NIHSS (NATIONAL INSTITUTES OF HEALTH
STROKE SCALE) RENEWAL EXAM QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1:
A 68-year-old man presents to the ER with sudden right-sided weakness and
slurred speech. You perform the NIHSS assessment. His answers to orientation
questions are correct, he follows commands correctly, but you notice drift in his
right arm and leg. There is mild facial droop on the right side. What NIHSS score
for motor arm and leg is most appropriate?
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale:
Motor arm/leg scoring:
o 0 = No drift
o 1 = Drift (limb falls before 10 seconds but not against gravity)
o 2 = Some effort against gravity
o 3 = No effort against gravity
o 4 = No movement
In this scenario, the patient’s limb drifts but maintains some strength against
gravity, which corresponds to 1.
,Question 2:
A patient presents with left-sided hemiplegia after a stroke. During NIHSS
assessment, you note aphasia and partial neglect. Which part of the NIHSS
would most reflect language and neglect deficits?
A. Level of consciousness
B. Best language
C. Extinction and inattention
D. Facial palsy
Answer: B & C
Rationale:
Best language (B) measures aphasia (word-finding and comprehension
deficits).
Extinction and inattention (C) measures neglect or hemineglect, often seen
in right hemisphere strokes.
Both are separate components on NIHSS. Correct scoring should include
both.
Question 3
A patient answers orientation questions correctly, opens eyes spontaneously, but
cannot follow commands. Right-sided drift is noted, and the left leg has no
movement. NIHSS assessments for gaze and visual fields are normal. What is the
total NIHSS score?
Answer: Approx. 8–9
Rationale:
LOC questions: 0
Best gaze: 0
Visual fields: 0
Facial palsy: Assume 0 if normal
Motor arm: Right arm drift → 1
, Motor leg: Left leg no movement → 4
Limb ataxia: 0
Sensory: Not mentioned → 0
Best language: Cannot follow commands → 2
Dysarthria: Not mentioned → 0
Extinction/inattention: Not mentioned → 0
Total = 1+4+2 = 7, may vary slightly based on assumptions.
Question 4:
Why is accurate NIHSS scoring critical in acute stroke management?
A. Determines long-term rehabilitation only
B. Guides thrombolytic therapy eligibility and predicts outcome
C. Only used for research
D. Has no impact on treatment decisions
Answer: B
Rationale:
NIHSS is a validated tool to quantify stroke severity.
It predicts functional outcome, guides thrombolysis or thrombectomy
decisions, and helps monitor neurological changes.
, Question 5
A patient with severe expressive aphasia scores 2 on Best Language, but can
follow simple commands. Which adjustment should you make in NIHSS scoring?
A. Record 0 for language because patient understands commands
B. Score based on expressive ability, not comprehension
C. Score 3 because patient cannot communicate
D. Skip this item
Answer: B
Rationale:
NIHSS evaluates both comprehension and expression.
Even if comprehension is intact, deficits in expressive language warrant
scoring based on ability to produce coherent speech.
Question 6:
A patient with right-sided hemiparesis has mild drift of the right arm, complete
paralysis of the right leg, no facial droop, no visual deficits, and alert and
oriented. What is the NIHSS motor score?
A. 1 arm, 3 leg
B. 2 arm, 2 leg
C. 1 arm, 4 leg
D. 0 arm, 3 leg
Answer: C
Rationale:
Right arm drift → 1
Right leg no movement → 4
Motor scores are independent for arm and leg.
STROKE SCALE) RENEWAL EXAM QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
Question 1:
A 68-year-old man presents to the ER with sudden right-sided weakness and
slurred speech. You perform the NIHSS assessment. His answers to orientation
questions are correct, he follows commands correctly, but you notice drift in his
right arm and leg. There is mild facial droop on the right side. What NIHSS score
for motor arm and leg is most appropriate?
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale:
Motor arm/leg scoring:
o 0 = No drift
o 1 = Drift (limb falls before 10 seconds but not against gravity)
o 2 = Some effort against gravity
o 3 = No effort against gravity
o 4 = No movement
In this scenario, the patient’s limb drifts but maintains some strength against
gravity, which corresponds to 1.
,Question 2:
A patient presents with left-sided hemiplegia after a stroke. During NIHSS
assessment, you note aphasia and partial neglect. Which part of the NIHSS
would most reflect language and neglect deficits?
A. Level of consciousness
B. Best language
C. Extinction and inattention
D. Facial palsy
Answer: B & C
Rationale:
Best language (B) measures aphasia (word-finding and comprehension
deficits).
Extinction and inattention (C) measures neglect or hemineglect, often seen
in right hemisphere strokes.
Both are separate components on NIHSS. Correct scoring should include
both.
Question 3
A patient answers orientation questions correctly, opens eyes spontaneously, but
cannot follow commands. Right-sided drift is noted, and the left leg has no
movement. NIHSS assessments for gaze and visual fields are normal. What is the
total NIHSS score?
Answer: Approx. 8–9
Rationale:
LOC questions: 0
Best gaze: 0
Visual fields: 0
Facial palsy: Assume 0 if normal
Motor arm: Right arm drift → 1
, Motor leg: Left leg no movement → 4
Limb ataxia: 0
Sensory: Not mentioned → 0
Best language: Cannot follow commands → 2
Dysarthria: Not mentioned → 0
Extinction/inattention: Not mentioned → 0
Total = 1+4+2 = 7, may vary slightly based on assumptions.
Question 4:
Why is accurate NIHSS scoring critical in acute stroke management?
A. Determines long-term rehabilitation only
B. Guides thrombolytic therapy eligibility and predicts outcome
C. Only used for research
D. Has no impact on treatment decisions
Answer: B
Rationale:
NIHSS is a validated tool to quantify stroke severity.
It predicts functional outcome, guides thrombolysis or thrombectomy
decisions, and helps monitor neurological changes.
, Question 5
A patient with severe expressive aphasia scores 2 on Best Language, but can
follow simple commands. Which adjustment should you make in NIHSS scoring?
A. Record 0 for language because patient understands commands
B. Score based on expressive ability, not comprehension
C. Score 3 because patient cannot communicate
D. Skip this item
Answer: B
Rationale:
NIHSS evaluates both comprehension and expression.
Even if comprehension is intact, deficits in expressive language warrant
scoring based on ability to produce coherent speech.
Question 6:
A patient with right-sided hemiparesis has mild drift of the right arm, complete
paralysis of the right leg, no facial droop, no visual deficits, and alert and
oriented. What is the NIHSS motor score?
A. 1 arm, 3 leg
B. 2 arm, 2 leg
C. 1 arm, 4 leg
D. 0 arm, 3 leg
Answer: C
Rationale:
Right arm drift → 1
Right leg no movement → 4
Motor scores are independent for arm and leg.
