APEX NIH Stroke Scale Group A Patients 1–6 (Complete) Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Level of Consciousness & Orientation | Q1 – Q10
Section 2 | Visual & Motor Function Assessment | Q11 – Q20
Section 3 | Facial Palsy, Ataxia & Sensory Testing | Q21 – Q30
Section 4 | Language, Dysarthria & Neglect | Q31 – Q40
Section 5 | Composite Scoring & Clinical Scenarios | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: LEVEL OF CONSCIOUSNESS & ORIENTATION Q1 – Q10
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Question 1 of 50
A 68-year-old man arrives in the emergency department alert, fully oriented, and able to
state the current month and his exact age. He opens and closes his eyes on command
and grips and releases the examiner's hand without difficulty. What are the correct
NIHSS scores for items 1a, 1b, and 1c?
A. 1a=0, 1b=0, 1c=0 ✓ CORRECT
B. 1a=0, 1b=1, 1c=1
C. 1a=1, 1b=0, 1c=0
D. 1a=0, 1b=0, 1c=1
Correct Answer: A
Rationale: A score of 0 across all three LOC items indicates full alertness, correct
orientation, and intact command following. A score of 1 on any LOC item would indicate
some impairment, which is not present in this fully alert patient. Accurate baseline
scoring of 0 establishes the foundation for detecting subsequent neurologic decline.
,Question 2 of 50
A 74-year-old woman is brought in by ambulance drowsy but opens her eyes when the
examiner speaks her name loudly. She incorrectly states the month but correctly states
her age. She successfully grips the examiner's hand but does not release on command.
What are the correct NIHSS scores for items 1a, 1b, and 1c?
A. 1a=1, 1b=1, 1c=1 ✓ CORRECT
B. 1a=2, 1b=1, 1c=1
C. 1a=1, 1b=2, 1c=2
D. 1a=0, 1b=1, 1c=1
Correct Answer: A
Rationale: 1a=1 because she arouses to voice, 1b=1 because she answers one question
correctly, and 1c=1 because she follows one command. A score of 2 on 1a would
require repeated or strong stimulation, which is not needed when the patient opens to
voice. This pattern of partial responsiveness is common in acute stroke and requires
frequent reassessment.
Question 3 of 50
A 71-year-old man with a left arm amputation below the elbow is alert and fully oriented.
He successfully closes his eyes on command, but when asked to grip and release the
examiner's hand he explains that he cannot because of the amputation. What is the
correct NIHSS score for item 1c?
A. 1c=0
B. 1c=1
C. 1c=UN ✓ CORRECT
D. 1c=2
Correct Answer: C
, Rationale: 1c is scored UN when the patient cannot perform the command due to
amputation or joint fusion, even if they successfully complete the other command. A
score of 1 would imply the patient failed the command due to neurologic deficit rather
than physical barrier. Always distinguish between inability from stroke and inability from
pre-existing mechanical limitations.
Question 4 of 50
A 69-year-old woman is obtunded in the emergency department, moaning in response
to sternal rub but not opening her eyes. She is unable to state the month or her age, and
she does not follow commands but localizes to pain. What are the correct NIHSS scores
for items 1a, 1b, and 1c?
A. 1a=1, 1b=2, 1c=2
B. 1a=3, 1b=2, 1c=2
C. 1a=2, 1b=1, 1c=1
D. 1a=2, 1b=2, 1c=2 ✓ CORRECT
Correct Answer: D
Rationale: 1a=2 because she is not alert and requires repeated painful stimulation, 1b=2
and 1c=2 because she cannot answer or follow commands. 1a=3 would be reserved for
completely unresponsive patients with only reflex movements. This pattern indicates a
severe bihemispheric or brainstem process that may require airway protection.
Question 5 of 50
A 76-year-old man with Broca's aphasia says "December" when asked the current
month, but correctly states his age as 76. He successfully opens and closes his eyes on
command and grips and releases the examiner's hand. What is the correct NIHSS score
for item 1b?
