NIH Stroke Scale (NIHSS) Practice Exam: 65
Questions & Answers Guide
________________________________________________
**Question 1**
What is the most important general rule to follow when administering and scoring the
NIH Stroke Scale (NIHSS)?
o Score the patient based on what you think their baseline is
☑ Score what you see during the exam, not what you think the patient can do
o Coach the patient until they get the correct answer
o Go back and change previous scores if the patient's performance improves
________________________________________________
**Question 2**
During the administration of the NIHSS, if a patient’s first attempt at a task is incorrect,
but they immediately correct themselves, which performance should you score?
o The best attempt out of three
o The corrected attempt
o The average of their attempts
☑ The very first attempt or response
________________________________________________
**Question 3**
For Item 1a (Level of Consciousness), a patient who requires repeated verbal
stimulation or painful stimulation to make movements or open their eyes is scored as:
,o 0 (Alert)
o 1 (Not alert, but arousable by minor stimulation)
☑ 2 (Not alert, requires repeated stimulation to attend)
o 3 (Responds only with reflex motor or autonomic effects, or totally unresponsive)
________________________________________________
**Question 4**
For Item 1b (LOC Questions), what are the two standard questions the patient must
answer?
o What is your name and what day of the week is it?
☑ What is the current month and what is your age?
o Where are you right now and what is the year?
o What is the current month and what is your date of birth?
________________________________________________
**Question 5**
When asking the LOC Questions (Item 1b), the patient answers the month correctly but
is off by one year for their age. How should this be scored?
o 0 (Answers both correctly)
☑ 1 (Answers one correctly)
o 2 (Answers neither correctly)
o UN (Untestable)
________________________________________________
**Question 6**
A patient is intubated and cannot speak, but is awake and alert. How do you score Item
1b (LOC Questions)?
o Give them a pen and paper to write the answers
, o UN (Untestable)
☑ 1 (Answers one correctly - standard exception rule for intubated/dysarthric patients
who cannot answer but appear to know)
o 2 (Answers neither correctly)
________________________________________________
**Question 7**
For Item 1c (LOC Commands), what two commands are given to the patient?
o Smile and raise your eyebrows
o Lift your left arm and touch your nose
☑ Open and close your eyes, and grip and release your non-paretic hand
o Stick out your tongue and wiggle your toes
________________________________________________
**Question 8**
If a patient has severe aphasia and cannot comprehend the verbal commands for Item
1c (LOC Commands), what should the examiner do?
o Score them a 2 immediately
☑ Pantomime the command (demonstrate it) and score if they can mimic the action
o Skip the item and mark it UN
o Speak louder and repeat the command three times
________________________________________________
**Question 9**
Item 2 (Best Gaze) evaluates horizontal eye movements. If a patient has a forced
deviation of the eyes that cannot be overcome by the oculocephalic (doll’s eyes)
maneuver, what is the score?
o 0 (Normal)
Questions & Answers Guide
________________________________________________
**Question 1**
What is the most important general rule to follow when administering and scoring the
NIH Stroke Scale (NIHSS)?
o Score the patient based on what you think their baseline is
☑ Score what you see during the exam, not what you think the patient can do
o Coach the patient until they get the correct answer
o Go back and change previous scores if the patient's performance improves
________________________________________________
**Question 2**
During the administration of the NIHSS, if a patient’s first attempt at a task is incorrect,
but they immediately correct themselves, which performance should you score?
o The best attempt out of three
o The corrected attempt
o The average of their attempts
☑ The very first attempt or response
________________________________________________
**Question 3**
For Item 1a (Level of Consciousness), a patient who requires repeated verbal
stimulation or painful stimulation to make movements or open their eyes is scored as:
,o 0 (Alert)
o 1 (Not alert, but arousable by minor stimulation)
☑ 2 (Not alert, requires repeated stimulation to attend)
o 3 (Responds only with reflex motor or autonomic effects, or totally unresponsive)
________________________________________________
**Question 4**
For Item 1b (LOC Questions), what are the two standard questions the patient must
answer?
o What is your name and what day of the week is it?
☑ What is the current month and what is your age?
o Where are you right now and what is the year?
o What is the current month and what is your date of birth?
________________________________________________
**Question 5**
When asking the LOC Questions (Item 1b), the patient answers the month correctly but
is off by one year for their age. How should this be scored?
o 0 (Answers both correctly)
☑ 1 (Answers one correctly)
o 2 (Answers neither correctly)
o UN (Untestable)
________________________________________________
**Question 6**
A patient is intubated and cannot speak, but is awake and alert. How do you score Item
1b (LOC Questions)?
o Give them a pen and paper to write the answers
, o UN (Untestable)
☑ 1 (Answers one correctly - standard exception rule for intubated/dysarthric patients
who cannot answer but appear to know)
o 2 (Answers neither correctly)
________________________________________________
**Question 7**
For Item 1c (LOC Commands), what two commands are given to the patient?
o Smile and raise your eyebrows
o Lift your left arm and touch your nose
☑ Open and close your eyes, and grip and release your non-paretic hand
o Stick out your tongue and wiggle your toes
________________________________________________
**Question 8**
If a patient has severe aphasia and cannot comprehend the verbal commands for Item
1c (LOC Commands), what should the examiner do?
o Score them a 2 immediately
☑ Pantomime the command (demonstrate it) and score if they can mimic the action
o Skip the item and mark it UN
o Speak louder and repeat the command three times
________________________________________________
**Question 9**
Item 2 (Best Gaze) evaluates horizontal eye movements. If a patient has a forced
deviation of the eyes that cannot be overcome by the oculocephalic (doll’s eyes)
maneuver, what is the score?
o 0 (Normal)
