APEX NIH STROKE SCALE GROUP A (PATIENT 1-6) PRACTICE EXAM
AND STUDY GUIDE 2026/2027 CURRENT QUESTIONS AND RELIABLE
ANSWERS WITH RATIONALES (100% VERIFIED SOLUTIONS) A NEW
UPDATED VERSION 2026 EDITION |ALREADY GRADED A+ (BRAND
NEW!) FULL REVISED APEX NIH STROKE SCALE GROUP A
1. A 58-year-old male with a suspected stroke is unable to follow commands to open and close his eyes
but withdraws to painful stimulation. According to the NIH Stroke Scale, what is the correct score for
Level of Consciousness (Item 1a)?
A) 0
B) 1
C) 2 CORRECT ANSWER
D) 3
Rationale: A score of 2 is assigned when the patient requires repeated or painful stimulation to achieve
a state of consciousness where they can perform the requested tasks. The inability to follow commands
with only withdrawal to pain indicates a stupors state.
2. For the Level of Consciousness (Item 1a), what is the scoring parameter for a patient who is awake,
alert, and responds appropriately without prompting?
A) 1
B) 0 CORRECT ANSWER
C) 2
D) 3
Rationale: A score of 0 indicates alertness and full responsiveness. The patient is keenly aware of their
environment and can follow commands without needing stimulation.
3. When assessing Level of Consciousness Questions (Item 1b), a patient correctly states the current
month but says it is winter when it is actually spring. What is the correct score?
A) 1 CORRECT ANSWER
B) 0
,C) 2
D) Untestable
Rationale: The patient is given 1 point for an incorrect answer. The month is correct, but the season is
incorrect. The score is based on the total number of correct answers out of two; one correct answer
yields a score of 1.
4. A patient with a history of intubation and aphasia is unable to answer any questions regarding the
month and age. What is the most appropriate score for Item 1b (Questions)?
A) 0
B) 1
C) 2
D) Untestable (recorded as 1 for scoring purposes) CORRECT ANSWER
Rationale: If the patient cannot speak due to intubation or severe aphasia, the item is considered
untestable. The administrative rules for the NIHSS dictate that in the Apex program and clinical use, this
is typically scored as 1 to account for the deficit.
5. For Level of Consciousness Commands (Item 1c), the patient is asked to open and close their eyes and
then grip and release their non-paretic hand. The patient makes a clear attempt at the eye command
but does not perform the hand command. What is the score?
A) 0
B) 1 CORRECT ANSWER
C) 2
D) 3
Rationale: A score of 1 is given if one command is performed correctly. The patient receives credit for
the eye command, making the attempt on the second command unnecessary for a score of 1.
6. A patient is able to follow the command to close their eyes but cannot follow the command to grip
and release due to a prior amputation of that hand. How is Item 1c scored?
A) 0
, B) 1
C) Untestable (scored as 1) CORRECT ANSWER
D) 2
Rationale: If a command cannot be performed due to a physical limitation like amputation, the item is
considered untestable. The standardized scoring protocol mandates scoring this as 1 to reflect the
inability to perform the task.
7. In assessing Best Gaze (Item 2), a patient has a forced deviation of the eyes to the right that is fully
overcome by the oculocephalic maneuver. What is the correct score?
A) 0
B) 1 CORRECT ANSWER
C) 2
D) 3
Rationale: A score of 1 indicates partial gaze palsy. This is defined as gaze that is abnormal in one or
both eyes but can be overcome by voluntary or reflexive (oculocephalic) maneuvers.
8. A patient has a conjugate gaze deviation to the left that does not correct with the oculocephalic
maneuver. What is the score for Best Gaze?
A) 0
B) 1
C) 2 CORRECT ANSWER
D) 3
Rationale: A score of 2 is reserved for forced deviation that is persistent and cannot be overcome by the
oculocephalic maneuver, indicating a severe or total gaze palsy.
9. When testing Visual Fields (Item 3), a patient with a left hemianopia is able to see a threat to the left
side if both visual fields are stimulated simultaneously. What is the score?
