VSIM 9 VERNON RUSSELL RIGHT-SIDED
STROKE 2026/2027 | 100% Scored Validation
Exam | Complete Solutions | Pass Guaranteed -
A+ Graded
Section 1: Neurological Assessment & NIHSS Application
(Questions 1-12)
Q1. A 72-year-old male, Vernon Russell, is admitted with suspected right-sided
stroke. During NIHSS assessment, the patient consistently ignores tactile stimuli
presented to his left arm when both arms are stimulated simultaneously, but
responds appropriately when the left arm is stimulated alone. What is the correct
NIHSS score for this finding?
A. 0 - Normal; no sensory extinction detected [INCORRECT] - The patient clearly
demonstrates extinction to simultaneous stimulation, which is a scored deficit.
B. 1 - Inattention or extinction to bilateral stimulation in one sensory modality
[CORRECT] - The patient exhibits extinction specifically during simultaneous
stimulation while responding to unilateral stimulation, which meets criteria for a
score of 1. This indicates mild hemispatial inattention consistent with right-
hemisphere stroke.
C. 2 - Profound hemi-inattention or extinction to more than one modality
[INCORRECT] - A score of 2 requires inattention in more than one modality (e.g.,
visual and tactile) or profound unilateral neglect, which is not described here.
D. 3 - Severe neglect with complete unawareness of one side [INCORRECT] - NIHSS
neglect scoring only ranges from 0-2; there is no score of 3 for this item.
,Rationale: NIHSS Item 11 (Extinction and Inattention) scores 1 for extinction to
simultaneous stimulation in one modality. The patient responds to unilateral left
stimulation but ignores it when bilateral, confirming mild inattention. This is
characteristic of right-hemisphere stroke affecting spatial attention networks.
Correct Answer: B
Q2. During the NIHSS assessment of Vernon Russell (72 years old, right-sided stroke),
the examiner asks the patient to "close your eyes and make a fist." The patient closes
his eyes but does not make a fist. When the command is repeated with
demonstration, the patient successfully makes a fist. What is the correct NIHSS score
for Best Language (Item 9)?
A. 0 - No language deficit; patient follows all commands perfectly [INCRECT] - The
patient initially failed to follow the command without demonstration, indicating
some language comprehension impairment.
B. 1 - Mild-to-moderate aphasia; some obvious loss of fluency or comprehension
[CORRECT] - The patient requires demonstration to follow commands, indicating
mild-to-moderate comprehension difficulty. This is consistent with a score of 1, as
the patient can eventually complete the task with additional cues.
C. 2 - Severe aphasia; communication through fragmentary expression only
[INCORRECT] - The patient can eventually follow the command when demonstrated,
which does not meet criteria for severe aphasia where communication is severely
limited.
D. 3 - Mute, global aphasia; no usable speech or auditory comprehension
[INCORRECT] - The patient demonstrates some comprehension with cueing, ruling
out global aphasia.
Rationale: NIHSS Item 9 (Best Language) scores 1 when there is mild-to-moderate
aphasia with some loss of fluency or comprehension but the patient can still
communicate and follow commands with assistance. The need for demonstration to
complete the command indicates mild comprehension deficit.
Correct Answer: B
,Q3. Vernon Russell's NIHSS assessment reveals: left facial droop (1), left arm drift (2),
left leg drift (1), left visual field cut (2), partial gaze deviation to the right (1), mild left-
sided sensory loss (1), mild dysarthria (1), and left-sided extinction (1). His total
NIHSS score is 10. Which statement accurately describes the clinical significance of
this score in the context of his right-hemisphere stroke?
A. The score indicates mild stroke; patient likely does not qualify for thrombolytic
therapy [INCORRECT] - An NIHSS of 10 represents moderate stroke severity, not
mild. Patients with disabling symptoms and NIHSS ≥4 may be candidates for
reperfusion therapy.
B. The score reflects moderate stroke severity; functional recovery is unlikely
[INCORRECT] - While moderate severity is correct, functional recovery is still possible
with appropriate intervention. The statement is overly pessimistic.
C. The score indicates moderate stroke severity; the patient may underestimate his
deficits due to anosognosia common in right-hemisphere strokes [CORRECT] - An
NIHSS of 10 falls in the moderate range (5-15). Right-hemisphere strokes are
associated with anosognosia (lack of awareness of deficits), which can lead to safety
risks. The score may actually underestimate functional impact due to the NIHSS's
relative insensitivity to neglect and spatial deficits.
D. The score indicates severe stroke requiring immediate intubation and ICU
admission [INCORRECT] - Severe stroke is typically NIHSS >20. An NIHSS of 10 does
not automatically require intubation.
