NIHSS CERTIFICATION MASTERY EXAM PACK
GROUP A-D PATIENTS FULL QUESTIONS,
ANSWERS & GRADED RATIONALE MATRIX
This comprehensive, question master practice bank provides
verified 100% correct answers and bolded rationales for the
American Heart Association NIH Stroke Scale (NIHSS)
certification exams. Designed specifically to mimic real
clinical tracks, it includes detailed patient summaries and
complex case variants to guarantee an A+ score. It serves as
the ultimate high-yield study companion for medical,
nursing, and emergency care students looking to ace their
clinical assessments on the first attempt.
Question 1
When assessing Item 1a (Level of Consciousness) on the NIH
Stroke Scale, a patient opens their eyes only in response to a
strong noxious tactile stimulus (sternal rub) but does not respond
to verbal commands. What score should be assigned?
A) 0 - Alert
B) 1 - Not alert; arousable by minor stimulation
C) 2 - Not alert; requires repeated stimulation or painful stimuli to
attend
D) 3 - Responds only with reflex motor or autonomic effects, or
totally unresponsive
,Answer: C) 2 - Not alert; requires repeated stimulation or painful
stimuli to attend
Rationale: A score of 2 is appropriate when a patient requires
strong or repeated noxious stimuli to show any arousability.
If they only exhibit reflex movements or are completely
flaccid, it would be scored as a 3.
Question 2
During the assessment of Item 1b (LOC Questions), the patient is
asked the current month and their age. The patient correctly
states their age but incorrectly states the month due to a mild
dysarthria that is still understandable. How should this be scored?
A) 0 - Answers both questions correctly
B) 1 - Answers one question correctly
C) 2 - Answers neither question correctly
Answer: A) 0 - Answers both questions correctly
Rationale: The scale explicitly dictates that dysarthria does
not penalize the patient on the language/LOC questions as
long as the answer is identifiable and correct. Since the
patient provided the correct facts, they receive a score of 0.
Question 3
A patient with a known history of advanced dementia is unable to
state their age or the current month during Item 1b. They are,
however, able to follow commands perfectly. What is the correct
scoring action?
A) Score as 0 because their impairment is pre-existing
,B) Score as 1 because they followed commands
C) Score as 2 because they failed to provide both correct answers
D) Leave the item blank and document "untestable"
Answer: C) 2 - Answers neither question correctly
Rationale: The NIHSS is a real-time clinical snapshot. Pre-
existing cognitive deficits, trauma, or language barriers do
not change the strict scoring rules; if both answers are
incorrect or not provided, the patient must be scored a 2.
Question 4
For Item 1c (LOC Commands), the patient is instructed to open
and close their eyes, and then to grip and release their non-
paretic hand. The patient attempts the movement but stops
halfway due to profound weakness. How is this scored?
A) 0 - Performs both tasks correctly
B) 1 - Performs one task correctly
C) 2 - Performs neither task correctly
Answer: A) 0 - Performs both tasks correctly
Rationale: If a patient makes a clear, unambiguous attempt to
follow the command but is thwarted solely by structural
weakness or paralysis, the attempt is scored as correct. The
purpose of this subscale is to evaluate comprehension, not
motor strength.
Question 5
When examining Item 2 (Best Gaze), the patient exhibits a partial
gaze palsy where lateral ocular movement is restricted in one
, eye, but forced deviation is absent. What score is assigned?
A) 0 - Normal
B) 1 - Partial gaze palsy
C) 2 - Forced deviation
Answer: B) 1 - Partial gaze palsy
Rationale: A score of 1 is reserved for a partial gaze palsy
where gaze is abnormal in one or both eyes, but total,
uncorrectable forced deviation is not present. Forced
deviation (score 2) implies that the gaze cannot be overcome
by oculocephalic maneuvers.
Question 6
During the evaluation of Item 3 (Visual Fields), a patient is found
to have a complete homonymous hemianopia. What is the correct
score?
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
Answer: C) 2 - Complete homonymous hemianopia
Rationale: A complete breakdown of vision in a homologous
half-field warrants a score of 2. A score of 3 is reserved for
total blindness or bilateral hemianopia.
