1
NIHSS Group A Answer Key Updated
Actual Exam 2026/2027 Complete Exam-
Style Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+
Graded
Group A: Patient 1 (Questions 1-25)
Patient 1 Clinical Vignette (for reference throughout Patient 1
questions):
Patient 1: Margaret Thompson, 68-year-old female, brought to
the ED by EMS at 14:30 after her daughter found her slurring
her speech about 2 hours ago. Last known well: 12:30 PM. CT
head shows no hemorrhage. She has a history of hypertension
and atrial fibrillation. On examination, she is awake but seems
slightly drowsy, follows simple commands slowly, has left facial
droop, left arm drifts, mild left leg drift, sensory loss on the left
side, mild aphasia, and mild dysarthria.
Part I: Patient 1 – Level of Consciousness, Orientation &
Commands (Questions 1-7)
Q1: You begin your NIHSS assessment on Ms. Thompson.
When you enter the room, she opens her eyes spontaneously,
looks toward you when you say her name, and attempts to
,2
answer when spoken to, though her responses are slow and
slightly confused. She does not require repeated stimulation to
stay awake. How do you score 1a: Level of Consciousness
(Alertness)?
A. 0 – Alert
B. 1 – Drowsy; requires minor stimulation to remain alert
[CORRECT]
C. 2 – Requires repeated stimulation to attend or is obtunded
D. 3 – Responds only with reflex motor or autonomic effects or
is unresponsive
Correct Answer: B
Rationale: The best answer is B because the patient opens her
eyes spontaneously and responds without needing repeated
stimulation, but she is described as "slightly drowsy" with "slow
and slightly confused responses"—this fits the criteria for a
score of 1, which captures the patient who is not fully crisp and
alert but doesn't need constant prodding to stay engaged. A score
of 0 (option A) would require her to be fully alert, responsive,
and completely oriented without any drowsiness.
Q2: You ask Ms. Thompson, "What month is it?" She looks at
you, pauses for about 10 seconds, and then says, "Um... I think
it's... October? Wait... no... March?" She seems uncertain. Then
,3
you ask, "How old are you?" She replies correctly, "I'm 68."
How do you score 1b: Level of Consciousness (Orientation)?
A. 0 – Answers both questions correctly
B. 1 – Answers one question correctly [CORRECT]
C. 2 – Answers neither question correctly
D. 3 – Intubated or has severe language barrier precluding
orientation assessment
Correct Answer: B
Rationale: This choice is correct because she answered only one
of the two orientation questions correctly—she got her age right
but could not accurately identify the current month. The 1b
score is based simply on counting how many of the two
questions (month and age) are answered correctly: 0 correct =
score 2, 1 correct = score 1, 2 correct = score 0. It's
straightforward counting, so make sure you're precise about
whether the answer is truly correct or just close.
Q3: Moving to 1c: Level of Consciousness (Commands), you
instruct Ms. Thompson to perform two tasks. First: "Open and
close your non-paretic (right) hand." She opens and closes her
right hand after a slight delay, but completes the action. Second:
"Release grip." She releases her hand. Both tasks are performed,
, 4
though her movements are somewhat slow. What is the correct
score for 1c?
