NIH Stroke Scale Group E Test (Patients 1–6) 2026–2028 | Practice
Questions & Answers | Complete Study Guide
Prepare for the NIH Stroke Scale (NIHSS) Group E Test covering Patients 1–6 with this
comprehensive study guide featuring practice questions, verified answers, and detailed
rationales. This resource reviews NIHSS scoring principles, neurological assessment techniques,
level of consciousness, gaze, visual fields, facial palsy, motor function, limb ataxia, sensory
deficits, language, dysarthria, extinction, and inattention. Designed to strengthen stroke
assessment skills and improve certification readiness, this guide is ideal for nurses, physicians,
EMS professionals, and healthcare providers.
Question 1
A patient is evaluated in the emergency department. They are fully alert, responsive,
and eagerly interact with the examiner without any delay. What is the correct score for
Item 1a (Level of Consciousness)?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: A score of 0 on Item 1a indicates that the patient is keenly alert, responsive,
and fully oriented to their immediate surroundings.
Question 2
During a neuro assessment, the patient requires repeated tactile stimulation and loud
verbal prompting to wake up. Once aroused, they attend to the examiner for a few
seconds but quickly drift back to sleep. How should Item 1a be scored?
A) 0
B) 1
C) 2
D) 3
,Answer: B) 1
Rationale: A score of 1 is assigned for drowsiness when a patient requires mild to
moderate stimulation to arouse but can remain alert for short intervals.
Question 3
A patient responds only to strong, repeated painful stimuli applied to the nail bed. Their
responses are limited to non-purposeful motor movements, and they cannot be fully
aroused to an alert state. What is the correct score for Item 1a?
A) 1
B) 2
C) 3
D) 4
Answer: B) 2
Rationale: A score of 2 represents stupor, where the patient responds only to painful or
noxious stimuli with reflex or non-purposeful movements.
Question 4
An unresponsive patient demonstrates no motor or verbal response to deep painful
stimuli, showing only flaccid posturing. What score must be documented for Item 1a?
A) 1
B) 2
C) 3
D) 4
Answer: C) 3
Rationale: A score of 3 indicates a state of coma, defined as a complete lack of
response or purposeful movement to any verbal or painful stimuli.
Question 5
The examiner asks a patient to state the current month and their current age. The
patient answers both questions correctly without hesitation. What is the score for Item
1b (LOC Questions)?
, A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: Answering both orientation questions correctly yields a score of 0 on Item 1b.
Question 6
When asked for the current month and their age, a patient correctly identifies that it is
October but states their age incorrectly by five years. What is the correct score for Item
1b?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Rationale: Answering exactly one of the two orientation questions correctly results in a
score of 1 for Item 1b.
Question 7
A patient with an advanced severe dysarthria understands the orientation questions but
cannot produce intelligible words, failing to give either correct answer. How should Item
1b be scored?
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Rationale: Patients who fail to provide the correct answer to both questions—whether
due to severe aphasia, profound dysarthria, or confusion—must receive a score of 2.
Questions & Answers | Complete Study Guide
Prepare for the NIH Stroke Scale (NIHSS) Group E Test covering Patients 1–6 with this
comprehensive study guide featuring practice questions, verified answers, and detailed
rationales. This resource reviews NIHSS scoring principles, neurological assessment techniques,
level of consciousness, gaze, visual fields, facial palsy, motor function, limb ataxia, sensory
deficits, language, dysarthria, extinction, and inattention. Designed to strengthen stroke
assessment skills and improve certification readiness, this guide is ideal for nurses, physicians,
EMS professionals, and healthcare providers.
Question 1
A patient is evaluated in the emergency department. They are fully alert, responsive,
and eagerly interact with the examiner without any delay. What is the correct score for
Item 1a (Level of Consciousness)?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: A score of 0 on Item 1a indicates that the patient is keenly alert, responsive,
and fully oriented to their immediate surroundings.
Question 2
During a neuro assessment, the patient requires repeated tactile stimulation and loud
verbal prompting to wake up. Once aroused, they attend to the examiner for a few
seconds but quickly drift back to sleep. How should Item 1a be scored?
A) 0
B) 1
C) 2
D) 3
,Answer: B) 1
Rationale: A score of 1 is assigned for drowsiness when a patient requires mild to
moderate stimulation to arouse but can remain alert for short intervals.
Question 3
A patient responds only to strong, repeated painful stimuli applied to the nail bed. Their
responses are limited to non-purposeful motor movements, and they cannot be fully
aroused to an alert state. What is the correct score for Item 1a?
A) 1
B) 2
C) 3
D) 4
Answer: B) 2
Rationale: A score of 2 represents stupor, where the patient responds only to painful or
noxious stimuli with reflex or non-purposeful movements.
Question 4
An unresponsive patient demonstrates no motor or verbal response to deep painful
stimuli, showing only flaccid posturing. What score must be documented for Item 1a?
A) 1
B) 2
C) 3
D) 4
Answer: C) 3
Rationale: A score of 3 indicates a state of coma, defined as a complete lack of
response or purposeful movement to any verbal or painful stimuli.
Question 5
The examiner asks a patient to state the current month and their current age. The
patient answers both questions correctly without hesitation. What is the score for Item
1b (LOC Questions)?
, A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: Answering both orientation questions correctly yields a score of 0 on Item 1b.
Question 6
When asked for the current month and their age, a patient correctly identifies that it is
October but states their age incorrectly by five years. What is the correct score for Item
1b?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Rationale: Answering exactly one of the two orientation questions correctly results in a
score of 1 for Item 1b.
Question 7
A patient with an advanced severe dysarthria understands the orientation questions but
cannot produce intelligible words, failing to give either correct answer. How should Item
1b be scored?
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Rationale: Patients who fail to provide the correct answer to both questions—whether
due to severe aphasia, profound dysarthria, or confusion—must receive a score of 2.
