NIH STROKE SCALE (NIHSS) COMPLETE EXAM VERIFIED ANSWERS AND
QUESTIONS GRADED A+ MOST RECENT EDITION 2026/2027 WITH
EXPLAINED ANSWERS
ITEMS 1a, 1b, 1c — Level of Consciousness
Q1. A patient opens their eyes spontaneously, follows commands
accurately, and answers questions correctly. What is the NIHSS score for
Level of Consciousness (1a)?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Explanation: Score 0 = Alert; keenly responsive.
Q2. A patient requires repeated stimulation to arouse but eventually
responds appropriately. What is the NIHSS 1a score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Explanation: Score 1 = Not alert; arousable by minor stimulation.
Q3. A patient responds only with reflex motor or autonomic effects to
repeated stimulation. What is the NIHSS 1a score?
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Explanation: Score 2 = Not alert; requires repeated stimulation or pain to
make non-stereotyped movements.
,Q4. A patient is unresponsive with no movements except reflexes. What
NIHSS 1a score applies?
A) 0
B) 1
C) 2
D) 3
Answer: D) 3
Explanation: Score 3 = Responds only with reflex motor or autonomic effects
or totally unresponsive.
Q5. The maximum score for NIHSS item 1a (Level of Consciousness) is:
A) 1
B) 2
C) 3
D) 4
Answer: C) 3
Explanation: LOC 1a is scored 0-3.
Q6. Which NIHSS 1a score indicates a patient who is alert and responsive?
A) 3
B) 2
C) 1
D) 0
Answer: D) 0
Explanation: Score 0 = fully alert and responsive.
Q7. A drowsy patient who opens eyes to voice but drifts back to sleep
earns which NIHSS 1a score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Explanation: Minor stimulation (voice) produces arousal — score 1.
,Q8. For NIHSS 1a, which response warrants a score of 2?
A) Eyes open spontaneously
B) Responds to verbal stimuli only
C) Only reflex responses to strong stimuli
D) Totally unresponsive
Answer: C) Only reflex responses to strong stimuli
Explanation: Score 2 requires repeated/painful stimulation and only
stereotyped responses.
Q9. NIHSS 1a is best described as testing which domain?
A) Orientation
B) Commands
C) Responsiveness/arousal
D) Language
Answer: C) Responsiveness/arousal
Explanation: Item 1a specifically assesses level of consciousness/arousal.
Q10. How should the examiner score NIHSS 1a if the patient cannot be
evaluated due to intubation?
A) Score 0
B) Score 3
C) Score the best estimate based on observation
D) Leave blank
Answer: C) Score the best estimate based on observation
Explanation: The examiner should use observation to make the best
estimate; never leave blank.
Q11. NIHSS item 1b asks two questions. What are they?
A) Name and birthdate
B) Current month and patient's age
C) Current year and day of week
D) Name of hospital and current season
Answer: B) Current month and patient's age
Explanation: 1b = current month and patient's age.
, Q12. A patient correctly answers both LOC questions. NIHSS 1b score is:
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Explanation: Both correct = score 0.
Q13. A patient answers only one of the two LOC questions correctly. NIHSS
1b score is:
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Explanation: One correct = score 1.
Q14. A patient with aphasia cannot answer either LOC question. NIHSS 1b
score is:
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Explanation: Neither correct (including aphasic or stuporous patients) = score
2.
Q15. For NIHSS 1b, an intubated patient who attempts to communicate the
correct answer should receive:
A) Score 0
B) Score 1
C) Score 2
D) It cannot be scored
Answer: A) Score 0
QUESTIONS GRADED A+ MOST RECENT EDITION 2026/2027 WITH
EXPLAINED ANSWERS
ITEMS 1a, 1b, 1c — Level of Consciousness
Q1. A patient opens their eyes spontaneously, follows commands
accurately, and answers questions correctly. What is the NIHSS score for
Level of Consciousness (1a)?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Explanation: Score 0 = Alert; keenly responsive.
Q2. A patient requires repeated stimulation to arouse but eventually
responds appropriately. What is the NIHSS 1a score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Explanation: Score 1 = Not alert; arousable by minor stimulation.
Q3. A patient responds only with reflex motor or autonomic effects to
repeated stimulation. What is the NIHSS 1a score?
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Explanation: Score 2 = Not alert; requires repeated stimulation or pain to
make non-stereotyped movements.
,Q4. A patient is unresponsive with no movements except reflexes. What
NIHSS 1a score applies?
A) 0
B) 1
C) 2
D) 3
Answer: D) 3
Explanation: Score 3 = Responds only with reflex motor or autonomic effects
or totally unresponsive.
Q5. The maximum score for NIHSS item 1a (Level of Consciousness) is:
A) 1
B) 2
C) 3
D) 4
Answer: C) 3
Explanation: LOC 1a is scored 0-3.
Q6. Which NIHSS 1a score indicates a patient who is alert and responsive?
A) 3
B) 2
C) 1
D) 0
Answer: D) 0
Explanation: Score 0 = fully alert and responsive.
Q7. A drowsy patient who opens eyes to voice but drifts back to sleep
earns which NIHSS 1a score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Explanation: Minor stimulation (voice) produces arousal — score 1.
,Q8. For NIHSS 1a, which response warrants a score of 2?
A) Eyes open spontaneously
B) Responds to verbal stimuli only
C) Only reflex responses to strong stimuli
D) Totally unresponsive
Answer: C) Only reflex responses to strong stimuli
Explanation: Score 2 requires repeated/painful stimulation and only
stereotyped responses.
Q9. NIHSS 1a is best described as testing which domain?
A) Orientation
B) Commands
C) Responsiveness/arousal
D) Language
Answer: C) Responsiveness/arousal
Explanation: Item 1a specifically assesses level of consciousness/arousal.
Q10. How should the examiner score NIHSS 1a if the patient cannot be
evaluated due to intubation?
A) Score 0
B) Score 3
C) Score the best estimate based on observation
D) Leave blank
Answer: C) Score the best estimate based on observation
Explanation: The examiner should use observation to make the best
estimate; never leave blank.
Q11. NIHSS item 1b asks two questions. What are they?
A) Name and birthdate
B) Current month and patient's age
C) Current year and day of week
D) Name of hospital and current season
Answer: B) Current month and patient's age
Explanation: 1b = current month and patient's age.
, Q12. A patient correctly answers both LOC questions. NIHSS 1b score is:
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Explanation: Both correct = score 0.
Q13. A patient answers only one of the two LOC questions correctly. NIHSS
1b score is:
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Explanation: One correct = score 1.
Q14. A patient with aphasia cannot answer either LOC question. NIHSS 1b
score is:
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Explanation: Neither correct (including aphasic or stuporous patients) = score
2.
Q15. For NIHSS 1b, an intubated patient who attempts to communicate the
correct answer should receive:
A) Score 0
B) Score 1
C) Score 2
D) It cannot be scored
Answer: A) Score 0
