APEX NIH STROKE SCALE – GROUP B PATIENTS
1–6 Complete Exam-Style Practice Bank | 300
Questions with Answers & Rationales
NATIONAL INSTITUTES OF HEALTH (NIH)
APEX Innovations Stroke Scale Certification
Group B – Patients 1–6 | Complete Practice Examination
Program: APEX Innovations NIH Stroke Scale (NIHSS) Certification
Test Group: Group B (Patients 1–6)
Edition: 2026/2027 Updated
Reference: National Institutes of Health Stroke Scale (NIHSS) Protocol
TABLE OF CONTENTS
1. Exam Overview & NIHSS Scoring Guide …………………………………………………… 3
2. Group B – Patient Answer Keys (Patients 1–6) …………………………………………… 4
3. Practice Questions (300 Questions) ……………………………………………………… 6
4. Complete Answer Key with Rationales …………………………………………………… 28
5. NIHSS Scoring Reference Cards …………………………………………………………… 32
1. EXAM OVERVIEW & NIHSS SCORING GUIDE
What Is the NIH Stroke Scale (NIHSS)?
The NIH Stroke Scale is a systematic assessment tool used to quantify the severity of
stroke-related neurological deficits. It evaluates 11 major categories of function and is widely
used in clinical settings and certification programs, including APEX Innovations training.
,NIHSS Assessment Items (11 Categories)
| Item | Description | Scoring |
||-||
| 1a | Level of Consciousness (LOC) | 0 = Alert; 1 = Drowsy; 2 = Stuporous; 3 = Coma |
| 1b | LOC Questions (month, age) | 0 = Both correct; 1 = One correct; 2 = Neither correct |
| 1c | LOC Commands (open/close eyes, grip/release) | 0 = Both correct; 1 = One correct; 2 =
Neither correct |
| 2 | Best Gaze (horizontal eye movement) | 0 = Normal; 1 = Partial gaze palsy; 2 = Forced
deviation |
| 3 | Visual Fields | 0 = Normal; 1 = Partial hemianopia; 2 = Complete hemianopia; 3 = Bilateral
hemianopia |
| 4 | Facial Palsy | 0 = Normal; 1 = Minor paralysis; 2 = Partial paralysis; 3 = Complete paralysis
|
| 5a | Motor Arm – Left | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 5b | Motor Arm – Right | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 6a | Motor Leg – Left | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 6b | Motor Leg – Right | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 7 | Limb Ataxia | 0 = Normal; 1 = Ataxia in one limb; 2 = Ataxia in two limbs |
| 8 | Sensory | 0 = Normal; 1 = Mild loss; 2 = Severe loss |
| 9 | Best Language | 0 = Normal; 1 = Mild aphasia; 2 = Severe aphasia; 3 = Mute/global
aphasia |
| 10 | Dysarthria | 0 = Normal; 1 = Mild; 2 = Severe |
| 11 | Extinction & Inattention (Neglect) | 0 = Normal; 1 = Partial neglect; 2 = Complete neglect |
Scoring Interpretation
| Total Score | Stroke Severity |
|-|--|
| 0 | No stroke symptoms |
| 1–4 | Minor stroke |
| 5–15 | Moderate stroke |
| 16–20 | Moderate to severe stroke |
| 21–42 | Severe stroke |
2. GROUP B – PATIENT ANSWER KEYS (PATIENTS 1–6)
,Patient 1 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 0 |
| 1b – LOC Questions | 1 | 6b – Motor Leg Right | 3 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 0 | 8 – Sensory | 1 |
| 3 – Visual Fields | 0 | 9 – Best Language | 1 |