Rationale: NIHSS scores of 5-15 indicate moderate stroke severity. Right-hemisphere
strokes often feature neglect, anosognosia, and spatial-perceptual deficits that may
not be fully captured by NIHSS, potentially leading to underestimation of disability.
The patient requires close monitoring for safety.
Correct Answer: C
Q4. During the NIHSS assessment, the examiner presents two visual stimuli
simultaneously—one in the patient's right visual field and one in the left. Vernon
, Russell reports seeing only the stimulus on the right. When each visual field is tested
individually, he correctly identifies stimuli on both sides. Which NIHSS item is being
tested, and what is the correct score?
A. Item 3 (Visual Fields), score 2 for complete left hemianopia [INCORRECT] - The
patient can see left-sided stimuli when tested individually, ruling out hemianopia.
This is extinction, not visual field loss.
B. Item 3 (Visual Fields), score 1 for partial left hemianopia [INCORRECT] - Again, the
patient demonstrates intact left visual field when tested alone. The deficit is
attentional, not visual.
C. Item 11 (Extinction and Inattention), score 1 for visual extinction [CORRECT] - This
presentation is classic for visual extinction: inability to perceive a contralesional
stimulus during simultaneous presentation despite intact unilateral perception. This is
scored under Item 11, not Item 3.
D. Item 11 (Extinction and Inattention), score 2 for profound visual neglect
[INCORRECT] - A score of 2 requires more than one modality of extinction or
profound inattention. This is isolated visual extinction.
Rationale: Visual extinction is an attentional deficit, not a primary visual field defect.
It is scored under NIHSS Item 11 (Extinction and Inattention), not Item 3 (Visual
Fields). The ability to detect left-sided stimuli when presented alone confirms intact
visual pathways with attentional impairment.
Correct Answer: C
Q5. Which of the following clinical manifestations is MOST characteristic of a right-
hemisphere stroke and would be expected in Vernon Russell's presentation?
A. Expressive aphasia with non-fluent speech and preserved comprehension
[INCORRECT] - Expressive aphasia is characteristic of left-hemisphere (dominant
hemisphere) lesions, typically involving Broca's area.
B. Right-sided hemiparesis with left gaze deviation [INCORRECT] - Right-sided
hemiparesis occurs with left-hemisphere stroke. Gaze deviation toward the side of
the lesion (right gaze deviation) would suggest left-hemisphere involvement.
STROKE 2026/2027 | 100% Scored Validation
Exam | Complete Solutions | Pass Guaranteed -
A+ Graded
Section 1: Neurological Assessment & NIHSS Application
(Questions 1-12)
Q1. A 72-year-old male, Vernon Russell, is admitted with suspected right-sided
stroke. During NIHSS assessment, the patient consistently ignores tactile stimuli
presented to his left arm when both arms are stimulated simultaneously, but
responds appropriately when the left arm is stimulated alone. What is the correct
NIHSS score for this finding?
A. 0 - Normal; no sensory extinction detected [INCORRECT] - The patient clearly
demonstrates extinction to simultaneous stimulation, which is a scored deficit.
B. 1 - Inattention or extinction to bilateral stimulation in one sensory modality
[CORRECT] - The patient exhibits extinction specifically during simultaneous
stimulation while responding to unilateral stimulation, which meets criteria for a
score of 1. This indicates mild hemispatial inattention consistent with right-
hemisphere stroke.
C. 2 - Profound hemi-inattention or extinction to more than one modality
[INCORRECT] - A score of 2 requires inattention in more than one modality (e.g.,
visual and tactile) or profound unilateral neglect, which is not described here.
D. 3 - Severe neglect with complete unawareness of one side [INCORRECT] - NIHSS
neglect scoring only ranges from 0-2; there is no score of 3 for this item.
,Rationale: NIHSS Item 11 (Extinction and Inattention) scores 1 for extinction to
simultaneous stimulation in one modality. The patient responds to unilateral left
stimulation but ignores it when bilateral, confirming mild inattention. This is
characteristic of right-hemisphere stroke affecting spatial attention networks.
Correct Answer: B
Q2. During the NIHSS assessment of Vernon Russell (72 years old, right-sided stroke),
the examiner asks the patient to "close your eyes and make a fist." The patient closes
his eyes but does not make a fist. When the command is repeated with
demonstration, the patient successfully makes a fist. What is the correct NIHSS score
for Best Language (Item 9)?
A. 0 - No language deficit; patient follows all commands perfectly [INCRECT] - The
patient initially failed to follow the command without demonstration, indicating
some language comprehension impairment.
