NIH Stroke Scale (NIHSS) Group A Patient
1-6 Exam Answers & Scoring Guide (2026
Updated)
Question 1:
Which of the following is the correct maximum score on the NIH Stroke Scale (NIHSS)?
A. 30
B. 42
C. 36
D. 45
Answer: B. 42
Rationale: The NIHSS consists of 11 items, each scored from 0 to 4 (some items 0-2 or 0-
3). The maximum possible score is 42, which indicates the most severe neurological deficit.
A score of 0 indicates no stroke symptoms.
Question 2:
When administering the NIHSS, which item is assessed FIRST?
A. Best Gaze
B. Level of Consciousness (LOC)
C. Motor Function – Arms
D. Language
Answer: B. Level of Consciousness (LOC)
,Rationale: The NIHSS is administered in a specific sequence, and Level of Consciousness
(1a, 1b, 1c) is always assessed first. This includes LOC responsiveness, LOC questions
(month and age), and LOC commands (open/close eyes, grip/release hand).
Question 3:
A patient incorrectly answers BOTH the month and their age during the NIHSS
assessment. What score should be documented for item 1b (LOC Questions)?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: For LOC Questions (1b): 0 = answers both correctly, 1 = answers ONE correctly,
2 = answers NEITHER correctly. Since the patient missed both questions, the score is 2.
Aphasic or stuporous patients who cannot understand are also scored as 2.
Question 4:
During the NIHSS "Best Gaze" assessment, the patient has a partial gaze palsy where
gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is NOT
present. What is the correct score?
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Best Gaze scoring: 0 = normal, 1 = partial gaze palsy (abnormal gaze in one or
both eyes but no forced deviation), 2 = forced deviation or total gaze paresis not overcome
by oculocephalic maneuver. Only assess horizontal eye movements.
, Question 5:
A patient with no visual loss is tested for visual fields. They have a dense hemianopia
with complete loss of vision in one half of the visual field. What NIHSS score is assigned
for Visual Fields?
A. 0
B. 1
C. 2
D. 3
Answer: D. 3
Rationale: Visual Fields scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete
hemianopia, 3 = bilateral hemianopia (blind including cortical blindness). A complete
hemianopia scores 2, while bilateral hemianopia scores 3.
Question 6:
When assessing Motor Function – Arms (Item 5), the patient has to hold their arms at
90° (sitting) or 45° (supine) for how many seconds?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: B. 10 seconds
Rationale: The patient is asked to hold each arm at 90 degrees (if sitting) or 45 degrees (if
supine) for 10 seconds. Drift is scored: 0 = no drift, 1 = drift but doesn't hit bed, 2 = some
effort against gravity but drifts down, 3 = no effort against gravity, 4 = no movement.
Question 7:
A patient's right arm drifts downward but does not hit the bed within the 10-second
period. What is the correct Motor Arm score?
1-6 Exam Answers & Scoring Guide (2026
Updated)
Question 1:
Which of the following is the correct maximum score on the NIH Stroke Scale (NIHSS)?
A. 30
B. 42
C. 36
D. 45
Answer: B. 42
Rationale: The NIHSS consists of 11 items, each scored from 0 to 4 (some items 0-2 or 0-
3). The maximum possible score is 42, which indicates the most severe neurological deficit.
A score of 0 indicates no stroke symptoms.
Question 2:
When administering the NIHSS, which item is assessed FIRST?
A. Best Gaze
B. Level of Consciousness (LOC)
C. Motor Function – Arms
D. Language
Answer: B. Level of Consciousness (LOC)
,Rationale: The NIHSS is administered in a specific sequence, and Level of Consciousness
(1a, 1b, 1c) is always assessed first. This includes LOC responsiveness, LOC questions
(month and age), and LOC commands (open/close eyes, grip/release hand).
Question 3:
A patient incorrectly answers BOTH the month and their age during the NIHSS
assessment. What score should be documented for item 1b (LOC Questions)?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Rationale: For LOC Questions (1b): 0 = answers both correctly, 1 = answers ONE correctly,
2 = answers NEITHER correctly. Since the patient missed both questions, the score is 2.
Aphasic or stuporous patients who cannot understand are also scored as 2.
Question 4:
During the NIHSS "Best Gaze" assessment, the patient has a partial gaze palsy where
gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is NOT
present. What is the correct score?
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Best Gaze scoring: 0 = normal, 1 = partial gaze palsy (abnormal gaze in one or
both eyes but no forced deviation), 2 = forced deviation or total gaze paresis not overcome
by oculocephalic maneuver. Only assess horizontal eye movements.
, Question 5:
A patient with no visual loss is tested for visual fields. They have a dense hemianopia
with complete loss of vision in one half of the visual field. What NIHSS score is assigned
for Visual Fields?
A. 0
B. 1
C. 2
D. 3
Answer: D. 3
Rationale: Visual Fields scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete
hemianopia, 3 = bilateral hemianopia (blind including cortical blindness). A complete
hemianopia scores 2, while bilateral hemianopia scores 3.
Question 6:
When assessing Motor Function – Arms (Item 5), the patient has to hold their arms at
90° (sitting) or 45° (supine) for how many seconds?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: B. 10 seconds
Rationale: The patient is asked to hold each arm at 90 degrees (if sitting) or 45 degrees (if
supine) for 10 seconds. Drift is scored: 0 = no drift, 1 = drift but doesn't hit bed, 2 = some
effort against gravity but drifts down, 3 = no effort against gravity, 4 = no movement.
Question 7:
A patient's right arm drifts downward but does not hit the bed within the 10-second
period. What is the correct Motor Arm score?
