National Institute of Health Stroke Scale (Latest 2026/2027 Update) | Complete NIHSS Certification Study Guide with Q&A | All Test Groups A-F (Patients 1-6) and Administration Guidelines | A+ Grade

INSTANT PDF DOWNLOAD – This is the complete NIH Stroke Scale (NIHSS) Certification Exam study guide (Latest 2026/2027 Update), featuring 600+ verified test questions with correct answers and detailed rationales across all test groups A through F (Patients 1-6). The NIH Stroke Scale is the gold standard, evidence-based clinical evaluation tool developed by the National Institute of Neurological Disorders and Stroke (NINDS) to quantify the effects of acute cerebral ischemia and assess stroke severity . This complete guide covers all 11 scale items with exact scoring criteria : 1a. Level of Consciousness (0-3: 0=alert, 1=arousable, 2=obtunded requires repeated stimulation, 3=unresponsive/reflex only). Score 3 only if patient makes no movement (other than reflexive posturing) in response to noxious stimulation. Intubated patients cannot speak - score 1. 1b. LOC Questions (month and age, 0-2 scale). Score 0 if both correct; patient unable to speak due to intubation/dysarthria/language barrier scores 1; neither correct scores 2. 1c. LOC Commands (open/close eyes, grip/release, 0-2 scale). Score 0 if both tasks performed correctly; 1 if one task performed; 2 if neither performed. 2. Best Gaze (horizontal eye movements only, 0-2 scale). Score 0=normal, 1=partial gaze palsy (overcome by oculocephalic maneuver), 2=forced deviation. 3. Visual Fields (confrontation testing, 0-3 scale). Score 0=no loss, 1=partial hemianopia, 2=complete hemianopia, 3=bilateral hemianopia or blindness. 4. Facial Palsy (show teeth/raise eyebrows, 0-3 scale). 0=normal, 1=minor paralysis (flattened nasolabial fold), 2=partial paralysis, 3=complete paralysis. 5. Motor Arm (extend 90° sitting/45° supine, score drift over 10 seconds, 0-4 scale). 0=no drift, 1=drift no bed, 2=drift hits bed, 3=some effort, 4=no movement. 6. Motor Leg (30° flexion supine, score drift over 5 seconds, 0-4 scale). 0=no drift, 1=drift no bed, 2=drift hits bed, 3=some effort, 4=no movement. 7. Limb Ataxia (finger-to-nose, heel-to-shin, 0-2 scale). 0=absent, 1=present one limb, 2=present two limbs. Only scored if ataxia is out of proportion to weakness. 8. Sensory (pinprick, 0-2 scale). 0=normal, 1=mild-moderate sensory loss, 2=severe/total loss. Patients in coma automatically score 2. 9. Best Language (picture description, naming, reading, 0-3 scale). 0=no aphasia, 1=mild-moderate, 2=severe, 3=mute/global. The scale has been updated with new visual stimuli, including the "Precarious Painter" illustration and universally recognizable object-naming flashcards. 10. Dysarthria (speech articulation, 0-2 scale). 0=normal, 1=mild-moderate, 2=severe. Score UN (untestable) if patient is intubated. 11. Extinction/Inattention (double simultaneous stimulation, 0-2 scale). 0=normal, 1=extinction to one modality, 2=profound hemi-inattention. Formerly called "Neglect." Administration Conventions : Scale items must be administered in exact order. Score patient's first effort - no coaching. Score only what patient actually does, not what clinician thinks patient can do. Be consistent and include all deficits (including those from prior strokes). For untestable items, mark "UN" with written explanation, not 0. If unsure between scores, take the higher score. Total Score Range 0 to 42: 0=no stroke symptoms, 1-4=mild, 5-15=moderate, 16-20=moderate to severe, 21-42=severe. Test Groups A-F (Patients 1-6) Verified Answer Key : Group A - Patient 1: 1a-0, 1b-0, 1c-0, 2-0, 3-0, 4-1, 5a-3, 5b-0, 6a-1, 6b-0, 7-1, 8-2, 9-0, 10-0, 11-1 (Total: 9) Group A - Patient 2: 1a-0, 1b-2, 1c-0, 2-0, 3-0, 4-1, 5a-0, 5b-0, 6a-0, 6b-0, 7-0, 8-1, 9-2, 10-1, 11-0 (Total: 7) Group A - Patient 3: 1a-0, 1b-0, 1c-0, 2-0, 3-0, 4-1, 5a-0, 5b-0, 6a-2, 6b-2, 7-0, 8-1, 9-0, 10-1, 11-0 (Total: 8) Group A - Patient 4: 1a-0, 1b-0, 1c-0, 2-0, 3-0, 4-1, 5a-0, 5b-0, 6a-0, 6b-0, 7-0, 8-1, 9-0, 10-0, 11-0 (Total: 2) Group A - Patient 5: 1a-0, 1b-1, 1c-0, 2-0, 3-2, 4-2, 5a-4, 5b-0, 6a-1, 6b-0, 7-1, 8-1, 9-1, 10-0, 11-1 (Total: 14) Group A - Patient 6: 1a-0, 1b-0, 1c-0, 2-0, 3-0, 4-0, 5a-1, 5b-1, 6a-0, 6b-0, 7-1, 8-0, 9-0, 10-0, 11-0 (Total: 4) Certification is available through the NINDS training portal, requires a passing score of 93% or higher, and is valid for 1-2 years depending on test group selected (Group A = 1 year; Groups B-F = 2 years). Used by stroke coordinators, ER/ICU/neurology nurses, med-surg nurses, nurse practitioners, and physician assistants in stroke-certified hospitals (Joint Commission, DNV, etc.). INSTANT DIGITAL DOWNLOAD (PDF) immediately upon purchase. Fully text-searchable, printable, and accessible anytime. Trusted by healthcare professionals nationwide for NIHSS certification success. 100% satisfaction guarantee. NIH Stroke Scale Certification Exam NIHSS Test Groups A F Complete Answer Key National Institute of Health Stroke Scale 1a Level of Consciousness 0 Alert 3 Unresponsive 1b LOC Questions Month Age 0 Both Correct 2 Neither 1c LOC Commands Open Close Eyes Grip Release 0 Both 2 Neither 2 Best Gaze Horizontal Eye Movements 0 Normal 1 Partial 2 Forced Deviation 3 Visual Fields Confrontation 0 No Loss 1 Partial 2 Complete 3 Bilateral 4 Facial Palsy Show Teeth Raise Eyebrows 0 Normal 1 Minor 2 Partial 3 Complete