NIH Stroke Scale – All Test Groups A-F (Patients 1-6)
Actual Exam 2026/2027 | Answer Key Updated | 100%
Correct Answers | Pass Guaranteed - A+ Graded
NIHSS Item Knowledge & Scoring Rules
Q1: When administering the NIH Stroke Scale, what is the maximum possible total
score a patient can receive, indicating the most severe stroke?
A. 24
B. 32
C. 42
D. 50
Correct Answer: C
Rationale: The best answer is C because the sum of the maximum scores across all 11
items equals 42, which represents the most profound neurological deficit possible on
this scale.
Q2: A patient is unresponsive and makes no movement (even to painful stimuli) except
for reflex posturing. What is the correct score for Item 1a, Level of Consciousness
(LOC)?
A. 1
B. 2
C. 3
D. 4
Correct Answer: C
Rationale: This choice is correct because a score of 3 on 1a is reserved for patients
who are in a deep coma and are completely unresponsive to any stimuli, whereas a
score of 2 indicates a reaction to pain (stuporous).
Q3: You ask a patient, "What month is it?" and "How old are you?" The patient answers
the age correctly but states the month incorrectly. How do you score Item 1b, LOC
Questions?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: According to NIHSS scoring rules, the patient must answer both questions
correctly to get a 0; answering only one correctly results in a score of 1.
,Q4: A patient is intubated and cannot speak. How do you score Item 1b (LOC
Questions) and Item 1c (LOC Commands)?
A. Score both as 0 and document that they are intubated.
B. Score both as 1 because the patient cannot physically respond.
C. Score both as 2 (Untestable) and write "intubated" on the form.
D. Skip the items and go to the next section.
Correct Answer: C
Rationale: Remember that for this item, if a patient is intubated or has a language
barrier that prevents them from understanding or responding, you must score a 2
(Untestable) and clearly note the reason.
Q5: During the assessment of Best Gaze (Item 2), you observe that the patient's eyes
are forced to the right side and they cannot look to the left, even with reflexive
movements (oculocephalic or oculovestibular). What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: This choice is correct because a score of 2 for Best Gaze indicates a total
gaze palsy or forced deviation where the patient cannot move their eyes past the
midline toward the side of the lesion.
Q6: When testing Visual Fields (Item 3), a patient has a complete loss of vision in the
left hemifield for both eyes. How is this scored?
A. 1
B. 2
C. 3
D. 4
Correct Answer: B
Rationale: The best answer is B because a score of 2 represents complete hemianopia
(loss of half the visual field in both eyes), whereas a score of 1 is for partial hemianopia
or quadrantanopia.
Q7: A patient presents with mild asymmetry in the face when smiling, but the forehead
lifts well and the eyes close tightly. How is Item 4, Facial Palsy, scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
, Rationale: This aligns with NIHSS scoring because a score of 1 is assigned for minor
paralysis, such as a slight asymmetry of the mouth or nasolabial fold, which resolves
during a full smile.
Q8: You are testing the Left Arm for Item 5 (Motor Arm). The patient holds the arm at 90
degrees for 10 seconds, but the arm drifts down halfway without touching the bed. What
is the correct score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: This choice is correct because a score of 1 indicates that the limb has some
effort against gravity but drifts down before the full 10 seconds; it would only be a 2 if
the arm fell quickly to the bed.
Q9: A patient has a prosthetic left leg (amputated above the knee). How do you score
Item 6, Motor Leg - Left?
A. Score 0 and mark "amputation" in the comments.
B. Score 1 and test the right leg twice.
C. Score 2 (Untestable) and write "amputation."
D. Skip the item entirely.
Correct Answer: C
Rationale: The best answer is C because limbs that are amputated or fused are
considered "untestable" and receive a score of 2, distinct from a 0, and must be
annotated on the score sheet.
Q10: A patient performs finger-to-nose and heel-to-shin tests. They demonstrate
dysmetria (clumsiness) in the left arm and the left leg, but the right side is normal. What
is the score for Item 7, Limb Ataxia?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: This choice is correct because ataxia is scored as 1 if present in one limb
and 2 if present in two limbs; since this patient has deficits in both the left arm and left
leg, the score is 2.
