NIH Stroke Scale NIHSS Group A ACTUAL
EXAM 2026/2027 | Patient 1–6 Practice
Exam | 100% Pass Preparation | Verified
Q&A | Pass Guaranteed - A+ Graded
Patient 1
Q1 (Item 1a — LOC): The patient is awake, alert, and responds appropriately to questions without
prompting. What is the correct score?
A. 0 — alert, keenly responsive [CORRECT]
B. 1 — not alert but arousable
C. 2 — not alert, requires repeated stimulation
D. 3 — reflex movements only
Correct Answer: A
Rationale: Item 1a scores 0 if the patient is alert and fully responsive. Score 1 requires drowsiness with
arousal to minor stimulation. Score 2 requires repeated stimulation to attend. Score 3 is coma or reflex
only. The description indicates full alertness.
Q2 (Item 2 — Horizontal Gaze): The patient is asked to follow the examiner's finger to the left and right.
The patient moves both eyes fully to both sides without any hesitation or deviation. What is the correct
score?
A. 0 — normal [CORRECT]
B. 1 — partial gaze palsy
C. 2 — forced deviation
D. Untestable
Correct Answer: A
Rationale: Item 2 scores 0 when the patient demonstrates normal horizontal eye movement in both
directions without any impairment. Score 1 is given for partial gaze palsy (one eye does not abduct fully
or there is nystagmus). Score 2 is forced deviation or total gaze paresis not overcome by oculocephalic
maneuver. The patient described has completely normal gaze.
,Q3 (Item 3 — Visual Fields): The patient is tested by confrontation using finger counting in all four
quadrants. The patient correctly counts fingers in all quadrants on both sides. What is the correct score?
A. 0 — no visual loss [CORRECT]
B. 1 — partial hemianopia
C. 2 — complete hemianopia
D. 3 — bilateral hemianopia
Correct Answer: A
Rationale: Item 3 scores 0 when the patient demonstrates intact visual fields in all quadrants bilaterally.
Score 1 is partial hemianopia (some vision preserved in the affected field). Score 2 is complete
hemianopia. Score 3 is bilateral hemianopia (blind, including cortical blindness). The patient correctly
counts fingers in all quadrants, indicating no visual field defect.
Q4 (Item 4 — Facial Palsy): The patient is asked to show teeth, raise eyebrows, and close eyes tightly.
The patient performs all movements symmetrically and with full strength. What is the correct score?
A. 0 — normal symmetrical movements [CORRECT]
B. 1 — minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 — partial paralysis (total or near-total paralysis of lower face)
D. 3 — complete paralysis of one or both sides
Correct Answer: A
Rationale: Item 4 scores 0 when the patient demonstrates normal, symmetrical facial movement in all
tested actions (show teeth, raise eyebrows, close eyes tightly). Score 1 indicates minor asymmetry such
as flattened nasolabial fold. Score 2 indicates partial paralysis with some movement preserved. Score 3
is complete unilateral or bilateral facial paralysis. The patient described has no facial weakness.
Q5 (Item 5a — Motor Arm, Left): The patient is asked to hold the left arm at 90 degrees (sitting) or 45
degrees (supine) for 10 seconds. The arm holds the position steadily for the full 10 seconds without any
drift. What is the correct score?
A. 0 — no drift; limb holds 90 (or 45) degrees for full 10 seconds [CORRECT]
B. 1 — drift; limb holds 90 (or 45) degrees but drifts down before 10 seconds
C. 2 — some effort against gravity; limb cannot get to or maintain 90 (or 45) degrees, drifts down to bed
D. 3 — no effort against gravity; limb falls
E. 4 — no movement
, Correct Answer: A
Rationale: Item 5a scores 0 when the arm holds the test position (90 degrees sitting, 45 degrees supine)
for the full 10 seconds without any downward drift. Score 1 requires the arm to drift from the test
position before 10 seconds but not hit the bed. Score 2 means the arm drifts down to the bed but has
some effort against gravity. Score 3 means the arm falls immediately with no effort against gravity.
