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NIH Stroke Scale (NIHSS) Complete Answer Key 2026 All Test
Groups A-F (Patients 1-6) – Updated Spring Questions with
Verified Solutions & Detailed Rationales
Question 1:
What is the total possible score range on the NIH Stroke Scale, and what does a score of
0 indicate?
A) 0-10; indicates severe stroke
B) 0-22; indicates moderate stroke
C) 0-42; indicates no stroke symptoms
D) 0-50; indicates minor stroke
Correct Answer: C) 0-42; indicates no stroke symptoms
Rationale: The NIHSS consists of 15 items with a total possible score of 42. A score of 0
indicates no neurological deficits and is often seen in patients with TIA or stroke mimics.
Higher scores indicate more severe stroke deficits, with 42 representing the most severe
neurological impairment .
Question 2:
A patient presents with an NIHSS score of 12. This would be classified as:
A) No stroke symptoms
B) Minor stroke
C) Moderate stroke
D) Severe stroke
Correct Answer: C) Moderate stroke
Rationale: NIHSS score categories: 0 = normal, 1-4 = minor stroke, 5-15 = moderate
stroke, 16-20 = moderate-severe, 21-42 = severe. A score of 12 falls within the moderate
Sure pass
,2
stroke range (5-15), indicating significant neurological impairment requiring
hospitalization and treatment .
Question 3:
How many items are included in the NIH Stroke Scale, and what is the maximum score
for each?
A) 10 items; maximum 5 points each
B) 12 items; maximum 4 points each
C) 15 items; variable maximum scores
D) 18 items; variable maximum scores
Correct Answer: C) 15 items; variable maximum scores
Rationale: The NIHSS includes 15 standardized assessment items covering level of
consciousness (3 items), gaze, visual fields, facial palsy, motor function (arms and legs),
limb ataxia, sensory, language, dysarthria, and extinction/inattention. Each item has a
variable maximum score based on the specific neurological function being assessed .
Question 4:
Which of the following is NOT assessed in the NIH Stroke Scale?
A) Level of consciousness
B) Visual fields
C) Bowel and bladder function
D) Language
Correct Answer: C) Bowel and bladder function
Rationale: The NIHSS assesses LOC, visual fields, motor function, sensory function,
language, and coordination. Bowel and bladder function are not included in the NIHSS as
they are not acute stroke severity indicators. These functions are assessed separately as
part of the overall neurological examination .
Sure pass
,3
Question 5:
What is the maximum score for the Level of Consciousness (1a) item?
A) 1
B) 2
C) 3
D) 4
Correct Answer: C) 3
Rationale: LOC (Item 1a) is scored 0-3: 0 = alert, 1 = drowsy but arousable by minor
stimulation, 2 = obtunded/repeated stimulation needed, 3 = unresponsive/reflex responses
only. This is one of the most critical items as it reflects overall brain function and is a
strong predictor of outcomes .
Question 6:
A patient who is completely aphasic with no comprehensible speech would score:
A) 1 on Best Language
B) 2 on Best Language
C) 3 on Best Language
D) 4 on Best Language
Correct Answer: B) 2 on Best Language
Rationale: Best Language (Item 9) scores: 0 = no aphasia, 1 = mild-moderate aphasia
(some difficulty but comprehensible), 2 = severe aphasia (fragmented speech, limited
information conveyed), 3 = mute/global aphasia (no comprehensible speech or
comprehension). Complete aphasia with no comprehensible speech scores 2 or 3
depending on severity .
Question 7:
Which NIHSS item assesses coordination and ataxia?
A) Item 6 (Motor Leg)
B) Item 7 (Limb Ataxia)
C) Item 8 (Sensory)
D) Item 11 (Extinction/Inattention)
Sure pass
, 4
Correct Answer: B) Item 7 (Limb Ataxia)
Rationale: Limb Ataxia (Item 7) assesses coordination and cerebellar function. Scoring: 0 =
no ataxia, 1 = ataxia in one limb, 2 = ataxia in two limbs. Test finger-to-nose and heel-to-
shin. Ataxia can be caused by cerebellar stroke or brainstem involvement .
Question 8:
The NIHSS is typically administered:
A) Only on admission
B) Only at discharge
C) Repeatedly to track changes in neurological status
D) By the patient's family
Correct Answer: C) Repeatedly to track changes in neurological status
Rationale: Serial NIHSS assessments monitor neurological deterioration or improvement
over time. Results guide treatment decisions (thrombolytics, thrombectomy) and predict
patient outcomes. The scale is typically administered on admission, at 24 hours, at 48
hours, and as clinically indicated .
Question 9:
Which item on the NIHSS is the MOST critical predictor of long-term outcomes?
A) Item 1 (LOC)
B) Item 2 (Gaze)
C) Item 5 (Motor Arm)
D) Item 9 (Language)
Correct Answer: A) Item 1 (LOC)
Rationale: Level of consciousness (LOC) is the strongest predictor of mortality and
functional outcomes in acute stroke. Severe LOC impairment (score 2-3) indicates
extensive brain damage and poor prognosis. The LOC score reflects overall brain function
and is assessed first in the NIHSS .
