2025 NIH Stroke Scale Group A V3 Answers | AHA NIHSS
Certification Test Answers with Full Rationale & 100% Pass
Proof | Complete Study Guide
**American Heart Association – Group A (V3)**
**ATTEMPT HISTORY**
**Student:** Hernandez, Delmy
**Test:** 01 NIHSSEnglish Group AV3 – 1st Certification
**Date:** 3/3/2018 4:12:38 AM
**Result:** PASSED – **89 of 90 (98.89%)**
**Only Incorrect Item:** Patient 1 – 5b. Motor Arm Right (selected 0, graded
Incorrect). All other 89 items = 100% Correct.
---
### **PATIENT 1**
**1a. Level of Consciousness**
The investigator must choose a response, even if a full evaluation is prevented by
such obstacles as an endotracheal tube, language barrier, orotracheal
trauma/bandages. A 3 is scored only if the patient makes no movement (other than
reflexive posturing) in response to noxious stimulation.
**Correct Answer:** 0 = Alert; keenly responsive
**Grade:** Correct
**1b. LOC Questions**
The patient is asked the month and his/her age. The answer must be correct there
is no partial credit for being close. Aphasic and stuporous patients who do not
,comprehend the questions will score 2. Patients unable to speak because of
endotracheal intubation, orotracheal trauma, severe dysarthria from any cause,
language barrier or any other problem not secondary to aphasia are given a 1. It is
important that only the initial answer be graded and that the examiner not "help"
the patient with verbal or nonverbal cues.
**Correct Answer:** 0 = Answers both questions correctly
**Grade:** Correct
**1c. LOC Commands**
The patient is asked to open and close the eyes and then to grip and release the
nonparetic hand. Substitute another one-step command if the hands cannot be
used. Credit is given if an unequivocal attempt is made but not completed due to
weakness. If the patient does not respond to command, the task should be
demonstrated to them (pantomime) and score the result (i.e., follows none, one or
two commands). Patients with trauma, amputation, or other physical impediments
should be given suitable one-step commands. Only the first attempt is scored.
**Correct Answer:** 0 = Performs both tasks correctly
**Grade:** Correct
**2. Best Gaze**
Only horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored but caloric testing is not done. If the
patient has a conjugate deviation of the eyes that can be overcome by voluntary or
reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve
paresis (CN III, IV or VI) score a 1. Gaze is testable in all aphasic patients. Patients
with ocular trauma, bandages, pre-existing blindness or other disorder of visual
acuity or fields should be tested with reflexive movements and a choice made by
the investigator. Establishing eye contact and then moving about the patient from
side to side will occasionally clarify the presence of a partial gaze palsy.
**Correct Answer:** 0 = Normal
**Grade:** Correct
**3. Visual**
Visual fields (upper and lower quadrants) are tested by confrontation, using finger
counting or visual threat as appropriate. Patient must be encouraged, but if they
look at the side of the moving fingers appropriately, this can be scored as normal.
,If there is unilateral blindness or enucleation, visual fields in the remaining eye are
scored. Score 1 only if a clearcut asymmetry, including quadrantanopia is found. If
patient is blind from any cause score 3. Double simultaneous stimulation is
performed at this point. If there is extinction patient receives a 1, and the results
are used to answer question 11.
**Correct Answer:** 0 = No visual loss
**Grade:** Correct
**4. Facial Palsy**
Ask, or use pantomime to encourage the patient to show teeth or raise eyebrows
and close eyes. Score symmetry of grimace in response to noxious stimuli in the
poorly responsive or noncomprehending patient. If facial trauma/bandages,
orotracheal tube, tape or other physical barriers obscure the face, these should be
removed to the extent possible.
**Correct Answer:** 0 = Normal symmetrical movement
**Grade:** Correct
**5a. Motor Arm Left**
The limb is placed in the appropriate position: extend the arms (palms down) 90
degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before
10 seconds. The aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with
the nonparetic arm. Only in the case of amputation or joint fusion at the shoulder,
the examiner should record the score as untestable (UN).