Score 4 is no movement at all. The patient holds steadily for the full duration.
Q6 (Item 6a — Motor Leg, Left): The patient is asked to hold the left leg at 30 degrees for 5 seconds.
The leg drifts down to the bed before 5 seconds but does not hit the bed with a sudden drop—it
gradually lowers with some effort against gravity. What is the correct score?
A. 0 — no drift; leg holds 30-degree position for full 5 seconds
B. 1 — drift; leg falls by the end of the 5 seconds but does not hit the bed
C. 2 — some effort against gravity; leg cannot get to 30 degrees and drifts down to the bed [CORRECT]
D. 3 — no effort against gravity; leg falls
E. 4 — no movement
Correct Answer: C
Rationale: Item 6a scores 2 when the limb cannot maintain the test position (30 degrees) and drifts
down to the bed, but some effort against gravity is evident (not a sudden drop). Score 0 is no drift for 5
seconds. Score 1 is drift from position but not to the bed by 5 seconds. Score 3 is immediate fall with no
effort against gravity. Score 4 is no movement. The description of gradual lowering with some effort
against gravity matches score 2.
Patient 2
Q7 (Item 7 — Limb Ataxia): The patient is asked to perform the finger-to-nose test and heel-to-shin test
bilaterally. The right side shows slight incoordination on finger-to-nose with past-pointing, but the left
side is normal. The patient has no motor weakness in either arm or leg. What is the correct score?
A. 0 — absent
B. 1 — present in one limb [CORRECT]
C. 2 — present in two limbs
D. Untestable
Correct Answer: B
Rationale: Item 7 scores 1 when ataxia is present in one limb (either arm or leg on one side). Score 0 is
no ataxia. Score 2 is ataxia in two or more limbs. Ataxia is only scored if present in the absence of
weakness; if weakness is present, the item is scored as untestable. The patient has slight incoordination
on the right side only with no weakness, warranting a score of 1.
EXAM 2026/2027 | Patient 1–6 Practice
Exam | 100% Pass Preparation | Verified
Q&A | Pass Guaranteed - A+ Graded
Patient 1
Q1 (Item 1a — LOC): The patient is awake, alert, and responds appropriately to questions without
prompting. What is the correct score?
A. 0 — alert, keenly responsive [CORRECT]
B. 1 — not alert but arousable
C. 2 — not alert, requires repeated stimulation
D. 3 — reflex movements only
Correct Answer: A
Rationale: Item 1a scores 0 if the patient is alert and fully responsive. Score 1 requires drowsiness with
arousal to minor stimulation. Score 2 requires repeated stimulation to attend. Score 3 is coma or reflex
only. The description indicates full alertness.
Q2 (Item 2 — Horizontal Gaze): The patient is asked to follow the examiner's finger to the left and right.
The patient moves both eyes fully to both sides without any hesitation or deviation. What is the correct
score?
A. 0 — normal [CORRECT]
B. 1 — partial gaze palsy
C. 2 — forced deviation
D. Untestable
Correct Answer: A
Rationale: Item 2 scores 0 when the patient demonstrates normal horizontal eye movement in both
directions without any impairment. Score 1 is given for partial gaze palsy (one eye does not abduct fully
or there is nystagmus). Score 2 is forced deviation or total gaze paresis not overcome by oculocephalic
maneuver. The patient described has completely normal gaze.
,Q3 (Item 3 — Visual Fields): The patient is tested by confrontation using finger counting in all four
quadrants. The patient correctly counts fingers in all quadrants on both sides. What is the correct score?
A. 0 — no visual loss [CORRECT]
B. 1 — partial hemianopia
C. 2 — complete hemianopia
D. 3 — bilateral hemianopia
Correct Answer: A
Rationale: Item 3 scores 0 when the patient demonstrates intact visual fields in all quadrants bilaterally.
