NIH Stroke Scale (NIHSS) Certification 2026 Full
Practice Exam with 100 Questions, Verified
Answers & Expert Rationales | Updated A+ Rated Prep
Instructions:
Select the best answer for each question based on the current NIH Stroke Scale (NIHSS)
standards as outlined by the National Institute of Neurological Disorders and Stroke (NINDS).
Section 1: General Principles & Scoring (Questions 1-15)
1. According to the NIHSS, what range of scores indicates a "moderate" stroke severity?
A) 0–4
B) 5–15
C) 16–20
D) 21–42
Rationale: The NIHSS total score classifies severity as follows: 0 = no stroke symptoms; 1–4 =
mild; 5–15 = moderate; 16–20 = moderate to severe; 21–42 = severe .
2. For item 1B (LOC Questions), the patient is asked which two specific questions?
A) "What is your name?" and "Where are you?"
B) "What month is it?" and "How old are you?"
C) "What day of the week is it?" and "What year is it?"
D) "Who is the President?" and "Where is the hospital?"
Rationale: The standardized questions for NIHSS item 1B are the current month and the
patient's age. This tests orientation specifically, not general knowledge.
3. A patient follows the command to blink but does not squeeze your hand when asked.
According to item 1C (LOC Commands), what score should be assigned?
A) 0
B) 1
C) 2
D) 3
Rationale: Item 1C scores the ability to perform two commands (open/close eyes and
grip/release hand). A score of 1 is given if the patient performs only one task correctly.
4. When testing motor function in the arm (item 5), how long should the patient be asked to
hold the limb in position?
,A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
Rationale: For the arm (item 5), the patient holds the limb at 90° (sitting) or 45° (supine) for a
full 10 seconds to check for drift. For the leg (item 6), the duration is 5 seconds.
5. A patient with known arthritis and joint fusion in the left arm is being tested. How
should the motor arm item (5a) be scored?
A) Score as 4 (No movement)
B) Score as 2 (Some effort against gravity)
C) Score as "UN" (Untestable)
D) Estimate the score based on the right arm
Rationale: If a limb is amputated or joint fusion prevents movement, the item is marked as
"Untestable" (UN). It should not be scored numerically, as the impairment is not due to the
stroke.
6. What does item 2 (Best Gaze) test?
A) Vertical eye movements and pupil reactivity
B) Horizontal eye movements
C) Convergence and accommodation
D) Oculocephalic reflex only
Rationale: Item 2 specifically assesses horizontal eye movements. It looks for partial gaze palsy
or forced deviation. Vertical gaze and reflexes are not part of this score.
7. A patient is intubated and cannot speak. How should item 10 (Dysarthria) be scored?
A) Score as 2 (Severe dysarthria)
B) Score as 1 (Mild dysarthria)
C) Score as "Untestable"
D) Ask the patient to write their response
Rationale: If the patient is intubated, has a physical barrier, or for any other reason cannot be
assessed for clarity of speech, the item should be marked "Untestable." It is not scored as an
abnormality.
8. In item 9 (Best Language), a patient with global aphasia (no usable speech or
comprehension) would receive a score of:
A) 1
B) 2
C) 3
D) 4
Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild to moderate aphasia; 2 = Severe aphasia; 3
= Mute or global aphasia .
9. What is the primary purpose of the NIH Stroke Scale?
A) To determine the exact location of the stroke
B) To quantify the level of neurological deficit caused by a stroke
C) To decide if a patient needs a CT scan
, D) To measure blood flow in the brain
Rationale: The NIHSS is a standardized tool used to objectively quantify the
impairment caused by a stroke. It helps in communication, triage, and predicting outcomes, but
it does not replace imaging for location.
10. For item 8 (Sensory), if a patient has severe sensory loss and is unaware of being
touched on the left side, the score should be:
A) 0
B) 1
C) 2
D) 3
Rationale: Sensory scoring: 0 = Normal; 1 = Mild to moderate sensory loss (feels less sharp or
dull); 2 = Severe to total sensory loss (patient is unaware of touch in the affected area) .
11. Limb ataxia (item 7) is tested by which of the following methods?
A) Asking the patient to stand with feet together
B) Finger-nose-finger and heel-shin tests
C) Observing the patient walk in a straight line
D) Checking for pronator drift
Rationale: Ataxia is tested in the limbs using point-to-point movements. The finger-nose-finger
tests the upper extremities, and the heel-shin test assesses the lower extremities.
12. If a patient has forced deviation of the eyes that cannot be overcome by the
oculocephalic maneuver (doll's eyes), the score for Best Gaze (item 2) is:
A) 0
B) 1
C) 2
D) 3
Rationale: A score of 2 indicates forced deviation or total gaze paresis that cannot be corrected
by reflexive eye movements (oculocephalic maneuver) .
13. Extinction or inattention (item 11) is best tested by:
A) Asking the patient to follow a pen with their eyes
B) Asking the patient to name two objects
C) Performing bilateral simultaneous stimulation in visual, tactile, or auditory modalities
D) Testing muscle strength in both arms simultaneously
Rationale: Item 11 checks for neglect. The standard method is to stimulate both sides of the
body at once. If the patient perceives the stimulus on one side only when presented alone but
"extinguishes" the contralateral side during bilateral stimulation, it indicates neglect .
14. What is the maximum possible total score on the NIH Stroke Scale?
A) 36
B) 40
C) 42
D) 50
Rationale: The NIHSS total score ranges from 0 to 42. The higher the score, the more severe the
neurological deficit.
