NIH STROKE SCALE GROUP PATIENT 1-6 STUDY GUIDE
UPDATED 2026/2027 SYLLABUS
100+ QUESTIONS AND VERIFIED ANSWERS
Instructions
This guide is divided into sections. The first section covers the fundamental principles of
each NIHSS item. The subsequent sections apply these principles to specific patient
scenarios typically found in Groups A through F. For each question, select the correct
score or interpretation.
Section 1: General Principles & Scoring Fundamentals (Questions
1-25)
1. According to the NIHSS, what range of scores indicates a "moderate" stroke severity?
A) 0–4
B) 5–15
C) 16–20
D) 21–42
o ANSWER ✓ B) 5–15. Rationale: The NIHSS total score classifies severity as follows: 0 =
no stroke symptoms; 1–4 = mild; 5–15 = moderate; 16–20 = moderate to severe; 21–42
= severe .
2. For item 1B (LOC Questions), the patient is asked which two specific questions?
A) "What is your name?" and "Where are you?"
B) "What month is it?" and "How old are you?"
C) "What day of the week is it?" and "What year is it?"
D) "Who is the President?" and "Where is the hospital?"
o ANSWER ✓ B) "What month is it?" and "How old are you?" Rationale: The
standardized questions for NIHSS item 1B are the current month and the patient's age .
3. A patient follows the command to blink but does not squeeze your hand when asked.
According to item 1C (LOC Commands), what score should be assigned?
A) 0
B) 1
C) 2
D) 3
,o ANSWER ✓ B) 1. Rationale: Item 1C scores the ability to perform two commands
(open/close eyes and grip/release hand). A score of 1 is given if the patient performs
only one task correctly .
4. When testing motor function in the arm (item 5), how long should the patient be asked
to hold the limb in position?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
o ANSWER ✓ B) 10 seconds. Rationale: For the arm, the patient holds the limb at 90°
(sitting) or 45° (supine) for a full 10 seconds to check for drift .
5. A patient with known arthritis and joint fusion in the left arm is being tested. How
should the motor arm item (5a) be scored?
A) Score as 4 (No movement)
B) Score as 2 (Some effort against gravity)
C) Score as "UN" (Untestable)
D) Estimate the score based on the right arm
o ANSWER ✓ C) Score as "UN" (Untestable). Rationale: If a limb is amputated or joint
fusion prevents movement, the item is marked as "Untestable" (UN) .
6. What does item 2 (Best Gaze) test?
A) Vertical eye movements and pupil reactivity
B) Horizontal eye movements
C) Convergence and accommodation
D) Oculocephalic reflex only
o ANSWER ✓ B) Horizontal eye movements. Rationale: Item 2 specifically assesses
horizontal eye movements, looking for partial gaze palsy or forced deviation .
7. A patient is intubated and cannot speak. How should item 10 (Dysarthria) be scored?
A) Score as 2 (Severe dysarthria)
B) Score as 1 (Mild dysarthria)
C) Score as "Untestable"
D) Ask the patient to write their response
o ANSWER ✓ C) Score as "Untestable". Rationale: If the patient is intubated, has a
physical barrier, or cannot be assessed for speech clarity, the item should be marked
"Untestable." .
8. In item 9 (Best Language), a patient with global aphasia (no usable speech or
comprehension) would receive a score of:
A) 1
B) 2
, C) 3
D) 4
o ANSWER ✓ C) 3. Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild to moderate
aphasia; 2 = Severe aphasia; 3 = Mute or global aphasia .
9. What is the primary purpose of the NIH Stroke Scale?
A) To determine the exact location of the stroke
B) To quantify the severity of stroke symptoms and neurological deficits
C) To diagnose the type of stroke (ischemic vs. hemorrhagic)
D) To assess the patient's long-term rehabilitation potential
o ANSWER ✓ B) To quantify the severity of stroke symptoms and neurological
deficits. Rationale: The NIHSS is a standardized tool used to objectively measure the
severity of stroke-related neurological impairment .
10. For item 8 (Sensory), if the patient's pinprick sensation on the affected side is clearly
diminished but not absent, the correct score is:
A) 0
B) 1
C) 2
D) UN
o ANSWER ✓ B) 1. Rationale: A score of 1 is given for mild-to-moderate sensory loss .
11. During the sensory exam, a patient with decreased level of consciousness withdraws or
grimaces to a painful stimulus on both sides. The correct score for item 8 is:
A) 0
B) 1
C) 2
D) UN
o ANSWER ✓ A) 0. Rationale: In an obtunded or aphasic patient, scoring is based on the
symmetry of grimacing or withdrawal. If symmetric, sensation is considered normal .
12. A patient's left arm drifts down to the bed 8 seconds after being placed in the proper
position but does not hit the bed. The score for item 5a (Left Motor Arm) is:
A) 0
B) 1
C) 2
D) 3
o ANSWER ✓ B) 1. Rationale: A score of 1 is given when the limb drifts down before the
full 10 seconds but does not hit the bed .
13. When testing motor function in the leg (item 6), how long should the patient be asked
to hold the limb in position?
