NIHSS - Group A Questions with Correct Answers 2026

NIHSS - Group A Questions with Correct
Answers 2026

NIHSS - Group A Certification Practice Exam
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1. A patient is able to answer all questions correctly but has severe dysarthria that makes th
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eir speech difficult to understand. What score do you give for "Level of Consciousness -
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Questions" (Item 1b)?
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A) 0 jh




B) 1 jh




C) 2 jh




D) 3 jh




2. You ask the patient to show their teeth and raise their eyebrows. The left side of the face
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moves normally, but the right side shows minimal movement. What is the correct score for
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"Facial Palsy" (Item 4)? jh jh jh




A) 0 - Normal
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B) 1 - Minor paralysis (asymmetric smile)
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C) 2 - Partial paralysis (total or near-total on one side)
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D) 3 - Complete paralysis (no movement)
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3. For "Motor Arm" (Item 5a & 5b), the patient holds their left arm out for 10 seconds befo
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re it drifts down. The right arm holds for the full 10 seconds. What is the correct score for t
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he left arm? jh jh




A) 0 - No drift
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B) 1 - Drift (drifts down, but does not hit the bed)
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C) 2 - Some effort against gravity (falls to bed within 10 seconds)
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D) 3 - No effort against gravity (falls immediately)
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E) 4 - No movement (amputation, fusion, etc.)
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4. A patient is unable to feel a pinprick on their right hand, forearm, and face, but can feel i
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t on their left side and their leg. How is "Sensory" (Item 8) scored?
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,A) 0 - Normal
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B) 1 - Mild to moderate loss (patient feels it less on one side)
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C) 2 - Severe loss (no sensation on one side)
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D) 3 - Comatose or unable to respond
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5. What score do you give for "Best Language" (Item 9) if a patient is confused, speaks in in
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appropriate words, and cannot name simple objects, but is not completely mute?
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A) 0 - No aphasia
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B) 1 - Mild to moderate aphasia (some obvious changes)
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C) 2 - Severe aphasia (almost no information conveyed)
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D) 3 - Mute or global aphasia
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6. The "Extinction and Inattention" (Item 11) test is performed by:
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A) Touching the patient's arm and asking them to lift it.
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B) Asking the patient to read a sentence.
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C) Simultaneously touching the patient on both sides and asking them to identify where they were
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touched.
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D) Asking the patient to identify a smell.
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7. The patient is alert and answers both "What month is it?" and "How old are you?" correc
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tly. What score is given for "LOC - Questions" (1b)?
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A) 0 jh




B) 1 jh




C) 2 jh




D) 3 jh




8. A patient follows your commands perfectly: "Open your eyes" and "Squeeze my hand."
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What score is given for "LOC - Commands" (Item 1c)?
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A) 0 jh




B) 1 jh




C) 2 jh




D) 3 jh

, 9. A patient is able to read the sentence on the exam card clearly but their words are slurre
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d. You give them a score of "1" for "Dysarthria" (Item 10). This means:
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A) They have normal articulation.
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B) They have mild to moderate dysarthria (slurred but understandable).
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C) They have severe dysarthria (unintelligible).
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D) They are intubated.
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10. During the "Motor Leg" test (Item 6a & 6b), the patient raises their leg, but it drifts do
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wn and hits the bed within 5 seconds. What is the score?
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A) 0 - No drift
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B) 1 - Drift
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C) 2 - Some effort against gravity
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D) 3 - No effort against gravity
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E) 4 - No movement
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Answer Key jh




1. A) 0 (Explanation: Item 1b tests orientation, not ability to speak clearly. If the patient answ
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ers correctly, they get a 0, regardless of dysarthria.)
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2. B) 1 - jh jh




Minor paralysis (Explanation: 1 is given for asymmetric smile or minor paralysis. 2 is for to
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tal/near-total paralysis on one side.) jh jh jh jh




3. B) 1 - jh jh




Drift (Explanation: Drift is scored if the arm drifts down before the 10 seconds are up, but
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does not fall completely to the bed/surface.) jh jh jh jh jh jh




4. B) 1 - jh jh




Mild to moderate loss (Explanation: Sensory is scored based on the patient's ability to fe
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el the pinprick. Loss on one side but not the other is a 1. A 2 is for dense loss. Since they ca
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n still feel on the leg, it's not total.)
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5. B) 1 - jh jh




Mild to moderate aphasia (Explanation: A score of 1 is for obvious changes like naming
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errors or mild confusion. A 2 is for severe aphasia where the patient cannot convey ideas.)
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6. C) Simultaneously touching the patient on both sides and asking them to identify w
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here they were touched. (Explanation: This tests for neglect/extinction. The standard is to
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touch one side, then the other, then both at the same time.)
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