NIH Stroke Scale NIHSS Group A Patients
1-6 Certification Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
Section 1: Patient 1 — Complete NIHSS Scoring (Questions
1–15)
Patient 1 Clinical Profile: 68-year-old male, 2 hours post onset of left-sided weakness. Alert,
cooperative, with mild dysarthria and subtle right facial droop. No visual field deficits. Able to follow
all commands.
Q1: Patient 1, Item 1a — Level of Consciousness: The patient opens eyes spontaneously when
you enter the room, is fully oriented to person, place, and time, and engages in normal
conversation. He remains alert throughout the entire examination without any stimulation required.
A. 0
,B. 1
C. 2
D. 3
Correct Answer: A
Rationale: The correct score is 0 because the patient is fully alert and responsive without any
stimulation needed. Per the NIHSS training manual, a score of 0 on Item 1a indicates the patient is
alert and engaged spontaneously. Remember that even if a patient has aphasia or other deficits, if
they are alert and responsive, they still score 0 on this item—LOC is about arousal, not cognitive
content.
Q2: Patient 1, Item 1b — LOC Questions (Month and Age): The patient correctly states he is 68
years old, but when asked what month it is, he pauses for 8 seconds, then says "October" when it
is actually November. He does not correct himself.
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: B
,Rationale: The correct score is 1 because the patient got one question correct (age) and one
incorrect (month). According to the standardized NIHSS instructions, you score 1 when the patient
answers one of the two questions correctly. A common pitfall is giving the "benefit of the doubt"
when a patient is close, but the rules are strict—it's either correct or incorrect, no partial credit for
being "almost right."
Q3: Patient 1, Item 1c — LOC Commands: You instruct the patient to "open and close your eyes"
and "make a fist and let go with your other hand." The patient performs both tasks correctly on the
first attempt without hesitation.
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: A
Rationale: The correct score is 0 because the patient correctly performs both commands.
Remember that for Item 1c, you test both limbs—if the patient gets both right, it's a 0; if they get
one right, it's a 1; if both are wrong, it's a 2. The "untestable" code only applies if there's an
amputation or severe arthritic deformity preventing the movement, which isn't the case here.
, Q4: Patient 1, Item 2 — Best Gaze: When testing horizontal eye movements, the patient's eyes
track your finger smoothly across the midline to both sides. There is no deviation, nystagmus, or
disconjugate gaze noted. The patient has full range of motion.
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: A
Rationale: The correct score is 0 for normal gaze. The patient's eyes move together across the full
range without any palsy or forced deviation. Per NIHSS standards, you only score higher if there's
clear evidence of gaze palsy—either partial (1) or total forced deviation (2). Remember that if the
patient has an ocular prosthesis or prior enucleation, you would mark "untestable," but normal
tracking is always a 0.
Q5: Patient 1, Item 3 — Visual Fields: Using confrontation testing, the patient correctly identifies
your fingers on both the right and left sides simultaneously. When testing upper and lower
quadrants, there are no areas where the patient fails to see the stimulus. Visual fields are intact in
both eyes.
A. 0
B. 1
1-6 Certification Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
Section 1: Patient 1 — Complete NIHSS Scoring (Questions
1–15)
Patient 1 Clinical Profile: 68-year-old male, 2 hours post onset of left-sided weakness. Alert,
cooperative, with mild dysarthria and subtle right facial droop. No visual field deficits. Able to follow
all commands.
Q1: Patient 1, Item 1a — Level of Consciousness: The patient opens eyes spontaneously when
you enter the room, is fully oriented to person, place, and time, and engages in normal
conversation. He remains alert throughout the entire examination without any stimulation required.
A. 0
,B. 1
C. 2
D. 3
Correct Answer: A
Rationale: The correct score is 0 because the patient is fully alert and responsive without any
stimulation needed. Per the NIHSS training manual, a score of 0 on Item 1a indicates the patient is
alert and engaged spontaneously. Remember that even if a patient has aphasia or other deficits, if
they are alert and responsive, they still score 0 on this item—LOC is about arousal, not cognitive
content.
Q2: Patient 1, Item 1b — LOC Questions (Month and Age): The patient correctly states he is 68
years old, but when asked what month it is, he pauses for 8 seconds, then says "October" when it
is actually November. He does not correct himself.
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: B
,Rationale: The correct score is 1 because the patient got one question correct (age) and one
incorrect (month). According to the standardized NIHSS instructions, you score 1 when the patient
answers one of the two questions correctly. A common pitfall is giving the "benefit of the doubt"
when a patient is close, but the rules are strict—it's either correct or incorrect, no partial credit for
being "almost right."
Q3: Patient 1, Item 1c — LOC Commands: You instruct the patient to "open and close your eyes"
and "make a fist and let go with your other hand." The patient performs both tasks correctly on the
first attempt without hesitation.
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: A
Rationale: The correct score is 0 because the patient correctly performs both commands.
Remember that for Item 1c, you test both limbs—if the patient gets both right, it's a 0; if they get
one right, it's a 1; if both are wrong, it's a 2. The "untestable" code only applies if there's an
amputation or severe arthritic deformity preventing the movement, which isn't the case here.
, Q4: Patient 1, Item 2 — Best Gaze: When testing horizontal eye movements, the patient's eyes
track your finger smoothly across the midline to both sides. There is no deviation, nystagmus, or
disconjugate gaze noted. The patient has full range of motion.
A. 0
B. 1
C. 2
D. Untestable
Correct Answer: A
Rationale: The correct score is 0 for normal gaze. The patient's eyes move together across the full
range without any palsy or forced deviation. Per NIHSS standards, you only score higher if there's
clear evidence of gaze palsy—either partial (1) or total forced deviation (2). Remember that if the
patient has an ocular prosthesis or prior enucleation, you would mark "untestable," but normal
tracking is always a 0.
Q5: Patient 1, Item 3 — Visual Fields: Using confrontation testing, the patient correctly identifies
your fingers on both the right and left sides simultaneously. When testing upper and lower
quadrants, there are no areas where the patient fails to see the stimulus. Visual fields are intact in
both eyes.
A. 0
B. 1
