NIHSS Group C Patients 1-6 Complete
Answer Key Actual Exam 2026/2027 – 100%
Verified | Detailed Rationales – Pass
Guaranteed – A+ Graded
Content Area Overview:
This actual examination reflects the comprehensive neurological assessment knowledge required for
success on the NIHSS Group C certification exam. The exam is designed to evaluate the healthcare
professional's ability to accurately score the 15-item NIH Stroke Scale across six distinct patient
scenarios. Questions are structured to assess recall of scoring criteria, application of neurological
assessment techniques, and analysis of stroke severity based on total scores. This authentic question
bank represents the real exams used in the course and serves as a comprehensive resource for
healthcare professionals demonstrating mastery of the NIHSS Group C certification requirements.
Patient 1 Assessment (Questions 1–12)
Q1. A 68-year-old male is brought to the emergency department with sudden onset left-sided weakness.
During your NIHSS assessment, you approach the patient and say his name loudly. He opens his eyes
immediately and is fully oriented to the current month and his exact age. When asked to open and close
his eyes and make a fist, he follows both commands correctly. What is the correct score for NIHSS Item
1a (Level of Consciousness)?
A. 0 – Alert; keenly responsive
B. 1 – Not alert; but arousable by minor stimulation
C. 2 – Not alert; requires repeated stimulation
D. 3 – Coma; unresponsive or reflex responses only
Rationale: The best answer is A. This patient is fully alert and responsive without any stimulation
needed, which is the definition of a score of 0 on Item 1a. He opens his eyes immediately, is oriented,
and follows commands appropriately, showing no impairment in his level of consciousness. A score of 1
would apply if he needed some prompting to respond.
,Correct Answer: A
Q2. For the same patient in Q1, what is the correct score for NIHSS Item 1b (LOC Questions)?
A. 0 – Answers both questions correctly
B. 1 – Answers one question correctly
C. 2 – Answers neither question correctly
D. 1.5 – Partial credit for one question
Rationale: The best answer is A. The patient is fully oriented to both month and age, answering both
questions correctly, which earns a score of 0. This item specifically tests orientation to time (month) and
personal information (age), and getting both right indicates intact cognitive function in these domains.
There is no partial scoring on this item—it's all or nothing per question.
Correct Answer: A
Q3. During the gaze assessment (Item 2) for Patient 1, you ask the patient to follow your finger
horizontally across the midline. The patient's eyes track your finger smoothly in both directions without
any deviation or corrective saccades needed. What is the correct score for Item 2?
A. 0 – Normal
B. 1 – Partial gaze palsy
C. 2 – Forced deviation
D. 1 – Gaze preference but overcomeable
Rationale: The best answer is A. Normal horizontal eye movement in both directions with smooth
tracking and no deviation is scored as 0. The patient's eyes move conjugately across the midline without
any evidence of gaze palsy or forced deviation, indicating intact brainstem and cortical eye movement
pathways. Any score higher than 0 would require observable abnormality in eye movement.
Correct Answer: A
Q4. When testing visual fields (Item 3) on Patient 1, you perform confrontation testing. The patient
consistently fails to identify your fingers in the left visual field of both eyes. The right visual fields are
intact. What is the correct score for Item 3?
A. 0 – No visual loss
B. 1 – Partial hemianopia
C. 2 – Complete hemianopia
D. 3 – Bilateral hemianopia
,Rationale: The best answer is C. A complete hemianopia is scored as 2 when the patient demonstrates a
complete loss of vision in one hemifield (left or right) of both eyes. Since this patient has a consistent,
complete loss in the left visual field bilaterally, this meets the criteria for a score of 2. Partial hemianopia
would apply if there were some preserved vision in the affected hemifield.
Correct Answer: C
Q5. During the facial palsy assessment (Item 4) for Patient 1, you ask the patient to show his teeth, raise
his eyebrows, and squeeze his eyes shut. You observe that the left nasolabial fold is flattened, and there
is mild asymmetry of the left corner of the mouth when showing teeth. The upper face (forehead
wrinkling and eye closure) appears symmetric. What is the correct score for Item 4?
A. 0 – Normal symmetric movements
B. 1 – Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 – Partial paralysis (total or near-total paralysis of lower face)
D. 3 – Complete paralysis of one or both sides
Rationale: The best answer is B. The description matches minor paralysis, scored as 1, characterized by a
flattened nasolabial fold and mild asymmetry of the mouth with preserved upper facial movement. The
key distinction here is that the upper face (forehead, eye closure) remains symmetric, which points to a
central facial palsy rather than a peripheral one. A score of 2 would require more pronounced lower face
weakness.
Correct Answer: B
Q6. When testing motor arm function (Items 5a and 5b) on Patient 1, you hold the patient's arms at 90
degrees (or 45 degrees if supine) and count to 10. The left arm drifts down to the bed before you finish
counting but does not hit the bed within the 10 seconds. The right arm remains in position for the full 10
seconds. What is the correct score for the left arm (Item 5a or 5b, depending on laterality)?
