NIH Stroke Scale (NIHSS) Group E Certification -
100 Question Practice Exam.
This comprehensive practice exam covers the NIHSS Group E-V3 (5th Certification) test
with 100 questions based on Patients 1-6. Each answer includes a rationale in italic to
help you understand the scoring logic for the 2025/2026 certification cycle .
PATIENT 1: MINIMAL NEUROLOGICAL DEFICITS
Clinical Scenario: Alert patient with minimal deficits, primarily mild sensory loss in right
arm/leg and mild right leg drift .
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 awake and responds appropriately to all stimuli without
delay. No decreased level of consciousness is present .
Question 2: Patient 1 - Item 1b (LOC Questions)
Patient 1 is asked the month and their age. They answer both 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: A) 0 - Answers both correctly
Rationale: The patient correctly states current age and month without prompting or error.
A score of 0 indicates both questions are answered correctly .
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 both tasks 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
Correct Answer: A) 0 - Performs both tasks correctly
Rationale: The patient follows both commands accurately and promptly without difficulty .
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: Full conjugate gaze is present; no gaze palsy or forced deviation is observed .
Question 5: Patient 1 - Item 3 (Visual Fields)
The patient has full visual fields on confrontation testing. What is the score?
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
Correct Answer: A) 0 - No visual loss
Rationale: Full visual fields bilaterally on confrontation testing; no hemianopia or
quadrantanopia is detected .
Question 6: Patient 1 - Item 4 (Facial Palsy)
The patient has normal symmetrical facial movement. What is the score?
A) 0 - Normal
B) 1 - Minor paralysis
C) 2 - Partial paralysis
D) 3 - Complete paralysis
Correct Answer: A) 0 - Normal
Rationale: Symmetric facial movement is present with no weakness of upper or lower
face .
, 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: The left arm is maintained at 90° (sitting) or 45° (supine) for the full 10 seconds
without drift .
Question 8: Patient 1 - Item 5b (Motor Arm - Right)
The right arm maintains position for 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: The right arm is maintained in position for the full 10 seconds without drift .
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: The left leg is maintained at 30° for the full 5 seconds without drift .
Question 10: Patient 1 - Item 6b (Motor Leg - Right)
The right leg drifts before 5 seconds but does not touch the bed surface. 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: B) 1 - Drift, does not hit bed
Rationale: The right leg drifts before 5 seconds but does not touch the bed surface, scoring
1.
100 Question Practice Exam.
This comprehensive practice exam covers the NIHSS Group E-V3 (5th Certification) test
with 100 questions based on Patients 1-6. Each answer includes a rationale in italic to
help you understand the scoring logic for the 2025/2026 certification cycle .
PATIENT 1: MINIMAL NEUROLOGICAL DEFICITS
Clinical Scenario: Alert patient with minimal deficits, primarily mild sensory loss in right
arm/leg and mild right leg drift .
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 awake and responds appropriately to all stimuli without
delay. No decreased level of consciousness is present .
Question 2: Patient 1 - Item 1b (LOC Questions)
Patient 1 is asked the month and their age. They answer both 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: A) 0 - Answers both correctly
Rationale: The patient correctly states current age and month without prompting or error.
A score of 0 indicates both questions are answered correctly .
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 both tasks 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
Correct Answer: A) 0 - Performs both tasks correctly
Rationale: The patient follows both commands accurately and promptly without difficulty .
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: Full conjugate gaze is present; no gaze palsy or forced deviation is observed .
Question 5: Patient 1 - Item 3 (Visual Fields)
The patient has full visual fields on confrontation testing. What is the score?
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
Correct Answer: A) 0 - No visual loss
Rationale: Full visual fields bilaterally on confrontation testing; no hemianopia or
quadrantanopia is detected .
Question 6: Patient 1 - Item 4 (Facial Palsy)
The patient has normal symmetrical facial movement. What is the score?
A) 0 - Normal
B) 1 - Minor paralysis
C) 2 - Partial paralysis
D) 3 - Complete paralysis
Correct Answer: A) 0 - Normal
Rationale: Symmetric facial movement is present with no weakness of upper or lower
face .
, 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: The left arm is maintained at 90° (sitting) or 45° (supine) for the full 10 seconds
without drift .
Question 8: Patient 1 - Item 5b (Motor Arm - Right)
The right arm maintains position for 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: The right arm is maintained in position for the full 10 seconds without drift .
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: The left leg is maintained at 30° for the full 5 seconds without drift .
Question 10: Patient 1 - Item 6b (Motor Leg - Right)
The right leg drifts before 5 seconds but does not touch the bed surface. 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: B) 1 - Drift, does not hit bed
Rationale: The right leg drifts before 5 seconds but does not touch the bed surface, scoring
1.
