A 71-year-old female with a right MCA stroke eats food from only the right half of her plate, shaves attention from the left side of tasks, and bumps her wheelchair into left doorframes — yet visual field testing shows her left visual field is INTACT. Which of the following BEST characterizes this problem and an appropriate intervention emphasis?

Left unilateral neglect — an attentional disorder; use scanning training, cueing to the left, and graded placement of task demands toward the neglected side

Left homonymous hemianopsia — teach compensatory head turning only

Left-sided blindness from optic nerve damage — refer for low vision services

Generalized confusion — reduce all environmental stimulation

A 66-year-old male with a right hemisphere stroke actively pushes with his non-paretic right arm and leg toward his paretic LEFT side in sitting and standing, and strongly resists attempts at passive correction toward midline — becoming fearful when moved toward his right. Which of the following intervention approaches is MOST appropriate?

Use VISUAL vertical references — mirrors, doorframes, vertical grid lines — and have the patient ACTIVELY explore and correct his own position toward them

Passively hold the patient at midline until the pushing fatigues

Strengthen the pushing extremities to improve overall stability

Position the patient leaning toward the non-paretic side to counteract the push

A 59-year-old female, six weeks post left CVA, attempts to reach forward with her right arm. Instead of isolated movement, her arm consistently produces scapular retraction and elevation, shoulder abduction and external rotation, elbow FLEXION, forearm supination, and wrist and finger flexion as one obligatory package. Which of the following BEST describes this movement pattern?

The upper extremity FLEXOR synergy, with elbow flexion as its strongest component

The upper extremity EXTENSOR synergy, dominated by shoulder adduction and elbow extension

Normal isolated voluntary movement with mild weakness

Ataxic movement from cerebellar involvement

A 63-year-old male with left hemiplegia ambulates with his left lower extremity held in extension, the ankle plantar flexed and inverted, and swings the left leg forward through a semicircular outward arc with hip hiking. Which of the following BEST explains WHY he circumducts?

The dominant lower extremity extensor synergy and plantar flexor tone make the limb functionally too long to clear during swing, so it swings around instead of through

The left leg is anatomically shorter, requiring vaulting on the right

Weak hip extensors force a posterior trunk lean during stance

Isolated dorsiflexor paralysis with otherwise normal selective control, identical to peripheral foot drop

A 70-year-old female, three weeks post right CVA with a flaccid left upper extremity, has a palpable inferior glenohumeral subluxation of about one fingerbreadth. Which of the following management approaches is MOST appropriate?

Support the limb at all times (arm troughs, lap tray, careful handling without pulling on the arm), maintain pain-free range with proper scapulohumeral rhythm, and consider NMES to the supraspinatus and posterior deltoid

Overhead pulley exercises to maintain shoulder range of motion

Aggressive passive stretching into full overhead elevation to prevent frozen shoulder

No intervention — subluxation is cosmetic and self-resolving

A physical therapist treats two patients with left hemisphere strokes. Patient 1 speaks fluently in long sentences that carry little meaning, follows almost no verbal instructions, and seems unaware of his errors. Patient 2 speaks in effortful, telegraphic fragments ("walk... bar... good") but follows demonstrated and verbal instructions well and is visibly frustrated by her speech. Which of the following correctly pairs each patient with the BEST communication approach?

Patient 1 has Wernicke's (receptive) aphasia — rely on demonstration, gesture, and modeling; Patient 2 has Broca's (expressive) aphasia — use yes/no questions, allow time, and don't pressure speech

Patient 1 has Broca's aphasia — speak louder; Patient 2 has Wernicke's aphasia — use longer, more detailed explanations

Both have global aphasia and cannot participate meaningfully in therapy

Both have dysarthria — refer for oral motor strengthening and proceed with normal verbal instruction

A 55-year-old male, five months post right CVA, asks about constraint-induced movement therapy (CIMT) for his left arm. Which of the following patient characteristics is MOST important for him to be an appropriate CIMT candidate?

Sufficient active movement in the paretic limb — commonly cited as roughly 10 to 20 degrees of active wrist extension and around 10 degrees of finger extension — plus adequate cognition and safety for restraint of the sound limb

A completely flaccid upper extremity, since CIMT works best before any movement returns

Severe spasticity, which the constraint will stretch out over time

Bilateral upper extremity involvement, so both limbs benefit from the restraint

During an early mobility session, a physical therapist gives a 74-year-old female, two days post stroke, a sip of water at her request. The patient coughs during the swallow, her voice afterward sounds wet and gurgly, and she needs several more coughs to clear. Which of the following is the MOST appropriate action?

