NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 2026/2027 | Page 1 | Passing Score: 90%
NATIONAL INSTITUTES OF HEALTH
NIHSS GROUP C - PATIENTS 1-6 FOR ME
(PASSING ANSWERS) 2026/2027!! 2026/2027
NIH STROKE SCALE | Official Exam 2026/2027
100 90% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Level of Consciousness & Cognitive Assessment Q1-Q20
Section 2 Cranial Nerve & Visual Assessment Q21-Q40
Section 3 Motor Function & Coordination Q41-Q65
Section 4 Sensory & Language Assessment Q66-Q85
Section 5 Extinction, Inattention & Clinical Integration Q86-Q100
Instructions: Select the single best answer for each question. This exam is designed for NIH Stroke Scale Group C certification
preparation. Passing score: 90% (90 questions correct).
NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 -- 2026/2027 | Passing Score: 90% | Page 1 of 39
, SECTION 1 | LEVEL OF CONSCIOUSNESS & COGNITIVE ASSESSMENT | Q1-Q20 | NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING
ANSWERS) 2026/2027!! 2026/2027 2026/2027
Q1 Question 1 of 100
A 72-year-old woman is brought to the emergency department after being found unresponsive at home by her
daughter. On arrival, she does not open her eyes or respond to verbal stimuli, but she briefly moans and withdraws
her arm when the examiner applies a sternal rub. Based on NIHSS Item 1a scoring criteria, the correct score for this
patient is:
A. 2, because she is not alert and requires repeated stimulation to attend
B. 1, because she responds to physical stimulation with purposeful movement
C. 3, because she does not open her eyes spontaneously or to voice
D. 0, because she demonstrates a localized motor response to pain
Correct Answer: A
Rationale:
A score of 2 on Item 1a is assigned when the patient is not alert and requires repeated stimulation to attend. This patient only
responded to noxious stimulation rather than verbal stimulation, which meets the criterion for a score of 2. A score of 1 requires
arousability with minor stimulation such as voice, and a score of 3 requires complete unresponsiveness to all stimuli including pain.
Q2 Question 2 of 100
A 68-year-old man presents to the stroke unit with acute left-sided weakness 3 hours after symptom onset. When
asked the month, he initially states "January" (it is March) but then immediately self-corrects to "March." For his age,
he correctly answers "68." According to NIHSS Item 1b scoring rules, what score should be assigned?
A. 0, since he ultimately provided both correct answers before moving on
B. 1, since only the first answer counts and he got one of two correct
C. 2, since self-correction indicates baseline uncertainty about both answers
D. 1, since the self-correction demonstrates preserved awareness of the error
Correct Answer: B
Rationale:
NIHSS rules state that only the first answer counts for Item 1b, so the initial incorrect answer of "January" stands despite the
immediate self-correction. Since he answered age correctly but month incorrectly, the score is 1 for answering one question
correctly. A score of 0 would require both answers to be correct on the first attempt.
Q3 Question 3 of 100
A 75-year-old woman with suspected acute ischemic stroke is being assessed using NIHSS Item 1c in the emergency
department. When asked to open and close her eyes, she correctly performs the task. When asked to grip and
release her non-paretic hand, she squeezes the examiners fingers but does not release them despite the verbal
request. Her correct NIHSS Item 1c score is:
A. 0, since she initiated a grip response demonstrating comprehension of the command
B. 2, since failing to release negates performance on both commands
C. 1, since she performed one command correctly but not the other
D. 0, since the grip component was completed and release is a separate motor task
Correct Answer: C
Rationale:
A score of 1 on Item 1c is assigned when the patient performs one command correctly. She correctly opened and closed her eyes
but failed to both grip and release on command, so one of two commands was performed correctly. A score of 0 would require
both commands performed correctly, and the grip without release does not count as completing the hand command.
NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 -- 2026/2027 | Passing Score: 90% | Page 2 of 39
, SECTION 1 | LEVEL OF CONSCIOUSNESS & COGNITIVE ASSESSMENT | Q1-Q20 | (continued) | NIHSS GROUP C - PATIENTS 1-6 FOR ME
(PASSING ANSWERS) 2026/2027!! 2026/2027
Q4 Question 4 of 100
A 63-year-old man arrives intubated and sedated after suffering a large left MCA stroke confirmed on CT
angiography. The bedside nurse asks whether NIHSS Items 1b and 1c can be properly assessed. The most accurate
guidance for scoring these items in this intubated and sedated patient is:
A. Score both items as 0 since the patient cannot respond due to medical management
B. Score Item 1b as 2 and Item 1c as 0 since intubation prevents speech but not movement
C. Delay scoring until sedation is fully metabolized and the patient can participate
D. Score Item 1b as 2 and Item 1c as 2 since the patient can neither answer nor follow commands
Correct Answer: D
Rationale:
For an intubated and sedated patient who is unable to answer questions or follow commands, Items 1b and 1c should each be
scored as 2, reflecting that the patient answers neither correctly and performs neither command correctly. Scoring these as 0
would incorrectly suggest full neurological intactness, and delaying scoring is not standard since the NIHSS must capture the
current neurological state at the time of examination.
Q5 Question 5 of 100
A 58-year-old woman with acute onset right hemiparesis is awake and makes eye contact when you enter the room.
She appears to be paying attention to her surroundings but yawns occasionally during the interview. When asked the
month, she answers "Tuesday," and when asked her age, she stares blankly and does not respond. Her NIHSS Item
1a score should be:
A. 0, because she is alert and spontaneously interacts with the examiner
B. 1, because her yawning suggests intermittent inattention
C. 2, because she fails to answer orientation questions correctly
D. 1, because she does not respond to the age question
Correct Answer: A
Rationale:
A score of 0 on Item 1a is assigned when the patient is alert and spontaneously interacts with the examiner. This patient is awake,
makes eye contact, and is aware of her surroundings, meeting the criterion for alert. Her incorrect answers on Item 1b reflect
cognitive or language impairment rather than a reduced level of consciousness, so Item 1a remains 0.
Q6 Question 6 of 100
A 70-year-old man presents with acute global aphasia following a left MCA stroke confirmed on imaging. He is alert
and attempts to communicate but produces only incomprehensible sounds. When asked the month, he says "blargh,"
and when asked his age, he holds up seven fingers then two fingers, which correctly corresponds to his age of 72.
How should Item 1b be scored?
A. 0, because he communicated his age correctly through gestural means
B. 2, because verbal responses to both questions were incorrect
C. 1, because he communicated one answer through nonverbal means
D. 1, because he attempted to answer both questions and one gesture was correct
Correct Answer: B
Rationale:
Item 1b requires verbal responses to the month and age questions, and nonverbal or gestural answers do not count as correct
under NIHSS scoring rules. Since his verbal responses were incomprehensible for both questions, the score is 2 for answering
NIHSS neither
GROUP correctly. Gestural
C - PATIENTS communication
1-6 FOR is clinically
ME (PASSING ANSWERS) meaningful
2026/2027!! but is --not
2026/2027 accepted
2026/2027 for Item
| Passing 1b 90%
Score: scoring.
| Page 3 of 39
, SECTION 1 | LEVEL OF CONSCIOUSNESS & COGNITIVE ASSESSMENT | Q1-Q20 | (continued) | NIHSS GROUP C - PATIENTS 1-6 FOR ME
(PASSING ANSWERS) 2026/2027!! 2026/2027
Q7 Question 7 of 100
A 65-year-old man is found slumped in his chair at his assisted living facility by the nursing staff. In the emergency
department, he does not spontaneously open his eyes but opens his eyes and briefly looks at the examiner when his
name is called loudly. He closes his eyes again within 10 seconds. His correct NIHSS Item 1a score is:
A. 0, because he is able to make eye contact when stimulated
B. 2, because he requires repeated stimulation to maintain wakefulness
C. 1, because he is not alert but is arousable with minor stimulation
D. 3, because he does not sustain wakefulness without ongoing stimulation
Correct Answer: C
Rationale:
A score of 1 on Item 1a is assigned when the patient is not alert but is arousable with minor stimulation such as calling their name.
