NIH Stroke Scale (NIHSS) Group E Practice Exam
2026 NIH Stroke Scale (NIHSS) Group E
Practice Exam 100 Questions and
Answers with Rationales
1. What is the primary purpose of the NIH Stroke Scale (NIHSS)?
A. Diagnose all neurological diseases
B. Determine blood glucose levels
C. ✅✅ Quantify the severity of neurological deficits caused by acute stroke
D. Predict long-term cognitive decline only
Answer: ✅✅ C
Rationale: The NIHSS provides a standardized, reproducible assessment of neurological
impairment in patients with suspected acute stroke. It helps guide treatment decisions, monitor
changes, and facilitate communication among healthcare providers.
2. Which patient is most appropriate for NIHSS assessment?
A. Patient with isolated migraine headache
B. Patient with chronic dementia and no acute change
C. ✅✅ Patient with suspected acute ischemic or hemorrhagic stroke
D. Patient with uncomplicated hypertension
Answer: ✅✅ C
Rationale: The NIHSS is designed for evaluating neurological deficits associated with acute
stroke.
3. Which NIHSS item assesses the patient's level of consciousness?
A. Facial palsy
B. ✅✅ Item 1
C. Motor arm
D. Dysarthria
Answer: ✅✅ B
, NIH Stroke Scale (NIHSS) Group E Practice Exam
Rationale: Item 1 evaluates level of consciousness, including responsiveness and ability to
answer questions and follow commands.
4. During the NIHSS examination, a patient correctly states the current month
but cannot state their age. How is Item 1b scored?
A. 0
B. ✅✅ 1
C. 2
D. 3
Answer: ✅✅ B
Rationale: Item 1b awards:
0 = both questions correct
1 = one question correct
2 = neither correct
5. Which command is commonly used for NIHSS Item 1c?
A. Count backward from 100
B. Name five animals
C. ✅✅ Open and close your eyes; grip and release your hand
D. Walk across the room
Answer: ✅✅ C
Rationale: Item 1c evaluates the ability to follow simple commands.
6. Which NIHSS item evaluates horizontal eye movements?
A. Visual fields
B. ✅✅ Best Gaze
C. Limb ataxia
D. Neglect
Answer: ✅✅ B
, NIH Stroke Scale (NIHSS) Group E Practice Exam
Rationale: Best Gaze assesses voluntary horizontal eye movement.
7. Forced deviation of the eyes is scored as:
A. 0
B. 1
C. ✅✅ 2
D. 3
Answer: ✅✅ C
Rationale: Forced gaze deviation that cannot be overcome scores the maximum for the Best
Gaze item.
8. Which NIHSS item evaluates visual field deficits?
A. Motor leg
B. ✅✅ Visual Fields
C. Sensory
D. Dysarthria
Answer: ✅✅ B
Rationale: Visual fields are tested by confrontation in each quadrant.
9. A patient has complete hemianopia. How is the visual field item scored?
A. 0
B. 1
C. ✅✅ 2
D. 3
Answer: ✅✅ C
Rationale: Complete hemianopia scores 2 points.
, NIH Stroke Scale (NIHSS) Group E Practice Exam
10. Which cranial nerve is primarily evaluated during the facial palsy
assessment?
A. CN III
B. CN V
C. ✅✅ CN VII
D. CN XII
Answer: ✅✅ C
Rationale: Facial movements are mediated by the facial nerve (cranial nerve VII).
11. Which facial finding receives the highest NIHSS facial palsy score?
A. Minor asymmetry
B. Flattened nasolabial fold
C. ✅✅ Complete unilateral facial paralysis
D. Mild drooping only
Answer: ✅✅ C
Rationale: Complete paralysis of one side of the face receives the highest facial palsy score.
12. During motor arm testing, how long should the patient maintain arm
elevation?
A. 5 seconds
B. ✅✅ 10 seconds
C. 15 seconds
D. 30 seconds
Answer: ✅✅ B
Rationale: Arms are held elevated for 10 seconds while observing for drift.
13. During motor leg testing, how long should the leg remain elevated?
A. 2 seconds
B. 3 seconds
2026 NIH Stroke Scale (NIHSS) Group E
Practice Exam 100 Questions and
Answers with Rationales
1. What is the primary purpose of the NIH Stroke Scale (NIHSS)?
A. Diagnose all neurological diseases
B. Determine blood glucose levels
C. ✅✅ Quantify the severity of neurological deficits caused by acute stroke
D. Predict long-term cognitive decline only
Answer: ✅✅ C
Rationale: The NIHSS provides a standardized, reproducible assessment of neurological
impairment in patients with suspected acute stroke. It helps guide treatment decisions, monitor
changes, and facilitate communication among healthcare providers.
2. Which patient is most appropriate for NIHSS assessment?
A. Patient with isolated migraine headache
B. Patient with chronic dementia and no acute change
C. ✅✅ Patient with suspected acute ischemic or hemorrhagic stroke
D. Patient with uncomplicated hypertension
Answer: ✅✅ C
Rationale: The NIHSS is designed for evaluating neurological deficits associated with acute
stroke.
3. Which NIHSS item assesses the patient's level of consciousness?
A. Facial palsy
B. ✅✅ Item 1
C. Motor arm
D. Dysarthria
Answer: ✅✅ B
, NIH Stroke Scale (NIHSS) Group E Practice Exam
Rationale: Item 1 evaluates level of consciousness, including responsiveness and ability to
answer questions and follow commands.
4. During the NIHSS examination, a patient correctly states the current month
but cannot state their age. How is Item 1b scored?
A. 0
B. ✅✅ 1
C. 2
D. 3
Answer: ✅✅ B
Rationale: Item 1b awards:
0 = both questions correct
1 = one question correct
2 = neither correct
5. Which command is commonly used for NIHSS Item 1c?
A. Count backward from 100
B. Name five animals
C. ✅✅ Open and close your eyes; grip and release your hand
D. Walk across the room
Answer: ✅✅ C
Rationale: Item 1c evaluates the ability to follow simple commands.
6. Which NIHSS item evaluates horizontal eye movements?
A. Visual fields
B. ✅✅ Best Gaze
C. Limb ataxia
D. Neglect
Answer: ✅✅ B
, NIH Stroke Scale (NIHSS) Group E Practice Exam
Rationale: Best Gaze assesses voluntary horizontal eye movement.
7. Forced deviation of the eyes is scored as:
A. 0
B. 1
C. ✅✅ 2
D. 3
Answer: ✅✅ C
Rationale: Forced gaze deviation that cannot be overcome scores the maximum for the Best
Gaze item.
8. Which NIHSS item evaluates visual field deficits?
A. Motor leg
B. ✅✅ Visual Fields
C. Sensory
D. Dysarthria
Answer: ✅✅ B
Rationale: Visual fields are tested by confrontation in each quadrant.
9. A patient has complete hemianopia. How is the visual field item scored?
A. 0
B. 1
C. ✅✅ 2
D. 3
Answer: ✅✅ C
Rationale: Complete hemianopia scores 2 points.
, NIH Stroke Scale (NIHSS) Group E Practice Exam
10. Which cranial nerve is primarily evaluated during the facial palsy
assessment?
A. CN III
B. CN V
C. ✅✅ CN VII
D. CN XII
Answer: ✅✅ C
Rationale: Facial movements are mediated by the facial nerve (cranial nerve VII).
11. Which facial finding receives the highest NIHSS facial palsy score?
A. Minor asymmetry
B. Flattened nasolabial fold
C. ✅✅ Complete unilateral facial paralysis
D. Mild drooping only
Answer: ✅✅ C
Rationale: Complete paralysis of one side of the face receives the highest facial palsy score.
12. During motor arm testing, how long should the patient maintain arm
elevation?
A. 5 seconds
B. ✅✅ 10 seconds
C. 15 seconds
D. 30 seconds
Answer: ✅✅ B
Rationale: Arms are held elevated for 10 seconds while observing for drift.
13. During motor leg testing, how long should the leg remain elevated?
A. 2 seconds
B. 3 seconds
