Updated NIH Stroke Scale – All Test Groups A-F (patients 1-6) 2025
updated!!
Question 1
When assessing the Level of Consciousness (1a) on the NIH Stroke Scale, what is the initial
step?
A) Ask the patient to open and close their eyes.
B) Ask the patient the month and their age.
C) Assess facial symmetry.
D) Determine if the patient is alert, oriented x4 (or their baseline).
E) Apply painful stimulation.
Correct Answer: D) Determine if the patient is alert, oriented x4 (or their baseline).
Rationale: The first step in assessing 1a is to establish the patient's general alertness
and orientation.
Question 2
For NIH Stroke Scale item 1b (Level of Consciousness: Questions), what is the scoring
criterion for partial credit?
A) Partial credit is given for being close to the correct answer.
B) Partial credit is given if the examiner provides a non-verbal cue.
C) Partial credit is given if the patient attempts to answer.
D) There is no partial credit for being close; the answer must be correct.
E) Partial credit is given for answering one question correctly.
Correct Answer: D) There is no partial credit for being close; the answer must be
correct.
Rationale: The scoring for 1b is strict, emphasizing absolute correctness of the initial
answer.
,Question 3
A patient responds only with reflex motor or autonomic effects, or is totally unresponsive,
flaccid, and areflexic for NIH Stroke Scale item 1a (Level of Consciousness). What is their
score?
A) 0
B) 1
C) 2
D) 3
E) This item is untestable.
Correct Answer: D) 3
Rationale: A score of 3 indicates the lowest level of consciousness, characteristic of
deep coma.
Question 4
If a patient answers one question correctly out of two (month and age) for NIH Stroke Scale
item 1b, what is their score?
A) 0
B) 1
C) 2
D) This item is untestable.
E) Depends on which question was answered correctly.
Correct Answer: B) 1
Rationale: The scoring for 1b is 0 for both correct, 1 for one correct, and 2 for
neither correct.
, Question 5
For NIH Stroke Scale item 1c (Level of Consciousness: Commands), if the patient does not
respond to a verbal command, what should the examiner do next?
A) Move to the next item.
B) Document the score as 2 immediately.
C) Demonstrate the task (pantomime) to them.
D) Apply noxious stimulation.
E) Rephrase the command repeatedly.
Correct Answer: C) Demonstrate the task (pantomime) to them.
Rationale: Pantomime is used to clarify the command for patients with
comprehension difficulties before scoring.
Question 6
A patient performs one task correctly (open/close eyes or grip/release hand) for NIH Stroke
Scale item 1c. What is their score?
A) 0
B) 1
C) 2
D) This item is untestable.
E) Depends on which task was performed correctly.
Correct Answer: B) 1
Rationale: The scoring for 1c is 0 for both correct, 1 for one correct, and 2 for
neither correct.
updated!!
Question 1
When assessing the Level of Consciousness (1a) on the NIH Stroke Scale, what is the initial
step?
A) Ask the patient to open and close their eyes.
B) Ask the patient the month and their age.
C) Assess facial symmetry.
D) Determine if the patient is alert, oriented x4 (or their baseline).
E) Apply painful stimulation.
Correct Answer: D) Determine if the patient is alert, oriented x4 (or their baseline).
Rationale: The first step in assessing 1a is to establish the patient's general alertness
and orientation.
Question 2
For NIH Stroke Scale item 1b (Level of Consciousness: Questions), what is the scoring
criterion for partial credit?
A) Partial credit is given for being close to the correct answer.
B) Partial credit is given if the examiner provides a non-verbal cue.
C) Partial credit is given if the patient attempts to answer.
D) There is no partial credit for being close; the answer must be correct.
E) Partial credit is given for answering one question correctly.
Correct Answer: D) There is no partial credit for being close; the answer must be
correct.
Rationale: The scoring for 1b is strict, emphasizing absolute correctness of the initial
answer.
,Question 3
A patient responds only with reflex motor or autonomic effects, or is totally unresponsive,
flaccid, and areflexic for NIH Stroke Scale item 1a (Level of Consciousness). What is their
score?
A) 0
B) 1
C) 2
D) 3
E) This item is untestable.
Correct Answer: D) 3
Rationale: A score of 3 indicates the lowest level of consciousness, characteristic of
deep coma.
Question 4
If a patient answers one question correctly out of two (month and age) for NIH Stroke Scale
item 1b, what is their score?
A) 0
B) 1
C) 2
D) This item is untestable.
E) Depends on which question was answered correctly.
Correct Answer: B) 1
Rationale: The scoring for 1b is 0 for both correct, 1 for one correct, and 2 for
neither correct.
, Question 5
For NIH Stroke Scale item 1c (Level of Consciousness: Commands), if the patient does not
respond to a verbal command, what should the examiner do next?
A) Move to the next item.
B) Document the score as 2 immediately.
C) Demonstrate the task (pantomime) to them.
D) Apply noxious stimulation.
E) Rephrase the command repeatedly.
Correct Answer: C) Demonstrate the task (pantomime) to them.
Rationale: Pantomime is used to clarify the command for patients with
comprehension difficulties before scoring.
Question 6
A patient performs one task correctly (open/close eyes or grip/release hand) for NIH Stroke
Scale item 1c. What is their score?
A) 0
B) 1
C) 2
D) This item is untestable.
E) Depends on which task was performed correctly.
Correct Answer: B) 1
Rationale: The scoring for 1c is 0 for both correct, 1 for one correct, and 2 for
neither correct.
