APEX MEDICAL EDUCATION
NIH Stroke Scale Group A
Patients 1-6 (Complete) - Verified Answers
Official Practice Exam - 2026/2027 Edition
60 Questions 60 Minutes 90% Passing Score 3 Sections
TABLE OF CONTENTS
Section 1: NIH Stroke Scale Administration and Scoring Principles .......... Questions 1-20
Section 2: Patient Assessment and Scoring - Patients 1-3 .......... Questions 21-40
Section 3: Patient Assessment and Scoring - Patients 4-6 .......... Questions 41-60
Answer Key .......................... Last Page
INSTRUCTIONS
This practice exam contains 60 multiple-choice questions divided into 3 sections covering NIH Stroke
Scale administration principles and Group A patient assessments.
You have 60 minutes to complete the entire exam. A passing score of 90% (54/60) is required.
Each question has four options (A, B, C, D). Select the single best answer for each question.
The correct answer and rationale are provided immediately after each question for study purposes.
The 2026/2027 designation confirms this exam reflects the most current NIHSS scoring criteria and
Group A patient profiles.
This is an independent practice exam and is not affiliated with or endorsed by APEX Education or NIH.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
1 of1 32
,Section 1: NIH Stroke Scale Administration and Scoring Principles - 2026/2027
Q1 Question 1 of 60
A 67-year-old male arrives in the emergency department with sudden-onset right-sided weakness and
slurred speech. The stroke team requests an NIHSS assessment before tPA consideration. The NIH
Stroke Scale was developed primarily to provide a standardized, reproducible measure of:
A. Neurological deficit severity that is consistent across examiners for stroke clinical trials and
acute care
B. Functional independence level for planning inpatient rehabilitation discharge goals
C. Cognitive impairment degree for differential diagnosis of dementia versus delirium
D. Vascular risk factor burden for guiding primary stroke prevention strategies
Correct Answer: A
Rationale:
The NIHSS was developed to provide a standardized, reproducible quantitative measure of neurological
deficit severity in stroke patients, enabling consistent assessment across examiners and settings for clinical
trials and acute care decisions. Functional independence is measured by the modified Rankin Scale or
Barthel Index, cognitive impairment by the MoCA or MMSE, and vascular risk by the Framingham score.
Q2 Question 2 of 60
A 54-year-old female with suspected ischemic stroke is being assessed using the NIHSS. For Item 2 (LOC
Questions), the examiner asks the patient to state her current age and the current month. The patient
correctly states the month but gives an incorrect age. The correct score for Item 2 is:
A. 0, because the patient demonstrated orientation by answering one question correctly and partial credit
is sufficient
B. 1, because the patient answered only one of the two required questions correctly
C. 2, because providing an incorrect age indicates severe cognitive impairment requiring full point
deduction
D. 0, because the age question is considered less clinically relevant than the month question
Correct Answer: B
Rationale:
Item 2 requires the patient to answer both the month and their age correctly. A score of 1 is assigned when
the patient answers only one of the two questions correctly, regardless of which question is answered
wrong. A score of 0 requires both correct, and a score of 2 means neither is correct.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
2 of2 32
,Q3 Question 3 of 60
A 72-year-old male is being assessed with the NIHSS after family members found him confused at home.
For Item 3 (LOC Commands), the examiner asks the patient to open and close both eyes and to grip and
release the non-paretic hand. The patient successfully opens and closes the eyes but cannot grip and
release the hand on command. The correct score for Item 3 is:
A. 0, because eye movement commands are the primary indicator of responsiveness on this item
B. 2, because failure to grip and release indicates significant motor pathway damage
C. 1, because the patient successfully performed only one of the two required commands
D. Cannot be scored, because the hand that was tested was not explicitly identified as non-paretic
Correct Answer: C
Rationale:
Item 3 requires the patient to perform two commands: open/close eyes and grip/release the non-paretic
hand. A score of 1 is assigned when only one command is performed correctly, regardless of which one.
Only the first attempt is scored, and the commands must be performed exactly as requested.
