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NIHSS Group C Patients 1-6 Actual Exam
2026/2027 – Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
[SECTION 1: Level of Consciousness (1A, 1B, 1C) — Questions 1-8]
Q1: You are assessing Patient 1 from Group C. The patient is alert but responds slowly to your
initial greeting. When you ask the patient the month of the year, they answer correctly but
hesitate for 10 seconds. When asked their age, they respond correctly. How do you score LOC
1A (Level of Consciousness)?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: The patient is fully alert, despite a slow response time. In NIHSS scoring, LOC 1A is
scored as 0 only if the patient is alert and keenly responsive; a score of 1 requires the patient to
be lethargic or needing a mild stimulus to arouse. Since the patient is awake and responds
without physical stimulation, they are considered alert, regardless of processing speed. A score of
2 or 3 would imply obtundation or unresponsiveness, which is not present here.
Q2: Patient 2 is drowsy but awakens to voice. You ask the patient to name the current month and
their age. The patient states, "It is November... no, October, and I am 55." How do you score
LOC 1B (Questions)?
A. 0
B. 1
C. 2
D. 3
,2
Correct Answer: B
Rationale: The patient answers one question correctly (Age) and one incorrectly (Month). The
NIHSS scoring for LOC 1B assigns 1 point for answering one question correctly and 1 point for
answering zero questions correctly. Since the patient correctly identified their age but failed the
month question, the score is 1. A score of 0 requires both answers to be correct, adhering to the
strict certification standards to ensure accurate baseline neurological assessment for potential tPA
administration.
Q3: During the assessment of Patient 3, you ask the patient to open and close their eyes, and then
to squeeze your hand. The patient is unable to follow either command despite vigorous verbal
repetition. How is LOC 1C (Commands) scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: The patient scores a 2 on LOC 1C because they performed 0 tasks correctly. The
scoring scale is 0 (does both tasks), 1 (does one task), and 2 (does neither). This failure to follow
simple commands indicates a significant impairment in cortical function or level of
consciousness, necessitating rapid communication with the stroke team. It is critical to
distinguish between aphasia (inability to understand) and LOC issues, but in either case, the
inability to motor-plan a squeeze results in a score of 2.
Q4: Patient 4 is unresponsive to voice but localizes to painful sternal rub by moving their arms
across midline. What is the appropriate score for LOC 1A?
A. 0
B. 1
C. 2
D. 3
, 3
Correct Answer: C
Rationale: The patient scores a 2 because they are not alert and require a painful stimulus to
arouse (obtunded). A score of 1 is reserved for patients who are lethargic but awaken to voice; a
score of 3 is reserved for patients who are completely unresponsive or reflexive only to noxious
stimuli with no localization. Proper identification of this score is vital for severity stratification,
as a drop in LOC often correlates with increased intracranial pressure or expanding stroke
volume, alerting the ED team to potential airway compromise.
Q5: You ask Patient 5 to describe a specific scenario involving their current location. They
answer, "I am at the... hospital... place," but cannot name the hospital or the city. When asked the
month, they say "Winter." How do you score LOC 1B?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: The patient scores a 2 because they answered neither question correctly (neither the
precise month nor the location). To receive a score of 1, the patient must answer one of the two
questions precisely (e.g., correct month but wrong location, or vice versa). Inaccurate answers
like "Winter" or "Hospital place" do not count as correct, reflecting a significant deficit in
orientation and cognitive processing required for safe discharge planning or consent.
Q6: Patient 6 is intubated and sedated. You attempt to assess LOC 1C by asking the patient to
grip your hand and let go. The patient makes no movement. How do you score this?
A. 0
B. 1
C. 2
D. 9 (Untestable)
NIHSS Group C Patients 1-6 Actual Exam
2026/2027 – Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
[SECTION 1: Level of Consciousness (1A, 1B, 1C) — Questions 1-8]
Q1: You are assessing Patient 1 from Group C. The patient is alert but responds slowly to your
initial greeting. When you ask the patient the month of the year, they answer correctly but
hesitate for 10 seconds. When asked their age, they respond correctly. How do you score LOC
1A (Level of Consciousness)?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: The patient is fully alert, despite a slow response time. In NIHSS scoring, LOC 1A is
scored as 0 only if the patient is alert and keenly responsive; a score of 1 requires the patient to
be lethargic or needing a mild stimulus to arouse. Since the patient is awake and responds
without physical stimulation, they are considered alert, regardless of processing speed. A score of
2 or 3 would imply obtundation or unresponsiveness, which is not present here.
Q2: Patient 2 is drowsy but awakens to voice. You ask the patient to name the current month and
their age. The patient states, "It is November... no, October, and I am 55." How do you score
LOC 1B (Questions)?
A. 0
B. 1
C. 2
D. 3
,2
Correct Answer: B
Rationale: The patient answers one question correctly (Age) and one incorrectly (Month). The
NIHSS scoring for LOC 1B assigns 1 point for answering one question correctly and 1 point for
answering zero questions correctly. Since the patient correctly identified their age but failed the
month question, the score is 1. A score of 0 requires both answers to be correct, adhering to the
strict certification standards to ensure accurate baseline neurological assessment for potential tPA
administration.
Q3: During the assessment of Patient 3, you ask the patient to open and close their eyes, and then
to squeeze your hand. The patient is unable to follow either command despite vigorous verbal
repetition. How is LOC 1C (Commands) scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: The patient scores a 2 on LOC 1C because they performed 0 tasks correctly. The
scoring scale is 0 (does both tasks), 1 (does one task), and 2 (does neither). This failure to follow
simple commands indicates a significant impairment in cortical function or level of
consciousness, necessitating rapid communication with the stroke team. It is critical to
distinguish between aphasia (inability to understand) and LOC issues, but in either case, the
inability to motor-plan a squeeze results in a score of 2.
Q4: Patient 4 is unresponsive to voice but localizes to painful sternal rub by moving their arms
across midline. What is the appropriate score for LOC 1A?
A. 0
B. 1
C. 2
D. 3
, 3
Correct Answer: C
Rationale: The patient scores a 2 because they are not alert and require a painful stimulus to
arouse (obtunded). A score of 1 is reserved for patients who are lethargic but awaken to voice; a
score of 3 is reserved for patients who are completely unresponsive or reflexive only to noxious
stimuli with no localization. Proper identification of this score is vital for severity stratification,
as a drop in LOC often correlates with increased intracranial pressure or expanding stroke
volume, alerting the ED team to potential airway compromise.
Q5: You ask Patient 5 to describe a specific scenario involving their current location. They
answer, "I am at the... hospital... place," but cannot name the hospital or the city. When asked the
month, they say "Winter." How do you score LOC 1B?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: The patient scores a 2 because they answered neither question correctly (neither the
precise month nor the location). To receive a score of 1, the patient must answer one of the two
questions precisely (e.g., correct month but wrong location, or vice versa). Inaccurate answers
like "Winter" or "Hospital place" do not count as correct, reflecting a significant deficit in
orientation and cognitive processing required for safe discharge planning or consent.
Q6: Patient 6 is intubated and sedated. You attempt to assess LOC 1C by asking the patient to
grip your hand and let go. The patient makes no movement. How do you score this?
A. 0
B. 1
C. 2
D. 9 (Untestable)
