NIH STROKE SCALE ALL TEST GROUPS A-F 2026 | Patients
1-6 Complete Answer Key | 100% Correct Answers | Pass
Guaranteed - A+ Graded
Test Group A (Patient 1-6)
Q1: During an NIHSS assessment, the examiner asks the patient, "What month is it?"
and "How old are you?" The patient answers both questions correctly. How should the
examiner score LOC Questions (1b)?
A. 1 – Answers one question correctly
B. 2 – Answers neither question correctly
C. 0 – Answers both questions correctly [CORRECT]
D. 3 – Unable to answer due to intubation
Correct Answer: C
Rationale: Correct because NIHSS item 1b (Level of Consciousness Questions) scores 0
when the patient answers both orientation questions correctly, 1 when one is answered
correctly, and 2 when neither is answered correctly. This matches the standard scoring
criteria for LOC questions.
Q2: A 72-year-old male is being assessed with the NIHSS. When the examiner moves his
finger horizontally across the patient's visual field, the patient's left eye does not track
past midline. The right eye tracks normally. How should Visual Fields (item 3) be
scored?
A. 0 – No visual loss
B. 1 – Partial hemianopia
C. 2 – Complete hemianopia [CORRECT]
D. 3 – Bilateral hemianopia
Correct Answer: C
,Rationale: Correct because complete hemianopia (score 2) is assigned when the patient
demonstrates complete visual field loss on one side; the left eye not tracking past
midline indicates a complete left homonymous hemianopia. This matches the NIHSS
visual field scoring where complete unilateral loss = 2.
Q3: During the Motor Arm assessment, the patient's left arm drifts down to the bed
before the full 10 seconds elapse but does not hit the bed. The right arm holds at 90
degrees for the full 10 seconds. What are the correct scores for Motor Arm Left and
Right?
A. Left: 0, Right: 0
B. Left: 2, Right: 0
C. Left: 1, Right: 0 [CORRECT]
D. Left: 1, Right: 1
Correct Answer: C
Rationale: Correct because Motor Arm score 1 is assigned when the arm drifts down
before 10 seconds but does not hit the bed; score 0 is assigned when the arm holds at
90 degrees for the full 10 seconds. This matches the NIHSS motor arm scoring criteria
where drift = 1 and no drift = 0.
Q4: The examiner presents the patient with a visual stimulus in both visual fields
simultaneously. The patient consistently identifies the stimulus on the right side but
fails to identify the stimulus on the left side, even when presented alone. This finding
indicates:
A. Left visual field cut
B. Left hemispatial neglect
C. Left hemispatial neglect [CORRECT]
D. Right visual field cut
,Correct Answer: C
Rationale: Correct because extinction and inattention (item 11) is scored when the
patient fails to identify a stimulus on one side during simultaneous presentation but can
identify it when presented alone; this indicates hemispatial neglect rather than a primary
visual field deficit. This matches the NIHSS criteria for scoring neglect versus visual
field loss.
Q5: A patient with a pre-existing language barrier (does not speak English) is being
assessed with the NIHSS. The examiner uses an approved interpreter. For the Best
Language item (item 9), which scoring adjustment is required?
A. Score 3 (mute, global aphasia) automatically
B. Score 0 (normal) if interpreter confirms normal communication
C. Score 0 if interpreter confirms normal language function in native language; score 3
only if language impairment is evident [CORRECT]
D. Skip the item and prorate the total score
Correct Answer: C
Rationale: Correct because NIHSS instructions specify that patients with pre-existing
language barriers should be assessed in their primary language using an interpreter;
score 0 if language is normal in that language, and only assign aphasia scores if
impairment is evident. This matches the NIHSS certification training on language barrier
accommodations.
Q6: During the Limb Ataxia assessment, the patient is unable to perform the
finger-to-nose test with the left hand due to left arm weakness from a previous stroke
(old deficit). The right hand performs normally. How should item 7 be scored?
A. 1 – Present in one limb
B. 2 – Present in two limbs
C. 0 – Absent; do not score old deficits [CORRECT]
, D. UN (Unable to assess)
Correct Answer: C
Rationale: Correct because NIHSS item 7 (Limb Ataxia) is scored only for ataxia that is
out of proportion to weakness; if ataxia cannot be assessed due to pre-existing
weakness or amputation, the item is scored 0, not UN. This matches the specific NIHSS
rule that old deficits are scored as 0 for ataxia, not marked as unable to assess.
Q7: The patient is asked to show teeth, squeeze eyes shut, and raise eyebrows. The
right nasolabial fold is flattened, and the right eye does not close completely. The left
side moves symmetrically. What is the correct Facial Palsy score (item 4)?
A. 0 – Normal symmetrical movements
B. 1 – Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 – Partial paralysis (total or near-total paralysis of lower face) [CORRECT]
D. 3 – Complete paralysis of one or both sides (upper and lower face)
Correct Answer: C
Rationale: Correct because partial paralysis (score 2) is assigned when there is total or
near-total paralysis of the lower face; the inability to close the eye indicates some upper
facial involvement, but the key distinction is that complete paralysis (score 3) requires
total paralysis of both upper and lower face. This matches the NIHSS facial palsy
scoring where eye closure failure with lower face paralysis = score 2.
Q8: A patient is intubated and cannot speak. During the Dysarthria assessment (item
10), the examiner asks the patient to read words from a card. The patient is unable to
produce speech due to the endotracheal tube. What is the correct scoring approach?