A. 0 – No drift
B. 1 – Drift; limb holds 90 (or 45) degrees but drifts down before 10 seconds
C. 2 – Some effort against gravity; limb cannot get to or maintain 90 (or 45) degrees
D. 3 – No effort against gravity; limb falls
Rationale: The best answer is B. A score of 1 is assigned when the limb drifts from the initial position
before the full 10 seconds but does not actually hit the bed or other support surface. The limb
demonstrates some effort against gravity initially but cannot maintain the position throughout the
count. This is a clear distinction from a score of 2, where the limb cannot even reach or briefly maintain
the testing position.
, Correct Answer: B
Q7. When testing motor leg function (Items 6a and 6b) on Patient 1, you hold the left leg at 30 degrees.
The leg drifts down to the bed within 5 seconds but does not hit the bed. What is the correct score?
A. 0 – No drift
B. 1 – Drift; leg falls by the end of the 5 seconds but does not hit the bed
C. 2 – Some effort against gravity; leg falls to bed almost immediately
D. 3 – No effort against gravity; leg falls
Rationale: The best answer is B. The leg drifts down over the 5-second count but does not hit the bed,
which is the classic presentation for a score of 1 on motor leg testing. The limb demonstrates some
ability to maintain position against gravity but fatigues and drifts before the count is complete. The fact
that it doesn't hit the bed distinguishes it from a score of 2.
Correct Answer: B
Q8. During the limb ataxia assessment (Item 7) for Patient 1, you perform the finger-to-nose test and
heel-to-shin test. The patient shows no past-pointing or uncoordinated movements in either upper or
lower extremities. What is the correct score for Item 7?
A. 0 – Absent
B. 1 – Present in one limb
C. 2 – Present in two limbs
D. 0 – Unable to assess; intubated or limb amputated
Rationale: The best answer is A. A score of 0 indicates absent ataxia, meaning the patient performs the
finger-to-nose and heel-to-shin tests with normal coordination and accuracy in all four limbs. There is no
evidence of cerebellar dysfunction such as dysmetria, intention tremor, or decomposition of movement.
Ataxia must be distinguished from weakness—if the limb cannot move at all due to paralysis, score as
untestable (UN) rather than 0 for ataxia.
Correct Answer: A
Q9. During sensory testing (Item 8) for Patient 1, you use a safety pin to test pinprick sensation on both
sides of the body. The patient reports diminished but present sensation on the left side compared to the
right, describing it as "duller" but still noticeable. What is the correct score for Item 8?
A. 0 – Normal; no sensory loss
B. 1 – Mild-to-moderate sensory loss; patient feels pinprick but less sharp on the affected side
Answer Key Actual Exam 2026/2027 – 100%
Verified | Detailed Rationales – Pass
Guaranteed – A+ Graded
Content Area Overview:
This actual examination reflects the comprehensive neurological assessment knowledge required for
success on the NIHSS Group C certification exam. The exam is designed to evaluate the healthcare
professional's ability to accurately score the 15-item NIH Stroke Scale across six distinct patient
scenarios. Questions are structured to assess recall of scoring criteria, application of neurological
assessment techniques, and analysis of stroke severity based on total scores. This authentic question
bank represents the real exams used in the course and serves as a comprehensive resource for
healthcare professionals demonstrating mastery of the NIHSS Group C certification requirements.
Patient 1 Assessment (Questions 1–12)
Q1. A 68-year-old male is brought to the emergency department with sudden onset left-sided weakness.
During your NIHSS assessment, you approach the patient and say his name loudly. He opens his eyes
immediately and is fully oriented to the current month and his exact age. When asked to open and close
his eyes and make a fist, he follows both commands correctly. What is the correct score for NIHSS Item
1a (Level of Consciousness)?
A. 0 – Alert; keenly responsive
B. 1 – Not alert; but arousable by minor stimulation
C. 2 – Not alert; requires repeated stimulation
D. 3 – Coma; unresponsive or reflex responses only
Rationale: The best answer is A. This patient is fully alert and responsive without any stimulation
needed, which is the definition of a score of 0 on Item 1a. He opens his eyes immediately, is oriented,
and follows commands appropriately, showing no impairment in his level of consciousness. A score of 1
would apply if he needed some prompting to respond.
,Correct Answer: A
Q2. For the same patient in Q1, what is the correct score for NIHSS Item 1b (LOC Questions)?
A. 0 – Answers both questions correctly
B. 1 – Answers one question correctly
C. 2 – Answers neither question correctly
D. 1.5 – Partial credit for one question
Rationale: The best answer is A. The patient is fully oriented to both month and age, answering both
questions correctly, which earns a score of 0. This item specifically tests orientation to time (month) and
personal information (age), and getting both right indicates intact cognitive function in these domains.
There is no partial scoring on this item—it's all or nothing per question.
Correct Answer: A
Q3. During the gaze assessment (Item 2) for Patient 1, you ask the patient to follow your finger
horizontally across the midline. The patient's eyes track your finger smoothly in both directions without
any deviation or corrective saccades needed. What is the correct score for Item 2?
