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NIHSS Group A Comprehensive Examination 2026 –
NIH Stroke Scale Certification | National Institutes of
Health Stroke Scale (NIHSS) Assessment | Practice
Questions with Correct Answers & Detailed
Rationales
Description: This comprehensive 150-question examination is designed
for healthcare professionals seeking NIHSS certification, recertification,
or competency verification. The assessment covers all 15 items of the
NIH Stroke Scale including Level of Consciousness, LOC Questions,
LOC Commands, Best Gaze, Visual Field, Facial Palsy, Motor Arm,
Motor Leg, Limb Ataxia, Sensory, Best Language, Dysarthria,
Extinction/Inattention, and the administration and scoring of each
component. Based on the official NIHSS training and certification
curriculum, this exam tests both recall and clinical application expected
of competent stroke care providers .
SECTION 1: QUESTIONS 1-50
Question 1
A patient is alert and responds appropriately to all questions but is
oriented only to person and place (cannot state the month or age).
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According to the NIHSS, what score should be assigned for Level of
Consciousness (LOC) - Questions?
A) 0
B) 1
C) 2
D) 3
Answer: B
*The LOC Questions item (1a) scores the patient's ability to answer two
specific questions: the current month and the patient's age. A score of 1
is given when the patient answers one question correctly. The patient
must be able to state the month and age correctly to receive a score of 0.
A score of 2 is given if neither question is answered correctly. A score of
3 is not applicable for this item .
---
Question 2
A patient is able to perform both commands correctly when the examiner
asks them to open and close their eyes and then to make a fist and let go.
What score should be assigned for LOC - Commands?
A) 0
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B) 1
C) 2
D) 3
Answer: A
*The LOC Commands item (1b) tests the patient's ability to follow two
simple one-step commands: open and close eyes, and make a fist and let
go. A score of 0 is given when both commands are performed correctly.
If only one command is performed correctly, the score is 1. If neither
command is performed correctly, the score is 2. A score of 3 is not
applicable for this item .
---
Question 3
A patient is arousable to minor stimulation and obeys commands. What
is the correct score for Level of Consciousness (LOC) - Alertness?
A) 0
B) 1
C) 2
D) 3
Answer: B
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*The Level of Consciousness item (1a) assesses the patient's level of
responsiveness. A score of 0 is given for alert and responsive. A score of
1 is given for arousable to minor stimulation (arousable to voice or
touch). A score of 2 is given for requires repeated stimulation to arouse
or is obtunded. A score of 3 is given for unresponsive or reflex
movements only .
---
Question 4
A patient has a gaze palsy where they cannot move their eyes to the left
side. What score should be assigned for Best Gaze?
A) 0
B) 1
C) 2
D) 3
Answer: B
*The Best Gaze item (2) assesses conjugate eye movements. A score of
0 is normal. A score of 1 is partial gaze palsy (gaze is abnormal in one or
both eyes but forced deviation is not present). A score of 2 is forced
deviation (total gaze paresis) that cannot be overcome by oculocephalic
maneuver. A score of 3 is not applicable for this item .
NIHSS Group A Comprehensive Examination 2026 –
NIH Stroke Scale Certification | National Institutes of
Health Stroke Scale (NIHSS) Assessment | Practice
Questions with Correct Answers & Detailed
Rationales
Description: This comprehensive 150-question examination is designed
for healthcare professionals seeking NIHSS certification, recertification,
or competency verification. The assessment covers all 15 items of the
NIH Stroke Scale including Level of Consciousness, LOC Questions,
LOC Commands, Best Gaze, Visual Field, Facial Palsy, Motor Arm,
Motor Leg, Limb Ataxia, Sensory, Best Language, Dysarthria,
Extinction/Inattention, and the administration and scoring of each
component. Based on the official NIHSS training and certification
curriculum, this exam tests both recall and clinical application expected
of competent stroke care providers .
SECTION 1: QUESTIONS 1-50
Question 1
A patient is alert and responds appropriately to all questions but is
oriented only to person and place (cannot state the month or age).
,2|Page
According to the NIHSS, what score should be assigned for Level of
Consciousness (LOC) - Questions?
A) 0
B) 1
C) 2
D) 3
Answer: B
*The LOC Questions item (1a) scores the patient's ability to answer two
specific questions: the current month and the patient's age. A score of 1
is given when the patient answers one question correctly. The patient
must be able to state the month and age correctly to receive a score of 0.
A score of 2 is given if neither question is answered correctly. A score of
3 is not applicable for this item .
---
Question 2
A patient is able to perform both commands correctly when the examiner
asks them to open and close their eyes and then to make a fist and let go.
What score should be assigned for LOC - Commands?
A) 0
,3|Page
B) 1
C) 2
D) 3
Answer: A
*The LOC Commands item (1b) tests the patient's ability to follow two
simple one-step commands: open and close eyes, and make a fist and let
go. A score of 0 is given when both commands are performed correctly.
If only one command is performed correctly, the score is 1. If neither
command is performed correctly, the score is 2. A score of 3 is not
applicable for this item .
---
Question 3
A patient is arousable to minor stimulation and obeys commands. What
is the correct score for Level of Consciousness (LOC) - Alertness?
A) 0
B) 1
C) 2
D) 3
Answer: B
, 4|Page
*The Level of Consciousness item (1a) assesses the patient's level of
responsiveness. A score of 0 is given for alert and responsive. A score of
1 is given for arousable to minor stimulation (arousable to voice or
touch). A score of 2 is given for requires repeated stimulation to arouse
or is obtunded. A score of 3 is given for unresponsive or reflex
movements only .
---
Question 4
A patient has a gaze palsy where they cannot move their eyes to the left
side. What score should be assigned for Best Gaze?
A) 0
B) 1
C) 2
D) 3
Answer: B
*The Best Gaze item (2) assesses conjugate eye movements. A score of
0 is normal. A score of 1 is partial gaze palsy (gaze is abnormal in one or
both eyes but forced deviation is not present). A score of 2 is forced
deviation (total gaze paresis) that cannot be overcome by oculocephalic
maneuver. A score of 3 is not applicable for this item .