A) 5 seconds
UPDATED 2026/2027 SYLLABUS
100+ QUESTIONS AND VERIFIED ANSWERS
Instructions
This guide is divided into sections. The first section covers the fundamental principles of
each NIHSS item. The subsequent sections apply these principles to specific patient
scenarios typically found in Groups A through F. For each question, select the correct
score or interpretation.
Section 1: General Principles & Scoring Fundamentals (Questions
1-25)
1. According to the NIHSS, what range of scores indicates a "moderate" stroke severity?
A) 0–4
B) 5–15
C) 16–20
D) 21–42
o ANSWER ✓ B) 5–15. Rationale: The NIHSS total score classifies severity as follows: 0 =
no stroke symptoms; 1–4 = mild; 5–15 = moderate; 16–20 = moderate to severe; 21–42
= severe .
2. For item 1B (LOC Questions), the patient is asked which two specific questions?
A) "What is your name?" and "Where are you?"
B) "What month is it?" and "How old are you?"
C) "What day of the week is it?" and "What year is it?"
D) "Who is the President?" and "Where is the hospital?"
o ANSWER ✓ B) "What month is it?" and "How old are you?" Rationale: The
standardized questions for NIHSS item 1B are the current month and the patient's age .
3. A patient follows the command to blink but does not squeeze your hand when asked.
According to item 1C (LOC Commands), what score should be assigned?
A) 0
B) 1
C) 2
D) 3
,o ANSWER ✓ B) 1. Rationale: Item 1C scores the ability to perform two commands
(open/close eyes and grip/release hand). A score of 1 is given if the patient performs
only one task correctly .
4. When testing motor function in the arm (item 5), how long should the patient be asked
to hold the limb in position?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
o ANSWER ✓ B) 10 seconds. Rationale: For the arm, the patient holds the limb at 90°
(sitting) or 45° (supine) for a full 10 seconds to check for drift .
5. A patient with known arthritis and joint fusion in the left arm is being tested. How
should the motor arm item (5a) be scored?
A) Score as 4 (No movement)
B) Score as 2 (Some effort against gravity)
C) Score as "UN" (Untestable)
D) Estimate the score based on the right arm
o ANSWER ✓ C) Score as "UN" (Untestable). Rationale: If a limb is amputated or joint
fusion prevents movement, the item is marked as "Untestable" (UN) .
6. What does item 2 (Best Gaze) test?
A) Vertical eye movements and pupil reactivity
B) Horizontal eye movements
C) Convergence and accommodation
D) Oculocephalic reflex only
o ANSWER ✓ B) Horizontal eye movements. Rationale: Item 2 specifically assesses
horizontal eye movements, looking for partial gaze palsy or forced deviation .
7. A patient is intubated and cannot speak. How should item 10 (Dysarthria) be scored?
A) Score as 2 (Severe dysarthria)
B) Score as 1 (Mild dysarthria)
C) Score as "Untestable"
D) Ask the patient to write their response
o ANSWER ✓ C) Score as "Untestable". Rationale: If the patient is intubated, has a
physical barrier, or cannot be assessed for speech clarity, the item should be marked
"Untestable." .
8. In item 9 (Best Language), a patient with global aphasia (no usable speech or
comprehension) would receive a score of:
A) 1
B) 2
, C) 3
D) 4
o ANSWER ✓ C) 3. Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild to moderate
aphasia; 2 = Severe aphasia; 3 = Mute or global aphasia .
9. What is the primary purpose of the NIH Stroke Scale?
A) To determine the exact location of the stroke
B) To quantify the severity of stroke symptoms and neurological deficits
C) To diagnose the type of stroke (ischemic vs. hemorrhagic)
D) To assess the patient's long-term rehabilitation potential
o ANSWER ✓ B) To quantify the severity of stroke symptoms and neurological
deficits. Rationale: The NIHSS is a standardized tool used to objectively measure the
severity of stroke-related neurological impairment .
10. For item 8 (Sensory), if the patient's pinprick sensation on the affected side is clearly
diminished but not absent, the correct score is:
A) 0
B) 1
C) 2
D) UN
o ANSWER ✓ B) 1. Rationale: A score of 1 is given for mild-to-moderate sensory loss .
11. During the sensory exam, a patient with decreased level of consciousness withdraws or
grimaces to a painful stimulus on both sides. The correct score for item 8 is:
A) 0
B) 1
C) 2
D) UN
o ANSWER ✓ A) 0. Rationale: In an obtunded or aphasic patient, scoring is based on the
symmetry of grimacing or withdrawal. If symmetric, sensation is considered normal .
12. A patient's left arm drifts down to the bed 8 seconds after being placed in the proper
position but does not hit the bed. The score for item 5a (Left Motor Arm) is:
A) 0
B) 1
C) 2
D) 3
o ANSWER ✓ B) 1. Rationale: A score of 1 is given when the limb drifts down before the
full 10 seconds but does not hit the bed .
13. When testing motor function in the leg (item 6), how long should the patient be asked
to hold the limb in position?
A) 5 seconds
