NIHSS Group C - Patients 1-6 with Questions and Correct
Answers
Question 1: According to the NIHSS, what is the correct score for a patient who is alert and
keenly responsive, answering all orientation questions correctly?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: A. 0
Rationale: NIHSS Item 1a (Level of Consciousness) scores 0 for a patient who is alert and able to
perform all tasks correctly. A score of 1 indicates not alert but arousable by minor stimulation; 2
indicates obtunded; 3 indicates coma or unresponsive.
Question 2: In NIHSS Item 1b (LOC Questions), a patient correctly answers the current month
but cannot state their age. What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: B. 1
Rationale: Item 1b assesses orientation to month and age. A score of 0 requires both correct; 1
is given if one question is answered incorrectly; 2 is given if both are incorrect or the patient is
aphasic/unable to respond.
Question 3: For NIHSS Item 1c (LOC Commands), a patient successfully closes their eyes and
makes a fist with the non-paretic hand on first attempt. What score should be assigned?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: A. 0
,Rationale: Item 1c tests the ability to follow two-step commands. A score of 0 is assigned when
both tasks are performed correctly on the first attempt. A score of 1 is given if only one task is
completed; 2 if neither is completed.
Question 4: When assessing NIHSS Item 2 (Best Gaze), a patient has a forced deviation of the
eyes that cannot be overcome by oculocephalic maneuver. What is the correct score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: C. 2
Rationale: Item 2 scores: 0 = normal horizontal eye movements; 1 = partial gaze palsy (abnormal
in one or both eyes but not forced deviation); 2 = forced deviation or total gaze palsy not
overcome by oculocephalic maneuver.
Question 5: In NIHSS Item 3 (Visual Fields), a patient has complete homonymous hemianopia.
What score should be documented?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: C. 2
Rationale: Item 3 scores: 0 = no visual loss; 1 = partial hemianopia; 2 = complete hemianopia; 3
= bilateral hemianopia or cortical blindness. Complete homonymous hemianopia scores 2.
Question 6: For NIHSS Item 4 (Facial Palsy), a patient has complete paralysis of the lower half
of the face on one side. What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: C. 2
Rationale: Item 4 scores: 0 = normal symmetrical movements; 1 = minor paralysis (flattened
nasolabial fold, asymmetry on smiling); 2 = partial paralysis (total or near-total paralysis of lower
face); 3 = complete paralysis of one or both sides.
, Question 7: When scoring NIHSS Item 5a (Motor Arm - Right), a patient's arm drifts down but
does not hit the bed within 10 seconds. What score is assigned?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: B. 1
Rationale: Item 5 scores: 0 = no drift (holds arm at 90° for full 10 seconds); 1 = drift (arm drifts
down but does not hit bed within 10 seconds); 2 = some effort against gravity (arm falls to bed
but has effort); 3 = no effort against gravity; 4 = no movement.
Question 8: In NIHSS Item 6 (Motor Leg - Left), a patient cannot lift the leg against gravity but
can move it horizontally. What score should be documented?
A. 1
B. 2
C. 3
D. 4
CORRECT ANSWER: C. 3
Rationale: Item 6 scores: 0 = no drift; 1 = drift; 2 = some effort against gravity; 3 = no effort
against gravity but movement present; 4 = no movement. Inability to lift against gravity but able
to move horizontally scores 3.
Question 9: For NIHSS Item 7 (Limb Ataxia), a patient demonstrates ataxia in one arm only,
with no visual deficit contributing. What is the correct score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: B. 1
Rationale: Item 7 scores: 0 = absent; 1 = ataxia in one limb; 2 = ataxia in two limbs. Ataxia must
be out of proportion to weakness and not due to weakness, sensory loss, or comprehension
deficit.
Question 10: When assessing NIHSS Item 8 (Sensory), a patient has severe sensory loss to
pinprick on the entire right side of the body. What score should be assigned?
Answers
Question 1: According to the NIHSS, what is the correct score for a patient who is alert and
keenly responsive, answering all orientation questions correctly?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: A. 0
Rationale: NIHSS Item 1a (Level of Consciousness) scores 0 for a patient who is alert and able to
perform all tasks correctly. A score of 1 indicates not alert but arousable by minor stimulation; 2
indicates obtunded; 3 indicates coma or unresponsive.
Question 2: In NIHSS Item 1b (LOC Questions), a patient correctly answers the current month
but cannot state their age. What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: B. 1
Rationale: Item 1b assesses orientation to month and age. A score of 0 requires both correct; 1
is given if one question is answered incorrectly; 2 is given if both are incorrect or the patient is
aphasic/unable to respond.
Question 3: For NIHSS Item 1c (LOC Commands), a patient successfully closes their eyes and
makes a fist with the non-paretic hand on first attempt. What score should be assigned?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: A. 0
,Rationale: Item 1c tests the ability to follow two-step commands. A score of 0 is assigned when
both tasks are performed correctly on the first attempt. A score of 1 is given if only one task is
completed; 2 if neither is completed.
Question 4: When assessing NIHSS Item 2 (Best Gaze), a patient has a forced deviation of the
eyes that cannot be overcome by oculocephalic maneuver. What is the correct score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: C. 2
Rationale: Item 2 scores: 0 = normal horizontal eye movements; 1 = partial gaze palsy (abnormal
in one or both eyes but not forced deviation); 2 = forced deviation or total gaze palsy not
overcome by oculocephalic maneuver.
Question 5: In NIHSS Item 3 (Visual Fields), a patient has complete homonymous hemianopia.
What score should be documented?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: C. 2
Rationale: Item 3 scores: 0 = no visual loss; 1 = partial hemianopia; 2 = complete hemianopia; 3
= bilateral hemianopia or cortical blindness. Complete homonymous hemianopia scores 2.
Question 6: For NIHSS Item 4 (Facial Palsy), a patient has complete paralysis of the lower half
of the face on one side. What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: C. 2
Rationale: Item 4 scores: 0 = normal symmetrical movements; 1 = minor paralysis (flattened
nasolabial fold, asymmetry on smiling); 2 = partial paralysis (total or near-total paralysis of lower
face); 3 = complete paralysis of one or both sides.
, Question 7: When scoring NIHSS Item 5a (Motor Arm - Right), a patient's arm drifts down but
does not hit the bed within 10 seconds. What score is assigned?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: B. 1
Rationale: Item 5 scores: 0 = no drift (holds arm at 90° for full 10 seconds); 1 = drift (arm drifts
down but does not hit bed within 10 seconds); 2 = some effort against gravity (arm falls to bed
but has effort); 3 = no effort against gravity; 4 = no movement.
Question 8: In NIHSS Item 6 (Motor Leg - Left), a patient cannot lift the leg against gravity but
can move it horizontally. What score should be documented?
A. 1
B. 2
C. 3
D. 4
CORRECT ANSWER: C. 3
Rationale: Item 6 scores: 0 = no drift; 1 = drift; 2 = some effort against gravity; 3 = no effort
against gravity but movement present; 4 = no movement. Inability to lift against gravity but able
to move horizontally scores 3.
Question 9: For NIHSS Item 7 (Limb Ataxia), a patient demonstrates ataxia in one arm only,
with no visual deficit contributing. What is the correct score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER: B. 1
Rationale: Item 7 scores: 0 = absent; 1 = ataxia in one limb; 2 = ataxia in two limbs. Ataxia must
be out of proportion to weakness and not due to weakness, sensory loss, or comprehension
deficit.
Question 10: When assessing NIHSS Item 8 (Sensory), a patient has severe sensory loss to
pinprick on the entire right side of the body. What score should be assigned?