Stop oral intake, report the findings promptly so a swallowing evaluation can occur before further oral intake, and follow the resulting recommendations

Offer smaller sips more slowly for the rest of the session

Have her tilt the head backward to help the water go down faster

Document the cough as a normal post-stroke finding requiring no action

A rehabilitation team is planning safety education for two patients. Patient 1 (LEFT CVA) is cautious, anxious, hesitant to attempt tasks, and processes instructions slowly. Patient 2 (RIGHT CVA) is impulsive, overestimates his abilities, attempts unsafe transfers without calling for help, and denies significant deficits. Which of the following BEST characterizes these presentations and their treatment implications?

These are the classic hemisphere profiles: left CVA patients tend toward cautious, anxious behavior needing encouragement and time; right CVA patients tend toward impulsivity and impaired awareness needing external safety structure, supervision, and step-by-step cueing

The profiles are reversed — right hemisphere strokes produce cautious behavior and left hemisphere strokes produce impulsivity

Behavioral differences after stroke are random and carry no treatment implications

Both profiles indicate depression and should be managed identically

10 Free NPTE Stroke / CVA Practice Questions (2026) - Practitionr

About This Topic

How Stroke Is Tested on the NPTE

Stroke anchors the neuromuscular content of the FSBPT content outline — the exam’s second-largest area — spanning examination, perceptual and cognitive syndromes, intervention selection, and medical safety. Try our free 20-question timed NPTE practice test, Neuromuscular practice questions, or Vestibular practice questions to see the surrounding neuromuscular content.

The stroke contrasts the exam tests

→MCA vs ACA — face/arm vs leg predominance

→Left vs right hemisphere — aphasia/cautious vs neglect/impulsive

→Neglect vs hemianopsia — attention deficit vs field cut; awareness is the divider

→Pusher syndrome — pushes toward the paretic side; treat with visual vertical and active correction

→Synergies — UE flexor dominates the arm; LE extensor shapes the gait

→Circumduction vs steppage — synergy-blocked clearance vs isolated foot drop

→Flaccid shoulder — support always, no pulleys, no pulling on the arm

→Broca’s vs Wernicke’s — output vs comprehension; match the communication channel

→CIMT — needs residual wrist/finger extension; treats learned nonuse

→Wet voice or cough with intake — stop oral intake, get the swallow evaluated

Underneath the syndromes sits the intervention philosophy the exam consistently rewards: recovery is driven by high-repetition, task-specific, progressively challenging practice of meaningful activities — the principle behind CIMT, task-oriented gait training, and functional electrical stimulation alike. When two answer options both sound plausible, the one describing active, task-specific practice usually beats the one describing passive treatment. See our full NPTE exam format breakdown for how these items fit into the 225-question structure.

The pattern to recognize

Start every stroke vignette by fixing the geography: deficits on the right mean a left hemisphere lesion, and each hemisphere drags its whole profile with it — left brings aphasia and cautiousness, right brings neglect, impulsivity, and impaired awareness. Half the distractors in stroke questions are simply the correct finding attached to the wrong hemisphere or the wrong side of the body. Anchor the side first, then answer.

Cross-Content Reasoning

Where Stroke Connects Across the Exam

Stroke touches nearly every other page in this series. Upstream, its risk factors and warning signs live in the cardiopulmonary section — hypertension, atrial fibrillation, and the anticoagulants of the pharmacology thread that both prevent stroke and complicate its rehabilitation. The posterior circulation presentation — vertigo plus the dangerous D’s — is the emergency drilled on our Vestibular page, and the central-versus-peripheral reasoning is identical.

Downstream, hemiplegic circumduction completes the clearance-strategy family from the Gait Analysis page, AFO selection for the hemiplegic ankle applies the orthotic matching of the P&O page, and NMES for the subluxed shoulder and activation deficits uses the electrotherapy parameters of the Modalities page. The aspiration-pneumonia risk connects to the airway clearance content shared with the SCI page, and hemiplegic shoulder handling echoes its pressure-injury logic: in both populations, preventable secondary complications are tested as heavily as the primary diagnosis.

And the hemisphere behavioral profiles feed the safety and supervision judgment of the non-systems section — fall risk stratification, discharge planning, and family education questions frequently hinge on whether the vignette’s patient carries the cautious-left or impulsive-right profile.

Study tip

Build a two-column left-vs-right hemisphere table — motor side, language vs neglect, behavioral profile, teaching approach, supervision needs — and drill it until the hemisphere instantly produces its column. Then add four syndrome cards (neglect, pusher, Broca’s, Wernicke’s), each with its signature, its differentiator from the nearest look-alike, and its intervention emphasis. Finish with the artery map and the synergy components, and our complete NPTE study guide covers how to fold it all into a full study plan.

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