score 2; extinction in visual modality only
is common with occipital lesions still indicates severe neglect
Correct: A - Score 1; extinction in one modality indicates a parietal lesion
Rationale:Item 11 scores 1 if extinction is present in one sensory modality, even if other
modalities are intact. The visual extinction with intact tactile and auditory points to a parietal
lesion, which is the classic location for neglect. A score of 2 would require extinction in two or
more modalities.
Q4.
According to the 2019 AHA/ASA guidelines, which patient with acute ischemic stroke is
eligible for intravenous thrombolysis with alteplase within 4.5 hours of symptom onset,
despite an NIHSS score of 0?
A. A patient with isolated diplopia and B. A patient with mild but disabling
normal NIHSS, but with a known intracranial symptoms, such as complete hemianopia,
dural arteriovenous fistula even if NIHSS is 0
C. A patient with a NIHSS of 0 and no D. A patient with a NIHSS of 0 and a
measurable deficit, but with an acute M2 transient ischemic attack that resolved, but
occlusion on CTA with a high-risk ABCD2 score
Correct: B - A patient with mild but disabling symptoms, such as complete hemianopia,
even if NIHSS is 0
Rationale:The 2019 guidelines recommend alteplase for patients with disabling deficits even
if NIHSS is low. Complete hemianopia is disabling, so it qualifies. A NIHSS of 0 with no deficit
(C) is not an indication, and TIA (D) is not acute stroke. AV fistula (A) is a contraindication.
Page 4
A-F (6 PATIENTS) REAL EXAM QUESTIONS &
VERIFIED ANSWERS INSTANT DIGITAL DOWNLOAD
159 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
2026 APEX NIH STROKE SCALE ALL TEST GROUPS A-F (6 PATIENTS) REAL EXAM QUESTIONS &
VERIFIED ANSWERS INSTANT DIGITAL DOWNLOAD. It contains 159 carefully selected questions that reflect
the most current exam content and testing strategies. Each question is accompanied by a correct answer and a
detailed rationale that explains the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 159 Questions
Foundations - Application - 2026 APEX NIH Stroke Scale ALL Groups A-f 6 Patients REAL & Instant Digital
Download Neurology / Stroke Assessment Graduate / Advanced Clinical Neuroscience
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
2026 APEX NIH Stroke Scale 1-27 Nihss, Score, Stroke, Right, Aphasia
ALL Groups A-f 6 Patients
REAL & Instant Digital
Download Neurology / Stroke
Assessment Graduate /
Advanced Clinical
Neuroscience
Score 28-54 Nihss, Stroke, Right, Visual, Aphasia
Stroke 55-81 Nihss, Score, Right, Likely, Language
Right 82-108 Nihss, Stroke, Score, Scoring, Aphasia
Aphasia 109-135 Score, Nihss, Stroke, Finding, Motor
Likely 136-159 Nihss, Score, Stroke, Right, Hemispheric
TOTAL 159 All questions include answers and detailed rationales
,Section A - 2026 APEX NIH Stroke Scale ALL Groups A-f 6
Patients REAL & Instant Digital Download Neurology /
Stroke Assessment Graduate / Advanced Clinical
Neuroscience
Q1.
A patient with acute left MCA syndrome scores 2 on item 1a (LOC) because they only
respond to repeated painful stimulation. On item 1b (LOC questions), they are unable to
answer either question correctly. How should the examiner score item 1b, and what is the
critical implication for the total NIHSS?
A. Score 2; the total NIHSS is artificially B. Score 2; the total NIHSS is valid as the
inflated by the LOC, potentially patient's aphasia is a direct result of the
overestimating stroke severity stroke
C. Score 1; the patient's inability to answer D. Score 0; the patient is untestable, so the
is due to reduced consciousness, not item is not scored, and the total NIHSS is
aphasia, and the total NIHSS reflects unaffected
cortical dysfunction
Correct: B - Score 2; the total NIHSS is valid as the patient's aphasia is a direct result of
the stroke
Rationale:Item 1b is scored based on the patient's response to verbal commands, regardless
of the cause. If the patient cannot answer due to stupor or aphasia, they receive 2 points.
