NIH STROKE SCALE CERTIFICATION GROUP D EXAM ACTUAL
2026/2027 PATIENT 1-6 PRACTICE QUESTIONS AND STUDY GUIDE
COMPLETE ACCURATE EXAM ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED PASS A+ (BRAND NEW!)
Patient 1: A 65-year-old male with acute left hemisphere stroke is alert and fully
oriented. According to NIHSS item 1a (Level of Consciousness), what is the
correct score?
A) 1
B) 2
C) 3
D) 0 (CORRECT ANSWER)
Rationale: Item 1a scores 0 if the patient is alert and responsive. A score of 1
indicates drowsiness but arousable, 2 indicates stupor, and 3 indicates coma. The
patient is alert, so 0 is correct.
Patient 1: For the same patient, item 1b (LOC Questions) asks the month and age.
The patient answers both correctly. What is the score?
A) 1
B) 0 (CORRECT ANSWER)
C) 2
D) 3
Rationale: Item 1b scores 0 if both questions are answered correctly, 1 if one
correct, and 2 if neither correct. The patient answered both correctly, so score 0.
,Patient 1: Item 1c (LOC Commands) instructs the patient to open and close eyes
and then grip and release. The patient performs both tasks correctly. What is the
score?
A) 1
B) 2
C) 0 (CORRECT ANSWER)
D) 3
Rationale: Item 1c scores 0 if both commands are performed correctly, 1 if one
correct, 2 if neither. Correct performance of both yields 0.
Patient 1: For best gaze (item 2), the patient has conjugate eye deviation to the left
that is not overcome by voluntary or reflexive head movements. What is the score?
A) 0
B) 1
C) 2 (CORRECT ANSWER)
D) 3
Rationale: Item 2 scores 0 for normal, 1 for partial gaze palsy (deviation overcome
by oculocephalic reflex), and 2 for forced deviation (not overcome). Here deviation
is not overcome, so score 2.
Patient 1: Facial palsy (item 4) shows right lower facial weakness with nasolabial
fold flattening. The patient can move forehead symmetrically. What is the score?
A) 0
B) 1 (CORRECT ANSWER)
C) 2
D) 3
,Rationale: Item 4: 0=normal, 1=minor (flattened nasolabial fold, asymmetric
smile), 2=partial (lower face weakness, unable to show teeth), 3=complete. This
describes minor facial weakness, so score 1.
Patient 1: Motor arm (item 5a, left arm) – the patient holds the left arm at 90
degrees for 10 seconds without drift. Score?
A) 0 (CORRECT ANSWER)
B) 1
C) 2
D) 3
Rationale: Score 0 for no drift for full 10 seconds. Score 1 for drift before 10
seconds but does not hit bed. Score 2 for some effort against gravity but falls.
Score 3 for no effort. Here stable, so 0.
Patient 1: Motor arm (item 5b, right arm) – the patient’s right arm drifts down
before 10 seconds but does not touch the bed. Score?
A) 0
B) 1 (CORRECT ANSWER)
C) 2
D) 3
Rationale: Drift but not hitting bed is score 1. Score 2 if arm falls to bed. Score 0 if
no drift. So correct is 1.
Patient 1: Motor leg (item 6a, left leg) – the patient lifts left leg to 30 degrees and
maintains for 5 seconds before drifting to bed. Score?
A) 0
B) 1
C) 2 (CORRECT ANSWER)
, D) 3
Rationale: Leg held at 30 degrees: score 0 if no drift for 5 seconds; score 1 if drift
but not hitting bed; score 2 if falls to bed before 5 seconds; score 3 if no effort.
Drifting to bed gives score 2.
Patient 1: Motor leg (item 6b, right leg) – the patient has no movement in right leg
against gravity. Score?
A) 0
B) 1
C) 2
D) 3 (CORRECT ANSWER)
Rationale: No effort against gravity is score 3. Score 2 if some effort but falls, 1 if
drift, 0 if normal.
Patient 1: Limb ataxia (item 7) – finger-to-nose and heel-to-shin tests show no
dysmetria on either side. The patient is alert and able to cooperate. Score?
A) 0 (CORRECT ANSWER)
B) 1
C) 2
D) Untestable
Rationale: Score 0 if no ataxia. Score 1 if ataxia in one limb, 2 if in two or more
limbs. Untestable is not a score but a notation. Since no ataxia, score 0.
Patient 1: Sensory (item 8) – pinprick reveals decreased sensation on the right face,
arm, and leg. The patient is aware of the stimulus but feels it as dull. Score?
