1|Page
APEX NIH STROKE SCALE GROUP A PATIENTS 1–6 TEST EXAM
ACTUAL PREP QUESTIONS AND WELL REVISED ANSWERS
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|Page
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|Page
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.
APEX NIH STROKE SCALE GROUP A PATIENTS 1–6 TEST EXAM
ACTUAL PREP QUESTIONS AND WELL REVISED ANSWERS
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|Page
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|Page
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.
