PASSPOINT PRO
NIH STROKE SCALE STUDY SERIES
NIH Stroke Scale 150-Question
Comprehensive Practice Exam
Original multiple-choice scoring and administration questions with
immediate answers and explanations.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-03
,PASSPOINT PRO NIHSS 150Q Exam
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
150-Question Comprehensive Practice Exam
Each item is followed immediately by the correct answer and a detailed explanation so you can use the exam as both
assessment and review.
1. Which score best matches this Best Language finding: Mild-to-moderate aphasia is present, but communication
remains meaningfully possible.
A. Score 1
B. Score 3
C. Score 2
D. Score 0
Answer: A
Explanation: Best Language is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
2. During NIHSS testing, the examiner documents: Speech is severely dysarthric or unintelligible when a physical
barrier does not fully explain it. What score should be recorded for Dysarthria?
A. Score 1
B. Score 2
C. Score 0
D. Mark UN / untestable
Answer: B
Explanation: Dysarthria is scored 2 because the observed finding matches the scale definition for that level. The NIHSS uses the patient's
actual performance during the standardized item, not an estimate of what the patient might do under different conditions. Distinguish this
finding from adjacent score levels by focusing on the specific degree of deficit described.
NIHSS exam-prep and scoring practice Page 2
,PASSPOINT PRO NIHSS 150Q Exam
3. A patient demonstrates the following finding on Motor Arm - Left: Left arm drifts but does not hit the support before
10 seconds. Which NIHSS score is most appropriate?
A. Score 2
B. Score 0
C. Score 1
D. Score 3
Answer: C
Explanation: Motor Arm - Left is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
4. For Sensory, the observed performance is: There is mild-to-moderate sensory loss, but the patient remains aware of
being touched. Select the correct NIHSS score.
A. Mark UN / untestable
B. Score 0
C. Score 2
D. Score 1
Answer: D
Explanation: Sensory is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the patient's
actual performance during the standardized item, not an estimate of what the patient might do under different conditions. Distinguish this
finding from adjacent score levels by focusing on the specific degree of deficit described.
5. Which score best matches this Visual Fields finding: Partial hemianopia or consistent visual field asymmetry is
present.
A. Score 1
B. Score 0
C. Score 2
D. Score 3
Answer: A
Explanation: Visual Fields is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
6. During NIHSS testing, the examiner documents: Facial movement is symmetric. What score should be recorded for
Facial Palsy?
A. Score 3
B. Score 0
C. Score 2
D. Score 1
Answer: B
Explanation: Facial Palsy is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
NIHSS exam-prep and scoring practice Page 3
, PASSPOINT PRO NIHSS 150Q Exam
7. A patient demonstrates the following finding on Extinction/Inattention: No neglect or extinction is demonstrated.
Which NIHSS score is most appropriate?
A. Score 2
B. Score 1
C. Score 0
D. Mark UN / untestable
Answer: C
Explanation: Extinction/Inattention is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses
the patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
8. For Motor Leg - Right, the observed performance is: Right leg holds the required position without drift. Select the
correct NIHSS score.
A. Score 2
B. Score 1
C. Score 3
D. Score 0
Answer: D
Explanation: Motor Leg - Right is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
9. Which score best matches this Extinction/Inattention finding: Extinction or inattention is demonstrated in one
sensory modality.
A. Score 1
B. Mark UN / untestable
C. Score 2
D. Score 0
Answer: A
Explanation: Extinction/Inattention is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses
the patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
10. During NIHSS testing, the examiner documents: No limb ataxia is demonstrated, or weakness prevents valid
demonstration of ataxia. What score should be recorded for Limb Ataxia?
A. Mark UN / untestable
B. Score 0
C. Score 1
D. Score 2
Answer: B
Explanation: Limb Ataxia is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
NIHSS exam-prep and scoring practice Page 4
NIH STROKE SCALE STUDY SERIES
NIH Stroke Scale 150-Question
Comprehensive Practice Exam
Original multiple-choice scoring and administration questions with
immediate answers and explanations.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-03
,PASSPOINT PRO NIHSS 150Q Exam
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
150-Question Comprehensive Practice Exam
Each item is followed immediately by the correct answer and a detailed explanation so you can use the exam as both
assessment and review.