This patient required verbal stimulation to arouse but did respond, distinguishing this from a score of 2 where repeated or noxious
stimulation is needed. A score of 0 requires the patient to be spontaneously alert without any stimulation.
Q8 Question 8 of 100
A 79-year-old woman with acute stroke symptoms is assessed for NIHSS Item 1c. On the first attempt, she opens her
eyes when asked but does not close them, and when asked to grip and release her right hand, she does nothing. On
a second attempt 30 seconds later, she correctly opens and closes her eyes and correctly grips and releases. Her
correct Item 1c score is:
A. Score of 0, crediting her second-attempt performance of both commands
B. Score of 1, crediting the partial eye opening on the first attempt
C. Score of 1, since she demonstrated understanding by performing both on the second try
D. Score of 2, since neither command was correctly completed on the first attempt
Correct Answer: D
Rationale:
The NIHSS rules specify that only the first attempt counts for Item 1c. On the first attempt, she opened but did not close her eyes,
meaning the open-and-close command was incomplete, and she did not grip or release her hand. Since neither command was
performed correctly on the first attempt, the score is 2 regardless of her performance on subsequent attempts.
Q9 Question 9 of 100
A 54-year-old man presents with acute onset left-sided weakness and progressive unresponsiveness over the past
hour. He is evaluated in the emergency department and receives an NIHSS Item 1a score of 3 during the initial
assessment. This score has the most direct implication for which clinical decision?
A. The patient likely has a large vessel occlusion warranting emergent endovascular evaluation
B. The patient should be managed conservatively and discharged when alert
C. The patient has a minor stroke requiring only floor observation and monitoring
D. The patient does not need further neuroimaging since the clinical diagnosis is established
Correct Answer: A
Rationale:
An Item 1a score of 3 indicates unresponsiveness, which is associated with severe stroke and a higher likelihood of large vessel
occlusion, warranting emergent endovascular evaluation. This degree of consciousness impairment suggests a significant
neurological event rather than a minor stroke requiring only observation. Neuroimaging remains essential regardless of the clinical
examination findings.
NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 -- 2026/2027 | Passing Score: 90% | Page 4 of 39
NATIONAL INSTITUTES OF HEALTH
NIHSS GROUP C - PATIENTS 1-6 FOR ME
(PASSING ANSWERS) 2026/2027!! 2026/2027
NIH STROKE SCALE | Official Exam 2026/2027
100 90% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Level of Consciousness & Cognitive Assessment Q1-Q20
Section 2 Cranial Nerve & Visual Assessment Q21-Q40
Section 3 Motor Function & Coordination Q41-Q65
Section 4 Sensory & Language Assessment Q66-Q85
Section 5 Extinction, Inattention & Clinical Integration Q86-Q100
Instructions: Select the single best answer for each question. This exam is designed for NIH Stroke Scale Group C certification
preparation. Passing score: 90% (90 questions correct).
NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 -- 2026/2027 | Passing Score: 90% | Page 1 of 39
, SECTION 1 | LEVEL OF CONSCIOUSNESS & COGNITIVE ASSESSMENT | Q1-Q20 | NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING
ANSWERS) 2026/2027!! 2026/2027 2026/2027
Q1 Question 1 of 100
A 72-year-old woman is brought to the emergency department after being found unresponsive at home by her
daughter. On arrival, she does not open her eyes or respond to verbal stimuli, but she briefly moans and withdraws
her arm when the examiner applies a sternal rub. Based on NIHSS Item 1a scoring criteria, the correct score for this
patient is:
A. 2, because she is not alert and requires repeated stimulation to attend
B. 1, because she responds to physical stimulation with purposeful movement
C. 3, because she does not open her eyes spontaneously or to voice
D. 0, because she demonstrates a localized motor response to pain
Correct Answer: A
Rationale:
A score of 2 on Item 1a is assigned when the patient is not alert and requires repeated stimulation to attend. This patient only
responded to noxious stimulation rather than verbal stimulation, which meets the criterion for a score of 2. A score of 1 requires
arousability with minor stimulation such as voice, and a score of 3 requires complete unresponsiveness to all stimuli including pain.