A. Score 0 (normal) by default
B. Score 1 (mild-to-moderate dysarthria)
C. Score UN (Unable to assess) and clearly document the reason [CORRECT]
D. Score 2 (severe dysarthria or anarthria)
1-6 Complete Answer Key | 100% Correct Answers | Pass
Guaranteed - A+ Graded
Test Group A (Patient 1-6)
Q1: During an NIHSS assessment, the examiner asks the patient, "What month is it?"
and "How old are you?" The patient answers both questions correctly. How should the
examiner score LOC Questions (1b)?
A. 1 – Answers one question correctly
B. 2 – Answers neither question correctly
C. 0 – Answers both questions correctly [CORRECT]
D. 3 – Unable to answer due to intubation
Correct Answer: C
Rationale: Correct because NIHSS item 1b (Level of Consciousness Questions) scores 0
when the patient answers both orientation questions correctly, 1 when one is answered
correctly, and 2 when neither is answered correctly. This matches the standard scoring
criteria for LOC questions.
Q2: A 72-year-old male is being assessed with the NIHSS. When the examiner moves his
finger horizontally across the patient's visual field, the patient's left eye does not track
past midline. The right eye tracks normally. How should Visual Fields (item 3) be
scored?
A. 0 – No visual loss
B. 1 – Partial hemianopia
C. 2 – Complete hemianopia [CORRECT]
D. 3 – Bilateral hemianopia
Correct Answer: C
,Rationale: Correct because complete hemianopia (score 2) is assigned when the patient
demonstrates complete visual field loss on one side; the left eye not tracking past
midline indicates a complete left homonymous hemianopia. This matches the NIHSS
visual field scoring where complete unilateral loss = 2.
Q3: During the Motor Arm assessment, the patient's left arm drifts down to the bed
before the full 10 seconds elapse but does not hit the bed. The right arm holds at 90
degrees for the full 10 seconds. What are the correct scores for Motor Arm Left and
Right?
A. Left: 0, Right: 0
B. Left: 2, Right: 0
C. Left: 1, Right: 0 [CORRECT]
D. Left: 1, Right: 1
Correct Answer: C
Rationale: Correct because Motor Arm score 1 is assigned when the arm drifts down
before 10 seconds but does not hit the bed; score 0 is assigned when the arm holds at
90 degrees for the full 10 seconds. This matches the NIHSS motor arm scoring criteria
where drift = 1 and no drift = 0.
Q4: The examiner presents the patient with a visual stimulus in both visual fields
simultaneously. The patient consistently identifies the stimulus on the right side but
fails to identify the stimulus on the left side, even when presented alone. This finding
indicates:
A. Left visual field cut
B. Left hemispatial neglect
C. Left hemispatial neglect [CORRECT]
D. Right visual field cut
,Correct Answer: C
Rationale: Correct because extinction and inattention (item 11) is scored when the
patient fails to identify a stimulus on one side during simultaneous presentation but can
identify it when presented alone; this indicates hemispatial neglect rather than a primary
visual field deficit. This matches the NIHSS criteria for scoring neglect versus visual
field loss.
Q5: A patient with a pre-existing language barrier (does not speak English) is being
assessed with the NIHSS. The examiner uses an approved interpreter. For the Best
Language item (item 9), which scoring adjustment is required?
A. Score 3 (mute, global aphasia) automatically
B. Score 0 (normal) if interpreter confirms normal communication
C. Score 0 if interpreter confirms normal language function in native language; score 3
only if language impairment is evident [CORRECT]
D. Skip the item and prorate the total score
Correct Answer: C
Rationale: Correct because NIHSS instructions specify that patients with pre-existing
language barriers should be assessed in their primary language using an interpreter;
score 0 if language is normal in that language, and only assign aphasia scores if
impairment is evident. This matches the NIHSS certification training on language barrier
accommodations.
Q6: During the Limb Ataxia assessment, the patient is unable to perform the
finger-to-nose test with the left hand due to left arm weakness from a previous stroke
(old deficit). The right hand performs normally. How should item 7 be scored?
A. 1 – Present in one limb
B. 2 – Present in two limbs
C. 0 – Absent; do not score old deficits [CORRECT]
, D. UN (Unable to assess)
Correct Answer: C
Rationale: Correct because NIHSS item 7 (Limb Ataxia) is scored only for ataxia that is
out of proportion to weakness; if ataxia cannot be assessed due to pre-existing
weakness or amputation, the item is scored 0, not UN. This matches the specific NIHSS
rule that old deficits are scored as 0 for ataxia, not marked as unable to assess.
Q7: The patient is asked to show teeth, squeeze eyes shut, and raise eyebrows. The
right nasolabial fold is flattened, and the right eye does not close completely. The left
side moves symmetrically. What is the correct Facial Palsy score (item 4)?
A. 0 – Normal symmetrical movements
B. 1 – Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 – Partial paralysis (total or near-total paralysis of lower face) [CORRECT]
D. 3 – Complete paralysis of one or both sides (upper and lower face)
Correct Answer: C
Rationale: Correct because partial paralysis (score 2) is assigned when there is total or
near-total paralysis of the lower face; the inability to close the eye indicates some upper
facial involvement, but the key distinction is that complete paralysis (score 3) requires
total paralysis of both upper and lower face. This matches the NIHSS facial palsy
scoring where eye closure failure with lower face paralysis = score 2.
Q8: A patient is intubated and cannot speak. During the Dysarthria assessment (item
10), the examiner asks the patient to read words from a card. The patient is unable to
produce speech due to the endotracheal tube. What is the correct scoring approach?
A. Score 0 (normal) by default
B. Score 1 (mild-to-moderate dysarthria)
C. Score UN (Unable to assess) and clearly document the reason [CORRECT]
D. Score 2 (severe dysarthria or anarthria)