A) 0
AND STUDY GUIDE 2026/2027 CURRENT QUESTIONS AND RELIABLE
ANSWERS WITH RATIONALES (100% VERIFIED SOLUTIONS) A NEW
UPDATED VERSION 2026 EDITION |ALREADY GRADED A+ (BRAND
NEW!) FULL REVISED APEX NIH STROKE SCALE GROUP A
1. A 58-year-old male with a suspected stroke is unable to follow commands to open and close his eyes
but withdraws to painful stimulation. According to the NIH Stroke Scale, what is the correct score for
Level of Consciousness (Item 1a)?
A) 0
B) 1
C) 2 CORRECT ANSWER
D) 3
Rationale: A score of 2 is assigned when the patient requires repeated or painful stimulation to achieve
a state of consciousness where they can perform the requested tasks. The inability to follow commands
with only withdrawal to pain indicates a stupors state.
2. For the Level of Consciousness (Item 1a), what is the scoring parameter for a patient who is awake,
alert, and responds appropriately without prompting?
A) 1
B) 0 CORRECT ANSWER
C) 2
D) 3
Rationale: A score of 0 indicates alertness and full responsiveness. The patient is keenly aware of their
environment and can follow commands without needing stimulation.
3. When assessing Level of Consciousness Questions (Item 1b), a patient correctly states the current
month but says it is winter when it is actually spring. What is the correct score?
A) 1 CORRECT ANSWER
B) 0
,C) 2
D) Untestable
Rationale: The patient is given 1 point for an incorrect answer. The month is correct, but the season is
incorrect. The score is based on the total number of correct answers out of two; one correct answer
yields a score of 1.
4. A patient with a history of intubation and aphasia is unable to answer any questions regarding the
month and age. What is the most appropriate score for Item 1b (Questions)?
A) 0
B) 1
C) 2
D) Untestable (recorded as 1 for scoring purposes) CORRECT ANSWER
Rationale: If the patient cannot speak due to intubation or severe aphasia, the item is considered
untestable. The administrative rules for the NIHSS dictate that in the Apex program and clinical use, this
is typically scored as 1 to account for the deficit.
5. For Level of Consciousness Commands (Item 1c), the patient is asked to open and close their eyes and
then grip and release their non-paretic hand. The patient makes a clear attempt at the eye command
but does not perform the hand command. What is the score?
A) 0
B) 1 CORRECT ANSWER
C) 2
D) 3
Rationale: A score of 1 is given if one command is performed correctly. The patient receives credit for
the eye command, making the attempt on the second command unnecessary for a score of 1.
6. A patient is able to follow the command to close their eyes but cannot follow the command to grip
and release due to a prior amputation of that hand. How is Item 1c scored?
A) 0
, B) 1
C) Untestable (scored as 1) CORRECT ANSWER
D) 2
Rationale: If a command cannot be performed due to a physical limitation like amputation, the item is
considered untestable. The standardized scoring protocol mandates scoring this as 1 to reflect the
inability to perform the task.
7. In assessing Best Gaze (Item 2), a patient has a forced deviation of the eyes to the right that is fully
overcome by the oculocephalic maneuver. What is the correct score?
A) 0
B) 1 CORRECT ANSWER
C) 2
D) 3
Rationale: A score of 1 indicates partial gaze palsy. This is defined as gaze that is abnormal in one or
both eyes but can be overcome by voluntary or reflexive (oculocephalic) maneuvers.
8. A patient has a conjugate gaze deviation to the left that does not correct with the oculocephalic
maneuver. What is the score for Best Gaze?
A) 0
B) 1
C) 2 CORRECT ANSWER
D) 3
Rationale: A score of 2 is reserved for forced deviation that is persistent and cannot be overcome by the
oculocephalic maneuver, indicating a severe or total gaze palsy.
9. When testing Visual Fields (Item 3), a patient with a left hemianopia is able to see a threat to the left
side if both visual fields are stimulated simultaneously. What is the score?
A) 0
