APEX NIH Stroke Scale Group A (Apex Innovations)
Complete Questions and Correct ANSWERs – Latest
Verified 2025/2026
Question 1: A patient is unable to ANSWER questions regarding their age and the current month despite
being awake and able to follow commands. What score should be assigned to item 1b (Level of
Consciousness - Questions)?
A) 0 - ANSWERs both correctly
B) 1 - ANSWERs one correctly
C) 2 - ANSWERs neither correctly
D) 3 - Comatose, unable to respond
Correct ANSWER: C) 2 - ANSWERs neither correctly
Rationale: Item 1b assesses the patient's ability to ANSWER two specific questions: their age and the
current month. A score of 2 is given when the patient ANSWERs neither question correctly. This
indicates a significant impairment in orientation and language comprehension. The patient must be
awake to attempt ANSWERing; if intubated or severely dysarthric, the examiner should write the
questions for the patient to respond non-verbally. This item specifically tests language function rather
than cognitive impairment or disorientation due to other causes.
Question 2: During the Level of Consciousness assessment (item 1a), a patient is drowsy but responds to
verbal stimuli with appropriate movements. What is the correct score?
A) 0 - Alert
B) 1 - Drowsy but arousable
C) 2 - Requires repeated stimulation
,D) 3 - Comatose
Correct ANSWER: B) 1 - Drowsy but arousable
Rationale: Item 1a measures the patient's level of consciousness. A score of 1 indicates the patient is
drowsy but can be aroused by verbal stimuli to respond appropriately. This is differentiated from a score
of 2, where the patient requires repeated or painful stimulation to arouse, and 3, where the patient is
completely unresponsive (comatose). The response should be appropriate for the stimulus, and the
examiner must ensure the patient is not simply responding to pain from other sources.
Question 3: A patient with a left hemispheric stroke is asked to perform a motor task with their right
arm. They understand the command but cannot initiate movement. The examiner observes no visible
movement despite clear understanding. What score should be assigned to item 5a (Motor Arm - Left)?
A) 0 - No drift, normal movement
B) 1 - Drift but no fall
C) 2 - Some effort against gravity
D) 4 - No movement
Correct ANSWER: D) 4 - No movement
Rationale: Item 5a assesses motor function in the left arm. A score of 4 indicates that the patient
demonstrates no movement despite understanding the command. The arm must be placed in the
appropriate position (extended 90 degrees if sitting, 45 degrees if supine) and held for 10 seconds. The
absence of any movement suggests significant motor pathway involvement. It is important to ensure the
patient understands the command and is attempting to move the limb before assigning this score.
Question 4: A patient is asked to identify the month and their age. They respond correctly to both
questions but are intubated and cannot speak clearly. The examiner writes the questions, and the
patient points to the correct written ANSWERs. What score should be given for item 1b?
A) 0
B) 1
,C) 2
D) Unable to assess
Correct ANSWER: A) 0
Rationale: Item 1b can still be assessed in intubated or severely dysarthric patients by using written
questions. Since the patient correctly identified both the month and their age by pointing to the
ANSWERs, they receive a score of 0. This demonstrates intact language comprehension and orientation.
The examiner must ensure the patient can see and read the written questions and that the responses
are clearly indicated. This accommodation allows for accurate assessment even in patients with speech
limitations.
Question 5: During the motor arm assessment, a patient's left arm drifts downward but does not hit the
bed within the 10-second test period. How should this be scored for item 5a?
A) 0 - No drift
B) 1 - Drift without hitting bed
C) 2 - Drifts to hit bed
D) 3 - Some effort against gravity
Correct ANSWER: B) 1 - Drift without hitting bed
Rationale: Item 5a uses a scoring system where 1 indicates the arm drifts downward but does not make
contact with the bed or supporting surface within the 10-second testing period. The arm is initially
positioned with palm up at 90 degrees (sitting) or 45 degrees (supine). A drift that is maintained above
the surface suggests partial motor impairment but preserved antigravity strength. This finding typically
indicates mild to moderate weakness in the tested extremity.
Question 6: A patient with aphasia is unable to understand the commands for the motor arm
assessment. The examiner demonstrates the movement, and the patient mimics it successfully. What
should be the approach to scoring item 5a?
A) Score based on verbal command understanding
, B) Score based on the demonstrated movement
C) Score as untestable
D) Score as 4 - No movement
Correct ANSWER: B) Score based on the demonstrated movement
Rationale: In patients with aphasia or language comprehension difficulties, the examiner may use
demonstration to convey the task. The scoring should be based on the patient's motor performance of
the demonstrated movement. The goal is to assess motor function, not language comprehension. The
examiner should ensure the patient has clearly understood the task through demonstration and, if
necessary, through multiple attempts. This approach maintains the validity of the motor assessment.
Question 7: A patient's right leg is tested for motor function (item 6b). The leg drifts downward and
makes contact with the bed within 5 seconds. What is the correct score?
A) 0 - No drift
B) 1 - Drift without hitting bed
C) 2 - Drifts to hit bed
D) 4 - No movement
Correct ANSWER: C) 2 - Drifts to hit bed
Rationale: Item 6b assesses motor function in the right leg. The patient is positioned supine with the leg
raised 30 degrees. A score of 2 is assigned when the leg drifts downward and contacts the bed within
the 10-second testing period. This indicates significant weakness but with some initial muscle activation.
The examiner should time the drift and ensure the leg is properly positioned before beginning the
assessment. This finding suggests moderate to severe motor impairment.
Question 8: A patient is asked to identify the month and their age. They cannot speak due to severe
dysarthria but nod correctly to indicate the correct ANSWERs. What score should be assigned for item
1b?