A. 1b=1 ✓ CORRECT
2026/2027: Complete Exam-Style Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Level of Consciousness & Orientation | Q1 – Q10
Section 2 | Visual & Motor Function Assessment | Q11 – Q20
Section 3 | Facial Palsy, Ataxia & Sensory Testing | Q21 – Q30
Section 4 | Language, Dysarthria & Neglect | Q31 – Q40
Section 5 | Composite Scoring & Clinical Scenarios | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: LEVEL OF CONSCIOUSNESS & ORIENTATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man arrives in the emergency department alert, fully oriented, and able to
state the current month and his exact age. He opens and closes his eyes on command
and grips and releases the examiner's hand without difficulty. What are the correct
NIHSS scores for items 1a, 1b, and 1c?
A. 1a=0, 1b=0, 1c=0 ✓ CORRECT
B. 1a=0, 1b=1, 1c=1
C. 1a=1, 1b=0, 1c=0
D. 1a=0, 1b=0, 1c=1
Correct Answer: A
Rationale: A score of 0 across all three LOC items indicates full alertness, correct
orientation, and intact command following. A score of 1 on any LOC item would indicate
some impairment, which is not present in this fully alert patient. Accurate baseline
scoring of 0 establishes the foundation for detecting subsequent neurologic decline.
,Question 2 of 50
A 74-year-old woman is brought in by ambulance drowsy but opens her eyes when the
examiner speaks her name loudly. She incorrectly states the month but correctly states
her age. She successfully grips the examiner's hand but does not release on command.
What are the correct NIHSS scores for items 1a, 1b, and 1c?
A. 1a=1, 1b=1, 1c=1 ✓ CORRECT
B. 1a=2, 1b=1, 1c=1
C. 1a=1, 1b=2, 1c=2
D. 1a=0, 1b=1, 1c=1
Correct Answer: A
Rationale: 1a=1 because she arouses to voice, 1b=1 because she answers one question
correctly, and 1c=1 because she follows one command. A score of 2 on 1a would
require repeated or strong stimulation, which is not needed when the patient opens to
voice. This pattern of partial responsiveness is common in acute stroke and requires
frequent reassessment.
Question 3 of 50
A 71-year-old man with a left arm amputation below the elbow is alert and fully oriented.
He successfully closes his eyes on command, but when asked to grip and release the
examiner's hand he explains that he cannot because of the amputation. What is the
correct NIHSS score for item 1c?
A. 1c=0
B. 1c=1
C. 1c=UN ✓ CORRECT
D. 1c=2
Correct Answer: C
, Rationale: 1c is scored UN when the patient cannot perform the command due to
amputation or joint fusion, even if they successfully complete the other command. A
score of 1 would imply the patient failed the command due to neurologic deficit rather
than physical barrier. Always distinguish between inability from stroke and inability from
pre-existing mechanical limitations.
Question 4 of 50
A 69-year-old woman is obtunded in the emergency department, moaning in response
to sternal rub but not opening her eyes. She is unable to state the month or her age, and
she does not follow commands but localizes to pain. What are the correct NIHSS scores
for items 1a, 1b, and 1c?
A. 1a=1, 1b=2, 1c=2
B. 1a=3, 1b=2, 1c=2
C. 1a=2, 1b=1, 1c=1
D. 1a=2, 1b=2, 1c=2 ✓ CORRECT
Correct Answer: D
Rationale: 1a=2 because she is not alert and requires repeated painful stimulation, 1b=2
and 1c=2 because she cannot answer or follow commands. 1a=3 would be reserved for
completely unresponsive patients with only reflex movements. This pattern indicates a
severe bihemispheric or brainstem process that may require airway protection.
Question 5 of 50
A 76-year-old man with Broca's aphasia says "December" when asked the current
month, but correctly states his age as 76. He successfully opens and closes his eyes on
command and grips and releases the examiner's hand. What is the correct NIHSS score
for item 1b?
A. 1b=1 ✓ CORRECT
