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NIH Stroke Scale (NIHSS) Complete Answer Key 2026
All Test Groups A-F (Patients 1-6) – Updated Spring
250 Questions with Verified Solutions & Detailed Rationales
Question 1:
What is the total possible score range on the NIH Stroke Scale?
A) 0-10
B) 0-22
C) 0-42
D) 0-50
Correct Answer: C) 0-42
Rationale: The NIHSS consists of 15 items with a total possible score of 42. Higher scores
indicate more severe stroke deficits. A score of 0 indicates no stroke symptoms, while 42
represents the most severe neurological impairment. The scale is designed to quantify
neurological deficits in acute stroke patients.
Question 2:
A score of 8 on the NIHSS indicates:
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 8 falls within the moderate
stroke range (5-15), indicating significant neurological impairment requiring
hospitalization and treatment.
Sure pass
,2
Question 3:
How many items are included in the NIH Stroke Scale?
A) 10
B) 12
C) 15
D) 18
Correct Answer: C) 15
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 assesses a
specific neurological function affected by stroke.
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.
Question 5:
What is the maximum score for the Level of Consciousness (1a) item?
A) 1
B) 2
Sure pass
,3
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:
What is the maximum score for the Best Gaze (Item 2)?
A) 1
B) 2
C) 3
D) 4
Correct Answer: B) 2
Rationale: Best Gaze (Item 2) is scored 0-2: 0 = normal, 1 = partial gaze palsy, 2 = forced
deviation. Gaze deviation can indicate hemispheric stroke or brainstem involvement.
Scoring is based on horizontal eye movements tested by following the examiner's finger.
Question 7:
What is the maximum score for the Visual Fields (Item 3)?
A) 1
B) 2
C) 3
D) 4
Correct Answer: C) 3
Rationale: Visual Fields (Item 3) is scored 0-3: 0 = no visual loss, 1 = partial hemianopia
(quadrantanopia), 2 = complete hemianopia, 3 = bilateral hemianopia (cortical blindness).
Visual field deficits indicate damage to the visual pathways in the brain.
Sure pass
, 4
Question 8:
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 9:
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)
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 10:
The NIHSS is typically administered:
A) Only on admission
B) Only at discharge
Sure pass
NIH Stroke Scale (NIHSS) Complete Answer Key 2026
All Test Groups A-F (Patients 1-6) – Updated Spring
250 Questions with Verified Solutions & Detailed Rationales
Question 1:
What is the total possible score range on the NIH Stroke Scale?
A) 0-10
B) 0-22
C) 0-42
D) 0-50
Correct Answer: C) 0-42
Rationale: The NIHSS consists of 15 items with a total possible score of 42. Higher scores
indicate more severe stroke deficits. A score of 0 indicates no stroke symptoms, while 42
represents the most severe neurological impairment. The scale is designed to quantify
neurological deficits in acute stroke patients.
Question 2:
A score of 8 on the NIHSS indicates:
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 8 falls within the moderate
stroke range (5-15), indicating significant neurological impairment requiring
hospitalization and treatment.
Sure pass
,2
Question 3:
How many items are included in the NIH Stroke Scale?
A) 10
B) 12
C) 15
D) 18
Correct Answer: C) 15
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 assesses a
specific neurological function affected by stroke.
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.
Question 5:
What is the maximum score for the Level of Consciousness (1a) item?
A) 1
B) 2
Sure pass
,3
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:
What is the maximum score for the Best Gaze (Item 2)?
A) 1
B) 2
C) 3
D) 4
Correct Answer: B) 2
Rationale: Best Gaze (Item 2) is scored 0-2: 0 = normal, 1 = partial gaze palsy, 2 = forced
deviation. Gaze deviation can indicate hemispheric stroke or brainstem involvement.
Scoring is based on horizontal eye movements tested by following the examiner's finger.
Question 7:
What is the maximum score for the Visual Fields (Item 3)?
A) 1
B) 2
C) 3
D) 4
Correct Answer: C) 3
Rationale: Visual Fields (Item 3) is scored 0-3: 0 = no visual loss, 1 = partial hemianopia
(quadrantanopia), 2 = complete hemianopia, 3 = bilateral hemianopia (cortical blindness).
Visual field deficits indicate damage to the visual pathways in the brain.
Sure pass
, 4
Question 8:
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 9:
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)
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 10:
The NIHSS is typically administered:
A) Only on admission
B) Only at discharge
Sure pass