A) 0
Complete Questions and Correct ANSWERs – Latest
Verified 2025/2026
Question 1: A patient is unable to ANSWER questions regarding their age and the current month despite
being awake and able to follow commands. What score should be assigned to item 1b (Level of
Consciousness - Questions)?
A) 0 - ANSWERs both correctly
B) 1 - ANSWERs one correctly
C) 2 - ANSWERs neither correctly
D) 3 - Comatose, unable to respond
Correct ANSWER: C) 2 - ANSWERs neither correctly
Rationale: Item 1b assesses the patient's ability to ANSWER two specific questions: their age and the
current month. A score of 2 is given when the patient ANSWERs neither question correctly. This
indicates a significant impairment in orientation and language comprehension. The patient must be
awake to attempt ANSWERing; if intubated or severely dysarthric, the examiner should write the
questions for the patient to respond non-verbally. This item specifically tests language function rather
than cognitive impairment or disorientation due to other causes.
Question 2: During the Level of Consciousness assessment (item 1a), a patient is drowsy but responds to
verbal stimuli with appropriate movements. What is the correct score?
A) 0 - Alert
B) 1 - Drowsy but arousable
C) 2 - Requires repeated stimulation
,D) 3 - Comatose
Correct ANSWER: B) 1 - Drowsy but arousable
Rationale: Item 1a measures the patient's level of consciousness. A score of 1 indicates the patient is
drowsy but can be aroused by verbal stimuli to respond appropriately. This is differentiated from a score
of 2, where the patient requires repeated or painful stimulation to arouse, and 3, where the patient is
completely unresponsive (comatose). The response should be appropriate for the stimulus, and the
examiner must ensure the patient is not simply responding to pain from other sources.
Question 3: A patient with a left hemispheric stroke is asked to perform a motor task with their right
arm. They understand the command but cannot initiate movement. The examiner observes no visible
movement despite clear understanding. What score should be assigned to item 5a (Motor Arm - Left)?
A) 0 - No drift, normal movement
B) 1 - Drift but no fall
C) 2 - Some effort against gravity
D) 4 - No movement
Correct ANSWER: D) 4 - No movement
Rationale: Item 5a assesses motor function in the left arm. A score of 4 indicates that the patient
demonstrates no movement despite understanding the command. The arm must be placed in the
appropriate position (extended 90 degrees if sitting, 45 degrees if supine) and held for 10 seconds. The
absence of any movement suggests significant motor pathway involvement. It is important to ensure the
patient understands the command and is attempting to move the limb before assigning this score.
Question 4: A patient is asked to identify the month and their age. They respond correctly to both
questions but are intubated and cannot speak clearly. The examiner writes the questions, and the
patient points to the correct written ANSWERs. What score should be given for item 1b?
A) 0
B) 1
,C) 2
D) Unable to assess
Correct ANSWER: A) 0
Rationale: Item 1b can still be assessed in intubated or severely dysarthric patients by using written
questions. Since the patient correctly identified both the month and their age by pointing to the
ANSWERs, they receive a score of 0. This demonstrates intact language comprehension and orientation.
The examiner must ensure the patient can see and read the written questions and that the responses
are clearly indicated. This accommodation allows for accurate assessment even in patients with speech
limitations.
Question 5: During the motor arm assessment, a patient's left arm drifts downward but does not hit the
bed within the 10-second test period. How should this be scored for item 5a?
A) 0 - No drift
B) 1 - Drift without hitting bed
C) 2 - Drifts to hit bed
D) 3 - Some effort against gravity
Correct ANSWER: B) 1 - Drift without hitting bed
Rationale: Item 5a uses a scoring system where 1 indicates the arm drifts downward but does not make
contact with the bed or supporting surface within the 10-second testing period. The arm is initially
positioned with palm up at 90 degrees (sitting) or 45 degrees (supine). A drift that is maintained above
the surface suggests partial motor impairment but preserved antigravity strength. This finding typically
indicates mild to moderate weakness in the tested extremity.
Question 6: A patient with aphasia is unable to understand the commands for the motor arm
assessment. The examiner demonstrates the movement, and the patient mimics it successfully. What
should be the approach to scoring item 5a?
A) Score based on verbal command understanding
, B) Score based on the demonstrated movement
C) Score as untestable
D) Score as 4 - No movement
Correct ANSWER: B) Score based on the demonstrated movement
Rationale: In patients with aphasia or language comprehension difficulties, the examiner may use
demonstration to convey the task. The scoring should be based on the patient's motor performance of
the demonstrated movement. The goal is to assess motor function, not language comprehension. The
examiner should ensure the patient has clearly understood the task through demonstration and, if
necessary, through multiple attempts. This approach maintains the validity of the motor assessment.
Question 7: A patient's right leg is tested for motor function (item 6b). The leg drifts downward and
makes contact with the bed within 5 seconds. What is the correct score?
A) 0 - No drift
B) 1 - Drift without hitting bed
C) 2 - Drifts to hit bed
D) 4 - No movement
Correct ANSWER: C) 2 - Drifts to hit bed
Rationale: Item 6b assesses motor function in the right leg. The patient is positioned supine with the leg
raised 30 degrees. A score of 2 is assigned when the leg drifts downward and contacts the bed within
the 10-second testing period. This indicates significant weakness but with some initial muscle activation.
The examiner should time the drift and ensure the leg is properly positioned before beginning the
assessment. This finding suggests moderate to severe motor impairment.
Question 8: A patient is asked to identify the month and their age. They cannot speak due to severe
dysarthria but nod correctly to indicate the correct ANSWERs. What score should be assigned for item
1b?
A) 0
