NIH STROKE SCALE (NIHSS) COMPREHENSIVE PRACTICE
EXAM 300 MULTIPLE-CHOICE QUESTIONS WITH
ANSWERS AND RATIONALES
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SECTION 1: LEVEL OF CONSCIOUSNESS (Item 1a) — Questions 1–30
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Question 1
A patient opens their eyes spontaneously, follows commands, and responds to
questions appropriately. What is the correct score for Item 1a (Level of
Consciousness)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: A
Rationale: A score of 0 on Item 1a indicates the patient is alert and keenly
responsive. The patient described is fully awake, attentive, and able to follow
commands without any stimulation required.
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Question 2
A patient is drowsy but opens their eyes and responds appropriately when you
speak to them in a normal voice. How should you score Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Rationale: A score of 1 is assigned when the patient is not fully alert but is
arousable by minor stimulation to obey, answer, or respond. The patient
described is drowsy but responds to verbal stimulation.
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Question 3
A patient requires vigorous or repeated painful stimulation to become aroused.
What is the correct score for Item 1a?
A) 0
B) 1
,C) 2
D) 3
Correct Answer: C
Rationale: A score of 2 is specifically defined as requiring vigorous (painful) or
repeated stimulation to become awake. This patient is obtunded and requires
strong stimulation to make purposeful movements.
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Question 4
A patient demonstrates only reflex motor responses to painful stimuli and has no
purposeful movement. What is the correct score for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Rationale: A score of 3 is assigned when the patient responds only with reflex
motor or autonomic effects or is totally unresponsive, flaccid, and areflexic. This
patient has no purposeful response to any stimuli.
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Question 5
Which of the following best describes a patient who would receive a score of 0 on
Item 1a?
A) The patient is obtunded and requires painful stimulation
B) The patient is lethargic but responds to verbal stimuli
C) The patient is alert and keenly responsive
D) The patient responds only with reflex movements
Correct Answer: C
Rationale: A score of 0 on Item 1a indicates the patient is fully alert and
responsive. Higher scores indicate decreased alertness ranging from drowsy but
arousable (1) to stuporous (2) to comatose/unresponsive (3).
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Question 6
A patient is stuporous and only awakens briefly when you apply a painful stimulus
to the sternum. They immediately fall back to sleep. What is the correct score?
A) 0
B) 1
C) 2
EXAM 300 MULTIPLE-CHOICE QUESTIONS WITH
ANSWERS AND RATIONALES
---
SECTION 1: LEVEL OF CONSCIOUSNESS (Item 1a) — Questions 1–30
---
Question 1
A patient opens their eyes spontaneously, follows commands, and responds to
questions appropriately. What is the correct score for Item 1a (Level of
Consciousness)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: A
Rationale: A score of 0 on Item 1a indicates the patient is alert and keenly
responsive. The patient described is fully awake, attentive, and able to follow
commands without any stimulation required.
,---
Question 2
A patient is drowsy but opens their eyes and responds appropriately when you
speak to them in a normal voice. How should you score Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Rationale: A score of 1 is assigned when the patient is not fully alert but is
arousable by minor stimulation to obey, answer, or respond. The patient
described is drowsy but responds to verbal stimulation.
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Question 3
A patient requires vigorous or repeated painful stimulation to become aroused.
What is the correct score for Item 1a?
A) 0
B) 1
,C) 2
D) 3
Correct Answer: C
Rationale: A score of 2 is specifically defined as requiring vigorous (painful) or
repeated stimulation to become awake. This patient is obtunded and requires
strong stimulation to make purposeful movements.
---
Question 4
A patient demonstrates only reflex motor responses to painful stimuli and has no
purposeful movement. What is the correct score for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Rationale: A score of 3 is assigned when the patient responds only with reflex
motor or autonomic effects or is totally unresponsive, flaccid, and areflexic. This
patient has no purposeful response to any stimuli.
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Question 5
Which of the following best describes a patient who would receive a score of 0 on
Item 1a?
A) The patient is obtunded and requires painful stimulation
B) The patient is lethargic but responds to verbal stimuli
C) The patient is alert and keenly responsive
D) The patient responds only with reflex movements
Correct Answer: C
Rationale: A score of 0 on Item 1a indicates the patient is fully alert and
responsive. Higher scores indicate decreased alertness ranging from drowsy but
arousable (1) to stuporous (2) to comatose/unresponsive (3).
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Question 6
A patient is stuporous and only awakens briefly when you apply a painful stimulus
to the sternum. They immediately fall back to sleep. What is the correct score?
A) 0
B) 1
C) 2
