PREMIUM NIHSS CERTIFICATION EXAM TEST
BANK ULTIMATE QUESTIONS AND ANSWERS
WITH DETAILED CLINICAL RATIONALES
This premium study resource features a comprehensive test
bank of high-yield multiple-choice questions with verified
answer keys and detailed clinical rationales. Explicitly
engineered to mirror official certification criteria, each
scenario guides students through complex Level of
Consciousness, motor drift, visual field cuts, and language
evaluations. It serves as an essential, immediate-download
tool for nurses, clinicians, and medical students aiming to
master standardized stroke assessments and achieve top
grades.
Question 1: For a patient evaluated under stroke protocols, if
Level of Consciousness (LOC) State shows: A patient
responds only to noxious stimuli with reflex withdrawal.
What is the correct NIHSS score for Item 1a?
0 - Alert
1 - Not alert; arousable by minor stimulation
2 - Not alert; requires repeated stimulation to attend
3 - Responds only with reflex motor or autonomic effects, or
totally unresponsive
,Answer: 3
Rationale: Item 1a scores a 3 when the patient fails to
respond to any verbal commands and only exhibits reflex
motor responses or autonomic changes to painful or noxious
stimuli.
Question 2: For a patient evaluated under stroke protocols, if
Horizontal Eye Movements shows: During the gaze
assessment, a patient has a deviation that can be overcome
by the oculocephalic maneuver. How is this scored on NIHSS
Item 2?
0 - Normal
1 - Partial gaze palsy
2 - Forced deviation, or total gaze paresis not overcome by
oculocephalic maneuvers
Answer: 1
Rationale: A partial gaze palsy (score 1) is recorded when
gaze is abnormal in one or both eyes, but forced deviation is
not absolute and can be overcome by reflexes.
Question 3: A patient is asked the current month and their
age. They answer the month correctly but state their age
incorrectly by two years. How is NIHSS Item 1b (LOC
Questions) scored?
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly
,Answer: 1
Rationale: The patient only provided one correct answer (the
month). For Item 1b, a score of 1 is given if the patient
answers exactly one of the two questions correctly. Aphasic
and stuporous patients who do not comprehend the
questions will automatically score a 2.
Question 4: During the assessment of NIHSS Item 1c (LOC
Commands), the patient is asked to open and close their
eyes, and then grip and release their non-paretic hand. The
patient successfully opens their eyes but only makes a
partial, incomplete attempt to close them, and completely
fails to follow the hand command. What is the correct score?
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly
Answer: 1
Rationale: Only the first command (opening/closing eyes)
was executed successfully. Credit is given only if the action
is fully completed. Since only one task was performed
correctly, the score is 1.
Question 5: A stroke patient presents with a complete
homonymous hemianopia during confrontation testing. How
should NIHSS Item 3 (Visual Fields) be scored?
0 - No visual loss
, 1 - Partial hemianopia
2 - Complete hemianopia
3 - Bilateral hemianopia (blind from any cause)
Answer: 2
Rationale: A complete homonymous hemianopia represents
a complete loss of vision in one half of the visual field for
both eyes, which corresponds precisely to a score of 2 on
Item 3.
Question 6: While testing NIHSS Item 4 (Facial Palsy), you
note that the patient has a subtle flattening of the nasolabial
fold and an asymmetrical smile, but upper facial movement
(forehead wrinkling) is completely preserved. What is the
appropriate score?
0 - Normal symmetrical movements
1 - Minor paralysis (flattened nasolabial fold, asymmetry on
smiling)
2 - Partial paralysis (total or near-total paralysis of lower face)
3 - Complete paralysis of one or both sides (absence of facial
movement in the upper and lower face)
Answer: 1
Rationale: This presentation describes a classic upper motor
neuron facial weakness, typical in acute ischemic strokes,
which is scored as a 1 (minor paralysis) due to the flattening
of the nasolabial fold and mild asymmetry during a smile.
