NATIONAL INSTITUTES OF HEALTH | STROKE SCALE
NIH STROKE SCALE
PRACTICE EXAM
ALL TEST GROUPS A-F (PATIENTS 1-6)
2026/2027 EDITION
Official Practice Exam -- 2026/2027 Edition
Questions Minutes Passing Score Recertification
50 90 80% 2026/2027
TABLE OF CONTENTS
Section: Group A (Patient 1) -- Level of Consciousness, Orientation, and Gaze . . . . Q1-Q8
Section: Group B (Patient 2) -- Visual Fields, Facial Palsy, and Motor Arm . . . . Q9-Q17
Section: Group C (Patient 3) -- Motor Leg, Limb Ataxia, and Sensory . . . . Q18-Q26
Section: Group D (Patient 4) -- Language, Best Language Assessment . . . . Q27-Q34
Section: Group E (Patient 5) -- Dysarthria and Extinction/Inattention . . . . Q35-Q42
Section: Group F (Patient 6) -- Comprehensive Scoring and Clinical Scenarios . . . . Q43-Q50
Answer Key . . . . . . . . . Last Page
INSTRUCTIONS
This practice exam contains 50 multiple-choice questions across 6 test groups (A-F).
You have 90 minutes to complete the exam. A passing score of 80% (40/50) is required.
Select the single best answer for each question. No penalty for guessing.
The correct answer and rationale follow each question for immediate review.
The 2026/2027 edition reflects the latest NIH Stroke Scale certification standards.
NIH Stroke Scale -- 2026/2027 | Passing Score: 80% | Page 1
,SECTION 1: GROUP A (PATIENT 1) -- LEVEL OF CONSCIOUSNESS, ORIENTATION, AND GAZE -- 2026/2027
Q1 Question 1 of 50
A 72-year-old male arrives in the emergency department with acute left-sided weakness. The nurse applies
gentle pressure to the patient's nail bed and sternal rub, but the patient does not open his eyes or respond.
According to NIH Stroke Scale Item 1a (Level of Consciousness), the nurse should assign a score of which
of the following?
A. Score 3, indicating the patient responds only with reflex motor or autonomic effects or is
unresponsive
B. Score 0, indicating the patient is alert and responsive to stimuli
C. Score 1, indicating the patient is not alert but arouses with minor stimulation
D. Score 2, indicating the patient requires repeated stimulation to attend
Correct Answer: A
Rationale:
A patient who does not open the eyes or respond to noxious stimuli such as sternal rub and nail bed pressure
meets the criteria for a score of 3 on NIHSS Item 1a, which indicates unresponsiveness or reflex-only responses.
Score 0 requires alertness, score 1 requires arousability with minor stimulation, and score 2 requires repeated
stimulation to achieve attention.
Q2 Question 2 of 50
A 65-year-old female with suspected stroke is asked the current month and her age. She correctly states her
age but cannot name the current month, responding with a month from two years ago. Under NIHSS Item 1b
(Level of Consciousness Questions), the nurse should record a score of which of the following?
A. Score 1, because the patient answered only one of two questions correctly
B. Score 0, because the patient answered one of two questions correctly
C. Score 2, because the patient answered neither question correctly
D. Score 3, because the patient showed evidence of confusion
Correct Answer: A
Rationale:
NIHSS Item 1b requires the patient to answer both the month and their age correctly to receive a score of 0;
answering only one correctly results in a score of 1, while answering neither correctly results in a score of 2. The
scale does not have a score of 3 for this item, and partial credit is specifically defined as a score of 1.
NIH Stroke Scale -- 2026/2027 | Passing Score: 80% | Page 2 of 0
, Q3 Question 3 of 50
A 58-year-old male stroke patient is asked to open and close his eyes and to grip and release his
non-paretic hand. He opens his eyes correctly but does not follow the grip-and-release command with either
hand. Under NIHSS Item 1c (Level of Consciousness Commands), the nurse should assign which score?
A. Score 2, because the patient performed neither command correctly
B. Score 0, because the patient performed one of two commands correctly
C. Score 1, because the patient performed only one command correctly
D. Score 3, because the patient showed partial compliance with both commands
Correct Answer: A
Rationale:
NIHSS Item 1c requires the patient to perform both commands correctly for a score of 0, one command correctly
for a score of 1, and neither command correctly for a score of 2, and this patient only opened his eyes but did not
perform the grip-release task. Eye opening counts as one correct command, but since only the non-paretic hand
is assessed for grip, the failure to perform it results in only one of two commands being completed.
Q4 Question 4 of 50
A 70-year-old female with an acute right middle cerebral artery stroke has her eyes open but remains
drowsy and requires repeated verbal prompts to maintain attention during the examination. According to
NIHSS Item 1a, the nurse should assign which of the following scores?
A. Score 2, because the patient requires repeated stimulation to maintain attention
B. Score 0, because the patient is alert with eyes open
C. Score 1, because the patient is not alert but arouses with minor stimulation
D. Score 3, because the patient is unresponsive to verbal stimuli
Correct Answer: A
Rationale:
A patient who requires repeated stimulation to attend and maintain arousal meets the criteria for a score of 2 on
NIHSS Item 1a, as they cannot sustain attention without ongoing prompts. Score 0 requires full alertness, score 1
describes a patient who is not alert but arouses easily with minor stimulation, and score 3 requires complete
unresponsiveness.