1. Which score best matches this Best Language finding: Mild-to-moderate aphasia is present, but communication
remains meaningfully possible.
A. Score 1
B. Score 3
C. Score 2
D. Score 0
Answer: A
Explanation: Best Language is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
2. During NIHSS testing, the examiner documents: Speech is severely dysarthric or unintelligible when a physical
barrier does not fully explain it. What score should be recorded for Dysarthria?
A. Score 1
B. Score 2
C. Score 0
D. Mark UN / untestable
Answer: B
Explanation: Dysarthria is scored 2 because the observed finding matches the scale definition for that level. The NIHSS uses the patient's
actual performance during the standardized item, not an estimate of what the patient might do under different conditions. Distinguish this
finding from adjacent score levels by focusing on the specific degree of deficit described.
NIHSS exam-prep and scoring practice Page 2
,PASSPOINT PRO NIHSS 150Q Exam
3. A patient demonstrates the following finding on Motor Arm - Left: Left arm drifts but does not hit the support before
10 seconds. Which NIHSS score is most appropriate?
A. Score 2
B. Score 0
C. Score 1
D. Score 3
Answer: C
Explanation: Motor Arm - Left is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
4. For Sensory, the observed performance is: There is mild-to-moderate sensory loss, but the patient remains aware of
being touched. Select the correct NIHSS score.
A. Mark UN / untestable
B. Score 0
C. Score 2
D. Score 1
Answer: D
Explanation: Sensory is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the patient's
actual performance during the standardized item, not an estimate of what the patient might do under different conditions. Distinguish this
finding from adjacent score levels by focusing on the specific degree of deficit described.
5. Which score best matches this Visual Fields finding: Partial hemianopia or consistent visual field asymmetry is
present.
A. Score 1
B. Score 0
C. Score 2
D. Score 3
Answer: A
Explanation: Visual Fields is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
6. During NIHSS testing, the examiner documents: Facial movement is symmetric. What score should be recorded for
Facial Palsy?
A. Score 3
B. Score 0
C. Score 2
D. Score 1
Answer: B
Explanation: Facial Palsy is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
NIHSS exam-prep and scoring practice Page 3
, PASSPOINT PRO NIHSS 150Q Exam
7. A patient demonstrates the following finding on Extinction/Inattention: No neglect or extinction is demonstrated.
Which NIHSS score is most appropriate?
A. Score 2
B. Score 1
C. Score 0
D. Mark UN / untestable
Answer: C
Explanation: Extinction/Inattention is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses
the patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
8. For Motor Leg - Right, the observed performance is: Right leg holds the required position without drift. Select the
correct NIHSS score.
A. Score 2
B. Score 1
C. Score 3
D. Score 0
Answer: D
Explanation: Motor Leg - Right is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
9. Which score best matches this Extinction/Inattention finding: Extinction or inattention is demonstrated in one
sensory modality.
A. Score 1
B. Mark UN / untestable
C. Score 2
D. Score 0
Answer: A
Explanation: Extinction/Inattention is scored 1 because the observed finding matches the scale definition for that level. The NIHSS uses
the patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
10. During NIHSS testing, the examiner documents: No limb ataxia is demonstrated, or weakness prevents valid
demonstration of ataxia. What score should be recorded for Limb Ataxia?
A. Mark UN / untestable
B. Score 0
C. Score 1
D. Score 2
Answer: B
Explanation: Limb Ataxia is scored 0 because the observed finding matches the scale definition for that level. The NIHSS uses the
patient's actual performance during the standardized item, not an estimate of what the patient might do under different conditions.
Distinguish this finding from adjacent score levels by focusing on the specific degree of deficit described.
NIHSS exam-prep and scoring practice Page 4