B. 1 - Mild-to-moderate aphasia; some obvious loss of fluency or comprehension
[CORRECT] - The patient requires demonstration to follow commands, indicating
mild-to-moderate comprehension difficulty. This is consistent with a score of 1, as
the patient can eventually complete the task with additional cues.
C. 2 - Severe aphasia; communication through fragmentary expression only
[INCORRECT] - The patient can eventually follow the command when demonstrated,
which does not meet criteria for severe aphasia where communication is severely
limited.
D. 3 - Mute, global aphasia; no usable speech or auditory comprehension
[INCORRECT] - The patient demonstrates some comprehension with cueing, ruling
out global aphasia.
Rationale: NIHSS Item 9 (Best Language) scores 1 when there is mild-to-moderate
aphasia with some loss of fluency or comprehension but the patient can still
communicate and follow commands with assistance. The need for demonstration to
complete the command indicates mild comprehension deficit.
Correct Answer: B
,Q3. Vernon Russell's NIHSS assessment reveals: left facial droop (1), left arm drift (2),
left leg drift (1), left visual field cut (2), partial gaze deviation to the right (1), mild left-
sided sensory loss (1), mild dysarthria (1), and left-sided extinction (1). His total
NIHSS score is 10. Which statement accurately describes the clinical significance of
this score in the context of his right-hemisphere stroke?
A. The score indicates mild stroke; patient likely does not qualify for thrombolytic
therapy [INCORRECT] - An NIHSS of 10 represents moderate stroke severity, not
mild. Patients with disabling symptoms and NIHSS ≥4 may be candidates for
reperfusion therapy.
B. The score reflects moderate stroke severity; functional recovery is unlikely
[INCORRECT] - While moderate severity is correct, functional recovery is still possible
with appropriate intervention. The statement is overly pessimistic.
C. The score indicates moderate stroke severity; the patient may underestimate his
deficits due to anosognosia common in right-hemisphere strokes [CORRECT] - An
NIHSS of 10 falls in the moderate range (5-15). Right-hemisphere strokes are
associated with anosognosia (lack of awareness of deficits), which can lead to safety
risks. The score may actually underestimate functional impact due to the NIHSS's
relative insensitivity to neglect and spatial deficits.
D. The score indicates severe stroke requiring immediate intubation and ICU
admission [INCORRECT] - Severe stroke is typically NIHSS >20. An NIHSS of 10 does
not automatically require intubation.
Rationale: NIHSS scores of 5-15 indicate moderate stroke severity. Right-hemisphere
strokes often feature neglect, anosognosia, and spatial-perceptual deficits that may
not be fully captured by NIHSS, potentially leading to underestimation of disability.
The patient requires close monitoring for safety.
Correct Answer: C
Q4. During the NIHSS assessment, the examiner presents two visual stimuli
simultaneously—one in the patient's right visual field and one in the left. Vernon
, Russell reports seeing only the stimulus on the right. When each visual field is tested
individually, he correctly identifies stimuli on both sides. Which NIHSS item is being
tested, and what is the correct score?
A. Item 3 (Visual Fields), score 2 for complete left hemianopia [INCORRECT] - The
patient can see left-sided stimuli when tested individually, ruling out hemianopia.
This is extinction, not visual field loss.
B. Item 3 (Visual Fields), score 1 for partial left hemianopia [INCORRECT] - Again, the
patient demonstrates intact left visual field when tested alone. The deficit is
attentional, not visual.
C. Item 11 (Extinction and Inattention), score 1 for visual extinction [CORRECT] - This
presentation is classic for visual extinction: inability to perceive a contralesional
stimulus during simultaneous presentation despite intact unilateral perception. This is
scored under Item 11, not Item 3.
D. Item 11 (Extinction and Inattention), score 2 for profound visual neglect
[INCORRECT] - A score of 2 requires more than one modality of extinction or
profound inattention. This is isolated visual extinction.
Rationale: Visual extinction is an attentional deficit, not a primary visual field defect.
It is scored under NIHSS Item 11 (Extinction and Inattention), not Item 3 (Visual
Fields). The ability to detect left-sided stimuli when presented alone confirms intact
visual pathways with attentional impairment.
Correct Answer: C
Q5. Which of the following clinical manifestations is MOST characteristic of a right-
hemisphere stroke and would be expected in Vernon Russell's presentation?
A. Expressive aphasia with non-fluent speech and preserved comprehension
[INCORRECT] - Expressive aphasia is characteristic of left-hemisphere (dominant
hemisphere) lesions, typically involving Broca's area.
B. Right-sided hemiparesis with left gaze deviation [INCORRECT] - Right-sided
hemiparesis occurs with left-hemisphere stroke. Gaze deviation toward the side of
the lesion (right gaze deviation) would suggest left-hemisphere involvement.
