PASSPOINT PRO
NIH STROKE SCALE STUDY SERIES
NIH Stroke Scale Final Review +
100-Question Mock Exam
High-yield review, scoring distinctions, mock exam, and a separate
answer key with explanations.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-05
,PASSPOINT PRO NIHSS Final Review
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
NIHSS Item Map
Item Domain Score range High-yield focus
1a Level of Consciousness 0-3 Alertness and response to stimulation
1b LOC Questions 0-2 Month and age; first response counts
1c LOC Commands 0-2 Two simple commands
2 Best Gaze 0-2 Horizontal gaze and forced deviation
3 Visual Fields 0-3 Field loss and bilateral blindness
4 Facial Palsy 0-3 Minor vs partial vs complete facial weakness
5L Motor Arm - Left 0-4 10-second arm drift
5R Motor Arm - Right 0-4 10-second arm drift
6L Motor Leg - Left 0-4 5-second leg drift
6R Motor Leg - Right 0-4 5-second leg drift
7 Limb Ataxia 0-2 Ataxia beyond weakness
8 Sensory 0-2 Mild vs severe sensory loss
9 Best Language 0-3 Language, naming, comprehension
10 Dysarthria 0-2 Articulation clarity
11 Extinction/Inattention 0-2 Extinction and hemi-inattention
NIHSS exam-prep and scoring practice Page 2
, PASSPOINT PRO NIHSS Final Review
Final Review: High-Yield Distinctions
Aphasia vs dysarthria: Aphasia affects language formulation/comprehension; dysarthria affects articulation. A patient
can understand and choose words correctly yet sound slurred.
Visual field loss vs neglect: A field cut is a primary visual deficit. Neglect/extinction is an attentional failure, often
exposed when competing stimuli are presented simultaneously.
Weakness vs ataxia: Motor weakness is scored under arm/leg items. Ataxia requires clear incoordination beyond the
weakness.
Drift vs no effort against gravity: Drift means the limb initially maintains the position and then descends. No effort
against gravity means the patient cannot meaningfully lift or sustain the limb against gravity.
Observed score vs presumed ability: NIHSS scoring uses the performance seen during the standardized item. Do not
give credit based only on what the patient seems capable of doing later.
NIHSS exam-prep and scoring practice Page 3
NIH STROKE SCALE STUDY SERIES
NIH Stroke Scale Final Review +
100-Question Mock Exam
High-yield review, scoring distinctions, mock exam, and a separate
answer key with explanations.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-05
,PASSPOINT PRO NIHSS Final Review
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
NIHSS Item Map
Item Domain Score range High-yield focus
1a Level of Consciousness 0-3 Alertness and response to stimulation
1b LOC Questions 0-2 Month and age; first response counts
1c LOC Commands 0-2 Two simple commands
2 Best Gaze 0-2 Horizontal gaze and forced deviation
3 Visual Fields 0-3 Field loss and bilateral blindness
4 Facial Palsy 0-3 Minor vs partial vs complete facial weakness
5L Motor Arm - Left 0-4 10-second arm drift
5R Motor Arm - Right 0-4 10-second arm drift
6L Motor Leg - Left 0-4 5-second leg drift
6R Motor Leg - Right 0-4 5-second leg drift
7 Limb Ataxia 0-2 Ataxia beyond weakness
8 Sensory 0-2 Mild vs severe sensory loss
9 Best Language 0-3 Language, naming, comprehension
10 Dysarthria 0-2 Articulation clarity
11 Extinction/Inattention 0-2 Extinction and hemi-inattention
NIHSS exam-prep and scoring practice Page 2
, PASSPOINT PRO NIHSS Final Review
Final Review: High-Yield Distinctions
Aphasia vs dysarthria: Aphasia affects language formulation/comprehension; dysarthria affects articulation. A patient
can understand and choose words correctly yet sound slurred.
Visual field loss vs neglect: A field cut is a primary visual deficit. Neglect/extinction is an attentional failure, often
exposed when competing stimuli are presented simultaneously.
Weakness vs ataxia: Motor weakness is scored under arm/leg items. Ataxia requires clear incoordination beyond the
weakness.
Drift vs no effort against gravity: Drift means the limb initially maintains the position and then descends. No effort
against gravity means the patient cannot meaningfully lift or sustain the limb against gravity.
Observed score vs presumed ability: NIHSS scoring uses the performance seen during the standardized item. Do not
give credit based only on what the patient seems capable of doing later.
NIHSS exam-prep and scoring practice Page 3
