NIH Stroke Scale – All Test Groups A–F
(Patients 1–6) Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed –
A+ Graded
**Foundations of the NIHSS**
Q1: A colleague who is new to stroke care asks you what total score range the NIHSS covers.
What do you tell her?
A. 0 to 30
B. 0 to 36
C. 0 to 42 [CORRECT]
D. 1 to 45
Correct Answer: C
Rationale: The best answer is C. Every item is added together, and the combined maximums
across all 15 scored entries total 42, with zero representing a completely normal
neurological exam.
Q2: Which NIHSS items are scored separately for the left and right sides of the body?
A. Motor arm and motor leg [CORRECT]
B. Best gaze and visual fields
C. Facial palsy and sensory
D. Ataxia and extinction
Correct Answer: A
Rationale: This choice is correct because items 5 and 6 each carry an "a" entry for the left
limb and a "b" entry for the right limb, giving four separate motor scores. The remaining
items are scored once for the whole patient.
Q3: What is the primary purpose of the NIHSS at the bedside?
A. To predict the exact vessel that is occluded
B. To replace imaging when deciding on acute treatment
C. To determine the patient's discharge disposition
D. To provide a standardized, repeatable measure of stroke-related neurological impairment
[CORRECT]
Correct Answer: D
Rationale: The best answer is D. The scale was built to quantify deficit severity the same way
every time so different clinicians can communicate and compare findings reliably, and it
supplements rather than replaces imaging and clinical judgment.
,Q4: You begin your assessment and Mr. Bell answers your first question appropriately. He
then falls asleep, and your voice alone no longer rouses him — you have to shake his
shoulder and repeat your prompts several times before he attends again. How should item
1a be scored?
A. 0 – alert
B. 1 – drowsy
C. 2 – requires repeated stimulation [CORRECT]
D. 3 – comatose
Correct Answer: C
Rationale: This choice is correct because needing repeated or stronger stimulation to stay
engaged is the definition of an obtunded response. He is not comatose since he does
respond, and a 1 only fits when light stimulation is enough.
Q5: Item 1b asks the patient two orientation questions. Which pair does the scale specify?
A. The current month and the patient's age [CORRECT]
B. The patient's name and date of birth
C. The year and the name of the hospital
D. The day of the week and the season
Correct Answer: A
Rationale: The best answer is A. The scripted questions are the current month and the
patient's age, and a birthday month may be substituted when exact age is difficult to give.
Q6: Your patient has expressive aphasia. She clearly understands you but cannot say the
month or her age, and her gestures do not answer the questions. What score does item 1b
receive?
A. 0
B. 1
C. 2 [CORRECT]
D. UN
Correct Answer: C
Rationale: This choice is correct because the scale directs you to score 2 when the patient
cannot answer either orientation question, including when aphasia blocks the response
despite intact understanding. The item is still scored rather than marked untestable.
Q7: What is the maximum score for item 3, visual fields?
A. 1
B. 2
C. 3 [CORRECT]
D. 4
Correct Answer: C
Rationale: The best answer is C. Visual fields run from 0 to 3, with 3 reserved for bilateral
hemianopia or blindness, while a maximum of 2 belongs to items like gaze, ataxia, sensory,
dysarthria, and extinction.
Q8: For item 1c, you need the patient to follow two commands. Which pair matches the
scale?
A. Squeeze my hand and lift your leg
, B. Stick out your tongue and follow my finger
C. Say your name and count backward
D. Open and close your eyes, then grip and release the non-paretic hand [CORRECT]
Correct Answer: D
Rationale: This choice is correct because the standardized commands are open/close the
eyes and grip/release, with the non-paretic hand used for the grip so weakness does not
mask comprehension.
Q9: During testing you notice Mrs. Cho's eyes are deviated toward her weak side, but her
gaze returns to midline when you turn her head. How do you score item 2, best gaze?
A. 0 – normal
B. 1 – partial gaze palsy [CORRECT]
C. 2 – forced deviation
D. UN – untestable
Correct Answer: B
Rationale: The best answer is B. Gaze that is abnormal but can be brought back to midline
with the maneuver is a partial gaze palsy worth 1, while a 2 is reserved for deviation the
maneuver cannot overcome.
Q10: Which statement best reflects the scoring rule for item 7, limb ataxia?
A. Score ataxia whenever the patient is weak on one side
B. Score ataxia as 2 whenever tremor is present
C. Score ataxia only when it is out of proportion to any weakness [CORRECT]
D. Score ataxia before testing motor strength
Correct Answer: C
Rationale: This choice is correct because the scale credits ataxia only when the
incoordination exceeds what the weakness alone would explain, and weakness by itself
never earns an ataxia point.
Q11: When you ask Mr. Alvarez the month, he answers "May" — it is actually April. He
immediately corrects himself and says "April, sorry." With no coaching from you, what score
does item 1b receive?
A. 0, because his second answer was right
B. 1, one question answered incorrectly [CORRECT]
C. 2, both questions answered incorrectly
D. 1, but only if he repeats April twice
Correct Answer: B
Rationale: The best answer is B. The scale scores the first response, so one correct and one
incorrect answer equals a 1, and his self-correction does not change what gets recorded.
Q12: A new nurse asks why the scale forbids coaching patients during the orientation
questions. What is the best explanation?
A. Coaching is only prohibited during certification testing, not at the bedside
B. Coaching is allowed as long as the patient eventually answers correctly
C. Coaching is only a problem when the patient has aphasia
D. Coaching changes the score and destroys the consistency that makes serial exams
comparable [CORRECT]
(Patients 1–6) Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed –
A+ Graded
**Foundations of the NIHSS**
Q1: A colleague who is new to stroke care asks you what total score range the NIHSS covers.
