2025 NIH Stroke Scale – Complete Test Groups A–F (Patients 1–6)
500 Practice Questions with Verified Answers & Detailed Rationales | A+ Graded
Exam Overview
The NIH Stroke Scale (NIHSS) is a 15-item neurological examination tool developed by the
National Institutes of Health to quantify stroke severity and track neurological change over
time. The certification program includes six test groups (Groups A through F), each
containing six patient scenarios (Patients 1–6) , for a total of 36 unique patient
presentations.
| Feature | Description |
|---------|-------------|
| Total Items | 15 (scored across 11 neurological domains) |
| Score Range | 0 (normal) to 42 (severe stroke) |
| Certification Groups | A, B, C, D, E, F |
| Patients per Group | 6 |
| Total Patient Scenarios | 36 |
| Group A Validity | 1 year from initial testing (renewable at 6 months) |
| Groups B–F Validity | 2 years from testing date |
NIHSS Score Interpretation:
| Score Range | Severity |
|-------------|----------|
| 0 | No stroke symptoms |
| 1–4 | Minor stroke |
| 5–15 | Moderate stroke |
,| 16–20 | Moderate to severe stroke |
| 21–42 | Severe stroke |
Core Domains (NIHSS Items):
| Item | Domain | Score Range |
|------|--------|-------------|
| 1a | Level of Consciousness | 0–3 |
| 1b | LOC Questions (month, age) | 0–2 |
| 1c | LOC Commands (open/close eyes, grip/release) | 0–2 |
| 2 | Best Gaze (horizontal eye movement) | 0–2 |
| 3 | Visual Fields | 0–3 |
| 4 | Facial Palsy | 0–3 |
| 5a | Left Arm Motor Drift | 0–4 |
| 5b | Right Arm Motor Drift | 0–4 |
| 6a | Left Leg Motor Drift | 0–4 |
| 6b | Right Leg Motor Drift | 0–4 |
| 7 | Limb Ataxia | 0–2 |
| 8 | Sensory | 0–2 |
| 9 | Best Language | 0–3 |
| 10 | Dysarthria | 0–2 |
| 11 | Extinction/Inattention (Neglect) | 0–2 |
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Table of Contents
1. Domain 1: Level of Consciousness (Items 1a, 1b, 1c) (80 Questions)
,2. Domain 2: Best Gaze & Visual Fields (Items 2, 3) (70 Questions)
3. Domain 3: Facial Palsy (Item 4) (50 Questions)
4. Domain 4: Motor Function – Arms & Legs (Items 5a, 5b, 6a, 6b) (100 Questions)
5. Domain 5: Limb Ataxia & Sensory (Items 7, 8) (60 Questions)
6. Domain 6: Language & Dysarthria (Items 9, 10) (70 Questions)
7. Domain 7: Extinction/Inattention (Item 11) (40 Questions)
8. Domain 8: Group A Patient Scenarios 1–6 (30 Questions)
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Domain 1: Level of Consciousness (Items 1a, 1b, 1c)
(80 Questions)
Question 1
A patient is alert, keenly responsive, and answers all questions appropriately. What is the
correct score for Item 1a?
A) 1
B) 2
C) 3
D) 0
Correct Answer: D) 0
Rationale: Item 1a (Level of Consciousness) scores 0 if the patient is alert and responsive. A
score of 1 indicates drowsiness but arousable by minor stimulation; 2 indicates stupor
requiring repeated stimulation; 3 indicates coma with only reflex responses.
---
, Question 2
A patient is not alert but is arousable by minor stimulation to obey, answer, or respond.
What is the correct score for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B) 1
Rationale: Item 1a scores 1 if the patient is not alert but arousable by minor stimulation. This
indicates drowsiness or mild impairment of consciousness. A score of 0 is alert; 2 is not alert,
requires repeated stimulation; 3 is coma.
