NIH Stroke Scale (NIHSS) Group C Certification
Patients 1-6. Scoring guide – Exam Question
and correct answers.
This comprehensive practice exam covers the NIHSS Group C certification test with 100
questions based on Patients 1-6. Each answer includes a rationale in italic to help you
understand the scoring logic.
PATIENT 1: SEVERE RIGHT HEMISPHERIC STROKE
Clinical Scenario: Patient presents with sudden onset of left-sided weakness, confusion,
and inability to follow commands. Alert but has significant neurological deficits
including complete paralysis of one side and severe language impairment .
Question 1: Patient 1 - Item 1a (Level of Consciousness)
What is the correct score for this patient's LOC?
A) 0 - Alert
B) 1 - Not alert, but arousable
C) 2 - Not alert, requires repeated stimulation
D) 3 - Comatose, unresponsive
Correct Answer: A) 0 - Alert
Rationale: The patient is fully alert and responsive to the environment. Item 1a scores 0 for
an alert patient who is keenly responsive. A score of 1 would indicate drowsiness with
arousal by minor stimulation, 2 indicates obtundation requiring strong stimulation, and 3
indicates coma .
Question 2: Patient 1 - Item 1b (LOC Questions)
Patient 1 is asked the month and their age. They cannot answer either correctly. What is
the score?
A) 0 - Answers both correctly
B) 1 - Answers one correctly
,C) 2 - Answers neither correctly
D) 3 - Unable to respond
Correct Answer: C) 2 - Answers neither correctly
Rationale: The patient is asked two standard questions: current month and age. There is
no partial credit for being close. Since both answers are incorrect, the score is 2. Aphasic or
stuporous patients who cannot comprehend the questions also score 2 .
Question 3: Patient 1 - Item 1c (LOC Commands)
The patient is asked to open/close eyes and grip/release the non-paretic hand. They
perform only the eye task correctly. What is the score?
A) 0 - Performs both tasks correctly
B) 1 - Performs one task correctly
C) 2 - Performs neither task correctly
D) 3 - Unable to perform due to other deficits
Correct Answer: B) 1 - Performs one task correctly
Rationale: The commands test the patient's ability to follow simple instructions. Scoring: 0
= both tasks performed correctly; 1 = one task performed correctly; 2 = neither task
performed correctly .
Question 4: Patient 1 - Item 2 (Best Gaze)
The patient's eye movements are conjugate without deviation. What is the score?
A) 0 - Normal
B) 1 - Partial gaze palsy
C) 2 - Forced deviation, total gaze palsy
D) 3 - Unable to assess
Correct Answer: A) 0 - Normal
Rationale: Best gaze tests horizontal eye movements only. A score of 0 indicates normal
conjugate eye movement. Score 1 is given for partial gaze palsy, and score 2 for forced
deviation or total gaze paresis not overcome by oculocephalic maneuver .
Question 5: Patient 1 - Item 3 (Visual Fields)
The patient has severe visual field loss on one side. What is the score?
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
Correct Answer: C) 2 - Complete hemianopia
Rationale: Visual fields are tested by confrontation. A score of 2 indicates severe visual loss
,or complete hemianopia. The deficit must be clearly demonstrated. Score 1 is for partial
hemianopia, and score 3 for bilateral loss .
Question 6: Patient 1 - Item 4 (Facial Palsy)
The patient has minor facial paralysis with a flattened nasolabial fold. What is the score?
A) 0 - Normal
B) 1 - Minor paralysis
C) 2 - Partial paralysis
D) 3 - Complete paralysis
Correct Answer: B) 1 - Minor paralysis
Rationale: Facial palsy is scored based on symmetry of movement. Score 1 indicates minor
paralysis with subtle asymmetry such as flattened nasolabial fold. Score 2 indicates partial
paralysis (near-total lower face paralysis), and score 3 indicates complete paralysis .
Question 7: Patient 1 - Item 5a (Motor Arm - Left)
The left arm holds 90 degrees for the full 10 seconds without drift. What is the score?