**Correct Answer:** 0 = No drift, limb holds 90 (or 45) degrees for full 10 seconds
**Grade:** Correct
**5b. Motor Arm Right**
The limb is placed in the appropriate position: extend the arms (palms down) 90
degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before
10 seconds. The aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with
the nonparetic arm. Only in the case of amputation or joint fusion at the shoulder,
the examiner should record the score as untestable (UN).
**Selected Answer:** 0 = No drift, limb holds 90 (or 45) degrees for full 10
seconds
, **Grade:** Incorrect (Only error in the test)
**6a. Motor Leg Left**
The limb is placed in the appropriate position: hold the leg at 30 degrees (always
tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient
is encouraged using urgency in the voice and pantomime but not noxious
stimulation. Each limb is tested in turn, beginning with the nonparetic leg. Only in
the case of amputation or joint fusion at the hip, the examiner should record the
score as untestable (UN).
**Correct Answer:** 1 = Drift, leg falls by the end of the 5-second period, but does
not hit bed
**Grade:** Correct
**6b. Motor Leg Right**
The limb is placed in the appropriate position: hold the leg at 30 degrees (always
tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient
is encouraged using urgency in the voice and pantomime but not noxious
stimulation. Each limb is tested in turn, beginning with the nonparetic leg. Only in
the case of amputation or joint fusion at the hip, the examiner should record the
score as untestable (UN).
**Correct Answer:** 0 = No drift, leg holds 30 degrees position for full 5 seconds
**Grade:** Correct
**7. Limb Ataxia**
This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with
eyes open. In case of visual defect, ensure testing is done in intact visual field. The
finger-nose-finger and heel-shin tests are performed on both sides, and ataxia is
scored only if present out of proportion to weakness. Ataxia is absent in the patient
who cannot understand or is paralyzed. Only in the case of amputation or joint
fusion, the examiner should record the score as untestable (UN), and clearly write
the explanation for this choice. In case of blindness, test by having the patient
touch nose from extended arm position.
**Correct Answer:** 1 = Present in one limb
**Grade:** Correct
Certification Test Answers with Full Rationale & 100% Pass
Proof | Complete Study Guide
**American Heart Association – Group A (V3)**
**ATTEMPT HISTORY**
**Student:** Hernandez, Delmy
**Test:** 01 NIHSSEnglish Group AV3 – 1st Certification
**Date:** 3/3/2018 4:12:38 AM
**Result:** PASSED – **89 of 90 (98.89%)**
**Only Incorrect Item:** Patient 1 – 5b. Motor Arm Right (selected 0, graded
Incorrect). All other 89 items = 100% Correct.
---
### **PATIENT 1**
**1a. Level of Consciousness**
The investigator must choose a response, even if a full evaluation is prevented by
such obstacles as an endotracheal tube, language barrier, orotracheal
trauma/bandages. A 3 is scored only if the patient makes no movement (other than
reflexive posturing) in response to noxious stimulation.
**Correct Answer:** 0 = Alert; keenly responsive
**Grade:** Correct
**1b. LOC Questions**
The patient is asked the month and his/her age. The answer must be correct there
is no partial credit for being close. Aphasic and stuporous patients who do not
,comprehend the questions will score 2. Patients unable to speak because of
endotracheal intubation, orotracheal trauma, severe dysarthria from any cause,
language barrier or any other problem not secondary to aphasia are given a 1. It is
important that only the initial answer be graded and that the examiner not "help"
the patient with verbal or nonverbal cues.
**Correct Answer:** 0 = Answers both questions correctly
**Grade:** Correct
**1c. LOC Commands**
The patient is asked to open and close the eyes and then to grip and release the
nonparetic hand. Substitute another one-step command if the hands cannot be
used. Credit is given if an unequivocal attempt is made but not completed due to
weakness. If the patient does not respond to command, the task should be
demonstrated to them (pantomime) and score the result (i.e., follows none, one or
two commands). Patients with trauma, amputation, or other physical impediments
should be given suitable one-step commands. Only the first attempt is scored.
