NIH Stroke Scale Group D Complete Patient 1-6
Certification Exam Actual 2026/2027 – Complete
Exam-Style Questions | 100% Verified – Pass
Guaranteed – A+ Graded
Question 1
What is the maximum total score on the standard NIH Stroke Scale (NIHSS)?
A. 36
B. 42
C. 24
D. 15
Answer: B. 42
Rationale: The NIHSS has 15 items (some with subparts) with a maximum total
score of 42. The scale ranges from 0 (no stroke symptoms) to 42 (severe stroke).
Higher scores indicate greater neurological deficit and poorer prognosis.
Question 2
Which NIHSS item assesses the patient's ability to answer two specific questions
(month and age)?
A. 1a – Level of Consciousness
B. 1b – LOC Questions
C. 1c – LOC Commands
D. 2 – Best Gaze
Answer: B. 1b – LOC Questions
Rationale: Item 1b asks the patient to state the current month and their age. Each
correct answer earns 1 point. Scoring: 0 = both correct, 1 = one correct, 2 = neither
correct.
,Question 3
For NIHSS Item 1c (LOC Commands), what are the two standard commands the
patient must perform?
A. Open/close eyes and stick out tongue
B. Point to the ceiling and show two fingers
C. Open/close eyes and grip/release hand
D. Say "ah" and lift both arms
Answer: C. Open/close eyes and grip/release hand
Rationale: The standard commands for Item 1c are: "Open and close your eyes"
and "Grip and release my hand." The patient must perform both correctly to score
0. If only one is performed correctly, the score is 1; if neither is performed, the
score is 2.
Question 4
A patient does not follow commands but makes a purposeful attempt to withdraw
from a painful stimulus. How should the examiner score Item 1a (Level of
Consciousness)?
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Item 1a scoring: 0 = alert and responsive; 1 = not alert but arousable by
minor stimulation; 2 = requires repeated stimulation or is obtunded; 3 =
unresponsive or only reflex motor responses. A purposeful withdrawal to pain
indicates some arousal, scoring a 1.
Question 5
When testing visual fields (Item 3), how should the examiner perform the
assessment?
,A. Full confrontation with finger counting in all four quadrants
B. Test only the left eye
C. Assess only central vision
D. Perform a dilated fundoscopic exam
Answer: A. Full confrontation with finger counting in all four quadrants
Rationale: Visual fields are tested by confrontation in each quadrant separately.
The examiner asks the patient to count fingers or detect movement in each of the
four quadrants. Both eyes should be tested individually.
Question 6
In the NIHSS, the term "dysarthria" refers to:
A. Difficulty understanding language
B. Difficulty producing speech due to motor problems
C. Difficulty finding words
D. Complete loss of voice
Answer: B. Difficulty producing speech due to motor problems
Rationale: Dysarthria is a motor speech disorder caused by weakness, paralysis, or
incoordination of the muscles used for speech. This is distinct from aphasia, which
is a language disorder affecting comprehension or expression.
Question 7
Which NIHSS item assesses the patient's ability to name objects and describe a
picture?
A. Item 1b – LOC Questions
B. Item 8 – Sensory
C. Item 9 – Best Language
D. Item 10 – Dysarthria
Answer: C. Item 9 – Best Language
Rationale: Item 9 (Best Language) assesses aphasia by having the patient name
objects, read sentences, and describe a picture. The examiner evaluates fluency,
, comprehension, and naming ability. Scores range from 0 (no aphasia) to 3 (global
aphasia).
Question 8
A patient with left-sided weakness and difficulty speaking is MOST likely
experiencing a stroke in which vascular territory?
A. Right middle cerebral artery
B. Left middle cerebral artery
C. Vertebrobasilar system
D. Anterior cerebral artery
Answer: B. Left middle cerebral artery
Rationale: The left middle cerebral artery (MCA) supplies the dominant
hemisphere's language areas (Broca's and Wernicke's areas). A left MCA stroke
typically causes right-sided weakness and aphasia. Left-sided weakness with
language impairment suggests a left-sided brain lesion.
Question 9
On the NIHSS, a score of 4 on a motor arm or leg item indicates:
A. Mild drift
B. Drifts down to bed but holds against gravity
C. Some effort against gravity
D. No movement at all
Answer: D. No movement at all
Rationale: Motor item scoring: 0 = no drift; 1 = drift but does not hit bed; 2 =
drifts to bed; 3 = some effort against gravity; 4 = no movement. A score of 4
indicates complete paralysis (no voluntary movement).
Question 10
A patient who is intubated and on mechanical ventilation is unable to speak. How
should the examiner score Item 10 (Dysarthria)?