A) 0
B) 1 (CORRECT ANSWER)
C) 2
2026/2027 PATIENT 1-6 PRACTICE QUESTIONS AND STUDY GUIDE
COMPLETE ACCURATE EXAM ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED PASS A+ (BRAND NEW!)
Patient 1: A 65-year-old male with acute left hemisphere stroke is alert and fully
oriented. According to NIHSS item 1a (Level of Consciousness), what is the
correct score?
A) 1
B) 2
C) 3
D) 0 (CORRECT ANSWER)
Rationale: Item 1a scores 0 if the patient is alert and responsive. A score of 1
indicates drowsiness but arousable, 2 indicates stupor, and 3 indicates coma. The
patient is alert, so 0 is correct.
Patient 1: For the same patient, item 1b (LOC Questions) asks the month and age.
The patient answers both correctly. What is the score?
A) 1
B) 0 (CORRECT ANSWER)
C) 2
D) 3
Rationale: Item 1b scores 0 if both questions are answered correctly, 1 if one
correct, and 2 if neither correct. The patient answered both correctly, so score 0.
,Patient 1: Item 1c (LOC Commands) instructs the patient to open and close eyes
and then grip and release. The patient performs both tasks correctly. What is the
score?
A) 1
B) 2
C) 0 (CORRECT ANSWER)
D) 3
Rationale: Item 1c scores 0 if both commands are performed correctly, 1 if one
correct, 2 if neither. Correct performance of both yields 0.
Patient 1: For best gaze (item 2), the patient has conjugate eye deviation to the left
that is not overcome by voluntary or reflexive head movements. What is the score?
A) 0
B) 1
C) 2 (CORRECT ANSWER)
D) 3
Rationale: Item 2 scores 0 for normal, 1 for partial gaze palsy (deviation overcome
by oculocephalic reflex), and 2 for forced deviation (not overcome). Here deviation
is not overcome, so score 2.
Patient 1: Facial palsy (item 4) shows right lower facial weakness with nasolabial
fold flattening. The patient can move forehead symmetrically. What is the score?
A) 0
B) 1 (CORRECT ANSWER)
C) 2
D) 3
,Rationale: Item 4: 0=normal, 1=minor (flattened nasolabial fold, asymmetric
smile), 2=partial (lower face weakness, unable to show teeth), 3=complete. This
describes minor facial weakness, so score 1.
Patient 1: Motor arm (item 5a, left arm) – the patient holds the left arm at 90
degrees for 10 seconds without drift. Score?
A) 0 (CORRECT ANSWER)
B) 1
C) 2
D) 3
Rationale: Score 0 for no drift for full 10 seconds. Score 1 for drift before 10
seconds but does not hit bed. Score 2 for some effort against gravity but falls.
Score 3 for no effort. Here stable, so 0.
Patient 1: Motor arm (item 5b, right arm) – the patient’s right arm drifts down
before 10 seconds but does not touch the bed. Score?
A) 0
B) 1 (CORRECT ANSWER)
C) 2
D) 3
Rationale: Drift but not hitting bed is score 1. Score 2 if arm falls to bed. Score 0 if
no drift. So correct is 1.
Patient 1: Motor leg (item 6a, left leg) – the patient lifts left leg to 30 degrees and
maintains for 5 seconds before drifting to bed. Score?
A) 0
B) 1
C) 2 (CORRECT ANSWER)
, D) 3
Rationale: Leg held at 30 degrees: score 0 if no drift for 5 seconds; score 1 if drift
but not hitting bed; score 2 if falls to bed before 5 seconds; score 3 if no effort.
Drifting to bed gives score 2.
Patient 1: Motor leg (item 6b, right leg) – the patient has no movement in right leg
against gravity. Score?
A) 0
B) 1
C) 2
D) 3 (CORRECT ANSWER)
Rationale: No effort against gravity is score 3. Score 2 if some effort but falls, 1 if
drift, 0 if normal.
Patient 1: Limb ataxia (item 7) – finger-to-nose and heel-to-shin tests show no
dysmetria on either side. The patient is alert and able to cooperate. Score?
A) 0 (CORRECT ANSWER)
B) 1
C) 2
D) Untestable
Rationale: Score 0 if no ataxia. Score 1 if ataxia in one limb, 2 if in two or more
limbs. Untestable is not a score but a notation. Since no ataxia, score 0.
Patient 1: Sensory (item 8) – pinprick reveals decreased sensation on the right face,
arm, and leg. The patient is aware of the stimulus but feels it as dull. Score?
A) 0
B) 1 (CORRECT ANSWER)
C) 2
