NIHSS | Group D
OBJECTIVE ASSESSMENT - EXAM
NIH Stroke Scale
Group D Complete
Patient 1-6 | Certification
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Level of Consciousness & Orientation Ataxia & Coordination Evaluation
Motor Function & Limb Drift Assessment Sensory Function & Language Assessment
Visual Field & Gaze Testing Extinction & Inattention Scoring
COVER PAGE - 1
,SECTION 1 | Level of Consciousness & Orientation | Q1-Q19 | NIH Stroke Scale Group D 2026/2027
Q1 Question 1 of 75
A 72-year-old man is brought to the emergency department after being found unresponsive at
home. On initial assessment, he requires repeated tactile stimulation to remain aroused and
does not maintain wakefulness without stimulation. According to NIHSS Item 1a, what score
should be assigned for Level of Consciousness?
A. 0 -- Alert, keenly responsive
B. 1 -- Not alert but arousable by minor stimulation
C. 2 -- Not alert, requires repeated stimulation to attend
D. 3 -- Unresponsive, requires no stimulation
Correct Answer: A
Rationale:
The patient requires repeated tactile stimulation to maintain arousal, which directly corresponds to a score of
2 on Item 1a. A score of 1 would apply only if minor stimulation were sufficient, and a score of 3 is reserved
for patients who are completely unresponsive to any stimulus.
Q2 Question 2 of 75
A 65-year-old woman with acute left hemiparesis is asked to state the current month and her
age. She correctly states her age but is unable to name the current month. How should this
response be scored under NIHSS Item 1b?
A. 0 -- Both answers correct
B. 1 -- One answer correct
C. 2 -- Neither answer correct
D. 3 -- Unable to assess due to intubation
Correct Answer: B
Rationale:
NIHSS Item 1b requires the patient to answer two questions: the current month and their age. Since the
patient answered one correctly, the score is 1. A score of 0 requires both answers correct, and a score of 2
means neither answer was correct.
NIH Stroke Scale Group D Patient 1-6 Complete -- 2026/2027 | Passing Score: 85% | Page 2 of 40
,Q3 Question 3 of 75
A 58-year-old man presenting with acute stroke is asked to open and close his eyes and to
grip and release his right hand. He performs both tasks correctly and without hesitation. What
is the appropriate NIHSS Item 1c score?
A. 0 -- Performs both tasks correctly
B. 1 -- Performs one task correctly
C. 2 -- Performs neither task correctly
D. UN -- Untestable due to amputation
Correct Answer: C
Rationale:
When a patient performs both tasks correctly on NIHSS Item 1c, the score is 0, indicating no deficit in the
ability to follow commands. A score of 1 applies when only one task is performed correctly, and a score of 2
indicates failure on both tasks.
Q4 Question 4 of 75
A 70-year-old woman is evaluated in the stroke unit following acute onset of right-sided
weakness. She is drowsy but opens her eyes and responds to verbal stimulation without any
physical contact needed. What is the correct NIHSS Item 1a score?
A. 0 -- Alert, keenly responsive
B. 1 -- Not alert but arousable by minor stimulation
C. 2 -- Not alert, requires repeated stimulation to attend
D. 3 -- Unresponsive, requires no stimulation
Correct Answer: D
Rationale:
The patient is not fully alert but can be aroused by verbal stimulation without requiring physical contact,
which corresponds to a score of 1 on Item 1a. A score of 0 requires the patient to be spontaneously alert,
while a score of 2 requires repeated tactile or noxious stimulation.
NIH Stroke Scale Group D Patient 1-6 Complete -- 2026/2027 | Passing Score: 85% | Page 3 of 40
, Q5 Question 5 of 75
A 63-year-old man with suspected stroke is asked the month and his age. He is intubated and
unable to produce verbal responses, but he nods correctly when the examiner asks if the
month is March and if he is 63. How should Item 1b be scored?
A. 0 -- Both answers correct
B. 1 -- One answer correct
C. 2 -- Neither answer correct
D. 1 -- Must be scored based on initial verbal attempt only
Correct Answer: A
Rationale:
For intubated or otherwise nonverbal patients, the examiner should use alternative communication methods
such as nodding or writing. Since the patient correctly confirmed both the month and age, the score is 0. The
NIHSS explicitly allows adaptation for intubated patients.
Q6 Question 6 of 75
A 74-year-old woman with a large right MCA infarct is deeply comatose and shows no
response to noxious stimulation during the NIHSS assessment. The examiner must score Item
1a. Which score is most appropriate?
A. 1 -- Not alert but arousable by minor stimulation
B. 2 -- Not alert, requires repeated stimulation to attend
C. 3 -- Unresponsive to all stimulation
D. 0 -- Alert but confused
Correct Answer: B
Rationale:
A patient who shows no response to noxious stimulation receives a score of 3 on Item 1a, reflecting
complete unresponsiveness. A score of 2 is reserved for patients who respond only to repeated stimulation,
and a score of 1 indicates responsiveness to minor stimulation.