Q2 Question 2 of 100
A 68-year-old man presents to the stroke unit with acute left-sided weakness 3 hours after symptom onset. When
asked the month, he initially states "January" (it is March) but then immediately self-corrects to "March." For his age,
he correctly answers "68." According to NIHSS Item 1b scoring rules, what score should be assigned?
A. 0, since he ultimately provided both correct answers before moving on
B. 1, since only the first answer counts and he got one of two correct
C. 2, since self-correction indicates baseline uncertainty about both answers
D. 1, since the self-correction demonstrates preserved awareness of the error
Correct Answer: B
Rationale:
NIHSS rules state that only the first answer counts for Item 1b, so the initial incorrect answer of "January" stands despite the
immediate self-correction. Since he answered age correctly but month incorrectly, the score is 1 for answering one question
correctly. A score of 0 would require both answers to be correct on the first attempt.
Q3 Question 3 of 100
A 75-year-old woman with suspected acute ischemic stroke is being assessed using NIHSS Item 1c in the emergency
department. When asked to open and close her eyes, she correctly performs the task. When asked to grip and
release her non-paretic hand, she squeezes the examiners fingers but does not release them despite the verbal
request. Her correct NIHSS Item 1c score is:
A. 0, since she initiated a grip response demonstrating comprehension of the command
B. 2, since failing to release negates performance on both commands
C. 1, since she performed one command correctly but not the other
D. 0, since the grip component was completed and release is a separate motor task
Correct Answer: C
Rationale:
A score of 1 on Item 1c is assigned when the patient performs one command correctly. She correctly opened and closed her eyes
but failed to both grip and release on command, so one of two commands was performed correctly. A score of 0 would require
both commands performed correctly, and the grip without release does not count as completing the hand command.
NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 -- 2026/2027 | Passing Score: 90% | Page 2 of 39
, SECTION 1 | LEVEL OF CONSCIOUSNESS & COGNITIVE ASSESSMENT | Q1-Q20 | (continued) | NIHSS GROUP C - PATIENTS 1-6 FOR ME
(PASSING ANSWERS) 2026/2027!! 2026/2027
Q4 Question 4 of 100
A 63-year-old man arrives intubated and sedated after suffering a large left MCA stroke confirmed on CT
angiography. The bedside nurse asks whether NIHSS Items 1b and 1c can be properly assessed. The most accurate
guidance for scoring these items in this intubated and sedated patient is:
A. Score both items as 0 since the patient cannot respond due to medical management
B. Score Item 1b as 2 and Item 1c as 0 since intubation prevents speech but not movement
C. Delay scoring until sedation is fully metabolized and the patient can participate
D. Score Item 1b as 2 and Item 1c as 2 since the patient can neither answer nor follow commands
Correct Answer: D
Rationale:
For an intubated and sedated patient who is unable to answer questions or follow commands, Items 1b and 1c should each be
scored as 2, reflecting that the patient answers neither correctly and performs neither command correctly. Scoring these as 0
would incorrectly suggest full neurological intactness, and delaying scoring is not standard since the NIHSS must capture the
current neurological state at the time of examination.
Q5 Question 5 of 100
A 58-year-old woman with acute onset right hemiparesis is awake and makes eye contact when you enter the room.
She appears to be paying attention to her surroundings but yawns occasionally during the interview. When asked the
month, she answers "Tuesday," and when asked her age, she stares blankly and does not respond. Her NIHSS Item
1a score should be:
A. 0, because she is alert and spontaneously interacts with the examiner
B. 1, because her yawning suggests intermittent inattention
C. 2, because she fails to answer orientation questions correctly
D. 1, because she does not respond to the age question
Correct Answer: A
Rationale:
A score of 0 on Item 1a is assigned when the patient is alert and spontaneously interacts with the examiner. This patient is awake,
makes eye contact, and is aware of her surroundings, meeting the criterion for alert. Her incorrect answers on Item 1b reflect
cognitive or language impairment rather than a reduced level of consciousness, so Item 1a remains 0.
Q6 Question 6 of 100
A 70-year-old man presents with acute global aphasia following a left MCA stroke confirmed on imaging. He is alert
and attempts to communicate but produces only incomprehensible sounds. When asked the month, he says "blargh,"
and when asked his age, he holds up seven fingers then two fingers, which correctly corresponds to his age of 72.
