NIHSS - Group A Questions with Correct
Answers 2026
1. A patient is able to state their name, the month, and their age correctly, but answe
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
rs "I don't know" when asked where they are. How do you score item 1a (Level of Co
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
nsciousness)?
• A) 0 - Alert
mn mn mn
• B) 1 - Not alert, but arousable
mn mn mn mn mn mn
• C) 2 - Not alert, requires repeated stimulation
mn mn mn mn mn mn mn
• D) 3 - Coma/Unresponsive (or worse)
mn mn mn mn mn
2. To correctly score item 1b (LOC Questions), what must the patient do to receive full
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
credit for the question about the month?
mn mn mn mn mn mn mn
• A) Give a response that is close, such as the previous month.
mn mn mn mn mn mn mn mn mn mn mn
• B) Nod their head "yes" when the examiner says the correct month.
mn mn mn mn mn mn mn mn mn mn mn
• C) Give the exact current month.
mn mn mn mn mn
• D) Answer within a one-month range.
mn mn mn mn mn
3. A patient follows the examiner's finger with their eyes perfectly to the left but only
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
tracks halfway to the right before the eyes drift back to midline. What is the correct
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
score for item 3 (Visual Fields)?
mn mn mn mn mn
• A) 0 - No visual loss
mn mn mn mn mn
• B) 1 - Partial hemianopia
mn mn mn mn
• C) 2 - Complete hemianopia
mn mn mn mn
• D) 3 - Bilateral hemianopia (blind)
mn mn mn mn mn
4. When testing item 4 (Facial Palsy), you ask the patient to show their teeth and rais
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
e their eyebrows. The patient shows asymmetry; the left side moves normally, but the
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
right side barely moves. What is the score?
mn mn mn mn mn mn mn
, • A) 0 - Normal
mn mn mn
• B) 1 - Minor paralysis (slight asymmetry)
mn mn mn mn mn mn
• C) 2 - Partial paralysis (total or near-total paralysis of lower face)
mn mn mn mn mn mn mn mn mn mn mn
• D) 3 - Complete paralysis (upper and lower face)
mn mn mn mn mn mn mn mn
5. For item 5 (Motor Arm), the patient holds the left arm up for 10 seconds before it
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
begins to drift down. The right arm holds for the full 10 seconds. What is the score fo
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
r the LEFT arm?
mn mn mn
• A) 0 - No drift
mn mn mn mn
• B) 1 - Drift (arm drifts before 10 seconds)
mn mn mn mn mn mn mn mn
• C) 2 - Some effort against gravity (cannot hold full 10 seconds but can lift)
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
• D) 3 - No effort against gravity (flails)
mn mn mn mn mn mn mn
6. A patient is intubated and cannot speak. How do you score item 9 (Best Language)?
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
• A) Score it as a 3 (Aphasic).
mn mn mn mn mn mn
• B) Score it based on the patient's ability to write or comprehend commands.
mn mn mn mn mn mn mn mn mn mn mn mn
• C) Score it as a 0 (Normal) since they cannot speak.
mn mn mn mn mn mn mn mn mn mn
• D) Score it as a 9 (Untestable).
mn mn mn mn mn mn
7. Which of the following is the most important reason to ensure the patient is not sl
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
eeping or lethargic during the exam?
mn mn mn mn mn
• A) It increases the risk of aspiration.
mn mn mn mn mn mn
• B) It can falsely elevate the score (making the stroke appear worse) due to met
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
abolic issues, not a focal deficit.
mn mn mn mn mn
• C) It prevents the examiner from seeing the patient's gait.
mn mn mn mn mn mn mn mn mn
• D) It only affects the sensory exam.
mn mn mn mn mn mn
8. A patient with a history of amputation of the left arm is being tested. How do you
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
score item 5 (Motor Arm) for the left side?
mn mn mn mn mn mn mn mn
, • A) Score it as a 9 (Untestable) and document the reason.
mn mn mn mn mn mn mn mn mn mn
• B) Score it as a 0 (Normal) since it is absent.