Certification Exam Actual 2026/2027 – Complete
Exam-Style Questions | 100% Verified – Pass
Guaranteed – A+ Graded
Question 1
What is the maximum total score on the standard NIH Stroke Scale (NIHSS)?
A. 36
B. 42
C. 24
D. 15
Answer: B. 42
Rationale: The NIHSS has 15 items (some with subparts) with a maximum total
score of 42. The scale ranges from 0 (no stroke symptoms) to 42 (severe stroke).
Higher scores indicate greater neurological deficit and poorer prognosis.
Question 2
Which NIHSS item assesses the patient's ability to answer two specific questions
(month and age)?
A. 1a – Level of Consciousness
B. 1b – LOC Questions
C. 1c – LOC Commands
D. 2 – Best Gaze
Answer: B. 1b – LOC Questions
Rationale: Item 1b asks the patient to state the current month and their age. Each
correct answer earns 1 point. Scoring: 0 = both correct, 1 = one correct, 2 = neither
correct.
,Question 3
For NIHSS Item 1c (LOC Commands), what are the two standard commands the
patient must perform?
A. Open/close eyes and stick out tongue
B. Point to the ceiling and show two fingers
C. Open/close eyes and grip/release hand
D. Say "ah" and lift both arms
Answer: C. Open/close eyes and grip/release hand
Rationale: The standard commands for Item 1c are: "Open and close your eyes"
and "Grip and release my hand." The patient must perform both correctly to score
0. If only one is performed correctly, the score is 1; if neither is performed, the
score is 2.
Question 4
A patient does not follow commands but makes a purposeful attempt to withdraw
from a painful stimulus. How should the examiner score Item 1a (Level of
Consciousness)?
A. 0
B. 1
C. 2
D. 3
Answer: B. 1
Rationale: Item 1a scoring: 0 = alert and responsive; 1 = not alert but arousable by
minor stimulation; 2 = requires repeated stimulation or is obtunded; 3 =
unresponsive or only reflex motor responses. A purposeful withdrawal to pain
indicates some arousal, scoring a 1.
Question 5
When testing visual fields (Item 3), how should the examiner perform the
assessment?
,A. Full confrontation with finger counting in all four quadrants
B. Test only the left eye
C. Assess only central vision
D. Perform a dilated fundoscopic exam
Answer: A. Full confrontation with finger counting in all four quadrants
Rationale: Visual fields are tested by confrontation in each quadrant separately.
The examiner asks the patient to count fingers or detect movement in each of the
four quadrants. Both eyes should be tested individually.
Question 6
In the NIHSS, the term "dysarthria" refers to:
A. Difficulty understanding language
B. Difficulty producing speech due to motor problems
C. Difficulty finding words
D. Complete loss of voice
Answer: B. Difficulty producing speech due to motor problems
Rationale: Dysarthria is a motor speech disorder caused by weakness, paralysis, or
incoordination of the muscles used for speech. This is distinct from aphasia, which
is a language disorder affecting comprehension or expression.
Question 7
Which NIHSS item assesses the patient's ability to name objects and describe a
picture?
A. Item 1b – LOC Questions
B. Item 8 – Sensory
C. Item 9 – Best Language
D. Item 10 – Dysarthria
Answer: C. Item 9 – Best Language
Rationale: Item 9 (Best Language) assesses aphasia by having the patient name
objects, read sentences, and describe a picture. The examiner evaluates fluency,
, comprehension, and naming ability. Scores range from 0 (no aphasia) to 3 (global
aphasia).
Question 8
A patient with left-sided weakness and difficulty speaking is MOST likely
experiencing a stroke in which vascular territory?
A. Right middle cerebral artery
B. Left middle cerebral artery
C. Vertebrobasilar system
D. Anterior cerebral artery
Answer: B. Left middle cerebral artery
Rationale: The left middle cerebral artery (MCA) supplies the dominant
hemisphere's language areas (Broca's and Wernicke's areas). A left MCA stroke
typically causes right-sided weakness and aphasia. Left-sided weakness with
language impairment suggests a left-sided brain lesion.
Question 9
On the NIHSS, a score of 4 on a motor arm or leg item indicates:
A. Mild drift
B. Drifts down to bed but holds against gravity
C. Some effort against gravity
D. No movement at all
Answer: D. No movement at all
Rationale: Motor item scoring: 0 = no drift; 1 = drift but does not hit bed; 2 =
drifts to bed; 3 = some effort against gravity; 4 = no movement. A score of 4
indicates complete paralysis (no voluntary movement).
Question 10
A patient who is intubated and on mechanical ventilation is unable to speak. How
should the examiner score Item 10 (Dysarthria)?