A. 0 – Normal
B. 1 – Partial gaze palsy
C. 2 – Forced deviation
D. 1 – Gaze preference but overcomeable
Rationale: The best answer is A. Normal horizontal eye movement in both directions with smooth
tracking and no deviation is scored as 0. The patient's eyes move conjugately across the midline without
any evidence of gaze palsy or forced deviation, indicating intact brainstem and cortical eye movement
pathways. Any score higher than 0 would require observable abnormality in eye movement.
Correct Answer: A
Q4. When testing visual fields (Item 3) on Patient 1, you perform confrontation testing. The patient
consistently fails to identify your fingers in the left visual field of both eyes. The right visual fields are
intact. What is the correct score for Item 3?
A. 0 – No visual loss
B. 1 – Partial hemianopia
C. 2 – Complete hemianopia
D. 3 – Bilateral hemianopia
,Rationale: The best answer is C. A complete hemianopia is scored as 2 when the patient demonstrates a
complete loss of vision in one hemifield (left or right) of both eyes. Since this patient has a consistent,
complete loss in the left visual field bilaterally, this meets the criteria for a score of 2. Partial hemianopia
would apply if there were some preserved vision in the affected hemifield.
Correct Answer: C
Q5. During the facial palsy assessment (Item 4) for Patient 1, you ask the patient to show his teeth, raise
his eyebrows, and squeeze his eyes shut. You observe that the left nasolabial fold is flattened, and there
is mild asymmetry of the left corner of the mouth when showing teeth. The upper face (forehead
wrinkling and eye closure) appears symmetric. What is the correct score for Item 4?
A. 0 – Normal symmetric movements
B. 1 – Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 – Partial paralysis (total or near-total paralysis of lower face)
D. 3 – Complete paralysis of one or both sides
Rationale: The best answer is B. The description matches minor paralysis, scored as 1, characterized by a
flattened nasolabial fold and mild asymmetry of the mouth with preserved upper facial movement. The
key distinction here is that the upper face (forehead, eye closure) remains symmetric, which points to a
central facial palsy rather than a peripheral one. A score of 2 would require more pronounced lower face
weakness.
Correct Answer: B
Q6. When testing motor arm function (Items 5a and 5b) on Patient 1, you hold the patient's arms at 90
degrees (or 45 degrees if supine) and count to 10. The left arm drifts down to the bed before you finish
counting but does not hit the bed within the 10 seconds. The right arm remains in position for the full 10
seconds. What is the correct score for the left arm (Item 5a or 5b, depending on laterality)?
A. 0 – No drift
B. 1 – Drift; limb holds 90 (or 45) degrees but drifts down before 10 seconds
C. 2 – Some effort against gravity; limb cannot get to or maintain 90 (or 45) degrees
D. 3 – No effort against gravity; limb falls
Rationale: The best answer is B. A score of 1 is assigned when the limb drifts from the initial position
before the full 10 seconds but does not actually hit the bed or other support surface. The limb
demonstrates some effort against gravity initially but cannot maintain the position throughout the
count. This is a clear distinction from a score of 2, where the limb cannot even reach or briefly maintain
the testing position.
, Correct Answer: B
Q7. When testing motor leg function (Items 6a and 6b) on Patient 1, you hold the left leg at 30 degrees.
The leg drifts down to the bed within 5 seconds but does not hit the bed. What is the correct score?
A. 0 – No drift
B. 1 – Drift; leg falls by the end of the 5 seconds but does not hit the bed
C. 2 – Some effort against gravity; leg falls to bed almost immediately
D. 3 – No effort against gravity; leg falls
Rationale: The best answer is B. The leg drifts down over the 5-second count but does not hit the bed,
which is the classic presentation for a score of 1 on motor leg testing. The limb demonstrates some
ability to maintain position against gravity but fatigues and drifts before the count is complete. The fact
that it doesn't hit the bed distinguishes it from a score of 2.
Correct Answer: B
Q8. During the limb ataxia assessment (Item 7) for Patient 1, you perform the finger-to-nose test and
heel-to-shin test. The patient shows no past-pointing or uncoordinated movements in either upper or
lower extremities. What is the correct score for Item 7?
A. 0 – Absent
B. 1 – Present in one limb
C. 2 – Present in two limbs
D. 0 – Unable to assess; intubated or limb amputated
Rationale: The best answer is A. A score of 0 indicates absent ataxia, meaning the patient performs the
finger-to-nose and heel-to-shin tests with normal coordination and accuracy in all four limbs. There is no
evidence of cerebellar dysfunction such as dysmetria, intention tremor, or decomposition of movement.
Ataxia must be distinguished from weakness—if the limb cannot move at all due to paralysis, score as
untestable (UN) rather than 0 for ataxia.
Correct Answer: A
Q9. During sensory testing (Item 8) for Patient 1, you use a safety pin to test pinprick sensation on both
sides of the body. The patient reports diminished but present sensation on the left side compared to the
right, describing it as "duller" but still noticeable. What is the correct score for Item 8?
A. 0 – Normal; no sensory loss
B. 1 – Mild-to-moderate sensory loss; patient feels pinprick but less sharp on the affected side
