2026 APEX NIH Stroke Scale (NIHSS) –
All Test Groups A–F | Complete Exam
Answer Keys for Patients 1–6 | Latest
2026/2027 Edition | PDF
APEX NIH STROKE SCALE (NIHSS)
2026/2027 Practice & Scoring Guide
Groups A–F • Patients 1–6 Style Practice • Correct Scoring • Detailed Rationales
PART I — NIHSS SCORING FUNDAMENTALS
Question 1 — Level of Consciousness
A patient is awake, alert, and responds appropriately without stimulation. What is the NIHSS
score for Item 1a?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A — 0
Rationale: A score of 0 is assigned when the patient is alert and responsive. Higher scores
represent increasing impairment of consciousness.
Question 2 — Level of Consciousness
A patient is drowsy but awakens and responds to minor stimulation. What is the appropriate 1a
score?
A. 0
B. 1
,C. 2
D. 3
Correct Answer: B — 1
Rationale: A score of 1 indicates that the patient is not fully alert but can be awakened by minor
stimulation.
Question 3 — Level of Consciousness
A patient requires repeated or painful stimulation to make non-reflexive movements. What
score should be assigned?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C — 2
Rationale: Score 2 represents stupor. The patient requires repeated or strong stimulation to
produce purposeful or non-reflexive responses.
Question 4 — Level of Consciousness
A patient is unresponsive except for reflexive motor or autonomic responses. What is the
correct score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D — 3
Rationale: A score of 3 is reserved for coma or a state in which the patient demonstrates only
reflexive responses or no response.
Question 5 — LOC Questions
The patient correctly states both the month and age. What is the score for Item 1b?
,A. 0
B. 1
C. 2
D. 3
Correct Answer: A — 0
Rationale: Item 1b tests orientation using the month and age. Correct responses to both
questions receive 0.
Question 6 — LOC Questions
The patient correctly answers the month but gives an incorrect age. What is the score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B — 1
Rationale: Correctly answering one of the two questions earns a score of 1.
Question 7 — LOC Questions
The patient incorrectly answers both the month and age. What is the score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C — 2
Rationale: Failure to correctly answer either question receives a score of 2.
Question 8 — LOC Commands
The patient correctly opens and closes the eyes and opens and closes the non-paralyzed hand.
What is the score?
, A. 0
B. 1
C. 2
D. 3
Correct Answer: A — 0
Rationale: Completion of both required commands earns 0.
Question 9 — LOC Commands
The patient correctly performs only one of the two commands. What score is appropriate?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B — 1
Rationale: Successfully performing one command earns a score of 1.
Question 10 — LOC Commands
The patient cannot perform either command. What score should be recorded?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C — 2
Rationale: Failure to perform both commands receives a score of 2.
PART II — BEST GAZE
Question 11
The patient's horizontal eye movements are normal. What is the NIHSS gaze score?
All Test Groups A–F | Complete Exam
Answer Keys for Patients 1–6 | Latest
2026/2027 Edition | PDF
APEX NIH STROKE SCALE (NIHSS)
2026/2027 Practice & Scoring Guide
Groups A–F • Patients 1–6 Style Practice • Correct Scoring • Detailed Rationales
PART I — NIHSS SCORING FUNDAMENTALS
Question 1 — Level of Consciousness
A patient is awake, alert, and responds appropriately without stimulation. What is the NIHSS
score for Item 1a?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A — 0
Rationale: A score of 0 is assigned when the patient is alert and responsive. Higher scores
represent increasing impairment of consciousness.
Question 2 — Level of Consciousness
A patient is drowsy but awakens and responds to minor stimulation. What is the appropriate 1a
score?
A. 0
B. 1
,C. 2
D. 3
Correct Answer: B — 1
Rationale: A score of 1 indicates that the patient is not fully alert but can be awakened by minor
stimulation.
Question 3 — Level of Consciousness
A patient requires repeated or painful stimulation to make non-reflexive movements. What
score should be assigned?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C — 2
Rationale: Score 2 represents stupor. The patient requires repeated or strong stimulation to
produce purposeful or non-reflexive responses.
Question 4 — Level of Consciousness
A patient is unresponsive except for reflexive motor or autonomic responses. What is the
correct score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D — 3
Rationale: A score of 3 is reserved for coma or a state in which the patient demonstrates only
reflexive responses or no response.
Question 5 — LOC Questions
The patient correctly states both the month and age. What is the score for Item 1b?
,A. 0
B. 1
C. 2
D. 3
Correct Answer: A — 0
Rationale: Item 1b tests orientation using the month and age. Correct responses to both
questions receive 0.
Question 6 — LOC Questions
The patient correctly answers the month but gives an incorrect age. What is the score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B — 1
Rationale: Correctly answering one of the two questions earns a score of 1.
Question 7 — LOC Questions
The patient incorrectly answers both the month and age. What is the score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C — 2
Rationale: Failure to correctly answer either question receives a score of 2.
Question 8 — LOC Commands
The patient correctly opens and closes the eyes and opens and closes the non-paralyzed hand.
What is the score?
, A. 0
B. 1
C. 2
D. 3
Correct Answer: A — 0
Rationale: Completion of both required commands earns 0.
Question 9 — LOC Commands
The patient correctly performs only one of the two commands. What score is appropriate?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B — 1
Rationale: Successfully performing one command earns a score of 1.
Question 10 — LOC Commands
The patient cannot perform either command. What score should be recorded?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C — 2
Rationale: Failure to perform both commands receives a score of 2.
PART II — BEST GAZE
Question 11
The patient's horizontal eye movements are normal. What is the NIHSS gaze score?