Question 7
A patient presents with a profound structural global aphasia and
cannot understand visual field testing instructions. When the
GROUP A-D PATIENTS FULL QUESTIONS,
ANSWERS & GRADED RATIONALE MATRIX
This comprehensive, question master practice bank provides
verified 100% correct answers and bolded rationales for the
American Heart Association NIH Stroke Scale (NIHSS)
certification exams. Designed specifically to mimic real
clinical tracks, it includes detailed patient summaries and
complex case variants to guarantee an A+ score. It serves as
the ultimate high-yield study companion for medical,
nursing, and emergency care students looking to ace their
clinical assessments on the first attempt.
Question 1
When assessing Item 1a (Level of Consciousness) on the NIH
Stroke Scale, a patient opens their eyes only in response to a
strong noxious tactile stimulus (sternal rub) but does not respond
to verbal commands. What score should be assigned?
A) 0 - Alert
B) 1 - Not alert; arousable by minor stimulation
C) 2 - Not alert; requires repeated stimulation or painful stimuli to
attend
D) 3 - Responds only with reflex motor or autonomic effects, or
totally unresponsive
,Answer: C) 2 - Not alert; requires repeated stimulation or painful
stimuli to attend
Rationale: A score of 2 is appropriate when a patient requires
strong or repeated noxious stimuli to show any arousability.
If they only exhibit reflex movements or are completely
flaccid, it would be scored as a 3.
Question 2
During the assessment of Item 1b (LOC Questions), the patient is
asked the current month and their age. The patient correctly
states their age but incorrectly states the month due to a mild
dysarthria that is still understandable. How should this be scored?
A) 0 - Answers both questions correctly
B) 1 - Answers one question correctly
C) 2 - Answers neither question correctly
Answer: A) 0 - Answers both questions correctly
Rationale: The scale explicitly dictates that dysarthria does
not penalize the patient on the language/LOC questions as
long as the answer is identifiable and correct. Since the
patient provided the correct facts, they receive a score of 0.
Question 3
A patient with a known history of advanced dementia is unable to
state their age or the current month during Item 1b. They are,
however, able to follow commands perfectly. What is the correct
scoring action?
A) Score as 0 because their impairment is pre-existing
,B) Score as 1 because they followed commands
C) Score as 2 because they failed to provide both correct answers
D) Leave the item blank and document "untestable"
Answer: C) 2 - Answers neither question correctly
Rationale: The NIHSS is a real-time clinical snapshot. Pre-
existing cognitive deficits, trauma, or language barriers do
not change the strict scoring rules; if both answers are
incorrect or not provided, the patient must be scored a 2.
Question 4
For Item 1c (LOC Commands), the patient is instructed to open
and close their eyes, and then to grip and release their non-
paretic hand. The patient attempts the movement but stops
halfway due to profound weakness. How is this scored?
A) 0 - Performs both tasks correctly
B) 1 - Performs one task correctly
C) 2 - Performs neither task correctly
Answer: A) 0 - Performs both tasks correctly
Rationale: If a patient makes a clear, unambiguous attempt to
follow the command but is thwarted solely by structural
weakness or paralysis, the attempt is scored as correct. The
purpose of this subscale is to evaluate comprehension, not
motor strength.
Question 5
When examining Item 2 (Best Gaze), the patient exhibits a partial
gaze palsy where lateral ocular movement is restricted in one
, eye, but forced deviation is absent. What score is assigned?
A) 0 - Normal
B) 1 - Partial gaze palsy
C) 2 - Forced deviation
Answer: B) 1 - Partial gaze palsy
Rationale: A score of 1 is reserved for a partial gaze palsy
where gaze is abnormal in one or both eyes, but total,
uncorrectable forced deviation is not present. Forced
deviation (score 2) implies that the gaze cannot be overcome
by oculocephalic maneuvers.
Question 6
During the evaluation of Item 3 (Visual Fields), a patient is found
to have a complete homonymous hemianopia. What is the correct
score?
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
Answer: C) 2 - Complete homonymous hemianopia
Rationale: A complete breakdown of vision in a homologous
half-field warrants a score of 2. A score of 3 is reserved for
total blindness or bilateral hemianopia.
Question 7
A patient presents with a profound structural global aphasia and
cannot understand visual field testing instructions. When the