What do you tell her?
A. 0 to 30
B. 0 to 36
C. 0 to 42 [CORRECT]
D. 1 to 45
Correct Answer: C
Rationale: The best answer is C. Every item is added together, and the combined maximums
across all 15 scored entries total 42, with zero representing a completely normal
neurological exam.
Q2: Which NIHSS items are scored separately for the left and right sides of the body?
A. Motor arm and motor leg [CORRECT]
B. Best gaze and visual fields
C. Facial palsy and sensory
D. Ataxia and extinction
Correct Answer: A
Rationale: This choice is correct because items 5 and 6 each carry an "a" entry for the left
limb and a "b" entry for the right limb, giving four separate motor scores. The remaining
items are scored once for the whole patient.
Q3: What is the primary purpose of the NIHSS at the bedside?
A. To predict the exact vessel that is occluded
B. To replace imaging when deciding on acute treatment
C. To determine the patient's discharge disposition
D. To provide a standardized, repeatable measure of stroke-related neurological impairment
[CORRECT]
Correct Answer: D
Rationale: The best answer is D. The scale was built to quantify deficit severity the same way
every time so different clinicians can communicate and compare findings reliably, and it
supplements rather than replaces imaging and clinical judgment.
,Q4: You begin your assessment and Mr. Bell answers your first question appropriately. He
then falls asleep, and your voice alone no longer rouses him — you have to shake his
shoulder and repeat your prompts several times before he attends again. How should item
1a be scored?
A. 0 – alert
B. 1 – drowsy
C. 2 – requires repeated stimulation [CORRECT]
D. 3 – comatose
Correct Answer: C
Rationale: This choice is correct because needing repeated or stronger stimulation to stay
engaged is the definition of an obtunded response. He is not comatose since he does
respond, and a 1 only fits when light stimulation is enough.
Q5: Item 1b asks the patient two orientation questions. Which pair does the scale specify?
A. The current month and the patient's age [CORRECT]
B. The patient's name and date of birth
C. The year and the name of the hospital
D. The day of the week and the season
Correct Answer: A
Rationale: The best answer is A. The scripted questions are the current month and the
patient's age, and a birthday month may be substituted when exact age is difficult to give.
Q6: Your patient has expressive aphasia. She clearly understands you but cannot say the
month or her age, and her gestures do not answer the questions. What score does item 1b
receive?
A. 0
B. 1
C. 2 [CORRECT]
D. UN
Correct Answer: C
Rationale: This choice is correct because the scale directs you to score 2 when the patient
cannot answer either orientation question, including when aphasia blocks the response
despite intact understanding. The item is still scored rather than marked untestable.
Q7: What is the maximum score for item 3, visual fields?
A. 1
B. 2
C. 3 [CORRECT]
D. 4
Correct Answer: C
Rationale: The best answer is C. Visual fields run from 0 to 3, with 3 reserved for bilateral
hemianopia or blindness, while a maximum of 2 belongs to items like gaze, ataxia, sensory,
dysarthria, and extinction.
Q8: For item 1c, you need the patient to follow two commands. Which pair matches the
scale?
A. Squeeze my hand and lift your leg
, B. Stick out your tongue and follow my finger
C. Say your name and count backward
D. Open and close your eyes, then grip and release the non-paretic hand [CORRECT]
Correct Answer: D
Rationale: This choice is correct because the standardized commands are open/close the
eyes and grip/release, with the non-paretic hand used for the grip so weakness does not
mask comprehension.
Q9: During testing you notice Mrs. Cho's eyes are deviated toward her weak side, but her
gaze returns to midline when you turn her head. How do you score item 2, best gaze?
A. 0 – normal
B. 1 – partial gaze palsy [CORRECT]
C. 2 – forced deviation
D. UN – untestable
Correct Answer: B
Rationale: The best answer is B. Gaze that is abnormal but can be brought back to midline
with the maneuver is a partial gaze palsy worth 1, while a 2 is reserved for deviation the
maneuver cannot overcome.
Q10: Which statement best reflects the scoring rule for item 7, limb ataxia?
A. Score ataxia whenever the patient is weak on one side
B. Score ataxia as 2 whenever tremor is present
C. Score ataxia only when it is out of proportion to any weakness [CORRECT]
D. Score ataxia before testing motor strength
Correct Answer: C
Rationale: This choice is correct because the scale credits ataxia only when the
incoordination exceeds what the weakness alone would explain, and weakness by itself
never earns an ataxia point.
Q11: When you ask Mr. Alvarez the month, he answers "May" — it is actually April. He
immediately corrects himself and says "April, sorry." With no coaching from you, what score
does item 1b receive?
A. 0, because his second answer was right
B. 1, one question answered incorrectly [CORRECT]
C. 2, both questions answered incorrectly
D. 1, but only if he repeats April twice
Correct Answer: B
Rationale: The best answer is B. The scale scores the first response, so one correct and one
incorrect answer equals a 1, and his self-correction does not change what gets recorded.
Q12: A new nurse asks why the scale forbids coaching patients during the orientation
questions. What is the best explanation?
A. Coaching is only prohibited during certification testing, not at the bedside
B. Coaching is allowed as long as the patient eventually answers correctly
C. Coaching is only a problem when the patient has aphasia
D. Coaching changes the score and destroys the consistency that makes serial exams
comparable [CORRECT]