mn mn mn mn mn mn mn mn mn mn
• C) Score it as a 4 (Amputation).
mn mn mn mn mn mn
• D) Score it based on the patient's shoulder shrug.
mn mn mn mn mn mn mn mn
9. When testing item 8 (Sensory), you touch the patient's arm and leg with a pin. The
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn m
patient correctly identifies the sharp sensation on the right side but reports the pin as
n mn mn mn mn mn mn mn mn mn mn mn mn mn mn
"dull" on the left side. What is the score?
mn mn mn mn mn mn mn mn mn
• A) 0 - Normal
mn mn mn
• B) 1 - Mild-to-moderate loss (patient feels it but is less sharp)
mn mn mn mn mn mn mn mn mn mn mn
• C) 2 - Severe loss (patient is unaware of being touched)
mn mn mn mn mn mn mn mn mn mn
• D) 3 - Total loss (no sensation at all)
mn mn mn mn mn mn mn mn
10. The maximum total score (worst possible outcome) on the NIHSS is:
mn mn mn mn mn mn mn mn mn mn mn
• A) 24 mn
• B) 36 mn
• C) 42 mn
• D) 50 mn
11. When scoring item 10 (Dysarthria), the patient is able to read a list of words clearl
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
y without slurring. However, the patient has dentures that are loose. What is the corre
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
ct approach?
mn
• A) Score it as a 2 (Severe) because of the loose dentures.
mn mn mn mn mn mn mn mn mn mn mn
• B) Score it as a 0 (Normal) if the speech is clear.
mn mn mn mn mn mn mn mn mn mn mn
• C) Score it as a 1 (Mild-to-moderate) due to the physical obstruction.
mn mn mn mn mn mn mn mn mn mn mn
• D) Score it as a 9 (Untestable).
mn mn mn mn mn mn
12. A patient is able to perform the motor tasks, answer questions, and follow comma
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
nds, but the examiner notices a distinct neglect of the left side. The patient fails to to
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
Answers 2026
1. A patient is able to state their name, the month, and their age correctly, but answe
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
rs "I don't know" when asked where they are. How do you score item 1a (Level of Co
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
nsciousness)?
• A) 0 - Alert
mn mn mn
• B) 1 - Not alert, but arousable
mn mn mn mn mn mn
• C) 2 - Not alert, requires repeated stimulation
mn mn mn mn mn mn mn
• D) 3 - Coma/Unresponsive (or worse)
mn mn mn mn mn
2. To correctly score item 1b (LOC Questions), what must the patient do to receive full
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
credit for the question about the month?
mn mn mn mn mn mn mn
• A) Give a response that is close, such as the previous month.
mn mn mn mn mn mn mn mn mn mn mn
• B) Nod their head "yes" when the examiner says the correct month.
mn mn mn mn mn mn mn mn mn mn mn
• C) Give the exact current month.
mn mn mn mn mn
• D) Answer within a one-month range.
mn mn mn mn mn
3. A patient follows the examiner's finger with their eyes perfectly to the left but only
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
tracks halfway to the right before the eyes drift back to midline. What is the correct
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
score for item 3 (Visual Fields)?
mn mn mn mn mn
• A) 0 - No visual loss
mn mn mn mn mn
• B) 1 - Partial hemianopia
mn mn mn mn
• C) 2 - Complete hemianopia
mn mn mn mn
• D) 3 - Bilateral hemianopia (blind)
mn mn mn mn mn
4. When testing item 4 (Facial Palsy), you ask the patient to show their teeth and rais
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
e their eyebrows. The patient shows asymmetry; the left side moves normally, but the
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
right side barely moves. What is the score?
mn mn mn mn mn mn mn
, • A) 0 - Normal
mn mn mn
• B) 1 - Minor paralysis (slight asymmetry)
mn mn mn mn mn mn
• C) 2 - Partial paralysis (total or near-total paralysis of lower face)
mn mn mn mn mn mn mn mn mn mn mn
• D) 3 - Complete paralysis (upper and lower face)
mn mn mn mn mn mn mn mn
5. For item 5 (Motor Arm), the patient holds the left arm up for 10 seconds before it
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
begins to drift down. The right arm holds for the full 10 seconds. What is the score fo
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
r the LEFT arm?
