NIH Stroke Scale (NIHSS) Comprehensive Practice
Exam 100 Questions with Correct Answers & Expert
Explanations | 2026/2027 Edition
SECTION 1: LEVEL OF CONSCIOUSNESS (Items 1a, 1b, 1c) –
Questions 1–15
1. A patient is alert, attentive, and responds appropriately to
questions. What is the correct score for Item 1a (Level of
Consciousness)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: A
Explanation: Item 1a (Level of Consciousness) is scored as 0 =
Alert; keenly responsive. An alert patient who responds
appropriately receives a score of 0. A score of 1 is given when the
patient is arousable by minor stimulation; 2 requires repeated or
strong stimulation; 3 indicates reflex responses only or
unresponsiveness.
2. A stroke patient is drowsy but awakens when the examiner
speaks their name and follows simple commands. What is the
correct score for Item 1a?
,A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Item 1a scores 1 = Not alert; but arousable by
minor stimulation to obey, answer, or respond. The patient is
drowsy but can be aroused by verbal stimulation and follows
commands, which fits the definition of score 1. Score 0 would
require the patient to be fully alert without any drowsiness.
3. A patient requires repeated painful stimulation to elicit
any movement and does not follow commands. What score
should be assigned for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C
Explanation: Item 1a scores 2 = Not alert; requires repeated
stimulation to attend or is obtunded and requires strong or
painful stimulation to make movements (not stereotyped).
The patient requires repeated painful stimulation to respond,
which meets the criteria for score 2. Score 3 is reserved for
patients with only reflex responses or no response at all.
,4. A comatose patient demonstrates only reflexive posturing
in response to noxious stimulation. What is the correct score
for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Explanation: Item 1a scores 3 = Responds only with reflex
motor or autonomic effects or is totally unresponsive, flaccid,
and areflexic. A score of 3 is given only when the patient makes
no movement other than reflexive posturing in response to
noxious stimulation. The patient is comatose with only reflex
responses.
5. When scoring Item 1a, a score of 3 is assigned ONLY when
the patient:
A) Is sleepy but arousable
B) Responds to minor stimulation
C) Makes no movement other than reflexive posturing to noxious
stimulation
D) Follows commands inconsistently
Correct Answer: C
Explanation: A score of 3 is scored only if the patient makes no
movement (other than reflexive posturing) in response to noxious
stimulation. This indicates a deep coma with only brainstem
reflexes intact. Scores 0–2 represent varying degrees of
responsiveness.
, 6. A patient correctly states their age but cannot remember
the current month. What is the correct score for Item 1b (LOC
Questions)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Item 1b asks two questions: the patient's age and
the current month. Scoring: 0 = Answers both correctly; 1 =
Answers one correctly; 2 = Neither correct. The patient
correctly answered one question (age) but not the other (month),
resulting in a score of 1.
7. A patient with global aphasia is unable to answer either
question for Item 1b. What is the correct score?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C
Explanation: Item 1b scores 2 = Neither correct. Even if the
patient's inability is due to aphasia rather than confusion, they
receive a score of 2 if they cannot answer either question. A score
of 0 requires both answers correct; 1 requires one correct.
8. For Item 1c (LOC Commands), the examiner instructs the
patient to:
Exam 100 Questions with Correct Answers & Expert
Explanations | 2026/2027 Edition
SECTION 1: LEVEL OF CONSCIOUSNESS (Items 1a, 1b, 1c) –
Questions 1–15
1. A patient is alert, attentive, and responds appropriately to
questions. What is the correct score for Item 1a (Level of
Consciousness)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: A
Explanation: Item 1a (Level of Consciousness) is scored as 0 =
Alert; keenly responsive. An alert patient who responds
appropriately receives a score of 0. A score of 1 is given when the
patient is arousable by minor stimulation; 2 requires repeated or
strong stimulation; 3 indicates reflex responses only or
unresponsiveness.
2. A stroke patient is drowsy but awakens when the examiner
speaks their name and follows simple commands. What is the
correct score for Item 1a?
,A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Item 1a scores 1 = Not alert; but arousable by
minor stimulation to obey, answer, or respond. The patient is
drowsy but can be aroused by verbal stimulation and follows
commands, which fits the definition of score 1. Score 0 would
require the patient to be fully alert without any drowsiness.
3. A patient requires repeated painful stimulation to elicit
any movement and does not follow commands. What score
should be assigned for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C
Explanation: Item 1a scores 2 = Not alert; requires repeated
stimulation to attend or is obtunded and requires strong or
painful stimulation to make movements (not stereotyped).
The patient requires repeated painful stimulation to respond,
which meets the criteria for score 2. Score 3 is reserved for
patients with only reflex responses or no response at all.
,4. A comatose patient demonstrates only reflexive posturing
in response to noxious stimulation. What is the correct score
for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Explanation: Item 1a scores 3 = Responds only with reflex
motor or autonomic effects or is totally unresponsive, flaccid,
and areflexic. A score of 3 is given only when the patient makes
no movement other than reflexive posturing in response to
noxious stimulation. The patient is comatose with only reflex
responses.
5. When scoring Item 1a, a score of 3 is assigned ONLY when
the patient:
A) Is sleepy but arousable
B) Responds to minor stimulation
C) Makes no movement other than reflexive posturing to noxious
stimulation
D) Follows commands inconsistently
Correct Answer: C
Explanation: A score of 3 is scored only if the patient makes no
movement (other than reflexive posturing) in response to noxious
stimulation. This indicates a deep coma with only brainstem
reflexes intact. Scores 0–2 represent varying degrees of
responsiveness.
, 6. A patient correctly states their age but cannot remember
the current month. What is the correct score for Item 1b (LOC
Questions)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Item 1b asks two questions: the patient's age and
the current month. Scoring: 0 = Answers both correctly; 1 =
Answers one correctly; 2 = Neither correct. The patient
correctly answered one question (age) but not the other (month),
resulting in a score of 1.
7. A patient with global aphasia is unable to answer either
question for Item 1b. What is the correct score?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C
Explanation: Item 1b scores 2 = Neither correct. Even if the
patient's inability is due to aphasia rather than confusion, they
receive a score of 2 if they cannot answer either question. A score
of 0 requires both answers correct; 1 requires one correct.
8. For Item 1c (LOC Commands), the examiner instructs the
patient to:
