NIHSS-English Group G-V3 – 7th Certification Examination
Complete Recertification Exam Simulation – Verified Answers &
Scoring Rationales – 2026/2027 Edition
NIH Stroke Scale International Certification | Version 3, Group G | Recertification
Level
SECTION 1: PATIENT 1 – Group G-V3
Presentation: 67-year-old male, acute left MCA stroke, alert, mild right facial droop, right
arm drift, fluent speech with mild word-finding pauses
Q1: Patient 1: 1a. Level of Consciousness
The patient opens eyes spontaneously when the examiner enters the room. He
responds immediately to questions about his name and the situation. He follows
commands without delay. There is no evidence of lethargy or reduced alertness. What is
the correct score?
A. 0 – Alert
B. 1 – Not alert, but arousable
C. 2 – Not alert, requires repeated stimulation
D. 3 – Unresponsive or responds only with reflex/posturing
Correct Answer: A
NIHSS Domain: 1a. Level of Consciousness
,Score Range: 0–3
Rationale: [CORRECT] A (Score 0): The patient is fully alert with spontaneous eye
opening, immediate response to verbal stimuli, and appropriate interaction. No
stimulation is required to maintain attention. B (Score 1): Incorrect — patient does not
require stimulation to arouse. C (Score 2): Incorrect — no repeated stimulation needed.
D (Score 3): Incorrect — patient is clearly responsive, not reflexive. Common
recertification error: Scoring 1 for patients who are "quiet" or reserved; NIHSS requires
objective evidence of reduced alertness, not personality style.
Q2: Patient 1: 1b. LOC Questions
The examiner asks, "What month is it?" The patient responds, "It's... uh... October, I think.
No, wait, November." For age, he states, "I'm 67... just had my birthday." He self-corrects
the month without prompting. What is the correct score?
A. 0 – Answers both correctly
B. 1 – Answers one correctly
C. 2 – Answers neither correctly
D. Untestable – Document reason
Correct Answer: A
NIHSS Domain: 1b. LOC Questions
Score Range: 0–2
Rationale: [CORRECT] A (Score 0): The patient correctly identifies both age (67) and
month (November, with self-correction). Self-correction is acceptable and does not
,constitute an error. The initial hesitation does not indicate incorrect answer. B (Score 1):
Incorrect — both answers were ultimately correct. C (Score 2): Incorrect — no incorrect
answers. D (Untestable): Incorrect — patient can communicate and comprehend.
Common recertification error: Scoring 1 for self-correction or hesitation; NIHSS scores
final answer, not process. Patients with aphasia may need alternative questioning, but this
patient is not aphasic.
Q3: Patient 1: 1c. LOC Commands
The examiner instructs, "Open and close your eyes." The patient performs promptly. For
"Grip and release my hand," the patient demonstrates appropriate grip and release with
the left hand (unaffected side). The right hand has motor weakness but attempts the
command. What is the correct score?
A. 0 – Performs both correctly
B. 1 – Performs one correctly
C. 2 – Performs neither correctly
D. Untestable – Document reason
Correct Answer: A
NIHSS Domain: 1c. LOC Commands
Score Range: 0–2
Rationale: [CORRECT] A (Score 0): The patient performs both commands correctly with
the unaffected limb. For patients with weakness, effort to perform is scored, not
perfection. The left hand executes grip/release normally; the right hand attempts the
command (effort counts). B (Score 1): Incorrect — both commands were attempted and
, executed appropriately. C (Score 2): Incorrect — patient is not unable to perform
commands. D (Untestable): Incorrect — patient can follow commands. Common
recertification error: Scoring down for weakness in execution; NIHSS 1c assesses
comprehension and effort, not strength. Intubated patients or those with bilateral
amputation are untestable.
Q4: Patient 1: 2. Best Gaze
The examiner performs the horizontal eye movement test. The patient's eyes track
appropriately to both sides. When asked to look to the right, there is slight hesitation but
full excursion. When asked to look to the left, movement is full and prompt. There is no
forced deviation or gaze preference. What is the correct score?