Practice Exam with 100 Questions, Verified
Answers & Expert Rationales | Updated A+ Rated Prep
Instructions:
Select the best answer for each question based on the current NIH Stroke Scale (NIHSS)
standards as outlined by the National Institute of Neurological Disorders and Stroke (NINDS).
Section 1: General Principles & Scoring (Questions 1-15)
1. According to the NIHSS, what range of scores indicates a "moderate" stroke severity?
A) 0–4
B) 5–15
C) 16–20
D) 21–42
Rationale: The NIHSS total score classifies severity as follows: 0 = no stroke symptoms; 1–4 =
mild; 5–15 = moderate; 16–20 = moderate to severe; 21–42 = severe .
2. For item 1B (LOC Questions), the patient is asked which two specific questions?
A) "What is your name?" and "Where are you?"
B) "What month is it?" and "How old are you?"
C) "What day of the week is it?" and "What year is it?"
D) "Who is the President?" and "Where is the hospital?"
Rationale: The standardized questions for NIHSS item 1B are the current month and the
patient's age. This tests orientation specifically, not general knowledge.
3. A patient follows the command to blink but does not squeeze your hand when asked.
According to item 1C (LOC Commands), what score should be assigned?
A) 0
B) 1
C) 2
D) 3
Rationale: Item 1C scores the ability to perform two commands (open/close eyes and
grip/release hand). A score of 1 is given if the patient performs only one task correctly.
4. When testing motor function in the arm (item 5), how long should the patient be asked to
hold the limb in position?
,A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
Rationale: For the arm (item 5), the patient holds the limb at 90° (sitting) or 45° (supine) for a
full 10 seconds to check for drift. For the leg (item 6), the duration is 5 seconds.
5. A patient with known arthritis and joint fusion in the left arm is being tested. How
should the motor arm item (5a) be scored?
A) Score as 4 (No movement)
B) Score as 2 (Some effort against gravity)
C) Score as "UN" (Untestable)
D) Estimate the score based on the right arm
Rationale: If a limb is amputated or joint fusion prevents movement, the item is marked as
"Untestable" (UN). It should not be scored numerically, as the impairment is not due to the
stroke.
6. What does item 2 (Best Gaze) test?
A) Vertical eye movements and pupil reactivity
B) Horizontal eye movements
C) Convergence and accommodation
D) Oculocephalic reflex only
Rationale: Item 2 specifically assesses horizontal eye movements. It looks for partial gaze palsy
or forced deviation. Vertical gaze and reflexes are not part of this score.
7. A patient is intubated and cannot speak. How should item 10 (Dysarthria) be scored?
A) Score as 2 (Severe dysarthria)
B) Score as 1 (Mild dysarthria)
C) Score as "Untestable"
D) Ask the patient to write their response
Rationale: If the patient is intubated, has a physical barrier, or for any other reason cannot be
assessed for clarity of speech, the item should be marked "Untestable." It is not scored as an
abnormality.
8. In item 9 (Best Language), a patient with global aphasia (no usable speech or
comprehension) would receive a score of:
A) 1
B) 2
C) 3
D) 4
Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild to moderate aphasia; 2 = Severe aphasia; 3
= Mute or global aphasia .
9. What is the primary purpose of the NIH Stroke Scale?
A) To determine the exact location of the stroke
B) To quantify the level of neurological deficit caused by a stroke
C) To decide if a patient needs a CT scan
, D) To measure blood flow in the brain
Rationale: The NIHSS is a standardized tool used to objectively quantify the
impairment caused by a stroke. It helps in communication, triage, and predicting outcomes, but
it does not replace imaging for location.
10. For item 8 (Sensory), if a patient has severe sensory loss and is unaware of being
touched on the left side, the score should be:
A) 0
B) 1
C) 2
D) 3
Rationale: Sensory scoring: 0 = Normal; 1 = Mild to moderate sensory loss (feels less sharp or
dull); 2 = Severe to total sensory loss (patient is unaware of touch in the affected area) .
11. Limb ataxia (item 7) is tested by which of the following methods?
A) Asking the patient to stand with feet together
B) Finger-nose-finger and heel-shin tests
C) Observing the patient walk in a straight line
D) Checking for pronator drift
Rationale: Ataxia is tested in the limbs using point-to-point movements. The finger-nose-finger
tests the upper extremities, and the heel-shin test assesses the lower extremities.
12. If a patient has forced deviation of the eyes that cannot be overcome by the
oculocephalic maneuver (doll's eyes), the score for Best Gaze (item 2) is:
A) 0
B) 1
C) 2
D) 3
Rationale: A score of 2 indicates forced deviation or total gaze paresis that cannot be corrected
by reflexive eye movements (oculocephalic maneuver) .
13. Extinction or inattention (item 11) is best tested by:
A) Asking the patient to follow a pen with their eyes
B) Asking the patient to name two objects
C) Performing bilateral simultaneous stimulation in visual, tactile, or auditory modalities
D) Testing muscle strength in both arms simultaneously
Rationale: Item 11 checks for neglect. The standard method is to stimulate both sides of the
body at once. If the patient perceives the stimulus on one side only when presented alone but
"extinguishes" the contralateral side during bilateral stimulation, it indicates neglect .
14. What is the maximum possible total score on the NIH Stroke Scale?
A) 36
B) 40
C) 42
D) 50
Rationale: The NIHSS total score ranges from 0 to 42. The higher the score, the more severe the
neurological deficit.