A. 0 – Performs both tasks correctly
B. 1 – Performs one task correctly
C. 2 – Performs neither task correctly
D. 3 – Intubated or has severe language barrier; cannot follow
commands at all [CORRECT]
Wait — let me reconsider. The patient actually performed both
tasks (open/close hand AND release grip), albeit slowly. Let me
correct this:
A. 0 – Performs both tasks correctly [CORRECT]
B. 1 – Performs one task correctly
C. 2 – Performs neither task correctly
D. 3 – Intubated or has severe language barrier; cannot follow
commands at all
Correct Answer: A
Rationale: The best answer is A because even though she was
slow, she successfully completed both commanded actions—
opening/closing her right hand and releasing her grip. The key
NIHSS Group A Answer Key Updated
Actual Exam 2026/2027 Complete Exam-
Style Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+
Graded
Group A: Patient 1 (Questions 1-25)
Patient 1 Clinical Vignette (for reference throughout Patient 1
questions):
Patient 1: Margaret Thompson, 68-year-old female, brought to
the ED by EMS at 14:30 after her daughter found her slurring
her speech about 2 hours ago. Last known well: 12:30 PM. CT
head shows no hemorrhage. She has a history of hypertension
and atrial fibrillation. On examination, she is awake but seems
slightly drowsy, follows simple commands slowly, has left facial
droop, left arm drifts, mild left leg drift, sensory loss on the left
side, mild aphasia, and mild dysarthria.
Part I: Patient 1 – Level of Consciousness, Orientation &
Commands (Questions 1-7)
Q1: You begin your NIHSS assessment on Ms. Thompson.
When you enter the room, she opens her eyes spontaneously,
looks toward you when you say her name, and attempts to
,2
answer when spoken to, though her responses are slow and
slightly confused. She does not require repeated stimulation to
stay awake. How do you score 1a: Level of Consciousness
(Alertness)?
A. 0 – Alert
B. 1 – Drowsy; requires minor stimulation to remain alert
[CORRECT]
C. 2 – Requires repeated stimulation to attend or is obtunded
D. 3 – Responds only with reflex motor or autonomic effects or
is unresponsive
Correct Answer: B
Rationale: The best answer is B because the patient opens her
eyes spontaneously and responds without needing repeated
stimulation, but she is described as "slightly drowsy" with "slow
and slightly confused responses"—this fits the criteria for a
score of 1, which captures the patient who is not fully crisp and
alert but doesn't need constant prodding to stay engaged. A score
of 0 (option A) would require her to be fully alert, responsive,
and completely oriented without any drowsiness.
Q2: You ask Ms. Thompson, "What month is it?" She looks at
you, pauses for about 10 seconds, and then says, "Um... I think
it's... October? Wait... no... March?" She seems uncertain. Then
,3
you ask, "How old are you?" She replies correctly, "I'm 68."
How do you score 1b: Level of Consciousness (Orientation)?
A. 0 – Answers both questions correctly
B. 1 – Answers one question correctly [CORRECT]
C. 2 – Answers neither question correctly
D. 3 – Intubated or has severe language barrier precluding
orientation assessment
Correct Answer: B
Rationale: This choice is correct because she answered only one
of the two orientation questions correctly—she got her age right
but could not accurately identify the current month. The 1b
score is based simply on counting how many of the two
questions (month and age) are answered correctly: 0 correct =
score 2, 1 correct = score 1, 2 correct = score 0. It's
straightforward counting, so make sure you're precise about
whether the answer is truly correct or just close.
Q3: Moving to 1c: Level of Consciousness (Commands), you
instruct Ms. Thompson to perform two tasks. First: "Open and
close your non-paretic (right) hand." She opens and closes her
right hand after a slight delay, but completes the action. Second:
"Release grip." She releases her hand. Both tasks are performed,
, 4
though her movements are somewhat slow. What is the correct
score for 1c?
A. 0 – Performs both tasks correctly
B. 1 – Performs one task correctly
C. 2 – Performs neither task correctly
D. 3 – Intubated or has severe language barrier; cannot follow
commands at all [CORRECT]
Wait — let me reconsider. The patient actually performed both
tasks (open/close hand AND release grip), albeit slowly. Let me
correct this:
A. 0 – Performs both tasks correctly [CORRECT]
B. 1 – Performs one task correctly
C. 2 – Performs neither task correctly
D. 3 – Intubated or has severe language barrier; cannot follow
commands at all
Correct Answer: A
Rationale: The best answer is A because even though she was
slow, she successfully completed both commanded actions—
opening/closing her right hand and releasing her grip. The key