A) 0 - No drift
B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: A) 0 - No drift
Rationale: Motor arm testing requires the patient to hold the arm at 90 degrees for 10
seconds. A score of 0 indicates no drift. Score 1 indicates drift before 10 seconds but not
hitting the bed; score 2 indicates some effort against gravity; score 4 indicates no
movement .
Question 8: Patient 1 - Item 5b (Motor Arm - Right)
The right arm has no movement at all. What is the score?
A) 0 - No drift
B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: D) 4 - No movement
Rationale: A score of 4 indicates no movement in the tested arm. The patient cannot
initiate any movement against gravity. This represents the most severe motor deficit .
Question 9: Patient 1 - Item 6a (Motor Leg - Left)
The left leg holds the 30-degree position for the full 5 seconds. What is the score?
A) 0 - No drift
, B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: A) 0 - No drift
Rationale: Motor leg testing requires holding the leg at 30 degrees for 5 seconds. A score
of 0 indicates no drift. Score 1 indicates drift but not hitting the bed; score 2 indicates
some effort against gravity; score 4 indicates no movement .
Question 10: Patient 1 - Item 6b (Motor Leg - Right)
The right leg shows no movement. What is the score?
A) 0 - No drift
B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: D) 4 - No movement
Rationale: A score of 4 indicates no movement in the tested leg. The patient cannot initiate
any movement. This represents the most severe motor deficit .
Question 11: Patient 1 - Item 7 (Limb Ataxia)
The patient has ataxia present in one limb, out of proportion to weakness. What is the
score?
A) 0 - Absent
B) 1 - Present in one limb
C) 2 - Present in two limbs
D) 3 - Unable to assess
Correct Answer: B) 1 - Present in one limb
Rationale: Limb ataxia tests for unilateral cerebellar lesions. It is scored only when present
out of proportion to weakness. Score 0 = absent; 1 = present in one limb; 2 = present in
two limbs .
Question 12: Patient 1 - Item 8 (Sensory)
The patient has severe sensory loss with no awareness of touch on the affected side.
What is the score?
A) 0 - Normal
B) 1 - Mild to moderate sensory loss
C) 2 - Severe or total sensory loss
D) 3 - Unable to assess
Patients 1-6. Scoring guide – Exam Question
and correct answers.
This comprehensive practice exam covers the NIHSS Group C certification test with 100
questions based on Patients 1-6. Each answer includes a rationale in italic to help you
understand the scoring logic.
PATIENT 1: SEVERE RIGHT HEMISPHERIC STROKE
Clinical Scenario: Patient presents with sudden onset of left-sided weakness, confusion,
and inability to follow commands. Alert but has significant neurological deficits
including complete paralysis of one side and severe language impairment .
Question 1: Patient 1 - Item 1a (Level of Consciousness)
What is the correct score for this patient's LOC?
A) 0 - Alert
B) 1 - Not alert, but arousable
C) 2 - Not alert, requires repeated stimulation
D) 3 - Comatose, unresponsive
Correct Answer: A) 0 - Alert
Rationale: The patient is fully alert and responsive to the environment. Item 1a scores 0 for
an alert patient who is keenly responsive. A score of 1 would indicate drowsiness with
arousal by minor stimulation, 2 indicates obtundation requiring strong stimulation, and 3
indicates coma .
Question 2: Patient 1 - Item 1b (LOC Questions)
Patient 1 is asked the month and their age. They cannot answer either correctly. What is
the score?
A) 0 - Answers both correctly
B) 1 - Answers one correctly
,C) 2 - Answers neither correctly
D) 3 - Unable to respond
Correct Answer: C) 2 - Answers neither correctly
Rationale: The patient is asked two standard questions: current month and age. There is
no partial credit for being close. Since both answers are incorrect, the score is 2. Aphasic or
stuporous patients who cannot comprehend the questions also score 2 .
Question 3: Patient 1 - Item 1c (LOC Commands)
The patient is asked to open/close eyes and grip/release the non-paretic hand. They
perform only the eye task correctly. What is the score?
A) 0 - Performs both tasks correctly
B) 1 - Performs one task correctly
C) 2 - Performs neither task correctly
D) 3 - Unable to perform due to other deficits
Correct Answer: B) 1 - Performs one task correctly
Rationale: The commands test the patient's ability to follow simple instructions. Scoring: 0
= both tasks performed correctly; 1 = one task performed correctly; 2 = neither task
performed correctly .
