NIH STROKE SCALE CERTIFICATION EXAM 2026/2027 –
EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT
DOWNLOAD PDF
1. During administration of the NIH Stroke Scale, which principle should guide the
examiner's scoring?
A. Score what the patient is likely capable of doing with encouragement
B. Allow several attempts and record the patient's best performance
C. Score what the patient actually does during the examination
D. Modify the score according to the suspected stroke location
Rationale: The NIH Stroke Scale instructions emphasize that scores should reflect the patient's
observed performance rather than what the examiner believes the patient could accomplish. The
examination should be administered according to the specified instructions and scored promptly.
2. What is the recommended approach to the order of NIH Stroke Scale
administration?
A. Begin with motor strength because it is the most clinically important finding
B. Administer the items in the order listed on the scale
C. Start with language and complete the remaining items in any order
D. Perform the most abnormal items first
Rationale: Standardized administration requires the NIH Stroke Scale items to be performed in
the prescribed order. Maintaining the sequence promotes consistency between examinations and
examiners.
3. A patient correctly identifies the current month but gives an incorrect age. How
should the level-of-consciousness questions be scored?
A. 1
B. 0
C. 2
D. 3
Rationale: The NIHSS level-of-consciousness questions ask for the month and the patient's age.
One correct response receives a score of 1, while both correct responses receive 0 and neither
correct receives 2.
4. A patient is asked for the month and age and answers neither question correctly.
What score is appropriate for the LOC questions?
,A. 0
B. 1
C. 2
D. 3
Rationale: The LOC questions are scored 0 when both responses are correct, 1 when one is
correct, and 2 when neither is correct. The responses must be correct rather than approximately
correct.
5. When evaluating LOC questions, the examiner asks the patient to identify the
month. The patient gives an answer that is close but incorrect. How should it be
scored?
A. Give partial credit
B. Give credit if the answer is within one month
C. Repeat the question until the patient gives the correct response
D. Score the response as incorrect
Rationale: The NIHSS instructions specify that the month and age responses must be correct and
that there is no partial credit for an answer that is merely close.
6. A patient does not initially respond when asked to open and close the eyes and
grip and release the non-paretic hand. What should the examiner do according to
the NIHSS instructions?
A. Automatically assign 2 points
B. Repeat the commands until the patient responds
C. Demonstrate the task and then score the patient's performance
D. Exclude the item from the examination
Rationale: If the patient does not respond to the command, the examiner should demonstrate the
task through pantomime and score whether the patient follows none, one, or both commands.
7. A patient has an amputation that prevents the usual hand command from being
performed. What is the appropriate approach?
A. Score the affected command as incorrect automatically
B. Use a suitable one-step command that can be performed
C. Remove the LOC command item from the NIHSS
D. Ask a family member to demonstrate the response
Rationale: The NIHSS instructions allow suitable one-step commands when trauma, amputation,
or another physical impediment prevents use of the standard task.
, 8. A patient with severe dysarthria cannot clearly speak the answers to the LOC
questions, but the communication problem is not caused by aphasia. How should
this situation be handled?
A. Always score 2 because the answers cannot be spoken
B. Score 0 if the examiner believes the patient knows the answers
C. Apply the NIHSS instruction for patients unable to speak because of severe dysarthria
or another non-aphasic communication limitation
D. Ask the patient's family to provide the answers
Rationale: The NIHSS distinguishes inability to speak because of conditions such as severe
dysarthria from impaired comprehension caused by aphasia. The scale provides specific scoring
instructions for these circumstances rather than allowing the examiner to infer the patient's
answer.
9. When testing LOC commands, which principle is important regarding attempts?
A. The examiner should coach the patient through several attempts
B. The strongest performance should always be recorded
C. Only the first attempt is scored
D. The final attempt is scored after repeated practice
Rationale: The NIHSS instructions specify that only the first attempt is scored for the LOC
commands. This helps standardize the examination and limits the effect of repeated coaching.
10. A patient follows the eye-opening command but does not follow the hand-grip
command despite understanding the examiner. What LOC command score is
appropriate?
A. 1
B. 0
C. 2
D. 3
Rationale: The LOC command component awards 0 when both commands are performed, 1
when one is performed, and 2 when neither is performed.
11. During the LOC command assessment, a patient makes an unequivocal attempt
to perform a command but cannot complete it because of weakness. How should
this be considered?
A. The attempt receives no credit because the movement was incomplete
B. The unequivocal attempt can receive credit according to the command-scoring
instructions
C. The examiner should repeat the command until it is completed
D. The item should automatically receive the maximum score
EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT
DOWNLOAD PDF
1. During administration of the NIH Stroke Scale, which principle should guide the
examiner's scoring?