NIH Stroke Scale Group D Patient 1-6 Complete -- 2026/2027 | Passing Score: 85% | Page 4 of 40
OBJECTIVE ASSESSMENT - EXAM
NIH Stroke Scale
Group D Complete
Patient 1-6 | Certification
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Level of Consciousness & Orientation Ataxia & Coordination Evaluation
Motor Function & Limb Drift Assessment Sensory Function & Language Assessment
Visual Field & Gaze Testing Extinction & Inattention Scoring
COVER PAGE - 1
,SECTION 1 | Level of Consciousness & Orientation | Q1-Q19 | NIH Stroke Scale Group D 2026/2027
Q1 Question 1 of 75
A 72-year-old man is brought to the emergency department after being found unresponsive at
home. On initial assessment, he requires repeated tactile stimulation to remain aroused and
does not maintain wakefulness without stimulation. According to NIHSS Item 1a, what score
should be assigned for Level of Consciousness?
A. 0 -- Alert, keenly responsive
B. 1 -- Not alert but arousable by minor stimulation
C. 2 -- Not alert, requires repeated stimulation to attend
D. 3 -- Unresponsive, requires no stimulation
Correct Answer: A
Rationale:
The patient requires repeated tactile stimulation to maintain arousal, which directly corresponds to a score of
2 on Item 1a. A score of 1 would apply only if minor stimulation were sufficient, and a score of 3 is reserved
for patients who are completely unresponsive to any stimulus.
Q2 Question 2 of 75
A 65-year-old woman with acute left hemiparesis is asked to state the current month and her
age. She correctly states her age but is unable to name the current month. How should this
response be scored under NIHSS Item 1b?
A. 0 -- Both answers correct
B. 1 -- One answer correct
C. 2 -- Neither answer correct
D. 3 -- Unable to assess due to intubation
Correct Answer: B
Rationale:
NIHSS Item 1b requires the patient to answer two questions: the current month and their age. Since the
patient answered one correctly, the score is 1. A score of 0 requires both answers correct, and a score of 2
means neither answer was correct.
NIH Stroke Scale Group D Patient 1-6 Complete -- 2026/2027 | Passing Score: 85% | Page 2 of 40
,Q3 Question 3 of 75
A 58-year-old man presenting with acute stroke is asked to open and close his eyes and to
grip and release his right hand. He performs both tasks correctly and without hesitation. What
is the appropriate NIHSS Item 1c score?
A. 0 -- Performs both tasks correctly
B. 1 -- Performs one task correctly
C. 2 -- Performs neither task correctly
D. UN -- Untestable due to amputation
Correct Answer: C
Rationale:
When a patient performs both tasks correctly on NIHSS Item 1c, the score is 0, indicating no deficit in the
ability to follow commands. A score of 1 applies when only one task is performed correctly, and a score of 2
indicates failure on both tasks.
Q4 Question 4 of 75
A 70-year-old woman is evaluated in the stroke unit following acute onset of right-sided
weakness. She is drowsy but opens her eyes and responds to verbal stimulation without any
physical contact needed. What is the correct NIHSS Item 1a score?
A. 0 -- Alert, keenly responsive
B. 1 -- Not alert but arousable by minor stimulation
C. 2 -- Not alert, requires repeated stimulation to attend
D. 3 -- Unresponsive, requires no stimulation
Correct Answer: D
Rationale:
The patient is not fully alert but can be aroused by verbal stimulation without requiring physical contact,
which corresponds to a score of 1 on Item 1a. A score of 0 requires the patient to be spontaneously alert,
while a score of 2 requires repeated tactile or noxious stimulation.
NIH Stroke Scale Group D Patient 1-6 Complete -- 2026/2027 | Passing Score: 85% | Page 3 of 40
, Q5 Question 5 of 75
A 63-year-old man with suspected stroke is asked the month and his age. He is intubated and
unable to produce verbal responses, but he nods correctly when the examiner asks if the
month is March and if he is 63. How should Item 1b be scored?
A. 0 -- Both answers correct
B. 1 -- One answer correct
C. 2 -- Neither answer correct
D. 1 -- Must be scored based on initial verbal attempt only
Correct Answer: A
Rationale:
For intubated or otherwise nonverbal patients, the examiner should use alternative communication methods
such as nodding or writing. Since the patient correctly confirmed both the month and age, the score is 0. The
NIHSS explicitly allows adaptation for intubated patients.
Q6 Question 6 of 75
A 74-year-old woman with a large right MCA infarct is deeply comatose and shows no
response to noxious stimulation during the NIHSS assessment. The examiner must score Item
1a. Which score is most appropriate?
A. 1 -- Not alert but arousable by minor stimulation
B. 2 -- Not alert, requires repeated stimulation to attend
C. 3 -- Unresponsive to all stimulation
D. 0 -- Alert but confused
Correct Answer: B
Rationale:
A patient who shows no response to noxious stimulation receives a score of 3 on Item 1a, reflecting
complete unresponsiveness. A score of 2 is reserved for patients who respond only to repeated stimulation,
and a score of 1 indicates responsiveness to minor stimulation.
NIH Stroke Scale Group D Patient 1-6 Complete -- 2026/2027 | Passing Score: 85% | Page 4 of 40
