NIHSS Group A Exam Prep 2026 | 200 Practice Questions &
Detailed Answers | Correct Answers Verified | Stroke Scale
Certification
SECTION 1: LEVEL OF CONSCIOUSNESS (LOC) – Item 1a (Questions 1–25)
Question 1
A patient opens their eyes only after a painful stimulus is applied. How should the Level of
Consciousness (LOC) be scored on the NIHSS?
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Rationale: LOC is scored as 2 when the patient opens eyes only to repeated or painful stimulation. A
score of 0 indicates alertness, 1 indicates drowsiness but arousal with minimal stimulation, and 3
indicates no response even with painful stimulation.
Question 2
A patient is fully alert and responds appropriately to questions. What is the correct LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
,Rationale: A score of 0 for LOC indicates that the patient is alert and fully responsive. This is the normal
finding in a patient without impaired consciousness.
Question 3
A patient requires repeated stimulation to remain awake and often falls asleep during the examination.
What is the appropriate LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Rationale: LOC score of 1 indicates that the patient is drowsy but can be aroused with minimal
stimulation to respond to commands or questions.
Question 4
A patient does not respond to any stimuli, including painful ones. What is the correct LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: D) 3
Rationale: A score of 3 for LOC indicates that the patient is unresponsive to any stimuli, including painful
ones. This is the most severe level of impaired consciousness.
,Question 5
What is the maximum possible score for Level of Consciousness (Item 1a) on the NIHSS?
A) 1
B) 2
C) 3
D) 4
Answer: C) 3
Rationale: The maximum score for LOC (Item 1a) is 3, indicating no response to any stimuli. The scores
range from 0 (alert) to 3 (unresponsive).
Question 6
A patient opens eyes to speech but falls asleep when not stimulated. What is the LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Rationale: LOC score of 1 is assigned when the patient is drowsy but responsive to speech or minimal
stimulation. The patient may fall asleep between assessments.
Question 7
, Which of the following is the correct order of LOC scoring from best to worst?
A) 0, 1, 2, 3
B) 3, 2, 1, 0
C) 1, 0, 2, 3
D) 2, 1, 0, 3
Answer: A) 0, 1, 2, 3
Rationale: LOC scores range from 0 (best, alert) to 3 (worst, unresponsive). Lower scores indicate better
neurological function.
Question 8
A patient has no eye opening to painful stimuli. What is the LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: D) 3
Rationale: No eye opening to painful stimuli indicates a severe impairment of consciousness, scored as
3. This is the most severe LOC score.
Question 9
In the NIHSS, the Level of Consciousness score is based on:
A) The patient's verbal response only
B) The patient's motor response only
Detailed Answers | Correct Answers Verified | Stroke Scale
Certification
SECTION 1: LEVEL OF CONSCIOUSNESS (LOC) – Item 1a (Questions 1–25)
Question 1
A patient opens their eyes only after a painful stimulus is applied. How should the Level of
Consciousness (LOC) be scored on the NIHSS?
A) 0
B) 1
C) 2
D) 3
Answer: C) 2
Rationale: LOC is scored as 2 when the patient opens eyes only to repeated or painful stimulation. A
score of 0 indicates alertness, 1 indicates drowsiness but arousal with minimal stimulation, and 3
indicates no response even with painful stimulation.
Question 2
A patient is fully alert and responds appropriately to questions. What is the correct LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
,Rationale: A score of 0 for LOC indicates that the patient is alert and fully responsive. This is the normal
finding in a patient without impaired consciousness.
Question 3
A patient requires repeated stimulation to remain awake and often falls asleep during the examination.
What is the appropriate LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Rationale: LOC score of 1 indicates that the patient is drowsy but can be aroused with minimal
stimulation to respond to commands or questions.
Question 4
A patient does not respond to any stimuli, including painful ones. What is the correct LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: D) 3
Rationale: A score of 3 for LOC indicates that the patient is unresponsive to any stimuli, including painful
ones. This is the most severe level of impaired consciousness.
,Question 5
What is the maximum possible score for Level of Consciousness (Item 1a) on the NIHSS?
A) 1
B) 2
C) 3
D) 4
Answer: C) 3
Rationale: The maximum score for LOC (Item 1a) is 3, indicating no response to any stimuli. The scores
range from 0 (alert) to 3 (unresponsive).
Question 6
A patient opens eyes to speech but falls asleep when not stimulated. What is the LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: B) 1
Rationale: LOC score of 1 is assigned when the patient is drowsy but responsive to speech or minimal
stimulation. The patient may fall asleep between assessments.
Question 7
, Which of the following is the correct order of LOC scoring from best to worst?
A) 0, 1, 2, 3
B) 3, 2, 1, 0
C) 1, 0, 2, 3
D) 2, 1, 0, 3
Answer: A) 0, 1, 2, 3
Rationale: LOC scores range from 0 (best, alert) to 3 (worst, unresponsive). Lower scores indicate better
neurological function.
Question 8
A patient has no eye opening to painful stimuli. What is the LOC score?
A) 0
B) 1
C) 2
D) 3
Answer: D) 3
Rationale: No eye opening to painful stimuli indicates a severe impairment of consciousness, scored as
3. This is the most severe LOC score.
Question 9
In the NIHSS, the Level of Consciousness score is based on:
A) The patient's verbal response only
B) The patient's motor response only
