NIH Stroke Scale — All Test Groups A–F (Patients 1–6)
Complete Practice Questions, Scoring Answers & Detailed Rationales
Updated 2026–2027
An original, educational NIHSS study and self-assessment guide.
All patient scenarios, questions, and answer rationales in this document are original educational material written to reflect the structure and
scoring criteria of the NIH Stroke Scale. This is not a reproduction of any proprietary, leaked, or official certification examination, and none of
the material should be represented as verified actual exam content.
This document is intended for educational self-study and does not replace formal NIHSS certification training or clinical judgment.
,Table of Contents
● Part 1 — Practice Questions (50 items)
● Part 2 — NIHSS Overview: High-Yield Q&A
● Part 3–4 — Test Groups A–F (36 Original Patient Scenarios)
● Part 5 — Complete Answer Key
● Part 6 — High-Yield Scoring Review
,Part 1 — Practice Questions
The following 50 original, clinically realistic questions cover all 15 NIHSS items. For each item below, choose the NIHSS
score that best matches the described examination finding.
Question 1 (1a. Level of Consciousness)
A 58-year-old man is brought to the emergency department after sudden onset of symptoms. On formal testing of Level
of Consciousness, the following is observed: Patient is alert, awake, and keenly responsive to the examiner without need
for stimulation. Which NIHSS score for Level of Consciousness does this finding represent?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A. 0
Rationale: A score of 0 is assigned whenever the patient is spontaneously alert and responsive, regardless of findings on other
items. The other listed scores describe findings that are either more severe or less severe than what is described, and do not
match this exam.
Question 2 (1a. Level of Consciousness)
A 64-year-old woman is being assessed at the bedside 90 minutes after symptom onset. On formal testing of Level of
Consciousness, the following is observed: Patient is drowsy but arouses easily to light verbal stimulation and cooperates
with the exam once aroused. Which NIHSS score for Level of Consciousness does this finding represent?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B. 1
Rationale: A score of 1 applies when minor stimulation (a raised voice, a gentle touch) is enough to obtain obedience, answers,
or responses. The other listed scores describe findings that are either more severe or less severe than what is described, and do
not match this exam.
Question 3 (1a. Level of Consciousness)
A 71-year-old man is evaluated by the stroke team shortly after arrival. On formal testing of Level of Consciousness, the
following is observed: Patient responds only with reflex posturing or autonomic changes to stimulation, or is completely
unresponsive, flaccid, and areflexic. Which NIHSS score for Level of Consciousness does this finding represent?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D. 3
Rationale: A score of 3 is assigned only when the patient shows no purposeful response to any stimulus, consistent with coma.
The other listed scores describe findings that are either more severe or less severe than what is described, and do not match this
exam.
, Question 4 (1b. LOC Questions)
A 67-year-old woman is examined on the neurology floor the morning after admission. On formal testing of LOC
Questions, the following is observed: Patient correctly states both the current month and their own age. Which NIHSS
score for LOC Questions does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: A. 0
Rationale: Both orientation questions must be answered exactly right for a score of 0. The other listed scores describe findings
that are either more severe or less severe than what is described, and do not match this exam.
Question 5 (1b. LOC Questions)
A 60-year-old man presents to triage with a witnessed acute neurological change. On formal testing of LOC Questions, the
following is observed: Patient answers one of the two orientation questions (month or age) correctly but misses the
other. Which NIHSS score for LOC Questions does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: B. 1
Rationale: A single correct answer out of two earns a score of 1, regardless of which question was missed. The other listed scores
describe findings that are either more severe or less severe than what is described, and do not match this exam.
Question 6 (1b. LOC Questions)
A 74-year-old woman is assessed at her bedside during a scheduled stroke scale check. On formal testing of LOC
Questions, the following is observed: Patient answers neither orientation question correctly; this includes patients who
cannot respond for reasons other than dysarthria, such as severe aphasia or stupor. Which NIHSS score for LOC Questions
does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: C. 2
Rationale: A score of 2 applies whenever both answers are wrong or the patient cannot produce a scorable verbal answer for a
reason unrelated to dysarthria. The other listed scores describe findings that are either more severe or less severe than what is
described, and do not match this exam.
Question 7 (1c. LOC Commands)
A 58-year-old man is brought to the emergency department after sudden onset of symptoms. On formal testing of LOC
Commands, the following is observed: Patient correctly performs both requested commands (opening/closing the eyes
and gripping/releasing the non-paretic hand). Which NIHSS score for LOC Commands does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: A. 0
Complete Practice Questions, Scoring Answers & Detailed Rationales
Updated 2026–2027
An original, educational NIHSS study and self-assessment guide.
