1
NIH Stroke Scale All Test Groups A-F Patients 1-6
Actual Exam 2025/2026 – Complete Exam-Style
Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
[SECTION 1: NIHSS FUNDAMENTALS & SCORING RULES — Questions 1-15]
Q1: A patient is presented with a pinprick on the left arm and grimaces but does not pull away.
On the right arm, the patient pulls away immediately. The patient is able to identify when they
are being touched but states the sensation feels "dull." How is the Sensory item (Item 8) scored?
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: B
Rationale: The patient demonstrates a mild to moderate sensory loss, characterized by a feeling
of dullness or a blunt sensation, though they are still aware of being touched. Option A is
incorrect because normal sensation involves feeling the pinprick sharply. Option C is reserved
for severe or total sensory loss where the patient is unaware of being touched or shows no
response to noxious stimuli. Option D is incorrect as the patient is awake and capable of
responding to the test.
Q2: When assessing a patient with profound aphasia for Level of Consciousness (LOC)
Commands (Item 1c), the patient is unable to understand the verbal command to "close eyes."
However, when the examiner physically demonstrates the action, the patient mimics it. What is
the correct score for Item 1c?
A. 0
B. 1
C. 2
D. Untestable
,2
Correct Answer: C
Rationale: The NIHSS stipulates that commands must be verbal; physical cues or pantomime
invalidate the specific assessment of auditory comprehension and response to verbal commands.
Since the patient did not perform the task solely based on the verbal command, the score is 0.
Option A is incorrect because the patient requires visual cues. Option B (1 correct) does not
apply as the task was not initiated by the verbal prompt. Option D is not applicable; the patient
can be tested, but simply failed the verbal requirement.
Q3: A patient with an acute right middle cerebral artery (MCA) stroke displays left-sided
hemiparesis. When asked to extend the left arm, the arm falls to the bed immediately with no
effort against gravity, but the patient can move the arm slightly when prompted. How is the
Motor Arm item (Item 5) scored for the left arm?
A. 1
B. 2
C. 3
D. 4
Correct Answer: C
Rationale: A score of 3 indicates "no effort against gravity," meaning the limb falls immediately
(within 5 seconds for legs, 10 seconds for arms) but the patient is not flaccid and may have some
trace movement. Option A is for drift without hitting the bed. Option B is for some effort against
gravity before the limb falls. Option D (4) is reserved for "no movement" (flaccid) or complete
absence of voluntary movement.
Q4: During the assessment of Limb Ataxia (Item 7), the patient has severe weakness in the right
arm (Motor Arm score 3) and leg (Motor Leg score 3). When asked to perform finger-to-nose
and heel-to-shin movements, the patient is unable to lift the limbs against gravity. What is the
score for Item 7?
A. 0
B. 1
C. 2
D. Untestable
,3
Correct Answer: A
Rationale: Limb ataxia is scored only if it is present out of proportion to weakness. If the patient
is too weak to perform the movement (cannot overcome gravity), the item is scored as 0 (normal)
because ataxia cannot be assessed. Option B or C would be incorrect because they assign scores
for ataxia when the deficit is actually paresis. Option D is incorrect; "Unscoreable" (UN) is for
amputation or fusion, not stroke-related weakness.
Q5: A patient is intubated and unable to speak. The examiner asks the patient to squeeze their
hand and open eyes; the patient performs both correctly. For the Language item (Item 9), the
patient is provided with a writing implement and writes a sentence that is intelligible but contains
a few grammar errors. How is Item 9 scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: A score of 1 corresponds to mild to moderate aphasia, characterized by some loss of
fluency or comprehension, or noticeable errors in expression (grammar/paraphasias). Even
though the patient is intubated, writing serves as the output modality. Option A is incorrect
because the errors indicate some deficit. Option C (Severe) and D (Mute/Global) are too severe
given the patient's ability to write an intelligible sentence.
Q6: When assessing Best Gaze (Item 2), a patient has a gaze preference to the right. The
examiner performs the oculocephalic maneuver (doll's eyes), and the eyes are able to move to the
midline but not past it. What is the correct score?
A. 0
B. 1
C. 2
D. Untestable
, 4
Correct Answer: B
Rationale: A score of 1 indicates a partial gaze palsy or gaze preference that can be overcome by
reflexive movements (doll's eyes) or voluntary effort to look past midline. Option A is incorrect
because the gaze is not normal/spontaneous. Option C is reserved for forced deviation where the
eyes cannot be moved to the midline even with the oculocephalic maneuver. Option D is
incorrect as the reflexive pathway can be tested.
Q7: Which of the following statements accurately describes the scoring for Extinction and
Inattention (Item 11)?
A. Score 1 if the patient has a visual field cut on one side.
B. Score 2 if the patient acknowledges stimuli from the right side only when both sides are
touched simultaneously.
C. Score 0 if the patient identifies a visual threat on both the left and right sides separately.
D. Score 1 if the patient has profound hemispatial neglect and ignores the left side of the body
during personal grooming.
Correct Answer: C
Rationale: A score of 0 indicates no neglect; recognizing stimuli on both sides when presented
individually is the baseline for "no neglect." Option A describes a visual field deficit (Item 3), not
neglect. Option B describes extinction, which is a score of 1. Option D describes profound
neglect (anosognosia/hemispatial inattention), which warrants a score of 2, not 1.
Q8: A patient is asked to repeat the phrase "You can't teach an old dog new tricks." The patient
says, "You can't teash a old dog new twicks," slurring slightly but understandable. The rest of the
exam is normal. What is the score for Dysarthria (Item 10)?
