NIHSS Group C - Patients 1-6 EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
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EXAM COVERAGE
1. Level of Consciousness (LOC) Assessment
2. Best Gaze and Visual Field Testing
3. Facial Palsy and Motor Arm/Leg Strength
4. Limb Ataxia and Sensory Function
5. Best Language and Dysarthria Evaluation
6. Extinction and Inattention (Neglect) Assessment
1. A patient with a right-sided MCA stroke presents with deviation of the eyes to the right and
inability to track to the left. When performing the NIHSS Gaze assessment, you note the patient
does not follow the examiner’s finger to the left but can move eyes to the midline. How should
this be scored?
A. 0 (Normal)
B. 1 (Partial gaze palsy)
C. 2 (Forced deviation)
D. 2 (Total gaze palsy)
CORRECT ANSWER : C
Rationale: Forced deviation signifies an inability to move the eyes past the midline despite
stimulation, which is distinct from a partial palsy. Option A is incorrect as the patient has a
deficit; B is incorrect because partial palsy implies some movement past midline; D is
technically a descriptor of the severity but the NIHSS specific score for forced deviation is 2.
,2. During the visual field testing for a patient in Group C, the patient correctly identifies fingers in
the right upper and lower quadrants but fails to acknowledge any stimuli in the left quadrants.
How is this recorded?
A. 0 (No visual loss)
B. 1 (Partial hemianopsia)
C. 2 (Complete hemianopsia)
D. 3 (Bilateral hemianopsia)
CORRECT ANSWER : C
Rationale: The complete loss of vision in one hemifield is scored as 2. Option A is incorrect as
there is a deficit; B is incorrect because the patient failed all testing in the left quadrants, not
just partial; D is incorrect because the loss is unilateral.
3. Upon testing facial movement, you ask the patient to show their teeth or smile. The patient
exhibits complete paralysis on the left side of the face with no movement attempted during the
grimace task. What is the correct score?
A. 1 (Minor paralysis)
B. 2 (Partial paralysis)
C. 3 (Complete paralysis)
D. 0 (Normal)
CORRECT ANSWER : C
Rationale: Complete paralysis (absence of facial movement) is scored as 3. Option A and B are
incorrect as they imply partial function remains; D is incorrect as the patient has clear deficits.
4. A patient exhibits drift in the right arm, falling to the bed before 10 seconds, but can make some
effort against gravity. The left arm remains elevated for the full 10 seconds. What is the score for
the right arm?
A. 0 (No drift)
B. 1 (Drift)
C. 2 (Does not reach position)
D. 4 (No movement)
, CORRECT ANSWER : B
Rationale: Scoring 1 is appropriate for a limb that drifts before the full 10 seconds but maintains
some effort against gravity. Option A is incorrect because there is drift; C is incorrect because
the patient reached the position initially; D is incorrect because the limb did move.
5. A patient is unable to sustain the left leg in a 30-degree position for 5 seconds, falling
immediately. However, the patient is still able to move the leg against gravity when prompted.
What is the correct score for the left leg?
A. 1 (Drift)
B. 2 (Some effort against gravity)
C. 3 (No effort against gravity)
D. 4 (No movement)
CORRECT ANSWER : B
Rationale: A score of 2 is assigned when the leg falls before 5 seconds but maintains effort
against gravity. Option A is incorrect as the duration is too short for a 1; C is incorrect because
the patient maintains some effort against gravity; D is incorrect as the patient is not flaccid.
6. During the Finger-Nose-Finger test, the patient exhibits significant dysmetria in the left arm,
missing the target by several inches, and similar findings occur in the left leg with the Heel-Shin
slide. What is the score for Limb Ataxia?
A. 0 (Absent)
B. 1 (Present in one limb)
C. 2 (Present in two limbs)
D. 3 (Present in three limbs)
CORRECT ANSWER : B
Rationale: The score is based on the presence of ataxia in limbs affected by motor weakness (in
this case, the left side). Since the ataxia is present in both the left arm and leg (representing one
side), the score is 1. Option A is incorrect as ataxia is present; C and D are incorrect as the
criteria count is based on the number of sides affected.
7. A patient demonstrates clear sensory loss to pinprick on the left side compared to the right. The
patient is aware of the stimulus but describes it as significantly duller. How is this scored?
, A. 0 (Normal)
B. 1 (Mild to moderate sensory loss)
C. 2 (Severe to total sensory loss)
D. 3 (Extinction)
CORRECT ANSWER : B
Rationale: A score of 1 indicates the patient is aware of the touch/pinprick but reports it as
diminished. Option A is incorrect as there is a clear deficit; C is incorrect as the patient is not
completely insensate; D is incorrect because this category evaluates sensory loss, not
inattention.
8. When asked to name items and describe a scene, the patient exhibits paraphasia and has
difficulty finding words but retains the ability to communicate basic needs. This is scored as:
A. 0 (Normal)
B. 1 (Mild to moderate aphasia)
C. 2 (Severe aphasia)
D. 3 (Mute)
CORRECT ANSWER : B
Rationale: Mild to moderate aphasia involves word-finding difficulties and paraphasias without
total loss of comprehension. Option A is incorrect as the patient has deficits; C is incorrect
because the patient can still communicate; D is incorrect as the patient is not mute.
