NIHSS GROUP C PATIENTS 1-6 ANSWER KEY 2026/2027 |
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PATIENT 1 - NIHSS Assessment (Questions 1-15)
Q1 (Patient 1, Item 1a - Level of Consciousness): Patient opens eyes spontaneously
upon entering the room, makes immediate eye contact, and responds appropriately
when asked how they are feeling. Patient is fully oriented and conversational.
A. 0 - Alert, keenly responsive
B. 1 - Not alert but arousable by minor stimulation
C. 2 - Not alert, requires repeated stimulation
D. 3 - Responds only with reflex effects or unresponsive
Correct Answer: A
Rationale: Per NIHSS criteria, the patient is alert and keenly responsive from the outset
without requiring any stimulation, fitting the definition of score 0.
Q2 (Patient 1, Item 1b - LOC Questions): When asked "What month is it?" the patient
correctly states "January." When asked "How old are you?" the patient correctly states
"68."
A. 0 - Answers both correctly
B. 1 - Answers one correctly
C. 2 - Answers neither correctly
D. 9 - Unable to test (intubated/trauma)
Correct Answer: A
Rationale: Per NIHSS guidelines, the patient correctly answers both orientation
questions (month and age), warranting a score of 0.
Q3 (Patient 1, Item 1c - LOC Commands): Patient is asked to open and close eyes and
then make a fist and let go. Patient performs both tasks promptly and accurately
without coaching or repetition.
A. 0 - Performs both tasks correctly
B. 1 - Performs one task correctly
C. 2 - Performs neither correctly
D. 9 - Untestable due to amputation
,Correct Answer: A
Rationale: Per NINDS standards, the patient demonstrates intact comprehension and
execution of both simple commands (eyes and fist), resulting in a score of 0.
Q4 (Patient 1, Item 2 - Best Gaze): Patient follows examiner's finger to the left and right
with normal conjugate eye movements. No deviation or paresis is noted, and doll's eyes
maneuver is unnecessary.
A. 0 - Normal
B. 1 - Partial gaze palsy
C. 2 - Forced deviation or total gaze paresis
D. 9 - Untestable due to orbital trauma
Correct Answer: A
Rationale: NIHSS criteria define score 0 as normal horizontal eye movements; patient
demonstrates intact voluntary gaze in both directions without abnormality.
Q5 (Patient 1, Item 3 - Visual): Patient correctly counts fingers in all four quadrants
bilaterally. Visual threat testing reveals no field cuts, and patient responds to stimuli
presented simultaneously in both visual fields.
A. 0 - No visual loss
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia
D. 3 - Bilateral hemianopia (cortical blindness)
Correct Answer: A
Rationale: Per NIHSS visual field testing standards, patient demonstrates intact visual
fields in all quadrants with no evidence of hemianopia, warranting score 0.
Q6 (Patient 1, Item 4 - Facial Palsy): Patient shows teeth symmetrically, raises eyebrows
fully with equal wrinkling on both sides, and squeezes eyes shut with equal force
bilaterally.
A. 0 - Normal symmetrical movement
B. 1 - Minor paralysis (flattened nasolabial fold)
C. 2 - Partial paralysis (lower face)
D. 3 - Complete paralysis (upper and lower face)
Correct Answer: A
Rationale: NIHSS scoring criteria indicate score 0 for normal symmetrical facial
movement; patient exhibits no asymmetry in any tested action.
, Q7 (Patient 1, Item 5 - Motor Arm Left): Left arm is held at 90 degrees (sitting). Arm
maintains full position for entire 10 seconds without any downward drift.
A. 0 - No drift (holds full 10 seconds)
B. 1 - Drift (does not hit support)
C. 2 - Some effort against gravity
D. 3 - No effort against gravity (falls immediately)
Correct Answer: A
Rationale: Per NIHSS motor arm testing protocols, the limb holds the initial position for
the full 10 seconds without any drift, consistent with score 0.
Q8 (Patient 1, Item 6 - Motor Arm Right): Right arm is held at 90 degrees (sitting). Arm
maintains full position for entire 10 seconds without any downward drift.
A. 0 - No drift (holds full 10 seconds)
B. 1 - Drift (does not hit support)
C. 2 - Some effort against gravity
D. 4 - No movement (flaccid)
Correct Answer: A
Rationale: NIHSS criteria specify score 0 for no drift during the full 10-second
observation period; patient demonstrates normal motor strength in the right arm.
Q9 (Patient 1, Item 7 - Motor Leg Left): Left leg is held at 30 degrees (supine). Leg
maintains full position for entire 5 seconds without drift.
A. 0 - No drift (holds full 5 seconds)
B. 1 - Drift (does not hit bed)
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: A
Rationale: Per NINDS motor leg assessment standards, the limb maintains the
30-degree position for the complete 5 seconds, indicating score 0.
Q10 (Patient 1, Item 8 - Motor Leg Right): Right leg is held at 30 degrees (supine). Leg
maintains full position for entire 5 seconds without drift.
