APEX NIH STROKE SCALE GROUP A (PATIENTS 1-6)
2026/2027 EXAM PREP: 100 HIGH-YIELD PRACTICE
QUESTIONS WITH RATIONALES & VERIFIED ANSWERS
1. A 72-year-old male is admitted with sudden onset right-sided
weakness and slurred speech. Upon assessment, he is awake,
makes eye contact, and immediately responds to your questions
without any stimulation. What is the correct score for NIHSS Item
1a?
A. 0 - Alert; keenly responsive
B. 1 - Not alert; arousable by minor stimulation
C. 2 - Not alert; requires repeated stimulation
D. 3 - Unresponsive
Correct Answer: A
Rationale: Item 1a scores consciousness. A patient who is fully
awake, makes eye contact, and responds immediately is considered
alert and scores 0. Scores 1-3 are reserved for patients who are
drowsy, require stimulation, or are unresponsive.
2. A 68-year-old female with a suspected stroke is being assessed.
She is drowsy and requires a gentle shake to stay awake, but she
remains responsive once aroused. What is the correct NIHSS score
for Item 1a?
A. 0 - Alert
B. 1 - Not alert; arousable by minor stimulation
, C. 2 - Not alert; requires repeated stimulation
D. 3 - Reflex motor or unresponsive
Correct Answer: B
Rationale: If a patient is not fully alert but can be aroused by minor
stimulation (like a gentle shake or voice) and stays awake to answer
questions, they score a 1 for Item 1a.
3. A 55-year-old male is being evaluated for a stroke. He is obtunded
and requires painful, repeated stimulation to keep his eyes open or
attend to the examiner. What is the correct NIHSS score for Item
1a?
A. 0 - Alert
B. 1 - Arousable by minor stimulation
C. 2 - Not alert; requires repeated stimulation
D. 3 - Unresponsive
Correct Answer: C
Rationale: If the patient requires repeated or painful stimulation to
attend, they score a 2 on Item 1a. If they only respond with reflex
motor or autonomic effects, they would score a 3.
4. A 61-year-old male is unresponsive and only exhibits reflex motor
movements when painful stimuli are applied. What is the correct
score for NIHSS Item 1a?
A. 1
B. 2
C. 3
D. 0
Correct Answer: C
Rationale: A score of 3 is given when the patient is unresponsive or
responds only with reflex motor or autonomic effects.
,5. During the assessment of a 70-year-old female, she is asked to
state her age and the current month. She correctly states she is 70
but incorrectly states the month is December when it is actually
July. What is the correct score for NIHSS Item 1b?
A. 0 - Answers both correctly
B. 1 - Answers one question correctly
C. 2 - Answers neither question correctly
D. 3 - Intubated or unable to speak
Correct Answer: B
Rationale: Item 1b requires the patient to answer both the month
and their age correctly for a score of 0. Since she answered one
correctly (age) and one incorrectly (month), she scores a 1.
6. A 58-year-old male is asked during his stroke assessment to state
his age and the current month. He provides incorrect answers for
both his age and the month. What is the correct NIHSS score for
Item 1b?
A. 0 - Answers both correctly
B. 1 - Answers one question correctly
C. 2 - Answers neither question correctly
D. 3 - Intubated or unable to speak
Correct Answer: C
Rationale: A score of 2 is given when the patient answers neither
question correctly. A score of 3 is reserved for patients who are
intubated or unable to speak due to aphasia or other reasons.
7. A 65-year-old female is intubated due to respiratory failure
secondary to a stroke. She is awake and able to communicate using
a letter board, correctly answering her age and the month. What is
the correct score for Item 1b?
, A. 0 - Answers both correctly
B. 1 - Answers one question correctly
C. 2 - Answers neither question correctly
D. 3 - Intubated or unable to speak
Correct Answer: D
Rationale: The NIHSS scoring for Item 1b explicitly states that a score
of 3 is given for patients who are intubated or unable to speak,
regardless of their ability to communicate via other means.
8. A 59-year-old male is asked to open and close his eyes and then
grip and release his hand. He successfully opens and closes his
eyes but is unable to grip and release his hand due to severe
weakness. What is the correct score for Item 1c?
A. 0 - Performs both tasks correctly
B. 1 - Performs one task correctly
C. 2 - Performs neither task correctly
D. 3 - Coma or unresponsive
Correct Answer: B
Rationale: Item 1c evaluates the ability to follow two commands.
The patient performed one task correctly (eyes) and failed the other
(hand). Therefore, the score is 1.
9. A 63-year-old female is asked to open and close her eyes and grip
and release her hand. She is unable to open her eyes or grip her
hand due to profound weakness and decreased consciousness.
What is the correct score for Item 1c?
