Page 1 of 154
NIH STROKE SCALE NEWEST UPDATED
EXAM WITH 150 QUESTIONS WITH
ANSWERS |AGRADE
1. What is the highest possible score on the NIHSS,
indicating the most severe stroke?
A) 36
B) 42
C) 50
D) 100
Answer: B) 42
Rationale: The NIHSS has 15 items, maximum total 42. Scores
>25 indicate very severe stroke.
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2. A score of 0 on the NIHSS means:
A) Mild stroke
B) Moderate stroke
C) No stroke symptoms detectable on this scale
D) Patient is comatose
Answer: C) No stroke symptoms detectable on this scale
*Rationale: 0 = normal exam, but posterior circulation strokes
can still be missed.*
3. Which item is NOT part of the NIHSS?
A) Level of consciousness
B) Limb ataxia
C) Plantar reflex (Babinski)
D) Extinction and inattention
Answer: C) Plantar reflex
Rationale: Babinski is not scored. NIHSS includes LOC, gaze,
visual fields, facial palsy, motor arm/leg, ataxia, sensory,
language, dysarthria, neglect.
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4. How many points are allocated to “Level of
Consciousness” (Item 1a, 1b, 1c combined)?
A) 3
B) 5
C) 6
D) 8
Answer: C) 6
*Rationale: 1a (0–3), 1b (0–2), 1c (0–2) = total 6 points for
LOC.*
5. What is the minimum time required to perform the NIHSS
properly?
A) 2 minutes
B) 5–10 minutes
C) 15–20 minutes
D) 30 minutes
Answer: B) 5–10 minutes
Rationale: A trained examiner completes it in under 10 minutes;
untrained may take longer.
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6. True or false: The NIHSS should be repeated serially to
assess improvement or deterioration.
A) True
B) False
Answer: A) True
Rationale: Serial NIHSS helps guide treatment decisions (e.g.,
thrombectomy, tPA).
7. Which of the following can invalidate a motor score on
NIHSS?
A) Aphasia
B) Amputation
C) Joint fusion
D) All of the above
Answer: D) All of the above
Rationale: Use “X” or “UN” (untestable) and document reason.
8. In a patient with right arm amputation, how should
“Motor Arm Right” be scored?
NIH STROKE SCALE NEWEST UPDATED
EXAM WITH 150 QUESTIONS WITH
ANSWERS |AGRADE
1. What is the highest possible score on the NIHSS,
indicating the most severe stroke?
A) 36
B) 42
C) 50
D) 100
Answer: B) 42
Rationale: The NIHSS has 15 items, maximum total 42. Scores
>25 indicate very severe stroke.
,Page 2 of 154
2. A score of 0 on the NIHSS means:
A) Mild stroke
B) Moderate stroke
C) No stroke symptoms detectable on this scale
D) Patient is comatose
Answer: C) No stroke symptoms detectable on this scale
*Rationale: 0 = normal exam, but posterior circulation strokes
can still be missed.*
3. Which item is NOT part of the NIHSS?
A) Level of consciousness
B) Limb ataxia
C) Plantar reflex (Babinski)
D) Extinction and inattention
Answer: C) Plantar reflex
Rationale: Babinski is not scored. NIHSS includes LOC, gaze,
visual fields, facial palsy, motor arm/leg, ataxia, sensory,
language, dysarthria, neglect.
,Page 3 of 154
4. How many points are allocated to “Level of
Consciousness” (Item 1a, 1b, 1c combined)?
A) 3
B) 5
C) 6
D) 8
Answer: C) 6
*Rationale: 1a (0–3), 1b (0–2), 1c (0–2) = total 6 points for
LOC.*
5. What is the minimum time required to perform the NIHSS
properly?
A) 2 minutes
B) 5–10 minutes
C) 15–20 minutes
D) 30 minutes
Answer: B) 5–10 minutes
Rationale: A trained examiner completes it in under 10 minutes;
untrained may take longer.
, Page 4 of 154
6. True or false: The NIHSS should be repeated serially to
assess improvement or deterioration.
A) True
B) False
Answer: A) True
Rationale: Serial NIHSS helps guide treatment decisions (e.g.,
thrombectomy, tPA).
7. Which of the following can invalidate a motor score on
NIHSS?
A) Aphasia
B) Amputation
C) Joint fusion
D) All of the above
Answer: D) All of the above
Rationale: Use “X” or “UN” (untestable) and document reason.
8. In a patient with right arm amputation, how should
“Motor Arm Right” be scored?