A. Score what the patient is likely capable of doing with encouragement
B. Allow several attempts and record the patient's best performance
C. Score what the patient actually does during the examination
D. Modify the score according to the suspected stroke location
Rationale: The NIH Stroke Scale instructions emphasize that scores should reflect the patient's
observed performance rather than what the examiner believes the patient could accomplish. The
examination should be administered according to the specified instructions and scored promptly.
2. What is the recommended approach to the order of NIH Stroke Scale
administration?
A. Begin with motor strength because it is the most clinically important finding
B. Administer the items in the order listed on the scale
C. Start with language and complete the remaining items in any order
D. Perform the most abnormal items first
Rationale: Standardized administration requires the NIH Stroke Scale items to be performed in
the prescribed order. Maintaining the sequence promotes consistency between examinations and
examiners.
3. A patient correctly identifies the current month but gives an incorrect age. How
should the level-of-consciousness questions be scored?
A. 1
B. 0
C. 2
D. 3
Rationale: The NIHSS level-of-consciousness questions ask for the month and the patient's age.
One correct response receives a score of 1, while both correct responses receive 0 and neither
correct receives 2.
4. A patient is asked for the month and age and answers neither question correctly.
What score is appropriate for the LOC questions?
,A. 0
B. 1
C. 2
D. 3
Rationale: The LOC questions are scored 0 when both responses are correct, 1 when one is
correct, and 2 when neither is correct. The responses must be correct rather than approximately
correct.
5. When evaluating LOC questions, the examiner asks the patient to identify the
month. The patient gives an answer that is close but incorrect. How should it be
scored?
A. Give partial credit
B. Give credit if the answer is within one month
C. Repeat the question until the patient gives the correct response
D. Score the response as incorrect
Rationale: The NIHSS instructions specify that the month and age responses must be correct and
that there is no partial credit for an answer that is merely close.
6. A patient does not initially respond when asked to open and close the eyes and
grip and release the non-paretic hand. What should the examiner do according to
the NIHSS instructions?
A. Automatically assign 2 points
B. Repeat the commands until the patient responds
C. Demonstrate the task and then score the patient's performance
D. Exclude the item from the examination
Rationale: If the patient does not respond to the command, the examiner should demonstrate the
task through pantomime and score whether the patient follows none, one, or both commands.
7. A patient has an amputation that prevents the usual hand command from being
performed. What is the appropriate approach?
A. Score the affected command as incorrect automatically
B. Use a suitable one-step command that can be performed
C. Remove the LOC command item from the NIHSS
D. Ask a family member to demonstrate the response
Rationale: The NIHSS instructions allow suitable one-step commands when trauma, amputation,
or another physical impediment prevents use of the standard task.
, 8. A patient with severe dysarthria cannot clearly speak the answers to the LOC
questions, but the communication problem is not caused by aphasia. How should
this situation be handled?
A. Always score 2 because the answers cannot be spoken
B. Score 0 if the examiner believes the patient knows the answers
C. Apply the NIHSS instruction for patients unable to speak because of severe dysarthria
or another non-aphasic communication limitation
D. Ask the patient's family to provide the answers
Rationale: The NIHSS distinguishes inability to speak because of conditions such as severe
dysarthria from impaired comprehension caused by aphasia. The scale provides specific scoring
instructions for these circumstances rather than allowing the examiner to infer the patient's
answer.
9. When testing LOC commands, which principle is important regarding attempts?
A. The examiner should coach the patient through several attempts
B. The strongest performance should always be recorded
C. Only the first attempt is scored
D. The final attempt is scored after repeated practice
Rationale: The NIHSS instructions specify that only the first attempt is scored for the LOC
commands. This helps standardize the examination and limits the effect of repeated coaching.
10. A patient follows the eye-opening command but does not follow the hand-grip
command despite understanding the examiner. What LOC command score is
appropriate?
A. 1
B. 0
C. 2
D. 3
Rationale: The LOC command component awards 0 when both commands are performed, 1
when one is performed, and 2 when neither is performed.
11. During the LOC command assessment, a patient makes an unequivocal attempt
to perform a command but cannot complete it because of weakness. How should
this be considered?
A. The attempt receives no credit because the movement was incomplete
B. The unequivocal attempt can receive credit according to the command-scoring
instructions
C. The examiner should repeat the command until it is completed
D. The item should automatically receive the maximum score
