NIH Stroke Scale Test Groups A–F Patients 1–6:
Certified Scoring Guide & Clinical Training Materials
This definitive clinical reference guide contains the complete set of all National Institutes
of Health Stroke Scale (NIHSS) Test Groups A through F, covering patient case
scenarios 1 through 6. It provides updated clinical training metrics, official scoring
criteria, and differential diagnosis rationales for evaluating acute neurological deficits,
including gaze, visual fields, motor function, ataxia, sensory loss, and language.
Healthcare practitioners, emergency nurses, and neurologists will master the standard
physical assessment protocols required to eliminate scoring variability and successfully
pass their official certification track.
SECTION 1: GENERAL NIHSS SCORING GUIDANCE (Questions
1–20)
1. What is the maximum total score on the NIH Stroke Scale (NIHSS)?
A. 32
B. 42
C. 52
D. 62
Answer: B. 42
Rationale: The NIHSS contains 11 items, and the maximum total score is 42, representing
the most severe neurological deficit. A score of 0 indicates no stroke symptoms.
2. What NIHSS score range indicates a moderate stroke?
A. 1–4
B. 5–15
,C. 16–20
D. 21–42
Answer: B. 5–15
Rationale: NIHSS severity classification: 1–4 = mild, 5–15 = moderate, 16–20 = moderate
to severe, 21–42 = severe.
3. In NIHSS Item 1a (Level of Consciousness), what score is assigned if the patient
is alert and keenly responsive?
A. 0
B. 1
C. 2
D. 3
Answer: A. 0
Rationale: A score of 0 is assigned when the patient is alert and responds spontaneously
without requiring any stimulation.
4. What score is given for Item 1a if the patient requires painful stimulation to
respond?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: A score of 2 on Item 1a is given when the patient is not alert and requires
repeated stimulation or painful stimulation to make movements.
,5. In NIHSS Item 1b (LOC Questions), what score is given if the patient answers
both the month and age correctly?
A. 0
B. 1
C. 2
D. 3
Answer: A. 0
Rationale: A score of 0 is assigned when the patient correctly answers both questions
(month and age). A score of 1 is given if only one is correct, and 2 if neither is correct.
6. What is the correct score for Item 1c (LOC Commands) if the patient performs
both tasks correctly?
A. 0
B. 1
C. 2
D. 3
Answer: A. 0
Rationale: Item 1c scores 0 if both commands (open/close eyes and grip/release hand) are
performed correctly. A score of 1 is given if one task is performed correctly, and 2 if neither
is performed.
7. In NIHSS Item 2 (Best Gaze), what score is assigned for forced eye deviation that
is not overcome by voluntary or reflexive head movements?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
, Rationale: Item 2 scores 0 for normal gaze, 1 for partial gaze palsy (deviation overcome by
oculocephalic reflex), and 2 for forced deviation (not overcome).
8. What is the maximum score for NIHSS Item 3 (Visual Fields)?
A. 1
B. 2
C. 3
D. 4
Answer: C. 3
Rationale: Visual fields scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete
hemianopia, 3 = bilateral hemianopia (blind including cortical blindness).
9. In NIHSS Item 4 (Facial Palsy), what score is given for complete paralysis of one
side of the face?
A. 0
B. 1
C. 2
D. 3
Answer: D. 3
Rationale: Facial palsy scoring: 0 = normal symmetrical movement, 1 = minor paralysis
(flattened nasolabial fold), 2 = partial paralysis (total or near-total paralysis of lower face),
3 = complete paralysis of one or both sides.
10. For NIHSS Item 5 (Motor Arm), what score is assigned if the arm drifts and hits
the bed within 10 seconds?
Certified Scoring Guide & Clinical Training Materials
This definitive clinical reference guide contains the complete set of all National Institutes
of Health Stroke Scale (NIHSS) Test Groups A through F, covering patient case
scenarios 1 through 6. It provides updated clinical training metrics, official scoring
criteria, and differential diagnosis rationales for evaluating acute neurological deficits,
including gaze, visual fields, motor function, ataxia, sensory loss, and language.
Healthcare practitioners, emergency nurses, and neurologists will master the standard
physical assessment protocols required to eliminate scoring variability and successfully
pass their official certification track.
SECTION 1: GENERAL NIHSS SCORING GUIDANCE (Questions
1–20)
1. What is the maximum total score on the NIH Stroke Scale (NIHSS)?
A. 32
B. 42
C. 52
D. 62
Answer: B. 42
Rationale: The NIHSS contains 11 items, and the maximum total score is 42, representing
the most severe neurological deficit. A score of 0 indicates no stroke symptoms.
2. What NIHSS score range indicates a moderate stroke?
A. 1–4
B. 5–15
,C. 16–20
D. 21–42
Answer: B. 5–15
Rationale: NIHSS severity classification: 1–4 = mild, 5–15 = moderate, 16–20 = moderate
to severe, 21–42 = severe.
3. In NIHSS Item 1a (Level of Consciousness), what score is assigned if the patient
is alert and keenly responsive?
A. 0
B. 1
C. 2
D. 3
Answer: A. 0
Rationale: A score of 0 is assigned when the patient is alert and responds spontaneously
without requiring any stimulation.
4. What score is given for Item 1a if the patient requires painful stimulation to
respond?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: A score of 2 on Item 1a is given when the patient is not alert and requires
repeated stimulation or painful stimulation to make movements.
,5. In NIHSS Item 1b (LOC Questions), what score is given if the patient answers
both the month and age correctly?
A. 0
B. 1
C. 2
D. 3
Answer: A. 0
Rationale: A score of 0 is assigned when the patient correctly answers both questions
(month and age). A score of 1 is given if only one is correct, and 2 if neither is correct.
6. What is the correct score for Item 1c (LOC Commands) if the patient performs
both tasks correctly?
A. 0
B. 1
C. 2
D. 3
Answer: A. 0
Rationale: Item 1c scores 0 if both commands (open/close eyes and grip/release hand) are
performed correctly. A score of 1 is given if one task is performed correctly, and 2 if neither
is performed.
7. In NIHSS Item 2 (Best Gaze), what score is assigned for forced eye deviation that
is not overcome by voluntary or reflexive head movements?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
, Rationale: Item 2 scores 0 for normal gaze, 1 for partial gaze palsy (deviation overcome by
oculocephalic reflex), and 2 for forced deviation (not overcome).
8. What is the maximum score for NIHSS Item 3 (Visual Fields)?
A. 1
B. 2
C. 3
D. 4
Answer: C. 3
Rationale: Visual fields scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete
hemianopia, 3 = bilateral hemianopia (blind including cortical blindness).
9. In NIHSS Item 4 (Facial Palsy), what score is given for complete paralysis of one
side of the face?
A. 0
B. 1
C. 2
D. 3
Answer: D. 3
Rationale: Facial palsy scoring: 0 = normal symmetrical movement, 1 = minor paralysis
(flattened nasolabial fold), 2 = partial paralysis (total or near-total paralysis of lower face),
3 = complete paralysis of one or both sides.
10. For NIHSS Item 5 (Motor Arm), what score is assigned if the arm drifts and hits
the bed within 10 seconds?
