NIH STROKE SCALE (NIHSS) CERTIFICATION
EXAM: COMPLETE PRACTICE QUESTIONS,
ANSWER KEY (GROUPS A–F, PATIENTS 1–6) &
DETAILED RATIONALES (2026 EDITION)
Part 1: General NIHSS Certification Exam Questions (1–25)
1. In what sequence must the eleven NIHSS items be evaluated?
A. From most to least impaired, based on examiner judgment
B. In any order the examiner prefers, as long as all eleven are completed
C. In the fixed item order 1a (Level of Consciousness) through 11 (Extinction
and Inattention)
D. Beginning with motor items, since weakness is the most time-sensitive
deficit
Answer: C. The NIHSS must be administered in the standardized eleven-
item sequence (1a through 11) to ensure comparability across raters and
institutions; this matches the certification blueprint and the official NIHSS
training manual .
2. What is the maximum possible NIHSS score?
A. 15
B. 25
C. 42
D. 50
Answer: C. The NIHSS has 15 scored items (1a, 1b, 1c, 2–11) with a
maximum total of 42. Scores >25 indicate very severe stroke .
3. How many items are included in the NIHSS?
A. 11
, B. 13
C. 15
D. 20
Answer: C. Although there are 11 numbered sections, items 1a, 1b, and 1c
are scored separately, yielding 15 scored elements .
4. For item 1a (Level of Consciousness), a score of 3 is assigned only
when:
A. The patient is drowsy but arousable
B. The patient is confused
C. The patient makes no movement (other than reflexive posturing) in
response to noxious stimulation
D. The patient is intubated
Answer: C. A 3 is scored only if the patient makes no movement (other
than reflexive posturing) in response to noxious stimulation .
5. Item 1b (LOC Questions) requires the patient to state:
A. Their full name and the name of the hospital
B. The current date and the names of three familiar objects
C. The current month and their age
D. Their address and the current president's name
Answer: C. Item 1b asks only the current month and the patient's age; one
point is scored for each incorrect answer .
6. Item 1c (LOC Commands) uses which two standard tasks?
A. Name two objects and count from one to ten
B. Recite the months forward and write a sentence
C. Open and close the eyes, then grip and release the non-paretic hand
D. Protrude the tongue and tap the index finger to the thumb repeatedly
Answer: C. Item 1c uses only two commands—open/close eyes and
grip/release the hand—and scoring reflects the patient's ability to follow
the command, not the limb movement itself .
EXAM: COMPLETE PRACTICE QUESTIONS,
ANSWER KEY (GROUPS A–F, PATIENTS 1–6) &
DETAILED RATIONALES (2026 EDITION)
Part 1: General NIHSS Certification Exam Questions (1–25)
1. In what sequence must the eleven NIHSS items be evaluated?
A. From most to least impaired, based on examiner judgment
B. In any order the examiner prefers, as long as all eleven are completed
C. In the fixed item order 1a (Level of Consciousness) through 11 (Extinction
and Inattention)
D. Beginning with motor items, since weakness is the most time-sensitive
deficit
Answer: C. The NIHSS must be administered in the standardized eleven-
item sequence (1a through 11) to ensure comparability across raters and
institutions; this matches the certification blueprint and the official NIHSS
training manual .
2. What is the maximum possible NIHSS score?
A. 15
B. 25
C. 42
D. 50
Answer: C. The NIHSS has 15 scored items (1a, 1b, 1c, 2–11) with a
maximum total of 42. Scores >25 indicate very severe stroke .
3. How many items are included in the NIHSS?
A. 11
, B. 13
C. 15
D. 20
Answer: C. Although there are 11 numbered sections, items 1a, 1b, and 1c
are scored separately, yielding 15 scored elements .
4. For item 1a (Level of Consciousness), a score of 3 is assigned only
when:
A. The patient is drowsy but arousable
B. The patient is confused
C. The patient makes no movement (other than reflexive posturing) in
response to noxious stimulation
D. The patient is intubated
Answer: C. A 3 is scored only if the patient makes no movement (other
than reflexive posturing) in response to noxious stimulation .
5. Item 1b (LOC Questions) requires the patient to state:
A. Their full name and the name of the hospital
B. The current date and the names of three familiar objects
C. The current month and their age
D. Their address and the current president's name
Answer: C. Item 1b asks only the current month and the patient's age; one
point is scored for each incorrect answer .
6. Item 1c (LOC Commands) uses which two standard tasks?
A. Name two objects and count from one to ten
B. Recite the months forward and write a sentence
C. Open and close the eyes, then grip and release the non-paretic hand
D. Protrude the tongue and tap the index finger to the thumb repeatedly
Answer: C. Item 1c uses only two commands—open/close eyes and
grip/release the hand—and scoring reflects the patient's ability to follow
the command, not the limb movement itself .
