NIH STROKE SCALE (NIHSS) [2026/ 2027] COMPREHENSIVE
EXAM QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A patient presents with sudden onset right facial droop and slurred speech.
On assessment, the patient raises both arms but the right drifts downward. What is the most likely
NIHSS score for arm motor function?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: NIHSS scores arm motor function as 0 (no drift), 1 (drift before 10 seconds), 2 (falls rapidly), 3
(no movement). Right arm drifts downward indicates moderate weakness, scored as 2.
2. During the NIHSS assessment, the patient cannot answer the question, "What month is it?"
and "How old are you?" What score is assigned for language?
A. 0
B ..........................................................................................................................................................................................................
1
C ..........................................................................................................................................................................................................
1
D ..........................................................................................................................................................................................................
1
Answer: DRationale: Language assessment scores 0 for normal, 1 for mild aphasia, 2 for severe aphasia,
and 3 for mute/nonverbal. Complete inability to answer scores 3. ................ Error! Bookmark not defined.
,B.
3. A patient has right visual field loss in both eyes. What is the NIHSS visual field score?
A. 0
1
C. 2
D. 3
Answer: C. 2
Rationale: NIHSS visual field scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete hemianopia,
3 = bilateral blindness. Right hemianopia in both eyes is complete in the right visual field, scoring 2.
4. A patient demonstrates left leg drift for 8 seconds but can hold the leg up. NIHSS lower limb
motor score is:
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Score 0 = no drift, 1 = drift, 2 = falls rapidly, 3 = no movement. Drift less than 10 seconds is
mild, scored as 1.
5. During NIHSS assessment, the patient is completely alert but requires repeated stimulation to
respond. Level of consciousness (LOC) question score:
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: LOC scoring: 0 = alert, 1 = drowsy/needs stimulation, 2 = responds only with effort, 3 =
unresponsive.
,C.
6. A patient has complete left hemiplegia and cannot move the left arm or leg. NIHSS motor score
for left arm and leg:
A. 3 + 3
B. 2 + 2
1+1
D. 0 + 0
Answer: A. 3 + 3
Rationale: Complete paralysis of extremities scores 3 for each limb.
7. During NIHSS assessment, the patient shows gaze deviation to the right and cannot voluntarily
move eyes left. What is the score for gaze?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: Gaze: 0 = normal, 1 = partial gaze palsy, 2 = forced deviation.
Complete inability to move eyes against deviation is forced deviation, scored 2.
8. A patient has dysarthria but can still be understood. NIHSS score for dysarthria:
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Dysarthria scoring: 0 = normal, 1 = mild moderate (slurred but intelligible), 2 = severe
(unintelligible), 3 = mute.
, D.
9. A patient is alert, oriented, can follow commands, but has mild right arm drift. NIHSS total
approximate score:
A. 2
B. 3
C. 4
5
Answer: B. 3
Rationale: LOC = 0, best gaze = 0, visual fields = 0, facial palsy = 0, motor arm right = 1 (drift <10 sec),
motor leg right = 1, dysarthria = 1 → total = 3.
10. During NIHSS assessment, patient exhibits left homonymous hemianopia. What is the score for
visual field assessment?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: Complete loss in half of the visual field is scored as 2.
11. Patient cannot answer questions but can follow simple commands by gestures. NIHSS score for
language:
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: Severe aphasia: patient communicates minimally and cannot answer questions but can
respond nonverbally.
EXAM QUESTIONS AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A patient presents with sudden onset right facial droop and slurred speech.
On assessment, the patient raises both arms but the right drifts downward. What is the most likely
NIHSS score for arm motor function?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: NIHSS scores arm motor function as 0 (no drift), 1 (drift before 10 seconds), 2 (falls rapidly), 3
(no movement). Right arm drifts downward indicates moderate weakness, scored as 2.
2. During the NIHSS assessment, the patient cannot answer the question, "What month is it?"
and "How old are you?" What score is assigned for language?
A. 0
B ..........................................................................................................................................................................................................
1
C ..........................................................................................................................................................................................................
1
D ..........................................................................................................................................................................................................
1
Answer: DRationale: Language assessment scores 0 for normal, 1 for mild aphasia, 2 for severe aphasia,
and 3 for mute/nonverbal. Complete inability to answer scores 3. ................ Error! Bookmark not defined.
,B.
3. A patient has right visual field loss in both eyes. What is the NIHSS visual field score?
A. 0
1
C. 2
D. 3
Answer: C. 2
Rationale: NIHSS visual field scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete hemianopia,
3 = bilateral blindness. Right hemianopia in both eyes is complete in the right visual field, scoring 2.
4. A patient demonstrates left leg drift for 8 seconds but can hold the leg up. NIHSS lower limb
motor score is:
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Score 0 = no drift, 1 = drift, 2 = falls rapidly, 3 = no movement. Drift less than 10 seconds is
mild, scored as 1.
5. During NIHSS assessment, the patient is completely alert but requires repeated stimulation to
respond. Level of consciousness (LOC) question score:
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: LOC scoring: 0 = alert, 1 = drowsy/needs stimulation, 2 = responds only with effort, 3 =
unresponsive.
,C.
6. A patient has complete left hemiplegia and cannot move the left arm or leg. NIHSS motor score
for left arm and leg:
A. 3 + 3
B. 2 + 2
1+1
D. 0 + 0
Answer: A. 3 + 3
Rationale: Complete paralysis of extremities scores 3 for each limb.
7. During NIHSS assessment, the patient shows gaze deviation to the right and cannot voluntarily
move eyes left. What is the score for gaze?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: Gaze: 0 = normal, 1 = partial gaze palsy, 2 = forced deviation.
Complete inability to move eyes against deviation is forced deviation, scored 2.
8. A patient has dysarthria but can still be understood. NIHSS score for dysarthria:
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Dysarthria scoring: 0 = normal, 1 = mild moderate (slurred but intelligible), 2 = severe
(unintelligible), 3 = mute.
, D.
9. A patient is alert, oriented, can follow commands, but has mild right arm drift. NIHSS total
approximate score:
A. 2
B. 3
C. 4
5
Answer: B. 3
Rationale: LOC = 0, best gaze = 0, visual fields = 0, facial palsy = 0, motor arm right = 1 (drift <10 sec),
motor leg right = 1, dysarthria = 1 → total = 3.
10. During NIHSS assessment, patient exhibits left homonymous hemianopia. What is the score for
visual field assessment?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: Complete loss in half of the visual field is scored as 2.
11. Patient cannot answer questions but can follow simple commands by gestures. NIHSS score for
language:
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: Severe aphasia: patient communicates minimally and cannot answer questions but can
respond nonverbally.