A. 0
B. 1
C. 2
D. 3
2026/2027 EXAM PREP: 100 HIGH-YIELD PRACTICE
QUESTIONS WITH RATIONALES & VERIFIED ANSWERS
1. A 72-year-old male is admitted with sudden onset right-sided
weakness and slurred speech. Upon assessment, he is awake,
makes eye contact, and immediately responds to your questions
without any stimulation. What is the correct score for NIHSS Item
1a?
A. 0 - Alert; keenly responsive
B. 1 - Not alert; arousable by minor stimulation
C. 2 - Not alert; requires repeated stimulation
D. 3 - Unresponsive
Correct Answer: A
Rationale: Item 1a scores consciousness. A patient who is fully
awake, makes eye contact, and responds immediately is considered
alert and scores 0. Scores 1-3 are reserved for patients who are
drowsy, require stimulation, or are unresponsive.
2. A 68-year-old female with a suspected stroke is being assessed.
She is drowsy and requires a gentle shake to stay awake, but she
remains responsive once aroused. What is the correct NIHSS score
for Item 1a?
A. 0 - Alert
B. 1 - Not alert; arousable by minor stimulation
, C. 2 - Not alert; requires repeated stimulation
D. 3 - Reflex motor or unresponsive
Correct Answer: B
Rationale: If a patient is not fully alert but can be aroused by minor
stimulation (like a gentle shake or voice) and stays awake to answer
questions, they score a 1 for Item 1a.
3. A 55-year-old male is being evaluated for a stroke. He is obtunded
and requires painful, repeated stimulation to keep his eyes open or
attend to the examiner. What is the correct NIHSS score for Item
1a?
A. 0 - Alert
B. 1 - Arousable by minor stimulation
C. 2 - Not alert; requires repeated stimulation
D. 3 - Unresponsive
Correct Answer: C
Rationale: If the patient requires repeated or painful stimulation to
attend, they score a 2 on Item 1a. If they only respond with reflex
motor or autonomic effects, they would score a 3.
4. A 61-year-old male is unresponsive and only exhibits reflex motor
movements when painful stimuli are applied. What is the correct
score for NIHSS Item 1a?
A. 1
B. 2
C. 3
D. 0
Correct Answer: C
Rationale: A score of 3 is given when the patient is unresponsive or
responds only with reflex motor or autonomic effects.
,5. During the assessment of a 70-year-old female, she is asked to
state her age and the current month. She correctly states she is 70
but incorrectly states the month is December when it is actually
July. What is the correct score for NIHSS Item 1b?
A. 0 - Answers both correctly
B. 1 - Answers one question correctly
C. 2 - Answers neither question correctly
D. 3 - Intubated or unable to speak
Correct Answer: B
Rationale: Item 1b requires the patient to answer both the month
and their age correctly for a score of 0. Since she answered one
correctly (age) and one incorrectly (month), she scores a 1.
6. A 58-year-old male is asked during his stroke assessment to state
his age and the current month. He provides incorrect answers for
both his age and the month. What is the correct NIHSS score for
Item 1b?
A. 0 - Answers both correctly
B. 1 - Answers one question correctly
C. 2 - Answers neither question correctly
D. 3 - Intubated or unable to speak
Correct Answer: C
Rationale: A score of 2 is given when the patient answers neither
question correctly. A score of 3 is reserved for patients who are
intubated or unable to speak due to aphasia or other reasons.
7. A 65-year-old female is intubated due to respiratory failure
secondary to a stroke. She is awake and able to communicate using
a letter board, correctly answering her age and the month. What is
the correct score for Item 1b?
, A. 0 - Answers both correctly
B. 1 - Answers one question correctly
C. 2 - Answers neither question correctly
D. 3 - Intubated or unable to speak
Correct Answer: D
Rationale: The NIHSS scoring for Item 1b explicitly states that a score
of 3 is given for patients who are intubated or unable to speak,
regardless of their ability to communicate via other means.
8. A 59-year-old male is asked to open and close his eyes and then
grip and release his hand. He successfully opens and closes his
eyes but is unable to grip and release his hand due to severe
weakness. What is the correct score for Item 1c?
A. 0 - Performs both tasks correctly
B. 1 - Performs one task correctly
C. 2 - Performs neither task correctly
D. 3 - Coma or unresponsive
Correct Answer: B
Rationale: Item 1c evaluates the ability to follow two commands.
The patient performed one task correctly (eyes) and failed the other
(hand). Therefore, the score is 1.
9. A 63-year-old female is asked to open and close her eyes and grip
and release her hand. She is unable to open her eyes or grip her
hand due to profound weakness and decreased consciousness.
What is the correct score for Item 1c?
A. 0
B. 1
C. 2
D. 3