BANK ULTIMATE QUESTIONS AND ANSWERS
WITH DETAILED CLINICAL RATIONALES
This premium study resource features a comprehensive test
bank of high-yield multiple-choice questions with verified
answer keys and detailed clinical rationales. Explicitly
engineered to mirror official certification criteria, each
scenario guides students through complex Level of
Consciousness, motor drift, visual field cuts, and language
evaluations. It serves as an essential, immediate-download
tool for nurses, clinicians, and medical students aiming to
master standardized stroke assessments and achieve top
grades.
Question 1: For a patient evaluated under stroke protocols, if
Level of Consciousness (LOC) State shows: A patient
responds only to noxious stimuli with reflex withdrawal.
What is the correct NIHSS score for Item 1a?
0 - Alert
1 - Not alert; arousable by minor stimulation
2 - Not alert; requires repeated stimulation to attend
3 - Responds only with reflex motor or autonomic effects, or
totally unresponsive
,Answer: 3
Rationale: Item 1a scores a 3 when the patient fails to
respond to any verbal commands and only exhibits reflex
motor responses or autonomic changes to painful or noxious
stimuli.
Question 2: For a patient evaluated under stroke protocols, if
Horizontal Eye Movements shows: During the gaze
assessment, a patient has a deviation that can be overcome
by the oculocephalic maneuver. How is this scored on NIHSS
Item 2?
0 - Normal
1 - Partial gaze palsy
2 - Forced deviation, or total gaze paresis not overcome by
oculocephalic maneuvers
Answer: 1
Rationale: A partial gaze palsy (score 1) is recorded when
gaze is abnormal in one or both eyes, but forced deviation is
not absolute and can be overcome by reflexes.
Question 3: A patient is asked the current month and their
age. They answer the month correctly but state their age
incorrectly by two years. How is NIHSS Item 1b (LOC
Questions) scored?
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly
,Answer: 1
Rationale: The patient only provided one correct answer (the
month). For Item 1b, a score of 1 is given if the patient
answers exactly one of the two questions correctly. Aphasic
and stuporous patients who do not comprehend the
questions will automatically score a 2.
Question 4: During the assessment of NIHSS Item 1c (LOC
Commands), the patient is asked to open and close their
eyes, and then grip and release their non-paretic hand. The
patient successfully opens their eyes but only makes a
partial, incomplete attempt to close them, and completely
fails to follow the hand command. What is the correct score?
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly
Answer: 1
Rationale: Only the first command (opening/closing eyes)
was executed successfully. Credit is given only if the action
is fully completed. Since only one task was performed
correctly, the score is 1.
Question 5: A stroke patient presents with a complete
homonymous hemianopia during confrontation testing. How
should NIHSS Item 3 (Visual Fields) be scored?
0 - No visual loss
, 1 - Partial hemianopia
2 - Complete hemianopia
3 - Bilateral hemianopia (blind from any cause)
Answer: 2
Rationale: A complete homonymous hemianopia represents
a complete loss of vision in one half of the visual field for
both eyes, which corresponds precisely to a score of 2 on
Item 3.
Question 6: While testing NIHSS Item 4 (Facial Palsy), you
note that the patient has a subtle flattening of the nasolabial
fold and an asymmetrical smile, but upper facial movement
(forehead wrinkling) is completely preserved. What is the
appropriate score?
0 - Normal symmetrical movements
1 - Minor paralysis (flattened nasolabial fold, asymmetry on
smiling)
2 - Partial paralysis (total or near-total paralysis of lower face)
3 - Complete paralysis of one or both sides (absence of facial
movement in the upper and lower face)
Answer: 1
Rationale: This presentation describes a classic upper motor
neuron facial weakness, typical in acute ischemic strokes,
which is scored as a 1 (minor paralysis) due to the flattening
of the nasolabial fold and mild asymmetry during a smile.