| 4 – Facial Palsy | 1 | 10 – Dysarthria | 0 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 1 |
| 5b – Motor Arm Right | 4 | | |
TOTAL NIHSS: 11 (Moderate stroke)
Patient 2 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 0 |
| 1b – LOC Questions | 1 | 6b – Motor Leg Right | 2 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 0 | 8 – Sensory | 1 |
| 3 – Visual Fields | 0 | 9 – Best Language | 0 |
| 4 – Facial Palsy | 1 | 10 – Dysarthria | 1 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 0 |
| 5b – Motor Arm Right | 0 | | |
TOTAL NIHSS: 6 (Moderate stroke)
Patient 3 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 0 |
| 1b – LOC Questions | 1 | 6b – Motor Leg Right | 0 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 0 | 8 – Sensory | 0 |
| 3 – Visual Fields | 0 | 9 – Best Language | 0 |
| 4 – Facial Palsy | 3 | 10 – Dysarthria | 1 |
, | 5a – Motor Arm Left | 0 | 11 – Neglect | 0 |
| 5b – Motor Arm Right | 0 | | |
TOTAL NIHSS: 5 (Moderate stroke)
Patient 4 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 3 | 6a – Motor Leg Left | 2 |
| 1b – LOC Questions | 2 | 6b – Motor Leg Right | 4 |
| 1c – LOC Commands | 2 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 2 | 8 – Sensory | 1 |
| 3 – Visual Fields | 2 | 9 – Best Language | 3 |
| 4 – Facial Palsy | 2 | 10 – Dysarthria | 2 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 2 |
| 5b – Motor Arm Right | 4 | | |
TOTAL NIHSS: 29 (Severe stroke)
Patient 5 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 1 |
| 1b – LOC Questions | 0 | 6b – Motor Leg Right | 0 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 1 |
| 2 – Best Gaze | 0 | 8 – Sensory | 1 |
| 3 – Visual Fields | 0 | 9 – Best Language | 0 |
| 4 – Facial Palsy | 0 | 10 – Dysarthria | 0 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 1 |
| 5b – Motor Arm Right | 0 | | |
TOTAL NIHSS: 4 (Minor stroke)
Patient 6 – Complete Scoring
| Item | Score | Item | Score |
1–6 Complete Exam-Style Practice Bank | 300
Questions with Answers & Rationales
NATIONAL INSTITUTES OF HEALTH (NIH)
APEX Innovations Stroke Scale Certification
Group B – Patients 1–6 | Complete Practice Examination
Program: APEX Innovations NIH Stroke Scale (NIHSS) Certification
Test Group: Group B (Patients 1–6)
Edition: 2026/2027 Updated
Reference: National Institutes of Health Stroke Scale (NIHSS) Protocol
TABLE OF CONTENTS
1. Exam Overview & NIHSS Scoring Guide …………………………………………………… 3
2. Group B – Patient Answer Keys (Patients 1–6) …………………………………………… 4
3. Practice Questions (300 Questions) ……………………………………………………… 6
4. Complete Answer Key with Rationales …………………………………………………… 28
5. NIHSS Scoring Reference Cards …………………………………………………………… 32
1. EXAM OVERVIEW & NIHSS SCORING GUIDE
What Is the NIH Stroke Scale (NIHSS)?
The NIH Stroke Scale is a systematic assessment tool used to quantify the severity of
stroke-related neurological deficits. It evaluates 11 major categories of function and is widely
used in clinical settings and certification programs, including APEX Innovations training.