Q4 Question 4 of 60
A 68-year-old female presents with acute left hemiparesis. During assessment of Item 4 (Best Gaze), the
examiner observes forced deviation of both eyes to the right with inability to look past midline to the left,
even with oculocephalic maneuver. The correct score for Best Gaze is:
A. 1, because the patient has a partial gaze palsy that can be overcome with adequate stimulation
B. 0, because the eyes move together in the direction of gaze without nystagmus
C. 1, because forced deviation with oculocephalic override qualifies as partial gaze palsy
D. 2, because forced deviation that cannot be overcome by the oculocephalic maneuver
constitutes total gaze paresis
Correct Answer: D
Rationale:
A score of 2 on Best Gaze is assigned when there is forced deviation or total gaze paresis that cannot be
overcome by the oculocephalic maneuver. Partial gaze palsy (score 1) is present when gaze is abnormal in
one or both eyes but forced deviation is absent or can be overcome. This patient has forced deviation
unresponsive to oculocephalic stimulation.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
3 of3 32
, Q5 Question 5 of 60
A 61-year-old male with a left MCA stroke undergoes NIHSS visual field testing. Confrontation testing
reveals that the patient cannot detect finger movement in the entire right half of the visual field in both
eyes. The left visual fields are intact. The correct score for Item 5 (Visual Fields) is:
A. 2, because a complete hemianopia involving the entire half of the visual field on one side is
present
B. 1, because partial visual field loss is demonstrated since the patient can still see the left side
C. 3, because the visual loss affects both eyes simultaneously on the right side
D. 0, because the patient retains vision in the left visual field which preserves functional sight
Correct Answer: A
Rationale:
A complete hemianopia, where the patient cannot detect visual stimuli in the entire half of the visual field on
one side, is scored as 2. Score 1 is for partial hemianopia including quadrantanopia, score 3 is for bilateral
hemianopia or cortical blindness, and score 0 requires no visual loss. A complete homonymous hemianopia
is a score of 2, not 3.
Q6 Question 6 of 60
A 59-year-old female with suspected stroke presents with right-sided facial drooping. During Item 6 (Facial
Palsy) assessment, the examiner asks the patient to show teeth, raise eyebrows, and squeeze both eyes
shut. The patient has a flattened nasolabial fold on the right and asymmetry when showing teeth, but
forehead wrinkling and eye closure remain symmetric. This presentation should be scored as:
A. 0, because forehead and eye movements are intact and symmetric, indicating no functional deficit
B. 1, because minor paralysis is present with a flattened nasolabial fold and asymmetry on
smiling
C. 2, because partial paralysis involves both the lower face and the upper face motor function
D. 3, because complete paralysis of the right side of the face is demonstrated
Correct Answer: B
Rationale:
A score of 1 (minor paralysis) is assigned when there is a flattened nasolabial fold and asymmetry on
smiling, even if forehead and eye movements remain intact. This pattern is characteristic of a central (upper
motor neuron) facial palsy. Score 2 requires partial or total paralysis of the lower face, and score 3 requires
complete paralysis of both upper and lower face.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
4 of4 32
NIH Stroke Scale Group A
Patients 1-6 (Complete) - Verified Answers
Official Practice Exam - 2026/2027 Edition
60 Questions 60 Minutes 90% Passing Score 3 Sections
TABLE OF CONTENTS
Section 1: NIH Stroke Scale Administration and Scoring Principles .......... Questions 1-20
Section 2: Patient Assessment and Scoring - Patients 1-3 .......... Questions 21-40
Section 3: Patient Assessment and Scoring - Patients 4-6 .......... Questions 41-60
Answer Key .......................... Last Page
INSTRUCTIONS
This practice exam contains 60 multiple-choice questions divided into 3 sections covering NIH Stroke
Scale administration principles and Group A patient assessments.
You have 60 minutes to complete the entire exam. A passing score of 90% (54/60) is required.
Each question has four options (A, B, C, D). Select the single best answer for each question.
The correct answer and rationale are provided immediately after each question for study purposes.
The 2026/2027 designation confirms this exam reflects the most current NIHSS scoring criteria and
Group A patient profiles.
This is an independent practice exam and is not affiliated with or endorsed by APEX Education or NIH.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
1 of1 32
,Section 1: NIH Stroke Scale Administration and Scoring Principles - 2026/2027
Q1 Question 1 of 60
A 67-year-old male arrives in the emergency department with sudden-onset right-sided weakness and
slurred speech. The stroke team requests an NIHSS assessment before tPA consideration. The NIH
Stroke Scale was developed primarily to provide a standardized, reproducible measure of:
A. Neurological deficit severity that is consistent across examiners for stroke clinical trials and
acute care
B. Functional independence level for planning inpatient rehabilitation discharge goals
C. Cognitive impairment degree for differential diagnosis of dementia versus delirium
D. Vascular risk factor burden for guiding primary stroke prevention strategies
Correct Answer: A
Rationale:
The NIHSS was developed to provide a standardized, reproducible quantitative measure of neurological
deficit severity in stroke patients, enabling consistent assessment across examiners and settings for clinical
trials and acute care decisions. Functional independence is measured by the modified Rankin Scale or
Barthel Index, cognitive impairment by the MoCA or MMSE, and vascular risk by the Framingham score.