NIH Stroke Scale -- 2026/2027 | Passing Score: 80% | Page 3 of 0
NIH STROKE SCALE
PRACTICE EXAM
ALL TEST GROUPS A-F (PATIENTS 1-6)
2026/2027 EDITION
Official Practice Exam -- 2026/2027 Edition
Questions Minutes Passing Score Recertification
50 90 80% 2026/2027
TABLE OF CONTENTS
Section: Group A (Patient 1) -- Level of Consciousness, Orientation, and Gaze . . . . Q1-Q8
Section: Group B (Patient 2) -- Visual Fields, Facial Palsy, and Motor Arm . . . . Q9-Q17
Section: Group C (Patient 3) -- Motor Leg, Limb Ataxia, and Sensory . . . . Q18-Q26
Section: Group D (Patient 4) -- Language, Best Language Assessment . . . . Q27-Q34
Section: Group E (Patient 5) -- Dysarthria and Extinction/Inattention . . . . Q35-Q42
Section: Group F (Patient 6) -- Comprehensive Scoring and Clinical Scenarios . . . . Q43-Q50
Answer Key . . . . . . . . . Last Page
INSTRUCTIONS
This practice exam contains 50 multiple-choice questions across 6 test groups (A-F).
You have 90 minutes to complete the exam. A passing score of 80% (40/50) is required.
Select the single best answer for each question. No penalty for guessing.
The correct answer and rationale follow each question for immediate review.
The 2026/2027 edition reflects the latest NIH Stroke Scale certification standards.
NIH Stroke Scale -- 2026/2027 | Passing Score: 80% | Page 1
,SECTION 1: GROUP A (PATIENT 1) -- LEVEL OF CONSCIOUSNESS, ORIENTATION, AND GAZE -- 2026/2027
Q1 Question 1 of 50
A 72-year-old male arrives in the emergency department with acute left-sided weakness. The nurse applies
gentle pressure to the patient's nail bed and sternal rub, but the patient does not open his eyes or respond.
According to NIH Stroke Scale Item 1a (Level of Consciousness), the nurse should assign a score of which
of the following?
A. Score 3, indicating the patient responds only with reflex motor or autonomic effects or is
unresponsive
B. Score 0, indicating the patient is alert and responsive to stimuli
C. Score 1, indicating the patient is not alert but arouses with minor stimulation
D. Score 2, indicating the patient requires repeated stimulation to attend
Correct Answer: A
Rationale:
A patient who does not open the eyes or respond to noxious stimuli such as sternal rub and nail bed pressure
meets the criteria for a score of 3 on NIHSS Item 1a, which indicates unresponsiveness or reflex-only responses.
Score 0 requires alertness, score 1 requires arousability with minor stimulation, and score 2 requires repeated
stimulation to achieve attention.
Q2 Question 2 of 50
A 65-year-old female with suspected stroke is asked the current month and her age. She correctly states her
age but cannot name the current month, responding with a month from two years ago. Under NIHSS Item 1b
(Level of Consciousness Questions), the nurse should record a score of which of the following?
A. Score 1, because the patient answered only one of two questions correctly
B. Score 0, because the patient answered one of two questions correctly
C. Score 2, because the patient answered neither question correctly
D. Score 3, because the patient showed evidence of confusion
Correct Answer: A
Rationale:
NIHSS Item 1b requires the patient to answer both the month and their age correctly to receive a score of 0;
answering only one correctly results in a score of 1, while answering neither correctly results in a score of 2. The
scale does not have a score of 3 for this item, and partial credit is specifically defined as a score of 1.
NIH Stroke Scale -- 2026/2027 | Passing Score: 80% | Page 2 of 0
, Q3 Question 3 of 50
A 58-year-old male stroke patient is asked to open and close his eyes and to grip and release his
non-paretic hand. He opens his eyes correctly but does not follow the grip-and-release command with either
hand. Under NIHSS Item 1c (Level of Consciousness Commands), the nurse should assign which score?
A. Score 2, because the patient performed neither command correctly
B. Score 0, because the patient performed one of two commands correctly
C. Score 1, because the patient performed only one command correctly
D. Score 3, because the patient showed partial compliance with both commands
Correct Answer: A
Rationale:
NIHSS Item 1c requires the patient to perform both commands correctly for a score of 0, one command correctly
for a score of 1, and neither command correctly for a score of 2, and this patient only opened his eyes but did not
perform the grip-release task. Eye opening counts as one correct command, but since only the non-paretic hand
is assessed for grip, the failure to perform it results in only one of two commands being completed.
Q4 Question 4 of 50
A 70-year-old female with an acute right middle cerebral artery stroke has her eyes open but remains
drowsy and requires repeated verbal prompts to maintain attention during the examination. According to
NIHSS Item 1a, the nurse should assign which of the following scores?
A. Score 2, because the patient requires repeated stimulation to maintain attention
B. Score 0, because the patient is alert with eyes open
C. Score 1, because the patient is not alert but arouses with minor stimulation
D. Score 3, because the patient is unresponsive to verbal stimuli
Correct Answer: A
Rationale:
A patient who requires repeated stimulation to attend and maintain arousal meets the criteria for a score of 2 on
NIHSS Item 1a, as they cannot sustain attention without ongoing prompts. Score 0 requires full alertness, score 1
describes a patient who is not alert but arouses easily with minor stimulation, and score 3 requires complete
unresponsiveness.
NIH Stroke Scale -- 2026/2027 | Passing Score: 80% | Page 3 of 0