All patient scenarios, questions, and answer rationales in this document are original educational material written to reflect the structure and
scoring criteria of the NIH Stroke Scale. This is not a reproduction of any proprietary, leaked, or official certification examination, and none of
the material should be represented as verified actual exam content.
This document is intended for educational self-study and does not replace formal NIHSS certification training or clinical judgment.
,Table of Contents
● Part 1 — Practice Questions (50 items)
● Part 2 — NIHSS Overview: High-Yield Q&A
● Part 3–4 — Test Groups A–F (36 Original Patient Scenarios)
● Part 5 — Complete Answer Key
● Part 6 — High-Yield Scoring Review
,Part 1 — Practice Questions
The following 50 original, clinically realistic questions cover all 15 NIHSS items. For each item below, choose the NIHSS
score that best matches the described examination finding.
Question 1 (1a. Level of Consciousness)
A 58-year-old man is brought to the emergency department after sudden onset of symptoms. On formal testing of Level
of Consciousness, the following is observed: Patient is alert, awake, and keenly responsive to the examiner without need
for stimulation. Which NIHSS score for Level of Consciousness does this finding represent?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A. 0
Rationale: A score of 0 is assigned whenever the patient is spontaneously alert and responsive, regardless of findings on other
items. The other listed scores describe findings that are either more severe or less severe than what is described, and do not
match this exam.
Question 2 (1a. Level of Consciousness)
A 64-year-old woman is being assessed at the bedside 90 minutes after symptom onset. On formal testing of Level of
Consciousness, the following is observed: Patient is drowsy but arouses easily to light verbal stimulation and cooperates
with the exam once aroused. Which NIHSS score for Level of Consciousness does this finding represent?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B. 1
Rationale: A score of 1 applies when minor stimulation (a raised voice, a gentle touch) is enough to obtain obedience, answers,
or responses. The other listed scores describe findings that are either more severe or less severe than what is described, and do
not match this exam.
Question 3 (1a. Level of Consciousness)
A 71-year-old man is evaluated by the stroke team shortly after arrival. On formal testing of Level of Consciousness, the
following is observed: Patient responds only with reflex posturing or autonomic changes to stimulation, or is completely
unresponsive, flaccid, and areflexic. Which NIHSS score for Level of Consciousness does this finding represent?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D. 3
Rationale: A score of 3 is assigned only when the patient shows no purposeful response to any stimulus, consistent with coma.
The other listed scores describe findings that are either more severe or less severe than what is described, and do not match this
exam.
, Question 4 (1b. LOC Questions)
A 67-year-old woman is examined on the neurology floor the morning after admission. On formal testing of LOC
Questions, the following is observed: Patient correctly states both the current month and their own age. Which NIHSS
score for LOC Questions does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: A. 0
Rationale: Both orientation questions must be answered exactly right for a score of 0. The other listed scores describe findings
that are either more severe or less severe than what is described, and do not match this exam.
Question 5 (1b. LOC Questions)
A 60-year-old man presents to triage with a witnessed acute neurological change. On formal testing of LOC Questions, the
following is observed: Patient answers one of the two orientation questions (month or age) correctly but misses the
other. Which NIHSS score for LOC Questions does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: B. 1
Rationale: A single correct answer out of two earns a score of 1, regardless of which question was missed. The other listed scores
describe findings that are either more severe or less severe than what is described, and do not match this exam.
Question 6 (1b. LOC Questions)
A 74-year-old woman is assessed at her bedside during a scheduled stroke scale check. On formal testing of LOC
Questions, the following is observed: Patient answers neither orientation question correctly; this includes patients who
cannot respond for reasons other than dysarthria, such as severe aphasia or stupor. Which NIHSS score for LOC Questions
does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: C. 2
Rationale: A score of 2 applies whenever both answers are wrong or the patient cannot produce a scorable verbal answer for a
reason unrelated to dysarthria. The other listed scores describe findings that are either more severe or less severe than what is
described, and do not match this exam.
Question 7 (1c. LOC Commands)
A 58-year-old man is brought to the emergency department after sudden onset of symptoms. On formal testing of LOC
Commands, the following is observed: Patient correctly performs both requested commands (opening/closing the eyes
and gripping/releasing the non-paretic hand). Which NIHSS score for LOC Commands does this finding represent?
A. 0
B. 1
C. 2
Correct Answer: A. 0