A. 0 - No drift (holds full 5 seconds)
B. 1 - Drift (does not hit bed)
C. 2 - Some effort against gravity
D. 4 - No movement (flaccid)
Correct Answer: A
Latest Update Complete Solutions | NIH Stroke Scale
Certification | Pass Guaranteed - A+ Graded
PATIENT 1 - NIHSS Assessment (Questions 1-15)
Q1 (Patient 1, Item 1a - Level of Consciousness): Patient opens eyes spontaneously
upon entering the room, makes immediate eye contact, and responds appropriately
when asked how they are feeling. Patient is fully oriented and conversational.
A. 0 - Alert, keenly responsive
B. 1 - Not alert but arousable by minor stimulation
C. 2 - Not alert, requires repeated stimulation
D. 3 - Responds only with reflex effects or unresponsive
Correct Answer: A
Rationale: Per NIHSS criteria, the patient is alert and keenly responsive from the outset
without requiring any stimulation, fitting the definition of score 0.
Q2 (Patient 1, Item 1b - LOC Questions): When asked "What month is it?" the patient
correctly states "January." When asked "How old are you?" the patient correctly states
"68."
A. 0 - Answers both correctly
B. 1 - Answers one correctly
C. 2 - Answers neither correctly
D. 9 - Unable to test (intubated/trauma)
Correct Answer: A
Rationale: Per NIHSS guidelines, the patient correctly answers both orientation
questions (month and age), warranting a score of 0.
Q3 (Patient 1, Item 1c - LOC Commands): Patient is asked to open and close eyes and
then make a fist and let go. Patient performs both tasks promptly and accurately
without coaching or repetition.
A. 0 - Performs both tasks correctly
B. 1 - Performs one task correctly
C. 2 - Performs neither correctly
D. 9 - Untestable due to amputation
,Correct Answer: A
Rationale: Per NINDS standards, the patient demonstrates intact comprehension and
execution of both simple commands (eyes and fist), resulting in a score of 0.
Q4 (Patient 1, Item 2 - Best Gaze): Patient follows examiner's finger to the left and right
with normal conjugate eye movements. No deviation or paresis is noted, and doll's eyes
maneuver is unnecessary.
A. 0 - Normal
B. 1 - Partial gaze palsy
C. 2 - Forced deviation or total gaze paresis
D. 9 - Untestable due to orbital trauma
Correct Answer: A
Rationale: NIHSS criteria define score 0 as normal horizontal eye movements; patient
demonstrates intact voluntary gaze in both directions without abnormality.
Q5 (Patient 1, Item 3 - Visual): Patient correctly counts fingers in all four quadrants
bilaterally. Visual threat testing reveals no field cuts, and patient responds to stimuli
presented simultaneously in both visual fields.
A. 0 - No visual loss
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia
D. 3 - Bilateral hemianopia (cortical blindness)
Correct Answer: A
Rationale: Per NIHSS visual field testing standards, patient demonstrates intact visual
fields in all quadrants with no evidence of hemianopia, warranting score 0.
Q6 (Patient 1, Item 4 - Facial Palsy): Patient shows teeth symmetrically, raises eyebrows
fully with equal wrinkling on both sides, and squeezes eyes shut with equal force
bilaterally.
A. 0 - Normal symmetrical movement
B. 1 - Minor paralysis (flattened nasolabial fold)
C. 2 - Partial paralysis (lower face)
D. 3 - Complete paralysis (upper and lower face)
Correct Answer: A
Rationale: NIHSS scoring criteria indicate score 0 for normal symmetrical facial
movement; patient exhibits no asymmetry in any tested action.
, Q7 (Patient 1, Item 5 - Motor Arm Left): Left arm is held at 90 degrees (sitting). Arm
maintains full position for entire 10 seconds without any downward drift.
A. 0 - No drift (holds full 10 seconds)
B. 1 - Drift (does not hit support)
C. 2 - Some effort against gravity
D. 3 - No effort against gravity (falls immediately)
Correct Answer: A
Rationale: Per NIHSS motor arm testing protocols, the limb holds the initial position for
the full 10 seconds without any drift, consistent with score 0.
Q8 (Patient 1, Item 6 - Motor Arm Right): Right arm is held at 90 degrees (sitting). Arm
maintains full position for entire 10 seconds without any downward drift.
A. 0 - No drift (holds full 10 seconds)
B. 1 - Drift (does not hit support)
C. 2 - Some effort against gravity
D. 4 - No movement (flaccid)
Correct Answer: A
Rationale: NIHSS criteria specify score 0 for no drift during the full 10-second
observation period; patient demonstrates normal motor strength in the right arm.
Q9 (Patient 1, Item 7 - Motor Leg Left): Left leg is held at 30 degrees (supine). Leg
maintains full position for entire 5 seconds without drift.
A. 0 - No drift (holds full 5 seconds)
B. 1 - Drift (does not hit bed)
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: A
Rationale: Per NINDS motor leg assessment standards, the limb maintains the
30-degree position for the complete 5 seconds, indicating score 0.
Q10 (Patient 1, Item 8 - Motor Leg Right): Right leg is held at 30 degrees (supine). Leg
maintains full position for entire 5 seconds without drift.
A. 0 - No drift (holds full 5 seconds)
B. 1 - Drift (does not hit bed)
C. 2 - Some effort against gravity
D. 4 - No movement (flaccid)
Correct Answer: A