How should Item 1b be scored?
A. 0, because he communicated his age correctly through gestural means
B. 2, because verbal responses to both questions were incorrect
C. 1, because he communicated one answer through nonverbal means
D. 1, because he attempted to answer both questions and one gesture was correct
Correct Answer: B
Rationale:
Item 1b requires verbal responses to the month and age questions, and nonverbal or gestural answers do not count as correct
under NIHSS scoring rules. Since his verbal responses were incomprehensible for both questions, the score is 2 for answering
NIHSS neither
GROUP correctly. Gestural
C - PATIENTS communication
1-6 FOR is clinically
ME (PASSING ANSWERS) meaningful
2026/2027!! but is --not
2026/2027 accepted
2026/2027 for Item
| Passing 1b 90%
Score: scoring.
| Page 3 of 39
, SECTION 1 | LEVEL OF CONSCIOUSNESS & COGNITIVE ASSESSMENT | Q1-Q20 | (continued) | NIHSS GROUP C - PATIENTS 1-6 FOR ME
(PASSING ANSWERS) 2026/2027!! 2026/2027
Q7 Question 7 of 100
A 65-year-old man is found slumped in his chair at his assisted living facility by the nursing staff. In the emergency
department, he does not spontaneously open his eyes but opens his eyes and briefly looks at the examiner when his
name is called loudly. He closes his eyes again within 10 seconds. His correct NIHSS Item 1a score is:
A. 0, because he is able to make eye contact when stimulated
B. 2, because he requires repeated stimulation to maintain wakefulness
C. 1, because he is not alert but is arousable with minor stimulation
D. 3, because he does not sustain wakefulness without ongoing stimulation
Correct Answer: C
Rationale:
A score of 1 on Item 1a is assigned when the patient is not alert but is arousable with minor stimulation such as calling their name.
This patient required verbal stimulation to arouse but did respond, distinguishing this from a score of 2 where repeated or noxious
stimulation is needed. A score of 0 requires the patient to be spontaneously alert without any stimulation.
Q8 Question 8 of 100
A 79-year-old woman with acute stroke symptoms is assessed for NIHSS Item 1c. On the first attempt, she opens her
eyes when asked but does not close them, and when asked to grip and release her right hand, she does nothing. On
a second attempt 30 seconds later, she correctly opens and closes her eyes and correctly grips and releases. Her
correct Item 1c score is:
A. Score of 0, crediting her second-attempt performance of both commands
B. Score of 1, crediting the partial eye opening on the first attempt
C. Score of 1, since she demonstrated understanding by performing both on the second try
D. Score of 2, since neither command was correctly completed on the first attempt
Correct Answer: D
Rationale:
The NIHSS rules specify that only the first attempt counts for Item 1c. On the first attempt, she opened but did not close her eyes,
meaning the open-and-close command was incomplete, and she did not grip or release her hand. Since neither command was
performed correctly on the first attempt, the score is 2 regardless of her performance on subsequent attempts.
Q9 Question 9 of 100
A 54-year-old man presents with acute onset left-sided weakness and progressive unresponsiveness over the past
hour. He is evaluated in the emergency department and receives an NIHSS Item 1a score of 3 during the initial
assessment. This score has the most direct implication for which clinical decision?
A. The patient likely has a large vessel occlusion warranting emergent endovascular evaluation
B. The patient should be managed conservatively and discharged when alert
C. The patient has a minor stroke requiring only floor observation and monitoring
D. The patient does not need further neuroimaging since the clinical diagnosis is established
Correct Answer: A
Rationale:
An Item 1a score of 3 indicates unresponsiveness, which is associated with severe stroke and a higher likelihood of large vessel
occlusion, warranting emergent endovascular evaluation. This degree of consciousness impairment suggests a significant
neurological event rather than a minor stroke requiring only observation. Neuroimaging remains essential regardless of the clinical
examination findings.
NIHSS GROUP C - PATIENTS 1-6 FOR ME (PASSING ANSWERS) 2026/2027!! 2026/2027 -- 2026/2027 | Passing Score: 90% | Page 4 of 39
