NIHSS – GROUP A QUESTIONS WITH CORRECT
ANSWERS 2026
Full Practice Exam (208 Items) – Every Option
Rationaled
SECTION 1 – NIHSS FOUNDATIONS
Q1. The NIHSS is primarily used to:
A. Quantify neurologic deficit in stroke
B. Diagnose migraine
C. Measure blood glucose
D. Stage chronic dementia
ANSWER: A
A) Correct – it standardizes stroke-related neurologic impairment.
B) Wrong – migraine is a clinical diagnosis, not NIHSS.
C) Wrong – glucose needs a lab test, not a scale.
D) Wrong – dementia uses tools like MMSE/MoCA.
Q2. The maximum possible total NIHSS score is:
A. 42
B. 30
C. 25
D. 15
ANSWER: A
A) Correct – sum of all 15 item maxima equals 42.
B) Wrong – 30 is the Glasgow Coma maximum.
C) Wrong – 25 matches no stroke scale total.
,D) Wrong – 15 is only a severity cutoff, not the max.
Q3. How many items does the standard NIHSS contain?
A. 15
B. 10
C. 12
D. 20
ANSWER: A
A) Correct – 1a,1b,1c,2–11 with 5a/5b/6a/6b split = 15 scores.
B) Wrong – too few; limbs are scored separately.
C) Wrong – 12 ignores the split limb items.
D) Wrong – 20 overcounts the scale.
Q4. A total NIHSS of 0 means:
A. No measurable stroke deficits
B. Massive stroke
C. Coma
D. Untestable patient
ANSWER: A
A) Correct – zero indicates normal examination on all items.
B) Wrong – massive stroke yields high scores.
C) Wrong – coma scores near maximum.
D) Wrong – untestable items are marked UN, not 0 by default.
Q5. Scores 1–4 on the NIHSS are generally classified as:
A. Minor stroke
B. Moderate stroke
C. Severe stroke
D. No stroke
ANSWER: A
A) Correct – 1–4 reflects minor deficits.
B) Wrong – moderate is roughly 5–15.
,C) Wrong – severe is above 15.
D) Wrong – 0 means no deficits; 1–4 is minor.
Q6. A total score of 5–15 usually indicates:
A. Mild-to-moderate stroke
B. Minor stroke
C. Severe stroke
D. Brain death
ANSWER: A
A) Correct – this band is mild/moderate severity.
B) Wrong – minor is 1–4.
C) Wrong – severe is >15.
D) Wrong – brain death is not scored by NIHSS.
Q7. A total score above 15 generally indicates:
A. Severe stroke
B. Minor stroke
C. Normal exam
D. TIA only
ANSWER: A
A) Correct – >15 denotes severe deficit burden.
B) Wrong – minor is 1–4.
C) Wrong – normal exam scores 0.
D) Wrong – TIA symptoms resolve; severity band unrelated.
Q8. The NIHSS should ideally be performed:
A. At baseline before thrombolysis and serially after
B. Only once at discharge
C. Only after MRI confirmation
D. Only by physicians
ANSWER: A
A) Correct – baseline guides treatment; serial scores track change.
, B) Wrong – discharge-only use misses treatment decisions.
C) Wrong – NIHSS is clinical and precedes imaging delays.
D) Wrong – trained nurses/EMTs may also administer it.
Q9. When scoring, the examiner should record:
A. What the patient actually does, not what they could do
B. Best performance imagined
C. Family-reported ability
D. Prior clinic notes
ANSWER: A
A) Correct – only observed performance counts.
B) Wrong – speculation inflates or deflates scores.
C) Wrong – family reports are not objective testing.
D) Wrong – old records ignore the current exam.
Q10. Which NIHSS domain receives the heaviest weighting?
A. Motor function
B. Sensory
C. Gaze
D. Ataxia
ANSWER: A
A) Correct – four limb items allow up to 16 points.
B) Wrong – sensory maxes at 2.
C) Wrong – gaze maxes at 2.
D) Wrong – ataxia maxes at 2.