Q2 Question 2 of 60
A 54-year-old female with suspected ischemic stroke is being assessed using the NIHSS. For Item 2 (LOC
Questions), the examiner asks the patient to state her current age and the current month. The patient
correctly states the month but gives an incorrect age. The correct score for Item 2 is:
A. 0, because the patient demonstrated orientation by answering one question correctly and partial credit
is sufficient
B. 1, because the patient answered only one of the two required questions correctly
C. 2, because providing an incorrect age indicates severe cognitive impairment requiring full point
deduction
D. 0, because the age question is considered less clinically relevant than the month question
Correct Answer: B
Rationale:
Item 2 requires the patient to answer both the month and their age correctly. A score of 1 is assigned when
the patient answers only one of the two questions correctly, regardless of which question is answered
wrong. A score of 0 requires both correct, and a score of 2 means neither is correct.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
2 of2 32
,Q3 Question 3 of 60
A 72-year-old male is being assessed with the NIHSS after family members found him confused at home.
For Item 3 (LOC Commands), the examiner asks the patient to open and close both eyes and to grip and
release the non-paretic hand. The patient successfully opens and closes the eyes but cannot grip and
release the hand on command. The correct score for Item 3 is:
A. 0, because eye movement commands are the primary indicator of responsiveness on this item
B. 2, because failure to grip and release indicates significant motor pathway damage
C. 1, because the patient successfully performed only one of the two required commands
D. Cannot be scored, because the hand that was tested was not explicitly identified as non-paretic
Correct Answer: C
Rationale:
Item 3 requires the patient to perform two commands: open/close eyes and grip/release the non-paretic
hand. A score of 1 is assigned when only one command is performed correctly, regardless of which one.
Only the first attempt is scored, and the commands must be performed exactly as requested.
Q4 Question 4 of 60
A 68-year-old female presents with acute left hemiparesis. During assessment of Item 4 (Best Gaze), the
examiner observes forced deviation of both eyes to the right with inability to look past midline to the left,
even with oculocephalic maneuver. The correct score for Best Gaze is:
A. 1, because the patient has a partial gaze palsy that can be overcome with adequate stimulation
B. 0, because the eyes move together in the direction of gaze without nystagmus
C. 1, because forced deviation with oculocephalic override qualifies as partial gaze palsy
D. 2, because forced deviation that cannot be overcome by the oculocephalic maneuver
constitutes total gaze paresis
Correct Answer: D
Rationale:
A score of 2 on Best Gaze is assigned when there is forced deviation or total gaze paresis that cannot be
overcome by the oculocephalic maneuver. Partial gaze palsy (score 1) is present when gaze is abnormal in
one or both eyes but forced deviation is absent or can be overcome. This patient has forced deviation
unresponsive to oculocephalic stimulation.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
3 of3 32
, Q5 Question 5 of 60
A 61-year-old male with a left MCA stroke undergoes NIHSS visual field testing. Confrontation testing
reveals that the patient cannot detect finger movement in the entire right half of the visual field in both
eyes. The left visual fields are intact. The correct score for Item 5 (Visual Fields) is:
A. 2, because a complete hemianopia involving the entire half of the visual field on one side is
present
B. 1, because partial visual field loss is demonstrated since the patient can still see the left side
C. 3, because the visual loss affects both eyes simultaneously on the right side
D. 0, because the patient retains vision in the left visual field which preserves functional sight
Correct Answer: A
Rationale:
A complete hemianopia, where the patient cannot detect visual stimuli in the entire half of the visual field on
one side, is scored as 2. Score 1 is for partial hemianopia including quadrantanopia, score 3 is for bilateral
hemianopia or cortical blindness, and score 0 requires no visual loss. A complete homonymous hemianopia
is a score of 2, not 3.
Q6 Question 6 of 60
A 59-year-old female with suspected stroke presents with right-sided facial drooping. During Item 6 (Facial
Palsy) assessment, the examiner asks the patient to show teeth, raise eyebrows, and squeeze both eyes
shut. The patient has a flattened nasolabial fold on the right and asymmetry when showing teeth, but
forehead wrinkling and eye closure remain symmetric. This presentation should be scored as:
A. 0, because forehead and eye movements are intact and symmetric, indicating no functional deficit
B. 1, because minor paralysis is present with a flattened nasolabial fold and asymmetry on
smiling
C. 2, because partial paralysis involves both the lower face and the upper face motor function
D. 3, because complete paralysis of the right side of the face is demonstrated
Correct Answer: B
Rationale:
A score of 1 (minor paralysis) is assigned when there is a flattened nasolabial fold and asymmetry on
smiling, even if forehead and eye movements remain intact. This pattern is characteristic of a central (upper
motor neuron) facial palsy. Score 2 requires partial or total paralysis of the lower face, and score 3 requires
complete paralysis of both upper and lower face.
APEX
APEX
NIHNIH
Stroke
Stroke
Scale
Scale
- 2026/2027
- 2026/2027
| Passing
| Passing
Score:
Score:
90%90%
| Page
| Page
4 of4 32
