NIHSS GROUP C PATIENTS 1-6 CERTIFICATION EXAM
2026 | NIH Stroke Scale Certification | Passing
Answers | Pass Guaranteed - A+ Graded
Section 1: NIHSS Administration Rules & Scoring Fundamentals (Q1-15)
Q1. What is the total possible score range on the NIH Stroke Scale?
A. 0 to 21
B. 0 to 30
C. 0 to 42 [CORRECT]
D. 0 to 50
Rationale: The NIHSS total score ranges from 0 (no stroke deficits) to 42 (most
severe). Scores greater than 21 indicate severe stroke, 5-15 indicate moderate stroke,
and 1-4 indicate mild stroke per NINDS standards.
Correct Answer: C
Q2. According to NIHSS classification, what score range indicates a severe stroke?
A. 16 to 20
B. Greater than 21 [CORRECT]
C. 10 to 15
D. 5 to 10
Rationale: NIHSS severity classification defines severe stroke as a total score greater
than 21. Moderate stroke is classified as 5-15, and mild stroke is 1-4.
Correct Answer: B
Q3. A patient receives a total NIHSS score of 8. How is this stroke severity classified?
,A. Mild stroke
B. Moderate stroke [CORRECT]
C. Moderate-severe stroke
D. Severe stroke
Rationale: A total score of 8 falls within the moderate stroke range of 5-15. Mild
stroke is 1-4, and severe stroke is greater than 21 per 2026 NINDS NIHSS standards.
Correct Answer: B
Q4. Which of the following is a fundamental rule of NIHSS administration?
A. Items may be skipped if the patient appears uncooperative
B. Score each item in the designated order without skipping [CORRECT]
C. Start with the most neurologically complex items first
D. Only score items where the patient gives a verbal response
Rationale: NIHSS protocol requires scoring each item in the designated order from
1A through 11 without skipping, even if the patient is uncooperative or has deficits
that make certain items difficult to assess.
Correct Answer: B
Q5. When scoring NIHSS items, which value should be recorded if a patient's
performance fluctuates during testing?
A. The first response observed
B. The best response observed
C. The last responsive value before moving to the next item [CORRECT]
D. The average of all responses
Rationale: The last responsive value rule requires scoring the final response observed
before moving to the next item, as this reflects the patient's sustained performance
and prevents coaching bias from artificially inflating scores.
Correct Answer: C
,Q6. A patient has a below-knee amputation of the left leg. How should the Motor
Leg (Item 6) left side be scored and documented?
A. Score 4 and document "no movement"
B. Score 0 and document "not tested"
C. Score 9 and document "untestable due to amputation" [CORRECT]
D. Skip the item and do not include in total
Rationale: Untestable items due to amputation, trauma, or fusion are scored as 9 and
clearly documented with the reason. The item is never skipped; score 9 is entered per
NIHSS rules and included in the documentation.
Correct Answer: C
Q7. A patient is intubated and cannot speak. How should the Dysarthria item (Item
10) be scored?
A. Score 2 because speech is absent
B. Score 3 because the patient is mute
C. Score 9 and document "untestable due to intubation" [CORRECT]
D. Score 0 because articulation cannot be assessed
Rationale: Intubation prevents assessment of speech clarity, making dysarthria
untestable (score 9). Muteness is a language item issue scored under Item 9, and
score 0 requires normal speech assessment.
Correct Answer: C
Q8. A patient has a fused right shoulder and cannot extend the right arm for Motor
Arm testing. What is the correct score for the right arm?
A. Score 4 for no movement
B. Score 0 for normal movement
, C. Score 9 and document "untestable due to fused joint" [CORRECT]
D. Score 2 for drift to support
Rationale: Physical limitations such as fused joints or amputations make motor items
untestable (score 9). Score 4 indicates neurologic paralysis from stroke, not
mechanical limitation of joint movement.
Correct Answer: C
Q9. A comatose patient (1A = 3) is being assessed for Best Language (Item 9). What
is the appropriate score?
A. Score 9 because the patient is untestable
B. Score 2 for severe aphasia
C. Score 3 for mute/global aphasia [CORRECT]
D. Score 0 because language cannot be assessed
Rationale: Comatose patients who cannot participate in language testing are scored
3 (mute/global aphasia) per NIHSS protocol. Untestable (9) is reserved for physical
barriers, not unconsciousness or neurologic inability.
Correct Answer: C
Q10. An aphasic patient is asked the month and age for Item 1B (LOC Questions).
The patient attempts to speak but produces incorrect words. How is this scored?
A. Score 0 because the patient attempted to answer
B. Score 1 because the patient made a verbal attempt
C. Score 2 because both answers are incorrect [CORRECT]
D. Score 9 because aphasia makes the item untestable
Rationale: Aphasic patients who cannot correctly state the month and age are scored
2 (none correct) for Item 1B. Aphasia does not make LOC questions untestable;
incorrect or uninterpretable responses are scored as wrong per NIHSS rules.