,NIHSS Assessment Items (11 Categories)
| Item | Description | Scoring |
||-||
| 1a | Level of Consciousness (LOC) | 0 = Alert; 1 = Drowsy; 2 = Stuporous; 3 = Coma |
| 1b | LOC Questions (month, age) | 0 = Both correct; 1 = One correct; 2 = Neither correct |
| 1c | LOC Commands (open/close eyes, grip/release) | 0 = Both correct; 1 = One correct; 2 =
Neither correct |
| 2 | Best Gaze (horizontal eye movement) | 0 = Normal; 1 = Partial gaze palsy; 2 = Forced
deviation |
| 3 | Visual Fields | 0 = Normal; 1 = Partial hemianopia; 2 = Complete hemianopia; 3 = Bilateral
hemianopia |
| 4 | Facial Palsy | 0 = Normal; 1 = Minor paralysis; 2 = Partial paralysis; 3 = Complete paralysis
|
| 5a | Motor Arm – Left | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 5b | Motor Arm – Right | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 6a | Motor Leg – Left | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 6b | Motor Leg – Right | 0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort; 4 =
No movement |
| 7 | Limb Ataxia | 0 = Normal; 1 = Ataxia in one limb; 2 = Ataxia in two limbs |
| 8 | Sensory | 0 = Normal; 1 = Mild loss; 2 = Severe loss |
| 9 | Best Language | 0 = Normal; 1 = Mild aphasia; 2 = Severe aphasia; 3 = Mute/global
aphasia |
| 10 | Dysarthria | 0 = Normal; 1 = Mild; 2 = Severe |
| 11 | Extinction & Inattention (Neglect) | 0 = Normal; 1 = Partial neglect; 2 = Complete neglect |
Scoring Interpretation
| Total Score | Stroke Severity |
|-|--|
| 0 | No stroke symptoms |
| 1–4 | Minor stroke |
| 5–15 | Moderate stroke |
| 16–20 | Moderate to severe stroke |
| 21–42 | Severe stroke |
2. GROUP B – PATIENT ANSWER KEYS (PATIENTS 1–6)
,Patient 1 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 0 |
| 1b – LOC Questions | 1 | 6b – Motor Leg Right | 3 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 0 | 8 – Sensory | 1 |
| 3 – Visual Fields | 0 | 9 – Best Language | 1 |
| 4 – Facial Palsy | 1 | 10 – Dysarthria | 0 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 1 |
| 5b – Motor Arm Right | 4 | | |
TOTAL NIHSS: 11 (Moderate stroke)
Patient 2 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 0 |
| 1b – LOC Questions | 1 | 6b – Motor Leg Right | 2 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 0 | 8 – Sensory | 1 |
| 3 – Visual Fields | 0 | 9 – Best Language | 0 |
| 4 – Facial Palsy | 1 | 10 – Dysarthria | 1 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 0 |
| 5b – Motor Arm Right | 0 | | |
TOTAL NIHSS: 6 (Moderate stroke)
Patient 3 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 0 |
| 1b – LOC Questions | 1 | 6b – Motor Leg Right | 0 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 0 | 8 – Sensory | 0 |
| 3 – Visual Fields | 0 | 9 – Best Language | 0 |
| 4 – Facial Palsy | 3 | 10 – Dysarthria | 1 |
, | 5a – Motor Arm Left | 0 | 11 – Neglect | 0 |
| 5b – Motor Arm Right | 0 | | |
TOTAL NIHSS: 5 (Moderate stroke)
Patient 4 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 3 | 6a – Motor Leg Left | 2 |
| 1b – LOC Questions | 2 | 6b – Motor Leg Right | 4 |
| 1c – LOC Commands | 2 | 7 – Limb Ataxia | 0 |
| 2 – Best Gaze | 2 | 8 – Sensory | 1 |
| 3 – Visual Fields | 2 | 9 – Best Language | 3 |
| 4 – Facial Palsy | 2 | 10 – Dysarthria | 2 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 2 |
| 5b – Motor Arm Right | 4 | | |
TOTAL NIHSS: 29 (Severe stroke)
Patient 5 – Complete Scoring
| Item | Score | Item | Score |
||-||-|
| 1a – LOC | 0 | 6a – Motor Leg Left | 1 |
| 1b – LOC Questions | 0 | 6b – Motor Leg Right | 0 |
| 1c – LOC Commands | 0 | 7 – Limb Ataxia | 1 |
| 2 – Best Gaze | 0 | 8 – Sensory | 1 |
| 3 – Visual Fields | 0 | 9 – Best Language | 0 |
| 4 – Facial Palsy | 0 | 10 – Dysarthria | 0 |
| 5a – Motor Arm Left | 0 | 11 – Neglect | 1 |
| 5b – Motor Arm Right | 0 | | |
TOTAL NIHSS: 4 (Minor stroke)
Patient 6 – Complete Scoring
| Item | Score | Item | Score |
