PASSPOINT PRO
NIH STROKE SCALE STUDY SERIES
NIHSS Scoring Mastery Workbook
100 scoring drills and mini cases focused on difficult distinctions,
timing, and item boundaries.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-04
,PASSPOINT PRO NIHSS Scoring Mastery
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.
100 Scoring Drills and Mini Cases
These drills concentrate on boundary decisions: 0 vs 1, 1 vs 2, motor timing, aphasia vs dysarthria, weakness vs ataxia,
and sensory loss vs extinction.
1. Scoring drill: A patient demonstrates the following finding on Level of Consciousness: Not fully alert but becomes
responsive with minor stimulation. Which NIHSS score is most appropriate?
A. Score 2
B. Score 0
C. Score 1
D. Score 3
Answer: C
Explanation: Level of Consciousness 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. Scoring drill: For LOC Questions, the observed performance is: Neither orientation question is answered correctly.
Select the correct NIHSS score.
A. Score 1
B. Score 0
C. Mark UN / untestable
D. Score 2
Answer: D
Explanation: LOC Questions 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 Scoring Mastery
3. Scoring drill: Which score best matches this LOC Commands finding: Both simple commands are performed
correctly.
A. Score 0
B. Score 2
C. Score 1
D. Mark UN / untestable
Answer: A
Explanation: LOC Commands 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.
4. Scoring drill: During NIHSS testing, the examiner documents: There is a partial gaze palsy or abnormal gaze in one or
both eyes without forced deviation. What score should be recorded for Best Gaze?
A. Score 0
B. Score 1
C. Mark UN / untestable
D. Score 2
Answer: B
Explanation: Best Gaze 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. Scoring drill: A patient demonstrates the following finding on Visual Fields: Partial hemianopia or consistent visual
field asymmetry is present. Which NIHSS score is most appropriate?
A. Score 2
B. Score 3
C. Score 1
D. Score 0
Answer: C
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. Scoring drill: For Facial Palsy, the observed performance is: Partial facial paralysis, especially of the lower face.
Select the correct NIHSS score.
A. Score 3
B. Score 0
C. Score 1
D. Score 2
Answer: D
Explanation: Facial Palsy 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 3
NIH STROKE SCALE STUDY SERIES
NIHSS Scoring Mastery Workbook
100 scoring drills and mini cases focused on difficult distinctions,
timing, and item boundaries.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-04
,PASSPOINT PRO NIHSS Scoring Mastery
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.
100 Scoring Drills and Mini Cases
These drills concentrate on boundary decisions: 0 vs 1, 1 vs 2, motor timing, aphasia vs dysarthria, weakness vs ataxia,
and sensory loss vs extinction.
1. Scoring drill: A patient demonstrates the following finding on Level of Consciousness: Not fully alert but becomes
responsive with minor stimulation. Which NIHSS score is most appropriate?
A. Score 2
B. Score 0
C. Score 1
D. Score 3
Answer: C
Explanation: Level of Consciousness 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. Scoring drill: For LOC Questions, the observed performance is: Neither orientation question is answered correctly.
Select the correct NIHSS score.
A. Score 1
B. Score 0
C. Mark UN / untestable
D. Score 2
Answer: D
Explanation: LOC Questions 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 Scoring Mastery
3. Scoring drill: Which score best matches this LOC Commands finding: Both simple commands are performed
correctly.
A. Score 0
B. Score 2
C. Score 1
D. Mark UN / untestable
Answer: A
Explanation: LOC Commands 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.
4. Scoring drill: During NIHSS testing, the examiner documents: There is a partial gaze palsy or abnormal gaze in one or
both eyes without forced deviation. What score should be recorded for Best Gaze?
A. Score 0
B. Score 1
C. Mark UN / untestable
D. Score 2
Answer: B
Explanation: Best Gaze 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. Scoring drill: A patient demonstrates the following finding on Visual Fields: Partial hemianopia or consistent visual
field asymmetry is present. Which NIHSS score is most appropriate?
A. Score 2
B. Score 3
C. Score 1
D. Score 0
Answer: C
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. Scoring drill: For Facial Palsy, the observed performance is: Partial facial paralysis, especially of the lower face.
Select the correct NIHSS score.
A. Score 3
B. Score 0
C. Score 1
D. Score 2
Answer: D
Explanation: Facial Palsy 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 3