mn mn mn
• A) 0 - No drift
mn mn mn mn
• B) 1 - Drift (arm drifts before 10 seconds)
mn mn mn mn mn mn mn mn
• C) 2 - Some effort against gravity (cannot hold full 10 seconds but can lift)
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
• D) 3 - No effort against gravity (flails)
mn mn mn mn mn mn mn
6. A patient is intubated and cannot speak. How do you score item 9 (Best Language)?
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
• A) Score it as a 3 (Aphasic).
mn mn mn mn mn mn
• B) Score it based on the patient's ability to write or comprehend commands.
mn mn mn mn mn mn mn mn mn mn mn mn
• C) Score it as a 0 (Normal) since they cannot speak.
mn mn mn mn mn mn mn mn mn mn
• D) Score it as a 9 (Untestable).
mn mn mn mn mn mn
7. Which of the following is the most important reason to ensure the patient is not sl
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
eeping or lethargic during the exam?
mn mn mn mn mn
• A) It increases the risk of aspiration.
mn mn mn mn mn mn
• B) It can falsely elevate the score (making the stroke appear worse) due to met
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
abolic issues, not a focal deficit.
mn mn mn mn mn
• C) It prevents the examiner from seeing the patient's gait.
mn mn mn mn mn mn mn mn mn
• D) It only affects the sensory exam.
mn mn mn mn mn mn
8. A patient with a history of amputation of the left arm is being tested. How do you
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
score item 5 (Motor Arm) for the left side?
mn mn mn mn mn mn mn mn
, • A) Score it as a 9 (Untestable) and document the reason.
mn mn mn mn mn mn mn mn mn mn
• B) Score it as a 0 (Normal) since it is absent.
mn mn mn mn mn mn mn mn mn mn
• C) Score it as a 4 (Amputation).
mn mn mn mn mn mn
• D) Score it based on the patient's shoulder shrug.
mn mn mn mn mn mn mn mn
9. When testing item 8 (Sensory), you touch the patient's arm and leg with a pin. The
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn m
patient correctly identifies the sharp sensation on the right side but reports the pin as
n mn mn mn mn mn mn mn mn mn mn mn mn mn mn
"dull" on the left side. What is the score?
mn mn mn mn mn mn mn mn mn
• A) 0 - Normal
mn mn mn
• B) 1 - Mild-to-moderate loss (patient feels it but is less sharp)
mn mn mn mn mn mn mn mn mn mn mn
• C) 2 - Severe loss (patient is unaware of being touched)
mn mn mn mn mn mn mn mn mn mn
• D) 3 - Total loss (no sensation at all)
mn mn mn mn mn mn mn mn
10. The maximum total score (worst possible outcome) on the NIHSS is:
mn mn mn mn mn mn mn mn mn mn mn
• A) 24 mn
• B) 36 mn
• C) 42 mn
• D) 50 mn
11. When scoring item 10 (Dysarthria), the patient is able to read a list of words clearl
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
y without slurring. However, the patient has dentures that are loose. What is the corre
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
ct approach?
mn
• A) Score it as a 2 (Severe) because of the loose dentures.
mn mn mn mn mn mn mn mn mn mn mn
• B) Score it as a 0 (Normal) if the speech is clear.
mn mn mn mn mn mn mn mn mn mn mn
• C) Score it as a 1 (Mild-to-moderate) due to the physical obstruction.
mn mn mn mn mn mn mn mn mn mn mn
• D) Score it as a 9 (Untestable).
mn mn mn mn mn mn
12. A patient is able to perform the motor tasks, answer questions, and follow comma
mn mn mn mn mn mn mn mn mn mn mn mn mn mn
nds, but the examiner notices a distinct neglect of the left side. The patient fails to to
mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn mn