Q11. Items 1a, 1b, 1c assess respectively:
A. LOC, LOC questions, LOC commands
B. Gaze, vision, face
C. Language, speech, neglect
D. Arms, legs, ataxia
ANSWER: A
ANSWERS 2026
Full Practice Exam (208 Items) – Every Option
Rationaled
SECTION 1 – NIHSS FOUNDATIONS
Q1. The NIHSS is primarily used to:
A. Quantify neurologic deficit in stroke
B. Diagnose migraine
C. Measure blood glucose
D. Stage chronic dementia
ANSWER: A
A) Correct – it standardizes stroke-related neurologic impairment.
B) Wrong – migraine is a clinical diagnosis, not NIHSS.
C) Wrong – glucose needs a lab test, not a scale.
D) Wrong – dementia uses tools like MMSE/MoCA.
Q2. The maximum possible total NIHSS score is:
A. 42
B. 30
C. 25
D. 15
ANSWER: A
A) Correct – sum of all 15 item maxima equals 42.
B) Wrong – 30 is the Glasgow Coma maximum.
C) Wrong – 25 matches no stroke scale total.
,D) Wrong – 15 is only a severity cutoff, not the max.
Q3. How many items does the standard NIHSS contain?
A. 15
B. 10
C. 12
D. 20
ANSWER: A
A) Correct – 1a,1b,1c,2–11 with 5a/5b/6a/6b split = 15 scores.
B) Wrong – too few; limbs are scored separately.
C) Wrong – 12 ignores the split limb items.
D) Wrong – 20 overcounts the scale.
Q4. A total NIHSS of 0 means:
A. No measurable stroke deficits
B. Massive stroke
C. Coma
D. Untestable patient
ANSWER: A
A) Correct – zero indicates normal examination on all items.
B) Wrong – massive stroke yields high scores.
C) Wrong – coma scores near maximum.
D) Wrong – untestable items are marked UN, not 0 by default.
Q5. Scores 1–4 on the NIHSS are generally classified as:
A. Minor stroke
B. Moderate stroke
C. Severe stroke
D. No stroke
ANSWER: A
A) Correct – 1–4 reflects minor deficits.
B) Wrong – moderate is roughly 5–15.
,C) Wrong – severe is above 15.
D) Wrong – 0 means no deficits; 1–4 is minor.
Q6. A total score of 5–15 usually indicates:
A. Mild-to-moderate stroke
B. Minor stroke
C. Severe stroke
D. Brain death
ANSWER: A
A) Correct – this band is mild/moderate severity.
B) Wrong – minor is 1–4.
C) Wrong – severe is >15.
D) Wrong – brain death is not scored by NIHSS.
Q7. A total score above 15 generally indicates:
A. Severe stroke
B. Minor stroke
C. Normal exam
D. TIA only
ANSWER: A
A) Correct – >15 denotes severe deficit burden.
B) Wrong – minor is 1–4.
C) Wrong – normal exam scores 0.
D) Wrong – TIA symptoms resolve; severity band unrelated.
Q8. The NIHSS should ideally be performed:
A. At baseline before thrombolysis and serially after
B. Only once at discharge
C. Only after MRI confirmation
D. Only by physicians
ANSWER: A
A) Correct – baseline guides treatment; serial scores track change.
, B) Wrong – discharge-only use misses treatment decisions.
C) Wrong – NIHSS is clinical and precedes imaging delays.
D) Wrong – trained nurses/EMTs may also administer it.
Q9. When scoring, the examiner should record:
A. What the patient actually does, not what they could do
B. Best performance imagined
C. Family-reported ability
D. Prior clinic notes
ANSWER: A
A) Correct – only observed performance counts.
B) Wrong – speculation inflates or deflates scores.
C) Wrong – family reports are not objective testing.
D) Wrong – old records ignore the current exam.
Q10. Which NIHSS domain receives the heaviest weighting?
A. Motor function
B. Sensory
C. Gaze
D. Ataxia
ANSWER: A
A) Correct – four limb items allow up to 16 points.
B) Wrong – sensory maxes at 2.
C) Wrong – gaze maxes at 2.
D) Wrong – ataxia maxes at 2.
Q11. Items 1a, 1b, 1c assess respectively:
A. LOC, LOC questions, LOC commands
B. Gaze, vision, face
C. Language, speech, neglect
D. Arms, legs, ataxia
ANSWER: A