Sure pass
NIH Stroke Scale (NIHSS) Complete Answer Key 2026 All Test
Groups A-F (Patients 1-6) – Updated Spring Questions with
Verified Solutions & Detailed Rationales
Question 1:
What is the total possible score range on the NIH Stroke Scale, and what does a score of
0 indicate?
A) 0-10; indicates severe stroke
B) 0-22; indicates moderate stroke
C) 0-42; indicates no stroke symptoms
D) 0-50; indicates minor stroke
Correct Answer: C) 0-42; indicates no stroke symptoms
Rationale: The NIHSS consists of 15 items with a total possible score of 42. A score of 0
indicates no neurological deficits and is often seen in patients with TIA or stroke mimics.
Higher scores indicate more severe stroke deficits, with 42 representing the most severe
neurological impairment .
Question 2:
A patient presents with an NIHSS score of 12. This would be classified as:
A) No stroke symptoms
B) Minor stroke
C) Moderate stroke
D) Severe stroke
Correct Answer: C) Moderate stroke
Rationale: NIHSS score categories: 0 = normal, 1-4 = minor stroke, 5-15 = moderate
stroke, 16-20 = moderate-severe, 21-42 = severe. A score of 12 falls within the moderate
Sure pass
,2
stroke range (5-15), indicating significant neurological impairment requiring
hospitalization and treatment .
Question 3:
How many items are included in the NIH Stroke Scale, and what is the maximum score
for each?
A) 10 items; maximum 5 points each
B) 12 items; maximum 4 points each
C) 15 items; variable maximum scores
D) 18 items; variable maximum scores
Correct Answer: C) 15 items; variable maximum scores
Rationale: The NIHSS includes 15 standardized assessment items covering level of
consciousness (3 items), gaze, visual fields, facial palsy, motor function (arms and legs),
limb ataxia, sensory, language, dysarthria, and extinction/inattention. Each item has a
variable maximum score based on the specific neurological function being assessed .
Question 4:
Which of the following is NOT assessed in the NIH Stroke Scale?
A) Level of consciousness
B) Visual fields
C) Bowel and bladder function
D) Language
Correct Answer: C) Bowel and bladder function
Rationale: The NIHSS assesses LOC, visual fields, motor function, sensory function,
language, and coordination. Bowel and bladder function are not included in the NIHSS as
they are not acute stroke severity indicators. These functions are assessed separately as
part of the overall neurological examination .
Sure pass
,3
Question 5:
What is the maximum score for the Level of Consciousness (1a) item?
A) 1
B) 2
C) 3
D) 4
Correct Answer: C) 3
Rationale: LOC (Item 1a) is scored 0-3: 0 = alert, 1 = drowsy but arousable by minor
stimulation, 2 = obtunded/repeated stimulation needed, 3 = unresponsive/reflex responses
only. This is one of the most critical items as it reflects overall brain function and is a
strong predictor of outcomes .
Question 6:
A patient who is completely aphasic with no comprehensible speech would score:
A) 1 on Best Language
B) 2 on Best Language
C) 3 on Best Language
D) 4 on Best Language
Correct Answer: B) 2 on Best Language
Rationale: Best Language (Item 9) scores: 0 = no aphasia, 1 = mild-moderate aphasia
(some difficulty but comprehensible), 2 = severe aphasia (fragmented speech, limited
information conveyed), 3 = mute/global aphasia (no comprehensible speech or
comprehension). Complete aphasia with no comprehensible speech scores 2 or 3
depending on severity .
Question 7:
Which NIHSS item assesses coordination and ataxia?
A) Item 6 (Motor Leg)
B) Item 7 (Limb Ataxia)
C) Item 8 (Sensory)
D) Item 11 (Extinction/Inattention)
Sure pass
, 4
Correct Answer: B) Item 7 (Limb Ataxia)
Rationale: Limb Ataxia (Item 7) assesses coordination and cerebellar function. Scoring: 0 =
no ataxia, 1 = ataxia in one limb, 2 = ataxia in two limbs. Test finger-to-nose and heel-to-
shin. Ataxia can be caused by cerebellar stroke or brainstem involvement .
Question 8:
The NIHSS is typically administered:
A) Only on admission
B) Only at discharge
C) Repeatedly to track changes in neurological status
D) By the patient's family
Correct Answer: C) Repeatedly to track changes in neurological status
Rationale: Serial NIHSS assessments monitor neurological deterioration or improvement
over time. Results guide treatment decisions (thrombolytics, thrombectomy) and predict
patient outcomes. The scale is typically administered on admission, at 24 hours, at 48
hours, and as clinically indicated .
Question 9:
Which item on the NIHSS is the MOST critical predictor of long-term outcomes?
A) Item 1 (LOC)
B) Item 2 (Gaze)
C) Item 5 (Motor Arm)
D) Item 9 (Language)
Correct Answer: A) Item 1 (LOC)
Rationale: Level of consciousness (LOC) is the strongest predictor of mortality and
functional outcomes in acute stroke. Severe LOC impairment (score 2-3) indicates
extensive brain damage and poor prognosis. The LOC score reflects overall brain function
and is assessed first in the NIHSS .
Sure pass
