NIHSS Group C Patients 1–6 | National Institutes of Health | Academic Year 2026/2027

NIHSS Group C Patients 1–6 | National
Institutes of Health | Academic Year
2026/2027
Section 1: Level of Consciousness & Orientation
Question 1
A 72-year-old female is evaluated for acute stroke symptoms. She is drowsy but
opens her eyes and responds appropriately to verbal questions. When asked her
name, she answers correctly but cannot state the current month or year. What is
the NIHSS score for Item 1a (Level of Consciousness)?
A. 0 (Alert)
B. 1 (Drowsy, responds to verbal stimuli)
C. 2 (Stuporous, responds to pain)
D. 3 (Coma)

Correct Answer: B
Rationale: The patient is drowsy but responds to verbal stimuli, which
corresponds to NIHSS Item 1a score of 1. Option A is incorrect because she is not
fully alert. Option C is incorrect as she does not require pain to arouse. Option D is
incorrect as she is not comatose. NIHSS guidelines specify that drowsiness with
verbal response is scored as 1, reflecting impaired consciousness without coma.


Question 2
A 65-year-old male with sudden left-sided weakness is assessed. He is alert and
oriented to person but becomes confused when asked to repeat the month and
year. What is the NIHSS score for Item 1b (Orientation)?
A. 0 (Oriented to both)
B. 1 (Oriented to person only)
C. 2 (Disoriented to both)
D. 3 (Unresponsive)

, Correct Answer: B
Rationale: The patient is oriented to person but not to time (month/year),
scoring 1 for Item 1b. Option A is incorrect as he is not fully oriented. Option C is
incorrect because he is not completely disoriented. Option D is irrelevant. NIHSS
guidelines specify that partial orientation (person only) scores 1, reflecting mild
cognitive impairment.


Question 3
During NIHSS assessment, a patient fails to respond to verbal commands but
withdraws from painful stimuli. What is the score for Item 1a?
A. 0
B. 1
C. 2
D. 3

Correct Answer: C
Rationale: Withdrawal from pain indicates stupor, scoring 2 for Item 1a.
Options A and B are incorrect as the patient does not respond to verbal stimuli.
Option D is incorrect as the patient responds to pain, not coma. This follows
NIHSS criteria where pain response without verbal interaction scores 2.


Question 4
A patient is alert but cannot state their age or current location. What is the Item
1b score?
A. 0
B. 1
C. 2
D. 3

Correct Answer: C
Rationale: Disorientation to both person (age) and place (location) scores
2 for Item 1b. Options A and B are incorrect as the patient is not oriented. NIHSS

,guidelines specify complete disorientation scores 2, indicating significant
cognitive deficit.


Question 5
A stroke patient is comatose and does not respond to any stimuli. What is the
Item 1a score?
A. 0
B. 1
C. 2
D. 3

Correct Answer: D
Rationale: Coma with no response to any stimuli scores 3 for Item 1a.
Options A through C are incorrect as they represent lesser degrees of impairment.
This represents the most severe level of consciousness impairment on the NIHSS.


Question 6
During assessment, a patient correctly identifies the month but gives an incorrect
age. How should NIHSS Item 1b be scored?
A. 0
B. 1
C. 2
D. 3

Correct Answer: B
Rationale: The NIHSS awards 1 point when one of the two LOC questions
is answered correctly. Both correct answers equal 0, and both incorrect answers
equal 2. This patient answered the month correctly but missed age, scoring 1.


Question 7
A patient is asked to open and close the eyes and then grip and release the non-

, paretic hand. The patient performs both tasks correctly. What is the appropriate
NIHSS LOC commands score (Item 1c)?
A. 0
B. 1
C. 2
D. 3

Correct Answer: A
Rationale: Both commands are completed correctly, so Item 1c receives 0.
If one of the two commands were performed correctly, the score would be 1;
inability to follow either command results in 2.


Question 8
Which finding represents the most severe abnormality for NIHSS Item 1c (LOC
Commands)?
A. The patient performs both commands correctly.
B. The patient performs one command correctly.
C. The patient performs neither command correctly.
D. The patient performs the commands only after encouragement.

Correct Answer: C
Rationale: LOC commands are scored 0 when both commands are
performed, 1 when one is performed, and 2 when neither is performed. The
scoring reflects the patient's ability to understand and execute the standardized
commands.


Question 9
A patient is lethargic but can be awakened briefly with repeated verbal
stimulation and can then answer questions. Which NIHSS level-of-consciousness
score is most appropriate?
A. 0
B. 1