Correct Answer: C
2026 | NIH Stroke Scale Certification | Passing
Answers | Pass Guaranteed - A+ Graded
Section 1: NIHSS Administration Rules & Scoring Fundamentals (Q1-15)
Q1. What is the total possible score range on the NIH Stroke Scale?
A. 0 to 21
B. 0 to 30
C. 0 to 42 [CORRECT]
D. 0 to 50
Rationale: The NIHSS total score ranges from 0 (no stroke deficits) to 42 (most
severe). Scores greater than 21 indicate severe stroke, 5-15 indicate moderate stroke,
and 1-4 indicate mild stroke per NINDS standards.
Correct Answer: C
Q2. According to NIHSS classification, what score range indicates a severe stroke?
A. 16 to 20
B. Greater than 21 [CORRECT]
C. 10 to 15
D. 5 to 10
Rationale: NIHSS severity classification defines severe stroke as a total score greater
than 21. Moderate stroke is classified as 5-15, and mild stroke is 1-4.
Correct Answer: B
Q3. A patient receives a total NIHSS score of 8. How is this stroke severity classified?
,A. Mild stroke
B. Moderate stroke [CORRECT]
C. Moderate-severe stroke
D. Severe stroke
Rationale: A total score of 8 falls within the moderate stroke range of 5-15. Mild
stroke is 1-4, and severe stroke is greater than 21 per 2026 NINDS NIHSS standards.
Correct Answer: B
Q4. Which of the following is a fundamental rule of NIHSS administration?
A. Items may be skipped if the patient appears uncooperative
B. Score each item in the designated order without skipping [CORRECT]
C. Start with the most neurologically complex items first
D. Only score items where the patient gives a verbal response
Rationale: NIHSS protocol requires scoring each item in the designated order from
1A through 11 without skipping, even if the patient is uncooperative or has deficits
that make certain items difficult to assess.
Correct Answer: B
Q5. When scoring NIHSS items, which value should be recorded if a patient's
performance fluctuates during testing?
A. The first response observed
B. The best response observed
C. The last responsive value before moving to the next item [CORRECT]
D. The average of all responses
Rationale: The last responsive value rule requires scoring the final response observed
before moving to the next item, as this reflects the patient's sustained performance
and prevents coaching bias from artificially inflating scores.
Correct Answer: C
,Q6. A patient has a below-knee amputation of the left leg. How should the Motor
Leg (Item 6) left side be scored and documented?
A. Score 4 and document "no movement"
B. Score 0 and document "not tested"
C. Score 9 and document "untestable due to amputation" [CORRECT]
D. Skip the item and do not include in total
Rationale: Untestable items due to amputation, trauma, or fusion are scored as 9 and
clearly documented with the reason. The item is never skipped; score 9 is entered per
NIHSS rules and included in the documentation.
Correct Answer: C
Q7. A patient is intubated and cannot speak. How should the Dysarthria item (Item
10) be scored?
A. Score 2 because speech is absent
B. Score 3 because the patient is mute
C. Score 9 and document "untestable due to intubation" [CORRECT]
D. Score 0 because articulation cannot be assessed
Rationale: Intubation prevents assessment of speech clarity, making dysarthria
untestable (score 9). Muteness is a language item issue scored under Item 9, and
score 0 requires normal speech assessment.
Correct Answer: C
Q8. A patient has a fused right shoulder and cannot extend the right arm for Motor
Arm testing. What is the correct score for the right arm?
A. Score 4 for no movement
B. Score 0 for normal movement
, C. Score 9 and document "untestable due to fused joint" [CORRECT]
D. Score 2 for drift to support
Rationale: Physical limitations such as fused joints or amputations make motor items
untestable (score 9). Score 4 indicates neurologic paralysis from stroke, not
mechanical limitation of joint movement.
Correct Answer: C
Q9. A comatose patient (1A = 3) is being assessed for Best Language (Item 9). What
is the appropriate score?
A. Score 9 because the patient is untestable
B. Score 2 for severe aphasia
C. Score 3 for mute/global aphasia [CORRECT]
D. Score 0 because language cannot be assessed
Rationale: Comatose patients who cannot participate in language testing are scored
3 (mute/global aphasia) per NIHSS protocol. Untestable (9) is reserved for physical
barriers, not unconsciousness or neurologic inability.
Correct Answer: C
Q10. An aphasic patient is asked the month and age for Item 1B (LOC Questions).
The patient attempts to speak but produces incorrect words. How is this scored?
A. Score 0 because the patient attempted to answer
B. Score 1 because the patient made a verbal attempt
C. Score 2 because both answers are incorrect [CORRECT]
D. Score 9 because aphasia makes the item untestable
Rationale: Aphasic patients who cannot correctly state the month and age are scored
2 (none correct) for Item 1B. Aphasia does not make LOC questions untestable;
incorrect or uninterpretable responses are scored as wrong per NIHSS rules.
Correct Answer: C