Actual Exam 2026/2027 | Answer Key Updated | 100%
Correct Answers | Pass Guaranteed - A+ Graded
NIHSS Item Knowledge & Scoring Rules
Q1: When administering the NIH Stroke Scale, what is the maximum possible total
score a patient can receive, indicating the most severe stroke?
A. 24
B. 32
C. 42
D. 50
Correct Answer: C
Rationale: The best answer is C because the sum of the maximum scores across all 11
items equals 42, which represents the most profound neurological deficit possible on
this scale.
Q2: A patient is unresponsive and makes no movement (even to painful stimuli) except
for reflex posturing. What is the correct score for Item 1a, Level of Consciousness
(LOC)?
A. 1
B. 2
C. 3
D. 4
Correct Answer: C
Rationale: This choice is correct because a score of 3 on 1a is reserved for patients
who are in a deep coma and are completely unresponsive to any stimuli, whereas a
score of 2 indicates a reaction to pain (stuporous).
Q3: You ask a patient, "What month is it?" and "How old are you?" The patient answers
the age correctly but states the month incorrectly. How do you score Item 1b, LOC
Questions?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: According to NIHSS scoring rules, the patient must answer both questions
correctly to get a 0; answering only one correctly results in a score of 1.
,Q4: A patient is intubated and cannot speak. How do you score Item 1b (LOC
Questions) and Item 1c (LOC Commands)?
A. Score both as 0 and document that they are intubated.
B. Score both as 1 because the patient cannot physically respond.
C. Score both as 2 (Untestable) and write "intubated" on the form.
D. Skip the items and go to the next section.
Correct Answer: C
Rationale: Remember that for this item, if a patient is intubated or has a language
barrier that prevents them from understanding or responding, you must score a 2
(Untestable) and clearly note the reason.
Q5: During the assessment of Best Gaze (Item 2), you observe that the patient's eyes
are forced to the right side and they cannot look to the left, even with reflexive
movements (oculocephalic or oculovestibular). What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: This choice is correct because a score of 2 for Best Gaze indicates a total
gaze palsy or forced deviation where the patient cannot move their eyes past the
midline toward the side of the lesion.
Q6: When testing Visual Fields (Item 3), a patient has a complete loss of vision in the
left hemifield for both eyes. How is this scored?
A. 1
B. 2
C. 3
D. 4
Correct Answer: B
Rationale: The best answer is B because a score of 2 represents complete hemianopia
(loss of half the visual field in both eyes), whereas a score of 1 is for partial hemianopia
or quadrantanopia.
Q7: A patient presents with mild asymmetry in the face when smiling, but the forehead
lifts well and the eyes close tightly. How is Item 4, Facial Palsy, scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
, Rationale: This aligns with NIHSS scoring because a score of 1 is assigned for minor
paralysis, such as a slight asymmetry of the mouth or nasolabial fold, which resolves
during a full smile.
Q8: You are testing the Left Arm for Item 5 (Motor Arm). The patient holds the arm at 90
degrees for 10 seconds, but the arm drifts down halfway without touching the bed. What
is the correct score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: This choice is correct because a score of 1 indicates that the limb has some
effort against gravity but drifts down before the full 10 seconds; it would only be a 2 if
the arm fell quickly to the bed.
Q9: A patient has a prosthetic left leg (amputated above the knee). How do you score
Item 6, Motor Leg - Left?
A. Score 0 and mark "amputation" in the comments.
B. Score 1 and test the right leg twice.
C. Score 2 (Untestable) and write "amputation."
D. Skip the item entirely.
Correct Answer: C
Rationale: The best answer is C because limbs that are amputated or fused are
considered "untestable" and receive a score of 2, distinct from a 0, and must be
annotated on the score sheet.
Q10: A patient performs finger-to-nose and heel-to-shin tests. They demonstrate
dysmetria (clumsiness) in the left arm and the left leg, but the right side is normal. What
is the score for Item 7, Limb Ataxia?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: This choice is correct because ataxia is scored as 1 if present in one limb
and 2 if present in two limbs; since this patient has deficits in both the left arm and left
leg, the score is 2.