This is not an overestimation; the NIHSS is designed to capture the overall neurological
deficit. Option B is correct because the score is valid and reflects the severity of the stroke.
Q2.
In the NIHSS, item 9 (best language) requires the patient to describe a picture, name
objects, and read sentences. A patient with fluent, paraphasic speech but severe
comprehension deficit scores 2. How does this score differentiate from a score of 3, and
what clinical syndrome does this pattern most likely represent?
A. Score 2 indicates global aphasia; score 3 B. Score 2 indicates severe aphasia with
indicates mutism; pattern suggests large left intact reading; score 3 indicates inability to
hemispheric infarct follow commands; pattern suggests
Wernicke's aphasia
C. Score 2 indicates severe aphasia with all D. Score 2 indicates moderate aphasia;
components impaired; score 3 indicates score 3 indicates severe aphasia; pattern
mute or global aphasia; pattern suggests suggests Broca's aphasia
Wernicke's aphasia
Correct: C - Score 2 indicates severe aphasia with all components impaired; score 3
indicates mute or global aphasia; pattern suggests Wernicke's aphasia
Page 3
, Section A - 2026 APEX NIH Stroke Scale ALL Groups A-f 6 Patients REAL & Instant Digital Download Neurology / Stroke Assessment Graduate
/ Advanced Clinical Neuroscience
Rationale: Item 9 scores 2 for severe aphasia where all components (naming, repetition,
reading) are impaired but the patient is not mute. A score of 3 is reserved for mutism or global
aphasia. Fluent paraphasic speech with poor comprehension is classic for Wernicke's
aphasia, typically from a posterior left MCA/STA territory infarct.
Q3.
A patient with a right hemispheric stroke has left-sided visual neglect. On item 11
(extinction and inattention), the examiner tests bilateral simultaneous stimulation. The
patient extinguishes the left visual stimulus but correctly identifies left tactile and auditory
stimuli. What score is given, and what does this pattern indicate about the lesion?
A. Score 1; extinction in one modality B. Score 2; extinction in more than one
indicates a parietal lesion modality indicates a large frontoparietal
lesion
C. Score 1; extinction in visual modality only D. Score 2; extinction in visual modality only
is common with occipital lesions still indicates severe neglect
Correct: A - Score 1; extinction in one modality indicates a parietal lesion
Rationale:Item 11 scores 1 if extinction is present in one sensory modality, even if other
modalities are intact. The visual extinction with intact tactile and auditory points to a parietal
lesion, which is the classic location for neglect. A score of 2 would require extinction in two or
more modalities.
Q4.
According to the 2019 AHA/ASA guidelines, which patient with acute ischemic stroke is
eligible for intravenous thrombolysis with alteplase within 4.5 hours of symptom onset,
despite an NIHSS score of 0?
A. A patient with isolated diplopia and B. A patient with mild but disabling
normal NIHSS, but with a known intracranial symptoms, such as complete hemianopia,
dural arteriovenous fistula even if NIHSS is 0
C. A patient with a NIHSS of 0 and no D. A patient with a NIHSS of 0 and a
measurable deficit, but with an acute M2 transient ischemic attack that resolved, but
occlusion on CTA with a high-risk ABCD2 score
Correct: B - A patient with mild but disabling symptoms, such as complete hemianopia,
even if NIHSS is 0
Rationale:The 2019 guidelines recommend alteplase for patients with disabling deficits even
if NIHSS is low. Complete hemianopia is disabling, so it qualifies. A NIHSS of 0 with no deficit
(C) is not an indication, and TIA (D) is not acute stroke. AV fistula (A) is a contraindication.
Page 4
