NIHSS – STROKE SCALE CERTIFICATION EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIONALES GRADED A+ LATEST

NIHSS – STROKE SCALE CERTIFICATION EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST



Question 1
A 68-year-old male presents with sudden onset of right-sided weakness and slurred
speech. On exam:
 Level of Consciousness: Alert and responsive
 Best Gaze: Eyes deviated slightly to the left
 Visual Fields: Right homonymous hemianopia
 Facial Palsy: Right lower face weakness
 Motor Arm (Right): 3/5 strength
 Motor Leg (Right): 4/5 strength
 Limb Ataxia: None
 Sensory: Decreased sensation on the right side
 Best Language: Mild expressive aphasia
 Dysarthria: Mild
 Extinction & Inattention: Right-sided neglect
Question: What is the approximate NIHSS score for this patient?
A) 8
B) 12
C) 15
D) 18
Answer: B) 12

,Rationale:
NIHSS scoring:
 Level of consciousness: 0 (alert)
 Best gaze: 1 (partial gaze palsy)
 Visual fields: 2 (complete hemianopia)
 Facial palsy: 1 (minor paralysis)
 Motor arm: 3 (3/5)
 Motor leg: 1 (4/5)
 Limb ataxia: 0
 Sensory: 1 (mild to moderate)
 Language: 1 (mild aphasia)
 Dysarthria: 1 (mild)
 Extinction & inattention: 2 (severe neglect)
Total = 12

,Question 2
A 74-year-old female with a history of atrial fibrillation is brought to the ER with
sudden onset left-sided weakness and slurred speech. On NIHSS assessment:
 Level of Consciousness: Alert, but disoriented to time
 Best Gaze: Normal
 Visual Fields: Full
 Facial Palsy: Left upper and lower face weakness
 Motor Arm (Left): 0/5
 Motor Leg (Left): 2/5
 Limb Ataxia: Unable to assess due to weakness
 Sensory: Severe left-sided sensory loss
 Best Language: Global aphasia
 Dysarthria: Moderate
 Extinction & Inattention: Left-sided neglect
Question: Which NIHSS items contribute most significantly to predicting poor
functional outcomes?
A) Level of Consciousness & Best Gaze
B) Motor Arm & Leg, Language, Extinction/Inattention
C) Dysarthria & Facial Palsy
D) Visual Fields & Limb Ataxia
Answer: B) Motor Arm & Leg, Language, Extinction/Inattention
Rationale:
Studies show that the severity of motor deficits, global aphasia, and neglect are
strong predictors of poor functional outcomes in acute stroke. While other NIHSS
items are important for scoring, these deficits correlate most with disability and
long-term prognosis.

, Question 3
During a NIHSS exam, you observe a patient with severe right-sided hemiplegia
but intact language and cognition. Which NIHSS items will likely contribute the
highest individual scores?
A) Motor Arm & Leg
B) Best Language & Dysarthria
C) Visual Fields & Extinction/Inattention
D) Limb Ataxia & Facial Palsy
Answer: A) Motor Arm & Leg
Rationale:
The NIHSS assigns higher point values to motor deficits. Severe hemiplegia
scores up to 4 points for each limb, which will dominate the overall NIHSS score,
while language or minor facial deficits contribute fewer points.


Question 4
A 70-year-old man presents with sudden left-sided weakness. Exam:
 Alert and oriented
 Eyes deviate to the right
 Left homonymous hemianopia
 Left lower face weakness
 Motor arm (left) 3/5, leg (left) 4/5
 No limb ataxia
 Mild left-sided sensory loss
 Mild expressive aphasia
 Mild dysarthria
 No extinction or neglect