Score 1 is partial hemianopia (some vision preserved in the affected field). Score 2 is complete
hemianopia. Score 3 is bilateral hemianopia (blind, including cortical blindness). The patient correctly
counts fingers in all quadrants, indicating no visual field defect.
Q4 (Item 4 — Facial Palsy): The patient is asked to show teeth, raise eyebrows, and close eyes tightly.
The patient performs all movements symmetrically and with full strength. What is the correct score?
A. 0 — normal symmetrical movements [CORRECT]
B. 1 — minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 — partial paralysis (total or near-total paralysis of lower face)
D. 3 — complete paralysis of one or both sides
Correct Answer: A
Rationale: Item 4 scores 0 when the patient demonstrates normal, symmetrical facial movement in all
tested actions (show teeth, raise eyebrows, close eyes tightly). Score 1 indicates minor asymmetry such
as flattened nasolabial fold. Score 2 indicates partial paralysis with some movement preserved. Score 3
is complete unilateral or bilateral facial paralysis. The patient described has no facial weakness.
Q5 (Item 5a — Motor Arm, Left): The patient is asked to hold the left arm at 90 degrees (sitting) or 45
degrees (supine) for 10 seconds. The arm holds the position steadily for the full 10 seconds without any
drift. What is the correct score?
A. 0 — no drift; limb holds 90 (or 45) degrees for full 10 seconds [CORRECT]
B. 1 — drift; limb holds 90 (or 45) degrees but drifts down before 10 seconds
C. 2 — some effort against gravity; limb cannot get to or maintain 90 (or 45) degrees, drifts down to bed
D. 3 — no effort against gravity; limb falls
E. 4 — no movement
, Correct Answer: A
Rationale: Item 5a scores 0 when the arm holds the test position (90 degrees sitting, 45 degrees supine)
for the full 10 seconds without any downward drift. Score 1 requires the arm to drift from the test
position before 10 seconds but not hit the bed. Score 2 means the arm drifts down to the bed but has
some effort against gravity. Score 3 means the arm falls immediately with no effort against gravity.
Score 4 is no movement at all. The patient holds steadily for the full duration.
Q6 (Item 6a — Motor Leg, Left): The patient is asked to hold the left leg at 30 degrees for 5 seconds.
The leg drifts down to the bed before 5 seconds but does not hit the bed with a sudden drop—it
gradually lowers with some effort against gravity. What is the correct score?
A. 0 — no drift; leg holds 30-degree position for full 5 seconds
B. 1 — drift; leg falls by the end of the 5 seconds but does not hit the bed
C. 2 — some effort against gravity; leg cannot get to 30 degrees and drifts down to the bed [CORRECT]
D. 3 — no effort against gravity; leg falls
E. 4 — no movement
Correct Answer: C
Rationale: Item 6a scores 2 when the limb cannot maintain the test position (30 degrees) and drifts
down to the bed, but some effort against gravity is evident (not a sudden drop). Score 0 is no drift for 5
seconds. Score 1 is drift from position but not to the bed by 5 seconds. Score 3 is immediate fall with no
effort against gravity. Score 4 is no movement. The description of gradual lowering with some effort
against gravity matches score 2.
Patient 2
Q7 (Item 7 — Limb Ataxia): The patient is asked to perform the finger-to-nose test and heel-to-shin test
bilaterally. The right side shows slight incoordination on finger-to-nose with past-pointing, but the left
side is normal. The patient has no motor weakness in either arm or leg. What is the correct score?
A. 0 — absent
B. 1 — present in one limb [CORRECT]
C. 2 — present in two limbs
D. Untestable
Correct Answer: B
Rationale: Item 7 scores 1 when ataxia is present in one limb (either arm or leg on one side). Score 0 is
no ataxia. Score 2 is ataxia in two or more limbs. Ataxia is only scored if present in the absence of
weakness; if weakness is present, the item is scored as untestable. The patient has slight incoordination
on the right side only with no weakness, warranting a score of 1.