A. 0 – Normal
B. 1 – Partial gaze palsy
C. 2 – Forced deviation or total gaze paresis
Correct Answer: A
NIHSS Domain: 2. Best Gaze
Score Range: 0–2
Rationale: [CORRECT] A (Score 0): Full horizontal eye movement in both directions
without forced deviation. Slight hesitation does not constitute gaze palsy. The
oculocephalic maneuver (doll's eyes) is not needed as voluntary gaze is intact. B (Score
1): Incorrect — no partial gaze palsy present (would show incomplete excursion or clear
asymmetry). C (Score 2): Incorrect — no forced deviation present. Common
Complete Recertification Exam Simulation – Verified Answers &
Scoring Rationales – 2026/2027 Edition
NIH Stroke Scale International Certification | Version 3, Group G | Recertification
Level
SECTION 1: PATIENT 1 – Group G-V3
Presentation: 67-year-old male, acute left MCA stroke, alert, mild right facial droop, right
arm drift, fluent speech with mild word-finding pauses
Q1: Patient 1: 1a. Level of Consciousness
The patient opens eyes spontaneously when the examiner enters the room. He
responds immediately to questions about his name and the situation. He follows
commands without delay. There is no evidence of lethargy or reduced alertness. What is
the correct score?
A. 0 – Alert
B. 1 – Not alert, but arousable
C. 2 – Not alert, requires repeated stimulation
D. 3 – Unresponsive or responds only with reflex/posturing
Correct Answer: A
NIHSS Domain: 1a. Level of Consciousness
,Score Range: 0–3
Rationale: [CORRECT] A (Score 0): The patient is fully alert with spontaneous eye
opening, immediate response to verbal stimuli, and appropriate interaction. No
stimulation is required to maintain attention. B (Score 1): Incorrect — patient does not
require stimulation to arouse. C (Score 2): Incorrect — no repeated stimulation needed.
D (Score 3): Incorrect — patient is clearly responsive, not reflexive. Common
recertification error: Scoring 1 for patients who are "quiet" or reserved; NIHSS requires
objective evidence of reduced alertness, not personality style.
Q2: Patient 1: 1b. LOC Questions
The examiner asks, "What month is it?" The patient responds, "It's... uh... October, I think.
No, wait, November." For age, he states, "I'm 67... just had my birthday." He self-corrects
the month without prompting. What is the correct score?
A. 0 – Answers both correctly
B. 1 – Answers one correctly
C. 2 – Answers neither correctly
D. Untestable – Document reason
Correct Answer: A
NIHSS Domain: 1b. LOC Questions
Score Range: 0–2
Rationale: [CORRECT] A (Score 0): The patient correctly identifies both age (67) and
month (November, with self-correction). Self-correction is acceptable and does not
,constitute an error. The initial hesitation does not indicate incorrect answer. B (Score 1):
Incorrect — both answers were ultimately correct. C (Score 2): Incorrect — no incorrect
answers. D (Untestable): Incorrect — patient can communicate and comprehend.
Common recertification error: Scoring 1 for self-correction or hesitation; NIHSS scores
final answer, not process. Patients with aphasia may need alternative questioning, but this
patient is not aphasic.
Q3: Patient 1: 1c. LOC Commands
The examiner instructs, "Open and close your eyes." The patient performs promptly. For
"Grip and release my hand," the patient demonstrates appropriate grip and release with
the left hand (unaffected side). The right hand has motor weakness but attempts the
command. What is the correct score?
A. 0 – Performs both correctly
B. 1 – Performs one correctly
C. 2 – Performs neither correctly
D. Untestable – Document reason
Correct Answer: A
NIHSS Domain: 1c. LOC Commands
Score Range: 0–2
Rationale: [CORRECT] A (Score 0): The patient performs both commands correctly with
the unaffected limb. For patients with weakness, effort to perform is scored, not
perfection. The left hand executes grip/release normally; the right hand attempts the
command (effort counts). B (Score 1): Incorrect — both commands were attempted and
, executed appropriately. C (Score 2): Incorrect — patient is not unable to perform
commands. D (Untestable): Incorrect — patient can follow commands. Common
recertification error: Scoring down for weakness in execution; NIHSS 1c assesses
comprehension and effort, not strength. Intubated patients or those with bilateral
amputation are untestable.
Q4: Patient 1: 2. Best Gaze
The examiner performs the horizontal eye movement test. The patient's eyes track
appropriately to both sides. When asked to look to the right, there is slight hesitation but
full excursion. When asked to look to the left, movement is full and prompt. There is no
forced deviation or gaze preference. What is the correct score?
A. 0 – Normal
B. 1 – Partial gaze palsy
C. 2 – Forced deviation or total gaze paresis
Correct Answer: A
NIHSS Domain: 2. Best Gaze
Score Range: 0–2
Rationale: [CORRECT] A (Score 0): Full horizontal eye movement in both directions
without forced deviation. Slight hesitation does not constitute gaze palsy. The
oculocephalic maneuver (doll's eyes) is not needed as voluntary gaze is intact. B (Score
1): Incorrect — no partial gaze palsy present (would show incomplete excursion or clear
asymmetry). C (Score 2): Incorrect — no forced deviation present. Common
