NIHSS CERTIFICATION EXAM LATEST 2026 UPDATED
QUESTIONS AND VERIFIED 100% SOLUTIONS (2026/2027)
GRADE: A+|STATUS: GUARANTEED PASS
1a. Level of Consciousness: The investigator must choose a response, even if a full evaluation is
prevented by such obstacles as an endotracheal tube, language barrier, orotracheal
trauma/bandages. A 3 is scored only if the patient makes no movement (other than reflexive
posturing) in response to noxious stimulation.*
1B - LOC Questions (2)
Month of year
Patient age
-----
0 = Answers both questions correctly
1 = Answers one question correctly
2 = Answers neither question correctly
---
11 components of NIHSS
1. LOC (Question & Command)
2. Gaze
3. Visual field
4. Facial palsy
5. Upper extremity
6. Lower extremity
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction & inattention
1A - LOC
1|Page
, 0 = Alert
1 = Not alert; aroused with minor verbal stimulation
2 = Not alert; requires strong or painful stimulation
3 = Reflex movements only or totally unresponsive (COMA ~ try rub on chest)
---
1b. LOC Questions: The patient is asked the month and his/her age. The answer must be correct
- there is no partial credit for being close. Aphasic and stuporous patients who do not
comprehend the questions will score 2. Patients unable to speak because of endotracheal
intubation, orotracheal trauma, severe dysarthria from any cause, language barrier or any other
problem not secondary to aphasia are given a 1. It is important that only the initial answer be
graded and that the examiner not "help" the patient with verbal or non-verbal cues.*
1C - LOC Commands
Two tasks
- Close your eye for me and now open
- Make a fist with your hand
--------
LEVEL OF CONSCIOUSNESS: COMMANDS
0 = Performs both tasks correctly
1 = Performs one task correctly
2 = Performs neither task correctly
--
1c. LOC Commands: The patient is asked to open and close the eyes and then to grip and
release the non-paretic hand. Substitute another one step command if the hands cannot be
used. Credit is given if an unequivocal attempt is made but not completed due to weakness. If
the patient does not respond to command, the task should be demonstrated to them
(pantomime) and score the result (i.e., follows none, one or two commands). Patients with
trauma, amputation, or other physical impediments should be given suitable one-step
commands. Only the first attempt is scored.*
2|Page
QUESTIONS AND VERIFIED 100% SOLUTIONS (2026/2027)
GRADE: A+|STATUS: GUARANTEED PASS
1a. Level of Consciousness: The investigator must choose a response, even if a full evaluation is
prevented by such obstacles as an endotracheal tube, language barrier, orotracheal
trauma/bandages. A 3 is scored only if the patient makes no movement (other than reflexive
posturing) in response to noxious stimulation.*
1B - LOC Questions (2)
Month of year
Patient age
-----
0 = Answers both questions correctly
1 = Answers one question correctly
2 = Answers neither question correctly
---
11 components of NIHSS
1. LOC (Question & Command)
2. Gaze
3. Visual field
4. Facial palsy
5. Upper extremity
6. Lower extremity
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction & inattention
1A - LOC
1|Page
, 0 = Alert
1 = Not alert; aroused with minor verbal stimulation
2 = Not alert; requires strong or painful stimulation
3 = Reflex movements only or totally unresponsive (COMA ~ try rub on chest)
---
1b. LOC Questions: The patient is asked the month and his/her age. The answer must be correct
- there is no partial credit for being close. Aphasic and stuporous patients who do not
comprehend the questions will score 2. Patients unable to speak because of endotracheal
intubation, orotracheal trauma, severe dysarthria from any cause, language barrier or any other
problem not secondary to aphasia are given a 1. It is important that only the initial answer be
graded and that the examiner not "help" the patient with verbal or non-verbal cues.*
1C - LOC Commands
Two tasks
- Close your eye for me and now open
- Make a fist with your hand
--------
LEVEL OF CONSCIOUSNESS: COMMANDS
0 = Performs both tasks correctly
1 = Performs one task correctly
2 = Performs neither task correctly
--
1c. LOC Commands: The patient is asked to open and close the eyes and then to grip and
release the non-paretic hand. Substitute another one step command if the hands cannot be
used. Credit is given if an unequivocal attempt is made but not completed due to weakness. If
the patient does not respond to command, the task should be demonstrated to them
(pantomime) and score the result (i.e., follows none, one or two commands). Patients with
trauma, amputation, or other physical impediments should be given suitable one-step
commands. Only the first attempt is scored.*
2|Page
