NIH Stroke Scale – All Test Groups A–F (Patients
1–6) | Complete Answer Key | Verified and Fully
Updated for 2025/2026.
INTRODUCTION
This comprehensive answer key provides complete scoring guidelines for the NIH Stroke Scale
(NIHSS) certification examination, covering all 36 patient scenarios across Test Groups A through
F. Based on the most current 2025/2026 NIHSS certification standards and established stroke
assessment protocols established by the National Institutes of Health, this resource is designed
for healthcare professionals—including nurses, physicians, emergency medical technicians, and
allied health practitioners—seeking initial certification or recertification in standardized stroke
assessment. The NIHSS is a critical tool for quantifying stroke severity, guiding treatment
decisions, and monitoring patient progress, with scores ranging from 0 (no stroke symptoms) to
42 (severe stroke). This answer key includes detailed scoring for all 11 NIHSS categories (1a
through 11) across six distinct test groups, each containing six unique patient presentations that
mirror actual certification examination scenarios. All scores have been verified against current
clinical guidelines and reflect the standardized video-based patient assessments used in official
NIHSS certification programs.
GROUP A: PATIENTS 1-6
Patient 1: Acute Ischemic Stroke - Right MCA Syndrome
1a: 1 - Not alert, but arousable by minor stimulation (Drowsy but confused)
1b: 0 - Answers both correctly
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
3: 2 - Complete hemianopia (left homonymous hemianopsia)
4: 3 - Complete paralysis (left facial droop, cannot move)
5a: 4 - No movement (left arm)
5b: 0 - No drift (right arm)
6a: 4 - No movement (left leg)
6b: 0 - No drift (right leg)
,7: 2 - Present in two limbs (left arm and leg ataxia)
8: 2 - Severe or total sensory loss (left side)
9: 1 - Mild to moderate aphasia
10: 2 - Severe dysarthria
11: 2 - Profound hemi-inattention (complete neglect, left-sided)
Patient 2:
1a: 0 - Alert; keenly responsive
1b: 2 - Answers neither correctly (aphasia-related impairment)
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
3: 0 - No visual loss
4: 1 - Minor paralysis (facial movement asymmetry)
5a: 0 - No drift (left arm)
5b: 0 - No drift (right arm)
6a: 1 - Drift, does not hit bed (left leg)
6b: 1 - Drift, does not hit bed (right leg)
7: 0 - Absent (no ataxia)
8: 1 - Mild to moderate sensory loss
9: 0 - No aphasia; normal language
10: 0 - Normal dysarthria
11: 0 - No abnormality (normal attention)
Patient 3:
1a: 0 - Alert; keenly responsive
1b: 0 - Answers both correctly
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
, 3: 0 - No visual loss
4: 1 - Minor paralysis
5a: 0 - No drift (left arm)
5b: 0 - No drift (right arm)
6a: 1 - Drift, does not hit bed (left leg)
6b: 0 - No drift (right leg)
7: 1 - Present in one limb
8: 1 - Mild to moderate sensory loss
9: 0 - No aphasia; normal
10: 0 - Normal
11: 0 - No abnormality
Patient 4:
1a: 0 - Alert; keenly responsive
1b: 0 - Answers both correctly
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
3: 0 - No visual loss
4: 1 - Minor paralysis
5a: 4 - No movement (left arm)
5b: 0 - No drift (right arm)
6a: 3 - No effort against gravity (left leg)
6b: 0 - No drift (right leg)
7: 1 - Present in one limb
8: 1 - Mild to moderate sensory loss
9: 1 - Mild to moderate aphasia
10: 1 - Mild to moderate dysarthria
1–6) | Complete Answer Key | Verified and Fully
Updated for 2025/2026.
INTRODUCTION
This comprehensive answer key provides complete scoring guidelines for the NIH Stroke Scale
(NIHSS) certification examination, covering all 36 patient scenarios across Test Groups A through
F. Based on the most current 2025/2026 NIHSS certification standards and established stroke
assessment protocols established by the National Institutes of Health, this resource is designed
for healthcare professionals—including nurses, physicians, emergency medical technicians, and
allied health practitioners—seeking initial certification or recertification in standardized stroke
assessment. The NIHSS is a critical tool for quantifying stroke severity, guiding treatment
decisions, and monitoring patient progress, with scores ranging from 0 (no stroke symptoms) to
42 (severe stroke). This answer key includes detailed scoring for all 11 NIHSS categories (1a
through 11) across six distinct test groups, each containing six unique patient presentations that
mirror actual certification examination scenarios. All scores have been verified against current
clinical guidelines and reflect the standardized video-based patient assessments used in official
NIHSS certification programs.
GROUP A: PATIENTS 1-6
Patient 1: Acute Ischemic Stroke - Right MCA Syndrome
1a: 1 - Not alert, but arousable by minor stimulation (Drowsy but confused)
1b: 0 - Answers both correctly
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
3: 2 - Complete hemianopia (left homonymous hemianopsia)
4: 3 - Complete paralysis (left facial droop, cannot move)
5a: 4 - No movement (left arm)
5b: 0 - No drift (right arm)
6a: 4 - No movement (left leg)
6b: 0 - No drift (right leg)
,7: 2 - Present in two limbs (left arm and leg ataxia)
8: 2 - Severe or total sensory loss (left side)
9: 1 - Mild to moderate aphasia
10: 2 - Severe dysarthria
11: 2 - Profound hemi-inattention (complete neglect, left-sided)
Patient 2:
1a: 0 - Alert; keenly responsive
1b: 2 - Answers neither correctly (aphasia-related impairment)
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
3: 0 - No visual loss
4: 1 - Minor paralysis (facial movement asymmetry)
5a: 0 - No drift (left arm)
5b: 0 - No drift (right arm)
6a: 1 - Drift, does not hit bed (left leg)
6b: 1 - Drift, does not hit bed (right leg)
7: 0 - Absent (no ataxia)
8: 1 - Mild to moderate sensory loss
9: 0 - No aphasia; normal language
10: 0 - Normal dysarthria
11: 0 - No abnormality (normal attention)
Patient 3:
1a: 0 - Alert; keenly responsive
1b: 0 - Answers both correctly
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
, 3: 0 - No visual loss
4: 1 - Minor paralysis
5a: 0 - No drift (left arm)
5b: 0 - No drift (right arm)
6a: 1 - Drift, does not hit bed (left leg)
6b: 0 - No drift (right leg)
7: 1 - Present in one limb
8: 1 - Mild to moderate sensory loss
9: 0 - No aphasia; normal
10: 0 - Normal
11: 0 - No abnormality
Patient 4:
1a: 0 - Alert; keenly responsive
1b: 0 - Answers both correctly
1c: 0 - Performs both tasks correctly
2: 0 - Normal gaze
3: 0 - No visual loss
4: 1 - Minor paralysis
5a: 4 - No movement (left arm)
5b: 0 - No drift (right arm)
6a: 3 - No effort against gravity (left leg)
6b: 0 - No drift (right leg)
7: 1 - Present in one limb
8: 1 - Mild to moderate sensory loss
9: 1 - Mild to moderate aphasia
10: 1 - Mild to moderate dysarthria