A. 0
B. 1
C. 2
D. Untestable
NIH Stroke Scale All Test Groups A-F Patients 1-6
Actual Exam 2025/2026 – Complete Exam-Style
Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
[SECTION 1: NIHSS FUNDAMENTALS & SCORING RULES — Questions 1-15]
Q1: A patient is presented with a pinprick on the left arm and grimaces but does not pull away.
On the right arm, the patient pulls away immediately. The patient is able to identify when they
are being touched but states the sensation feels "dull." How is the Sensory item (Item 8) scored?
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: B
Rationale: The patient demonstrates a mild to moderate sensory loss, characterized by a feeling
of dullness or a blunt sensation, though they are still aware of being touched. Option A is
incorrect because normal sensation involves feeling the pinprick sharply. Option C is reserved
for severe or total sensory loss where the patient is unaware of being touched or shows no
response to noxious stimuli. Option D is incorrect as the patient is awake and capable of
responding to the test.
Q2: When assessing a patient with profound aphasia for Level of Consciousness (LOC)
Commands (Item 1c), the patient is unable to understand the verbal command to "close eyes."
However, when the examiner physically demonstrates the action, the patient mimics it. What is
the correct score for Item 1c?
A. 0
B. 1
C. 2
D. Untestable
,2
Correct Answer: C
Rationale: The NIHSS stipulates that commands must be verbal; physical cues or pantomime
invalidate the specific assessment of auditory comprehension and response to verbal commands.
Since the patient did not perform the task solely based on the verbal command, the score is 0.
Option A is incorrect because the patient requires visual cues. Option B (1 correct) does not
apply as the task was not initiated by the verbal prompt. Option D is not applicable; the patient
can be tested, but simply failed the verbal requirement.
Q3: A patient with an acute right middle cerebral artery (MCA) stroke displays left-sided
hemiparesis. When asked to extend the left arm, the arm falls to the bed immediately with no
effort against gravity, but the patient can move the arm slightly when prompted. How is the
Motor Arm item (Item 5) scored for the left arm?
A. 1
B. 2
C. 3
D. 4
Correct Answer: C
Rationale: A score of 3 indicates "no effort against gravity," meaning the limb falls immediately
(within 5 seconds for legs, 10 seconds for arms) but the patient is not flaccid and may have some
trace movement. Option A is for drift without hitting the bed. Option B is for some effort against
gravity before the limb falls. Option D (4) is reserved for "no movement" (flaccid) or complete
absence of voluntary movement.
Q4: During the assessment of Limb Ataxia (Item 7), the patient has severe weakness in the right
arm (Motor Arm score 3) and leg (Motor Leg score 3). When asked to perform finger-to-nose
and heel-to-shin movements, the patient is unable to lift the limbs against gravity. What is the
score for Item 7?
A. 0
B. 1
C. 2
D. Untestable
,3
Correct Answer: A
Rationale: Limb ataxia is scored only if it is present out of proportion to weakness. If the patient
is too weak to perform the movement (cannot overcome gravity), the item is scored as 0 (normal)
because ataxia cannot be assessed. Option B or C would be incorrect because they assign scores
for ataxia when the deficit is actually paresis. Option D is incorrect; "Unscoreable" (UN) is for
amputation or fusion, not stroke-related weakness.
Q5: A patient is intubated and unable to speak. The examiner asks the patient to squeeze their
hand and open eyes; the patient performs both correctly. For the Language item (Item 9), the
patient is provided with a writing implement and writes a sentence that is intelligible but contains
a few grammar errors. How is Item 9 scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: A score of 1 corresponds to mild to moderate aphasia, characterized by some loss of
fluency or comprehension, or noticeable errors in expression (grammar/paraphasias). Even
though the patient is intubated, writing serves as the output modality. Option A is incorrect
because the errors indicate some deficit. Option C (Severe) and D (Mute/Global) are too severe
given the patient's ability to write an intelligible sentence.
Q6: When assessing Best Gaze (Item 2), a patient has a gaze preference to the right. The
examiner performs the oculocephalic maneuver (doll's eyes), and the eyes are able to move to the
midline but not past it. What is the correct score?
A. 0
B. 1
C. 2
D. Untestable
, 4
Correct Answer: B
Rationale: A score of 1 indicates a partial gaze palsy or gaze preference that can be overcome by
reflexive movements (doll's eyes) or voluntary effort to look past midline. Option A is incorrect
because the gaze is not normal/spontaneous. Option C is reserved for forced deviation where the
eyes cannot be moved to the midline even with the oculocephalic maneuver. Option D is
incorrect as the reflexive pathway can be tested.
Q7: Which of the following statements accurately describes the scoring for Extinction and
Inattention (Item 11)?
A. Score 1 if the patient has a visual field cut on one side.
B. Score 2 if the patient acknowledges stimuli from the right side only when both sides are
touched simultaneously.
C. Score 0 if the patient identifies a visual threat on both the left and right sides separately.
D. Score 1 if the patient has profound hemispatial neglect and ignores the left side of the body
during personal grooming.
Correct Answer: C
Rationale: A score of 0 indicates no neglect; recognizing stimuli on both sides when presented
individually is the baseline for "no neglect." Option A describes a visual field deficit (Item 3), not
neglect. Option B describes extinction, which is a score of 1. Option D describes profound
neglect (anosognosia/hemispatial inattention), which warrants a score of 2, not 1.
Q8: A patient is asked to repeat the phrase "You can't teach an old dog new tricks." The patient
says, "You can't teash a old dog new twicks," slurring slightly but understandable. The rest of the
exam is normal. What is the score for Dysarthria (Item 10)?
A. 0
B. 1
C. 2
D. Untestable
