NIHSS GROUP C PATIENTS 1-6 2026/2027 Actual
Exam – Complete Questions & Detailed Rationales
– Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Level of Consciousness & Orientation | Q1 – Q10
Section 2 | Gaze, Visual & Facial Palsy | Q11 – Q20
Section 3 | Motor Arm & Motor Leg | Q21 – Q30
Section 4 | Limb Ataxia, Sensory & Language | Q31 – Q40
Section 5 | Dysarthria, Extinction & Neglect | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
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SECTION 1: LEVEL OF CONSCIOUSNESS & ORIENTATION Q1 – Q10
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Question 1 of 50
A 72-year-old male is examined three hours after onset of a left MCA stroke. He is alert,
answers all questions correctly, and follows both commands without hesitation. What is
the correct NIHSS score for item 1a, Level of Consciousness?
A. 0 ✓ CORRECT
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: Item 1a is scored 0 when the patient is alert and responsive with a normal
level of consciousness. Some examiners mistakenly score 1 if the patient has aphasia
or other deficits, but LOC is strictly about arousal, not language or motor function.
Always assess arousal first before moving to questions and commands.
,Question 2 of 50
A 68-year-old female is evaluated six hours after stroke onset. When asked what month
it is, she states "December" correctly. When asked her age, she says "55," though her
chart confirms she is 68. What is the correct NIHSS score for item 1b, LOC Questions?
A. 0
B. 1 ✓ CORRECT
C. 2
D. UN
Correct Answer: B
Rationale: Item 1b is scored 1 when the patient correctly answers one of the two
orientation questions. Incorrect responses due to disorientation or aphasia are scored
the same way, and scoring 0 would require both answers to be correct. A score of 2 is
reserved for when neither question is answered correctly.
Question 3 of 50
A 55-year-old male with right hemiparesis is tested for item 1c. He opens and closes his
eyes on command correctly. When asked to grip and release the examiner's fingers with
his left hand, he grips firmly but is unable to release. What is the correct NIHSS score for
item 1c, LOC Commands?
A. 0
B. 2
C. 1 ✓ CORRECT
D. 3
Correct Answer: C
Rationale: Item 1c is scored 1 when the patient correctly performs one of the two
commands, testing the non-paretic hand for grip and release. Scoring 0 requires both
, commands to be correct, and 2 is for neither; there is no score of 3 on this item. Always
test the non-paretic hand to avoid confounding by motor weakness.
Question 4 of 50
An 80-year-old female is found down at home. She does not open her eyes to voice or
pain, is flaccid in all extremities, and shows no motor response to noxious stimulation.
What is the correct NIHSS score for item 1a, Level of Consciousness?
A. 0
B. 1
C. 2
D. 3 ✓ CORRECT
Correct Answer: D
Rationale: Item 1a is scored 3 for coma when there is no eye opening to voice or pain
and no motor response beyond reflex posturing. Withdrawal to pain would be scored 2,
so examiners must distinguish purposeful withdrawal from reflex responses. Flaccid
coma without any response represents the most severe impairment of consciousness.
Question 5 of 50
A 62-year-old male with severe global aphasia is unable to verbalize or write the month
or age despite multiple attempts and alternate phrasing. What is the correct NIHSS
score for item 1b, LOC Questions?
A. 2 ✓ CORRECT
B. 1
C. 0
D. UN
Correct Answer: A
Rationale: Item 1b is scored 2 when the patient cannot answer either question due to
aphasia, stupor, or disorientation. Scoring 1 would be appropriate if one answer was
Exam – Complete Questions & Detailed Rationales
– Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Level of Consciousness & Orientation | Q1 – Q10
Section 2 | Gaze, Visual & Facial Palsy | Q11 – Q20
Section 3 | Motor Arm & Motor Leg | Q21 – Q30
Section 4 | Limb Ataxia, Sensory & Language | Q31 – Q40
Section 5 | Dysarthria, Extinction & Neglect | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: LEVEL OF CONSCIOUSNESS & ORIENTATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old male is examined three hours after onset of a left MCA stroke. He is alert,
answers all questions correctly, and follows both commands without hesitation. What is
the correct NIHSS score for item 1a, Level of Consciousness?
A. 0 ✓ CORRECT
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: Item 1a is scored 0 when the patient is alert and responsive with a normal
level of consciousness. Some examiners mistakenly score 1 if the patient has aphasia
or other deficits, but LOC is strictly about arousal, not language or motor function.
Always assess arousal first before moving to questions and commands.
,Question 2 of 50
A 68-year-old female is evaluated six hours after stroke onset. When asked what month
it is, she states "December" correctly. When asked her age, she says "55," though her
chart confirms she is 68. What is the correct NIHSS score for item 1b, LOC Questions?
A. 0
B. 1 ✓ CORRECT
C. 2
D. UN
Correct Answer: B
Rationale: Item 1b is scored 1 when the patient correctly answers one of the two
orientation questions. Incorrect responses due to disorientation or aphasia are scored
the same way, and scoring 0 would require both answers to be correct. A score of 2 is
reserved for when neither question is answered correctly.
Question 3 of 50
A 55-year-old male with right hemiparesis is tested for item 1c. He opens and closes his
eyes on command correctly. When asked to grip and release the examiner's fingers with
his left hand, he grips firmly but is unable to release. What is the correct NIHSS score for
item 1c, LOC Commands?
A. 0
B. 2
C. 1 ✓ CORRECT
D. 3
Correct Answer: C
Rationale: Item 1c is scored 1 when the patient correctly performs one of the two
commands, testing the non-paretic hand for grip and release. Scoring 0 requires both
, commands to be correct, and 2 is for neither; there is no score of 3 on this item. Always
test the non-paretic hand to avoid confounding by motor weakness.
Question 4 of 50
An 80-year-old female is found down at home. She does not open her eyes to voice or
pain, is flaccid in all extremities, and shows no motor response to noxious stimulation.
What is the correct NIHSS score for item 1a, Level of Consciousness?
A. 0
B. 1
C. 2
D. 3 ✓ CORRECT
Correct Answer: D
Rationale: Item 1a is scored 3 for coma when there is no eye opening to voice or pain
and no motor response beyond reflex posturing. Withdrawal to pain would be scored 2,
so examiners must distinguish purposeful withdrawal from reflex responses. Flaccid
coma without any response represents the most severe impairment of consciousness.
Question 5 of 50
A 62-year-old male with severe global aphasia is unable to verbalize or write the month
or age despite multiple attempts and alternate phrasing. What is the correct NIHSS
score for item 1b, LOC Questions?
A. 2 ✓ CORRECT
B. 1
C. 0
D. UN
Correct Answer: A
Rationale: Item 1b is scored 2 when the patient cannot answer either question due to
aphasia, stupor, or disorientation. Scoring 1 would be appropriate if one answer was
