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NIH Stroke Scale (NIHSS) Certification Test Bank
2025/2026: A+ Graded Exam Questions with Verified
Answers & Rationales for a First-Time Pass.
What is an accurate statement about NIHSS and hemorrhagic stroke? -
ANSWER-NIHSS scores predict 30-day mortality and disability
outcomes for intracerebral hemorrhage.
True or False: The patient should be in the supine position for Motor
Leg assessment. - ANSWER-TRUE
You are assessing your patient using the NIHSS. Your patient is
intubated, and you determine that section 10: Dysarthria is UN (i.e.,
untestable). What do you do next? - ANSWER-Document the reason it
is untestable.
When assessing Motor Arm function, which of the following
considerations is correct? - ANSWER-Assess the arm opposite the weak
arm first.
What is the purpose of the NIHSS - ANSWER-To assess stroke severity
using a standardized tool administered the same way by every healthcare
professional who uses it.
Your patient with a stroke has an NIHSS score of 15. What is the most
likely discharge scenario for a patient with this NIHSS score? -
ANSWER-Discharge to a long-term skilled nursing care center
The healthcare professional is evaluating the Motor Leg function. The
examiner positions the leg in the correct position and then releases the
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leg. The leg slightly dips, returns to a normal position, and the position
is held up for 5 seconds. What is the appropriate score? - ANSWER-0
â€" No drift
What is item 2 (Best Gaze) designed to test? - ANSWER-Horizontal eye
movement only
True or False: One clinical application of the NIHSS is to assess patients
before they receive tissue plasminogen activator (tPA). - ANSWER-
TRUE
What technique used to assess visual extinction involves the examiner
placing their fingers in the patient's visual fields at the same time? -
ANSWER-Double simultaneous stimulation
NIHSS - ANSWER-National Institutes of Health Stroke Scale
Scoring range is 0 to 42 points, with higher numbers indicating greater
severity. a score of 5 to 15 represents a moderate stroke, a score of 16 to
20 represents a moderate to severe stroke, and a score of 21 to 42
represents a severe stroke.
A score of <5 on the NIHSS indicates what? - ANSWER-No stroke
symptoms or minor stroke
A score of 5-15 on the NIHSS indicates what? - ANSWER-Moderate
stroke
A score of 16-20 on the NIHSS indicates what? - ANSWER-Moderate
to severe
A score of 21-42 on the NIHSS indicates what? - ANSWER-Severe
stroke
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1A. Level of Consciousness (LOC) Scoring - ANSWER-0 - Alert;
keenly responsive.
1 - Not Alert; but arousable by minor stimulation to obey, answer, or
respond.
2 - Not Alert; requires repeated stimulation to attend, or is obtunded and
requires strong or painful stimulation to make movements (not
stereotyped).
3 - Responds only with reflex motor or autonomic effects, or totally
unresponsive, flaccid, and areflexic.
1B. Level of Consciousness (LOC) Scoring - ANSWER-The patient is
asked the month and his/her age. The answer must be correct
Aphasic and stuporous patients who do not comprehend the questions
are scored 2
Patients unable to speak because of endotracheal intubation, orotracheal
trauma, severe dysarthria from any cause, language barrier, or any other
problem not secondary to aphasia are scored 1
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly.
1C. Level of Consciousness (LOC) Scoring - ANSWER-The patient is
asked to open and close the eyes and then to grip and release the
nonparetic hand. Substitute another one-step command if the hands
cannot be used. Credit is given if an unequivocal attempt is made but not
completed due to weakness. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
2. Best Gaze NIHSS Scoring - ANSWER-Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
Establishing eye contact and then moving about the patient from side to
side will occasionally clarify the presence of a partial gaze palsy.
NIH Stroke Scale (NIHSS) Certification Test Bank
2025/2026: A+ Graded Exam Questions with Verified
Answers & Rationales for a First-Time Pass.
What is an accurate statement about NIHSS and hemorrhagic stroke? -
ANSWER-NIHSS scores predict 30-day mortality and disability
outcomes for intracerebral hemorrhage.
True or False: The patient should be in the supine position for Motor
Leg assessment. - ANSWER-TRUE
You are assessing your patient using the NIHSS. Your patient is
intubated, and you determine that section 10: Dysarthria is UN (i.e.,
untestable). What do you do next? - ANSWER-Document the reason it
is untestable.
When assessing Motor Arm function, which of the following
considerations is correct? - ANSWER-Assess the arm opposite the weak
arm first.
What is the purpose of the NIHSS - ANSWER-To assess stroke severity
using a standardized tool administered the same way by every healthcare
professional who uses it.
Your patient with a stroke has an NIHSS score of 15. What is the most
likely discharge scenario for a patient with this NIHSS score? -
ANSWER-Discharge to a long-term skilled nursing care center
The healthcare professional is evaluating the Motor Leg function. The
examiner positions the leg in the correct position and then releases the
,2|Page
leg. The leg slightly dips, returns to a normal position, and the position
is held up for 5 seconds. What is the appropriate score? - ANSWER-0
â€" No drift
What is item 2 (Best Gaze) designed to test? - ANSWER-Horizontal eye
movement only
True or False: One clinical application of the NIHSS is to assess patients
before they receive tissue plasminogen activator (tPA). - ANSWER-
TRUE
What technique used to assess visual extinction involves the examiner
placing their fingers in the patient's visual fields at the same time? -
ANSWER-Double simultaneous stimulation
NIHSS - ANSWER-National Institutes of Health Stroke Scale
Scoring range is 0 to 42 points, with higher numbers indicating greater
severity. a score of 5 to 15 represents a moderate stroke, a score of 16 to
20 represents a moderate to severe stroke, and a score of 21 to 42
represents a severe stroke.
A score of <5 on the NIHSS indicates what? - ANSWER-No stroke
symptoms or minor stroke
A score of 5-15 on the NIHSS indicates what? - ANSWER-Moderate
stroke
A score of 16-20 on the NIHSS indicates what? - ANSWER-Moderate
to severe
A score of 21-42 on the NIHSS indicates what? - ANSWER-Severe
stroke
, 3|Page
1A. Level of Consciousness (LOC) Scoring - ANSWER-0 - Alert;
keenly responsive.
1 - Not Alert; but arousable by minor stimulation to obey, answer, or
respond.
2 - Not Alert; requires repeated stimulation to attend, or is obtunded and
requires strong or painful stimulation to make movements (not
stereotyped).
3 - Responds only with reflex motor or autonomic effects, or totally
unresponsive, flaccid, and areflexic.
1B. Level of Consciousness (LOC) Scoring - ANSWER-The patient is
asked the month and his/her age. The answer must be correct
Aphasic and stuporous patients who do not comprehend the questions
are scored 2
Patients unable to speak because of endotracheal intubation, orotracheal
trauma, severe dysarthria from any cause, language barrier, or any other
problem not secondary to aphasia are scored 1
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly.
1C. Level of Consciousness (LOC) Scoring - ANSWER-The patient is
asked to open and close the eyes and then to grip and release the
nonparetic hand. Substitute another one-step command if the hands
cannot be used. Credit is given if an unequivocal attempt is made but not
completed due to weakness. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
2. Best Gaze NIHSS Scoring - ANSWER-Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
Establishing eye contact and then moving about the patient from side to
side will occasionally clarify the presence of a partial gaze palsy.