9. A patient slurs words significantly, making their speech difficult to understand, but the content
remains intelligible. This indicates:
A. 0 (Normal)
B. 1 (Mild to moderate dysarthria)
C. 2 (Severe dysarthria)
D. 3 (Intubated)
CORRECT ANSWER : B
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Level of Consciousness (LOC) Assessment
2. Best Gaze and Visual Field Testing
3. Facial Palsy and Motor Arm/Leg Strength
4. Limb Ataxia and Sensory Function
5. Best Language and Dysarthria Evaluation
6. Extinction and Inattention (Neglect) Assessment
1. A patient with a right-sided MCA stroke presents with deviation of the eyes to the right and
inability to track to the left. When performing the NIHSS Gaze assessment, you note the patient
does not follow the examiner’s finger to the left but can move eyes to the midline. How should
this be scored?
A. 0 (Normal)
B. 1 (Partial gaze palsy)
C. 2 (Forced deviation)
D. 2 (Total gaze palsy)
CORRECT ANSWER : C
Rationale: Forced deviation signifies an inability to move the eyes past the midline despite
stimulation, which is distinct from a partial palsy. Option A is incorrect as the patient has a
deficit; B is incorrect because partial palsy implies some movement past midline; D is
technically a descriptor of the severity but the NIHSS specific score for forced deviation is 2.
,2. During the visual field testing for a patient in Group C, the patient correctly identifies fingers in
the right upper and lower quadrants but fails to acknowledge any stimuli in the left quadrants.
How is this recorded?
A. 0 (No visual loss)
B. 1 (Partial hemianopsia)
C. 2 (Complete hemianopsia)
D. 3 (Bilateral hemianopsia)
CORRECT ANSWER : C
Rationale: The complete loss of vision in one hemifield is scored as 2. Option A is incorrect as
there is a deficit; B is incorrect because the patient failed all testing in the left quadrants, not
just partial; D is incorrect because the loss is unilateral.
3. Upon testing facial movement, you ask the patient to show their teeth or smile. The patient
exhibits complete paralysis on the left side of the face with no movement attempted during the
grimace task. What is the correct score?
A. 1 (Minor paralysis)
B. 2 (Partial paralysis)
C. 3 (Complete paralysis)
D. 0 (Normal)
CORRECT ANSWER : C
Rationale: Complete paralysis (absence of facial movement) is scored as 3. Option A and B are
incorrect as they imply partial function remains; D is incorrect as the patient has clear deficits.
4. A patient exhibits drift in the right arm, falling to the bed before 10 seconds, but can make some
effort against gravity. The left arm remains elevated for the full 10 seconds. What is the score for
the right arm?
A. 0 (No drift)
B. 1 (Drift)
C. 2 (Does not reach position)
D. 4 (No movement)
, CORRECT ANSWER : B
Rationale: Scoring 1 is appropriate for a limb that drifts before the full 10 seconds but maintains
some effort against gravity. Option A is incorrect because there is drift; C is incorrect because
the patient reached the position initially; D is incorrect because the limb did move.
5. A patient is unable to sustain the left leg in a 30-degree position for 5 seconds, falling
immediately. However, the patient is still able to move the leg against gravity when prompted.
What is the correct score for the left leg?
A. 1 (Drift)
B. 2 (Some effort against gravity)
C. 3 (No effort against gravity)
D. 4 (No movement)
CORRECT ANSWER : B
Rationale: A score of 2 is assigned when the leg falls before 5 seconds but maintains effort
against gravity. Option A is incorrect as the duration is too short for a 1; C is incorrect because
the patient maintains some effort against gravity; D is incorrect as the patient is not flaccid.
6. During the Finger-Nose-Finger test, the patient exhibits significant dysmetria in the left arm,
missing the target by several inches, and similar findings occur in the left leg with the Heel-Shin
slide. What is the score for Limb Ataxia?
A. 0 (Absent)
B. 1 (Present in one limb)
C. 2 (Present in two limbs)
D. 3 (Present in three limbs)
CORRECT ANSWER : B
Rationale: The score is based on the presence of ataxia in limbs affected by motor weakness (in
this case, the left side). Since the ataxia is present in both the left arm and leg (representing one
side), the score is 1. Option A is incorrect as ataxia is present; C and D are incorrect as the
criteria count is based on the number of sides affected.
7. A patient demonstrates clear sensory loss to pinprick on the left side compared to the right. The
patient is aware of the stimulus but describes it as significantly duller. How is this scored?
, A. 0 (Normal)
B. 1 (Mild to moderate sensory loss)
C. 2 (Severe to total sensory loss)
D. 3 (Extinction)
CORRECT ANSWER : B
Rationale: A score of 1 indicates the patient is aware of the touch/pinprick but reports it as
diminished. Option A is incorrect as there is a clear deficit; C is incorrect as the patient is not
completely insensate; D is incorrect because this category evaluates sensory loss, not
inattention.
8. When asked to name items and describe a scene, the patient exhibits paraphasia and has
difficulty finding words but retains the ability to communicate basic needs. This is scored as:
A. 0 (Normal)
B. 1 (Mild to moderate aphasia)
C. 2 (Severe aphasia)
D. 3 (Mute)
CORRECT ANSWER : B
Rationale: Mild to moderate aphasia involves word-finding difficulties and paraphasias without
total loss of comprehension. Option A is incorrect as the patient has deficits; C is incorrect
because the patient can still communicate; D is incorrect as the patient is not mute.
9. A patient slurs words significantly, making their speech difficult to understand, but the content
remains intelligible. This indicates:
A. 0 (Normal)
B. 1 (Mild to moderate dysarthria)
C. 2 (Severe dysarthria)
D. 3 (Intubated)
CORRECT ANSWER : B
