NIH STROKE SCALE GROUP A PATIENT 1-6 STUDY
GUIDE
2026/2027 Syllabus Updated Version with 100+ Answered
Questions
SECTION 1: GENERAL PRINCIPLES & SCORING (Questions 1-
25)
Question 1
According to the NIHSS, what range of scores indicates a "moderate" stroke severity?
A) 0–4
B) 5–15
C) 16–20
D) 21–42
ANSWER ✓ B) 5–15
Rationale: The NIHSS total score classifies severity as follows: 0 = no stroke symptoms;
1–4 = mild; 5–15 = moderate; 16–20 = moderate to severe; 21–42 = severe .
Question 2
What is the maximum possible total score on the NIH Stroke Scale?
A) 36
B) 42
C) 44
D) 48
ANSWER ✓ B) 42
,Rationale: The NIHSS total score ranges from 0 to 42. The higher the score, the more
severe the neurological deficit .
Question 3
For item 1B (LOC Questions), the patient is asked which two specific questions?
A) "What is your name?" and "Where are you?"
B) "What month is it?" and "How old are you?"
C) "What day of the week is it?" and "What year is it?"
D) "Who is the President?" and "Where is the hospital?"
ANSWER ✓ B) "What month is it?" and "How old are you?"
Rationale: The standardized questions for NIHSS item 1B are the current month and the
patient's age. This tests orientation specifically, not general knowledge .
Question 4
A patient follows the command to blink but does not squeeze your hand when asked.
According to item 1C (LOC Commands), what score should be assigned?
A) 0
B) 1
C) 2
D) 3
ANSWER ✓ B) 1
Rationale: Item 1C scores the ability to perform two commands (open/close eyes and
grip/release hand). A score of 1 is given if the patient performs only one task correctly .
Question 5
When testing motor function in the arm (item 5), how long should the patient be asked
to hold the limb in position?
,A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
ANSWER ✓ B) 10 seconds
Rationale: For the arm (item 5), the patient holds the limb at 90° (sitting) or 45° (supine)
for a full 10 seconds to check for drift. For the leg (item 6), the duration is 5 seconds .
Question 6
A patient with known arthritis and joint fusion in the left arm is being tested. How
should the motor arm item (5a) be scored?
A) Score as 4 (No movement)
B) Score as 2 (Some effort against gravity)
C) Score as "UN" (Untestable)
D) Estimate the score based on the right arm
ANSWER ✓ C) Score as "UN" (Untestable)
Rationale: If a limb is amputated or joint fusion prevents movement, the item is marked
as "Untestable" (UN). It should not be scored numerically, as the impairment is not due
to the stroke .
Question 7
What does item 2 (Best Gaze) test?
A) Vertical eye movements and pupil reactivity
B) Horizontal eye movements
C) Convergence and accommodation
D) Oculocephalic reflex only
ANSWER ✓ B) Horizontal eye movements
, Rationale: Item 2 specifically assesses horizontal eye movements. It looks for partial
gaze palsy or forced deviation. Vertical gaze and reflexes are not part of this score .
Question 8
A patient is intubated and cannot speak. How should item 10 (Dysarthria) be scored?
A) Score as 2 (Severe dysarthria)
B) Score as 1 (Mild dysarthria)
C) Score as "Untestable"
D) Ask the patient to write their response
ANSWER ✓ C) Score as "Untestable"
Rationale: If the patient is intubated, has a physical barrier, or for any other reason
cannot be assessed for clarity of speech, the item should be marked "Untestable." It is
not scored as an abnormality .
Question 9
In item 9 (Best Language), a patient with global aphasia (no usable speech or
comprehension) would receive a score of:
A) 1
B) 2
C) 3
D) 4
ANSWER ✓ C) 3
Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild to moderate aphasia; 2 = Severe
aphasia; 3 = Mute or global aphasia .
Question 10
What is the primary purpose of the NIH Stroke Scale?
GUIDE
2026/2027 Syllabus Updated Version with 100+ Answered
Questions
SECTION 1: GENERAL PRINCIPLES & SCORING (Questions 1-
25)
Question 1
According to the NIHSS, what range of scores indicates a "moderate" stroke severity?
A) 0–4
B) 5–15
C) 16–20
D) 21–42
ANSWER ✓ B) 5–15
Rationale: The NIHSS total score classifies severity as follows: 0 = no stroke symptoms;
1–4 = mild; 5–15 = moderate; 16–20 = moderate to severe; 21–42 = severe .
Question 2
What is the maximum possible total score on the NIH Stroke Scale?
A) 36
B) 42
C) 44
D) 48
ANSWER ✓ B) 42
,Rationale: The NIHSS total score ranges from 0 to 42. The higher the score, the more
severe the neurological deficit .
Question 3
For item 1B (LOC Questions), the patient is asked which two specific questions?
A) "What is your name?" and "Where are you?"
B) "What month is it?" and "How old are you?"
C) "What day of the week is it?" and "What year is it?"
D) "Who is the President?" and "Where is the hospital?"
ANSWER ✓ B) "What month is it?" and "How old are you?"
Rationale: The standardized questions for NIHSS item 1B are the current month and the
patient's age. This tests orientation specifically, not general knowledge .
Question 4
A patient follows the command to blink but does not squeeze your hand when asked.
According to item 1C (LOC Commands), what score should be assigned?
A) 0
B) 1
C) 2
D) 3
ANSWER ✓ B) 1
Rationale: Item 1C scores the ability to perform two commands (open/close eyes and
grip/release hand). A score of 1 is given if the patient performs only one task correctly .
Question 5
When testing motor function in the arm (item 5), how long should the patient be asked
to hold the limb in position?
,A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
ANSWER ✓ B) 10 seconds
Rationale: For the arm (item 5), the patient holds the limb at 90° (sitting) or 45° (supine)
for a full 10 seconds to check for drift. For the leg (item 6), the duration is 5 seconds .
Question 6
A patient with known arthritis and joint fusion in the left arm is being tested. How
should the motor arm item (5a) be scored?
A) Score as 4 (No movement)
B) Score as 2 (Some effort against gravity)
C) Score as "UN" (Untestable)
D) Estimate the score based on the right arm
ANSWER ✓ C) Score as "UN" (Untestable)
Rationale: If a limb is amputated or joint fusion prevents movement, the item is marked
as "Untestable" (UN). It should not be scored numerically, as the impairment is not due
to the stroke .
Question 7
What does item 2 (Best Gaze) test?
A) Vertical eye movements and pupil reactivity
B) Horizontal eye movements
C) Convergence and accommodation
D) Oculocephalic reflex only
ANSWER ✓ B) Horizontal eye movements
, Rationale: Item 2 specifically assesses horizontal eye movements. It looks for partial
gaze palsy or forced deviation. Vertical gaze and reflexes are not part of this score .
Question 8
A patient is intubated and cannot speak. How should item 10 (Dysarthria) be scored?
A) Score as 2 (Severe dysarthria)
B) Score as 1 (Mild dysarthria)
C) Score as "Untestable"
D) Ask the patient to write their response
ANSWER ✓ C) Score as "Untestable"
Rationale: If the patient is intubated, has a physical barrier, or for any other reason
cannot be assessed for clarity of speech, the item should be marked "Untestable." It is
not scored as an abnormality .
Question 9
In item 9 (Best Language), a patient with global aphasia (no usable speech or
comprehension) would receive a score of:
A) 1
B) 2
C) 3
D) 4
ANSWER ✓ C) 3
Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild to moderate aphasia; 2 = Severe
aphasia; 3 = Mute or global aphasia .
Question 10
What is the primary purpose of the NIH Stroke Scale?