---
Question 3
A patient requires repeated stimulation to attend or is obtunded and requires strong or
painful stimulation to make movements. What is the correct score for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C) 2
500 Practice Questions with Verified Answers & Detailed Rationales | A+ Graded
Exam Overview
The NIH Stroke Scale (NIHSS) is a 15-item neurological examination tool developed by the
National Institutes of Health to quantify stroke severity and track neurological change over
time. The certification program includes six test groups (Groups A through F), each
containing six patient scenarios (Patients 1–6) , for a total of 36 unique patient
presentations.
| Feature | Description |
|---------|-------------|
| Total Items | 15 (scored across 11 neurological domains) |
| Score Range | 0 (normal) to 42 (severe stroke) |
| Certification Groups | A, B, C, D, E, F |
| Patients per Group | 6 |
| Total Patient Scenarios | 36 |
| Group A Validity | 1 year from initial testing (renewable at 6 months) |
| Groups B–F Validity | 2 years from testing date |
NIHSS Score Interpretation:
| Score Range | Severity |
|-------------|----------|
| 0 | No stroke symptoms |
| 1–4 | Minor stroke |
| 5–15 | Moderate stroke |
,| 16–20 | Moderate to severe stroke |
| 21–42 | Severe stroke |
Core Domains (NIHSS Items):
| Item | Domain | Score Range |
|------|--------|-------------|
| 1a | Level of Consciousness | 0–3 |
| 1b | LOC Questions (month, age) | 0–2 |
| 1c | LOC Commands (open/close eyes, grip/release) | 0–2 |
| 2 | Best Gaze (horizontal eye movement) | 0–2 |
| 3 | Visual Fields | 0–3 |
| 4 | Facial Palsy | 0–3 |
| 5a | Left Arm Motor Drift | 0–4 |
| 5b | Right Arm Motor Drift | 0–4 |
| 6a | Left Leg Motor Drift | 0–4 |
| 6b | Right Leg Motor Drift | 0–4 |
| 7 | Limb Ataxia | 0–2 |
| 8 | Sensory | 0–2 |
| 9 | Best Language | 0–3 |
| 10 | Dysarthria | 0–2 |
| 11 | Extinction/Inattention (Neglect) | 0–2 |
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Table of Contents
1. Domain 1: Level of Consciousness (Items 1a, 1b, 1c) (80 Questions)
,2. Domain 2: Best Gaze & Visual Fields (Items 2, 3) (70 Questions)
3. Domain 3: Facial Palsy (Item 4) (50 Questions)
4. Domain 4: Motor Function – Arms & Legs (Items 5a, 5b, 6a, 6b) (100 Questions)
5. Domain 5: Limb Ataxia & Sensory (Items 7, 8) (60 Questions)
6. Domain 6: Language & Dysarthria (Items 9, 10) (70 Questions)
7. Domain 7: Extinction/Inattention (Item 11) (40 Questions)
8. Domain 8: Group A Patient Scenarios 1–6 (30 Questions)
---
Domain 1: Level of Consciousness (Items 1a, 1b, 1c)
(80 Questions)
Question 1
A patient is alert, keenly responsive, and answers all questions appropriately. What is the
correct score for Item 1a?
A) 1
B) 2
C) 3
D) 0
Correct Answer: D) 0
Rationale: Item 1a (Level of Consciousness) scores 0 if the patient is alert and responsive. A
score of 1 indicates drowsiness but arousable by minor stimulation; 2 indicates stupor
requiring repeated stimulation; 3 indicates coma with only reflex responses.
---
, Question 2
A patient is not alert but is arousable by minor stimulation to obey, answer, or respond.
What is the correct score for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B) 1
Rationale: Item 1a scores 1 if the patient is not alert but arousable by minor stimulation. This
indicates drowsiness or mild impairment of consciousness. A score of 0 is alert; 2 is not alert,
requires repeated stimulation; 3 is coma.
---
Question 3
A patient requires repeated stimulation to attend or is obtunded and requires strong or
painful stimulation to make movements. What is the correct score for Item 1a?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C) 2