Question 4: Patient 1 - Item 2 (Best Gaze)
The patient's eye movements are conjugate without deviation. What is the score?
A) 0 - Normal
B) 1 - Partial gaze palsy
C) 2 - Forced deviation, total gaze palsy
D) 3 - Unable to assess
Correct Answer: A) 0 - Normal
Rationale: Best gaze tests horizontal eye movements only. A score of 0 indicates normal
conjugate eye movement. Score 1 is given for partial gaze palsy, and score 2 for forced
deviation or total gaze paresis not overcome by oculocephalic maneuver .
Question 5: Patient 1 - Item 3 (Visual Fields)
The patient has severe visual field loss on one side. What is the score?
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
Correct Answer: C) 2 - Complete hemianopia
Rationale: Visual fields are tested by confrontation. A score of 2 indicates severe visual loss
,or complete hemianopia. The deficit must be clearly demonstrated. Score 1 is for partial
hemianopia, and score 3 for bilateral loss .
Question 6: Patient 1 - Item 4 (Facial Palsy)
The patient has minor facial paralysis with a flattened nasolabial fold. What is the score?
A) 0 - Normal
B) 1 - Minor paralysis
C) 2 - Partial paralysis
D) 3 - Complete paralysis
Correct Answer: B) 1 - Minor paralysis
Rationale: Facial palsy is scored based on symmetry of movement. Score 1 indicates minor
paralysis with subtle asymmetry such as flattened nasolabial fold. Score 2 indicates partial
paralysis (near-total lower face paralysis), and score 3 indicates complete paralysis .
Question 7: Patient 1 - Item 5a (Motor Arm - Left)
The left arm holds 90 degrees for the full 10 seconds without drift. What is the score?
A) 0 - No drift
B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: A) 0 - No drift
Rationale: Motor arm testing requires the patient to hold the arm at 90 degrees for 10
seconds. A score of 0 indicates no drift. Score 1 indicates drift before 10 seconds but not
hitting the bed; score 2 indicates some effort against gravity; score 4 indicates no
movement .
Question 8: Patient 1 - Item 5b (Motor Arm - Right)
The right arm has no movement at all. What is the score?
A) 0 - No drift
B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: D) 4 - No movement
Rationale: A score of 4 indicates no movement in the tested arm. The patient cannot
initiate any movement against gravity. This represents the most severe motor deficit .
Question 9: Patient 1 - Item 6a (Motor Leg - Left)
The left leg holds the 30-degree position for the full 5 seconds. What is the score?
A) 0 - No drift
, B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: A) 0 - No drift
Rationale: Motor leg testing requires holding the leg at 30 degrees for 5 seconds. A score
of 0 indicates no drift. Score 1 indicates drift but not hitting the bed; score 2 indicates
some effort against gravity; score 4 indicates no movement .
Question 10: Patient 1 - Item 6b (Motor Leg - Right)
The right leg shows no movement. What is the score?
A) 0 - No drift
B) 1 - Drift, does not hit bed
C) 2 - Some effort against gravity
D) 4 - No movement
Correct Answer: D) 4 - No movement
Rationale: A score of 4 indicates no movement in the tested leg. The patient cannot initiate
any movement. This represents the most severe motor deficit .
Question 11: Patient 1 - Item 7 (Limb Ataxia)
The patient has ataxia present in one limb, out of proportion to weakness. What is the
score?
A) 0 - Absent
B) 1 - Present in one limb
C) 2 - Present in two limbs
D) 3 - Unable to assess
Correct Answer: B) 1 - Present in one limb
Rationale: Limb ataxia tests for unilateral cerebellar lesions. It is scored only when present
out of proportion to weakness. Score 0 = absent; 1 = present in one limb; 2 = present in
two limbs .
Question 12: Patient 1 - Item 8 (Sensory)
The patient has severe sensory loss with no awareness of touch on the affected side.
What is the score?
A) 0 - Normal
B) 1 - Mild to moderate sensory loss
C) 2 - Severe or total sensory loss
D) 3 - Unable to assess
