1|P age
APEX NIH STROKE SCALE GROUP A
PATIENTS 1–6 TEST EXAM ACTUAL PREP
QUESTIONS AND WELL REVISED
ANSWERS - LATEST AND COMPLETE
UPDATE WITH VERIFIED SOLUTIONS
Course: Clinical Neurology & Emergency Stroke Assessment
Subject: NIH Stroke Scale (NIHSS) Competency Evaluation
Description
This exam evaluates mastery of the National Institutes of Health Stroke
Scale (NIHSS) using APEX-style Group A patient vignettes (Patients 1–6).
Questions emphasize scoring accuracy, pathophysiologic understanding,
correct interpretation of patient responses, assessment sequence, and
clinical decision- making. Candidates must demonstrate detailed proficiency
in evaluating level of consciousness, gaze, visual fields, facial palsy, motor
strength, limb ataxia, sensory deficits, language, dysarthria, and
extinction/inattention. The test reflects real- world stroke scenarios
requiring precision, clinical reasoning, and consistent scoring methodology.
1. When scoring LOC (1a) for a patient who is awake but disoriented, what
score is appropriate?
A. 0
B. 1
C. 2
D. 3
Answer: A
Rationale: LOC (1a) scores arousal, not orientation. As long as the patient
is awake and responsive, the score is 0.
,2|P age
2. A patient in Group A Patient 1 opens eyes only to painful stimulation.
What is the LOC (1a) score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Eye opening to pain corresponds to “not alert; requires repeated
stimulation,” scoring 2.
3. When assessing LOC Questions (1b), what determines scoring?
A. Whether the patient attempts to answer
B. Accuracy of answers
C. Level of consciousness
D. Motor ability to speak
Answer: B
Rationale: The score reflects correct vs. incorrect answers to age and month.
4. A patient responds “I don’t know” to both LOC questions. Score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Two incorrect responses = score 2.
5. Group A Patient 2 attempts to follow commands but performs the
wrong movement. What is the correct score for LOC Commands
(1c)?
A. 0
B. 1
C. 2
,3|P age
D. 3
Answer: B
Rationale: Two tasks require correct execution. One failed attempt = 1.
6. A patient is aphasic and makes no attempt to follow commands. What
is the score for 1c?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Failure of both tasks = 2, regardless of aphasia, unless physically
unable.
7. When testing horizontal gaze (2), what finding indicates a score of 1?
A. Normal gaze
B. Partial gaze palsy
C. Forced eye deviation
D. Vertical gaze limitation
Answer: B
Rationale: Partial limitation in horizontal gaze = 1.
8. Forced tonic deviation that cannot be overcome indicates what gaze score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Persistent forced deviation without recovery = 2.
, 4|P age
9. Group A Patient 3 shows right gaze preference that resolves with
oculocephalic testing. Score?
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Overcome deviation = partial palsy → 1.
10. Best Visual (3): Patient is unable to see fingers on the left but sees all
on the right. Score?
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Partial hemianopia scores 1.
11. A patient shows complete left homonymous hemianopia. Score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Complete hemianopia = 2.
12. No visual response to any stimuli in both eyes. Score?
A. 0
B. 1
C. 2
D. 3
APEX NIH STROKE SCALE GROUP A
PATIENTS 1–6 TEST EXAM ACTUAL PREP
QUESTIONS AND WELL REVISED
ANSWERS - LATEST AND COMPLETE
UPDATE WITH VERIFIED SOLUTIONS
Course: Clinical Neurology & Emergency Stroke Assessment
Subject: NIH Stroke Scale (NIHSS) Competency Evaluation
Description
This exam evaluates mastery of the National Institutes of Health Stroke
Scale (NIHSS) using APEX-style Group A patient vignettes (Patients 1–6).
Questions emphasize scoring accuracy, pathophysiologic understanding,
correct interpretation of patient responses, assessment sequence, and
clinical decision- making. Candidates must demonstrate detailed proficiency
in evaluating level of consciousness, gaze, visual fields, facial palsy, motor
strength, limb ataxia, sensory deficits, language, dysarthria, and
extinction/inattention. The test reflects real- world stroke scenarios
requiring precision, clinical reasoning, and consistent scoring methodology.
1. When scoring LOC (1a) for a patient who is awake but disoriented, what
score is appropriate?
A. 0
B. 1
C. 2
D. 3
Answer: A
Rationale: LOC (1a) scores arousal, not orientation. As long as the patient
is awake and responsive, the score is 0.
,2|P age
2. A patient in Group A Patient 1 opens eyes only to painful stimulation.
What is the LOC (1a) score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Eye opening to pain corresponds to “not alert; requires repeated
stimulation,” scoring 2.
3. When assessing LOC Questions (1b), what determines scoring?
A. Whether the patient attempts to answer
B. Accuracy of answers
C. Level of consciousness
D. Motor ability to speak
Answer: B
Rationale: The score reflects correct vs. incorrect answers to age and month.
4. A patient responds “I don’t know” to both LOC questions. Score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Two incorrect responses = score 2.
5. Group A Patient 2 attempts to follow commands but performs the
wrong movement. What is the correct score for LOC Commands
(1c)?
A. 0
B. 1
C. 2
,3|P age
D. 3
Answer: B
Rationale: Two tasks require correct execution. One failed attempt = 1.
6. A patient is aphasic and makes no attempt to follow commands. What
is the score for 1c?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Failure of both tasks = 2, regardless of aphasia, unless physically
unable.
7. When testing horizontal gaze (2), what finding indicates a score of 1?
A. Normal gaze
B. Partial gaze palsy
C. Forced eye deviation
D. Vertical gaze limitation
Answer: B
Rationale: Partial limitation in horizontal gaze = 1.
8. Forced tonic deviation that cannot be overcome indicates what gaze score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Persistent forced deviation without recovery = 2.
, 4|P age
9. Group A Patient 3 shows right gaze preference that resolves with
oculocephalic testing. Score?
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Overcome deviation = partial palsy → 1.
10. Best Visual (3): Patient is unable to see fingers on the left but sees all
on the right. Score?
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Partial hemianopia scores 1.
11. A patient shows complete left homonymous hemianopia. Score?
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Complete hemianopia = 2.
12. No visual response to any stimuli in both eyes. Score?
A. 0
B. 1
C. 2
D. 3