**Correct Answer:** 0 = Performs both tasks correctly
**Grade:** Correct
**2. Best Gaze**
Only horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored but caloric testing is not done. If the
patient has a conjugate deviation of the eyes that can be overcome by voluntary or
reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve
paresis (CN III, IV or VI) score a 1. Gaze is testable in all aphasic patients. Patients
with ocular trauma, bandages, pre-existing blindness or other disorder of visual
acuity or fields should be tested with reflexive movements and a choice made by
the investigator. Establishing eye contact and then moving about the patient from
side to side will occasionally clarify the presence of a partial gaze palsy.
**Correct Answer:** 0 = Normal
**Grade:** Correct
**3. Visual**
Visual fields (upper and lower quadrants) are tested by confrontation, using finger
counting or visual threat as appropriate. Patient must be encouraged, but if they
look at the side of the moving fingers appropriately, this can be scored as normal.
,If there is unilateral blindness or enucleation, visual fields in the remaining eye are
scored. Score 1 only if a clearcut asymmetry, including quadrantanopia is found. If
patient is blind from any cause score 3. Double simultaneous stimulation is
performed at this point. If there is extinction patient receives a 1, and the results
are used to answer question 11.
**Correct Answer:** 0 = No visual loss
**Grade:** Correct
**4. Facial Palsy**
Ask, or use pantomime to encourage the patient to show teeth or raise eyebrows
and close eyes. Score symmetry of grimace in response to noxious stimuli in the
poorly responsive or noncomprehending patient. If facial trauma/bandages,
orotracheal tube, tape or other physical barriers obscure the face, these should be
removed to the extent possible.
**Correct Answer:** 0 = Normal symmetrical movement
**Grade:** Correct
**5a. Motor Arm Left**
The limb is placed in the appropriate position: extend the arms (palms down) 90
degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before
10 seconds. The aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with
the nonparetic arm. Only in the case of amputation or joint fusion at the shoulder,
the examiner should record the score as untestable (UN).
**Correct Answer:** 0 = No drift, limb holds 90 (or 45) degrees for full 10 seconds
**Grade:** Correct
**5b. Motor Arm Right**
The limb is placed in the appropriate position: extend the arms (palms down) 90
degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before
10 seconds. The aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with
the nonparetic arm. Only in the case of amputation or joint fusion at the shoulder,
the examiner should record the score as untestable (UN).
**Selected Answer:** 0 = No drift, limb holds 90 (or 45) degrees for full 10
seconds
, **Grade:** Incorrect (Only error in the test)
**6a. Motor Leg Left**
The limb is placed in the appropriate position: hold the leg at 30 degrees (always
tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient
is encouraged using urgency in the voice and pantomime but not noxious
stimulation. Each limb is tested in turn, beginning with the nonparetic leg. Only in
the case of amputation or joint fusion at the hip, the examiner should record the
score as untestable (UN).
**Correct Answer:** 1 = Drift, leg falls by the end of the 5-second period, but does
not hit bed
**Grade:** Correct
**6b. Motor Leg Right**
The limb is placed in the appropriate position: hold the leg at 30 degrees (always
tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient
is encouraged using urgency in the voice and pantomime but not noxious
stimulation. Each limb is tested in turn, beginning with the nonparetic leg. Only in
the case of amputation or joint fusion at the hip, the examiner should record the
score as untestable (UN).
**Correct Answer:** 0 = No drift, leg holds 30 degrees position for full 5 seconds
**Grade:** Correct
**7. Limb Ataxia**
This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with
eyes open. In case of visual defect, ensure testing is done in intact visual field. The
finger-nose-finger and heel-shin tests are performed on both sides, and ataxia is
scored only if present out of proportion to weakness. Ataxia is absent in the patient
who cannot understand or is paralyzed. Only in the case of amputation or joint
fusion, the examiner should record the score as untestable (UN), and clearly write
the explanation for this choice. In case of blindness, test by having the patient
touch nose from extended arm position.
**Correct Answer:** 1 = Present in one limb
**Grade:** Correct
