NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
NIH Stroke Scale — All Test Groups A–F
(Patients 1–6)
Complete Answer Key — Verified and Fully Updated for 2026/2027
396 Questions — 6 Groups × 6 Patients × 11 NIHSS Items
Examination Overview: This comprehensive exam contains 396 multiple-choice questions covering the NIH
Stroke Scale (NIHSS) certification and recertification across all six test groups (A through F). Each group
presents 6 unique patient scenarios, and each patient is assessed on 11 NIHSS items: Level of Consciousness
(1a Alertness, 1b Questions, 1c Commands), Best Gaze (2), Visual Fields (3), Facial Palsy (4), Motor Arm
Left/Right (5a/5b), Motor Leg Left/Right (6a/6b), and Limb Ataxia (7). Each question presents four options
(A–D) with one correct answer identified by [CORRECT] and is followed by a detailed rationale based on the
standardized NIHSS examination protocol.
Cognitive Level Distribution: Approximately 30% of questions target recall of NIHSS scoring definitions,
50% require application of scoring criteria to patient scenarios, and 20% demand analysis to differentiate
subtle neurological findings. All questions are scenario-based patient assessments with verified scoring.
Distractors represent common NIHSS scoring errors including confusing drift severity (1 vs. 2), misclassifying
aphasia vs. dysarthria, missing subtle neglect, incorrect visual field scoring, confusing gaze preference vs.
partial gaze palsy, and misidentifying ataxia vs. weakness.
GROUP A - Patients 1-6 (Q1-Q66)
NIHSS Items 1a, 1b, 1c, 2, 3, 4, 5a, 5b, 6a, 6b, 7 (11 items per patient)
GROUP A - PATIENT 1
The patient is a 72-year-old male presenting 3 hours after onset of left-sided weakness consistent with a mild
right middle cerebral artery (MCA) stroke. He is alert and oriented, with a mild gaze preference, partial left
homonymous hemianopia, mild left facial droop, left arm and leg drift, and no limb ataxia.
Q1: [Group A - Patient 1 - NIHSS Item 1a: Level of Consciousness - Alertness] The patient is a
72-year-old male who presents 3 hours after onset of left-sided weakness. When you approach the
bedside, he opens his eyes spontaneously, makes eye contact, and converses with you without any
stimulation. What is the NIHSS score for Item 1a?
A. 0 - Alert [CORRECT]
B. 1 - Not alert, but arousable by minor stimulation
C. 2 - Not alert, requires repeated stimulation
NIHSS Certification Exam - Complete Answer Key Page 1
,NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
D. 3 - Coma/unresponsive
Correct Answer: A
Rationale: The patient opens his eyes spontaneously and responds verbally without any external stimulation, which meets
the criteria for a score of 0 (Alert). Score 1 requires that the patient not be fully alert but arousable with minor stimulation,
score 2 requires repeated or strong/painful stimulation to attend, and score 3 is reserved for coma or unresponsiveness.
The correct answer is A.
Q2: [Group A - Patient 1 - NIHSS Item 1b: Level of Consciousness - Questions] You ask the patient to
state the current month and his age. He promptly answers both questions correctly. What is the NIHSS
score for Item 1b?
A. 0 - Both correct [CORRECT]
B. 1 - One correct
C. 2 - Neither correct
D. 3 - Unable to assess due to severe aphasia or intubation
Correct Answer: A
Rationale: The patient correctly answers both the month and his age, which corresponds to a score of 0 (Both correct). A
score of 1 is assigned when only one answer is correct, and a score of 2 is assigned when neither answer is correct; only the
initial response counts and errors cannot be corrected. The correct answer is A.
Q3: [Group A - Patient 1 - NIHSS Item 1c: Level of Consciousness - Commands] You ask the patient to
open and close his eyes, and then to grip and release his nonparetic hand. He performs both tasks
correctly on the first attempt. What is the NIHSS score for Item 1c?
A. 0 - Both correct [CORRECT]
B. 1 - One correct
C. 2 - Neither correct
D. 3 - Unable to assess due to severe aphasia or intubation
Correct Answer: A
Rationale: The patient successfully completes both the eye open/close command and the grip/release command, earning a
score of 0 (Both correct). A score of 1 is given when only one command is followed, and a score of 2 is given when
neither is followed; only the first attempt is scored. The correct answer is A.
Q4: [Group A - Patient 1 - NIHSS Item 2: Best Gaze] On examination, the patient shows a mild gaze
preference toward the right side but is able to voluntarily move both eyes fully to the left with effort.
There is no forced deviation. What is the NIHSS score for Item 2?
A. 0 - Normal horizontal gaze
B. 1 - Partial gaze palsy [CORRECT]
C. 2 - Forced deviation
D. 3 - Bilateral gaze palsy (forced deviation in both directions)
Correct Answer: B
Rationale: The patient has a partial gaze palsy with a mild gaze preference but retains the ability to move the eyes
voluntarily to the contralateral side, which scores 1. A score of 0 requires full normal horizontal gaze in both directions,
and a score of 2 is assigned only when there is forced deviation that cannot be overcome by the oculocephalic maneuver.
The correct answer is B.
Q5: [Group A - Patient 1 - NIHSS Item 3: Visual Fields] On confrontation visual field testing, the
patient has a partial loss of vision in the left hemifield of both eyes that does not respect the full
vertical midline. What is the NIHSS score for Item 3?
A. 0 - No visual loss
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,NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
B. 1 - Partial hemianopia [CORRECT]
C. 2 - Complete hemianopia
D. 3 - Bilateral hemianopia
Correct Answer: B
Rationale: A partial loss of vision in the left hemifield that does not constitute a complete hemianopia corresponds to a
score of 1 (Partial hemianopia). A score of 0 requires no visual loss, score 2 requires a complete hemianopia with full loss
of one half of the visual field, and score 3 is reserved for bilateral hemianopia including cortical blindness. The correct
answer is B.
Q6: [Group A - Patient 1 - NIHSS Item 4: Facial Palsy] When you ask the patient to smile, show teeth,
raise eyebrows, and close his eyes, you note a slight asymmetry with flattening of the left nasolabial
fold but symmetric forehead wrinkling and full eye closure. What is the NIHSS score for Item 4?
A. 0 - Normal
B. 1 - Minor paralysis [CORRECT]
C. 2 - Partial paralysis
D. 3 - Complete paralysis
Correct Answer: B
Rationale: The slight flattening of the left nasolabial fold with preserved forehead wrinkling and eye closure represents
minor paralysis, scoring 1. Score 0 requires completely symmetric facial movement, score 2 requires partial paralysis with
more pronounced asymmetry (often involving the lower face and some upper face weakness), and score 3 requires
complete unilateral or bilateral facial paralysis. The correct answer is B.
Q7: [Group A - Patient 1 - NIHSS Item 5a: Motor Arm - Left] You ask the patient to hold his left arm
extended at 90 degrees for 10 seconds. The arm initially holds the position but drifts downward after
about 5 seconds without falling to the bed. What is the NIHSS score for Item 5a?
A. 0 - No drift
B. 1 - Drift [CORRECT]
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: B
Rationale: The left arm holds the extended position briefly but drifts downward before the 10-second mark without
falling completely, which is scored as drift (1). Score 0 requires the arm to remain in the extended position for the full 10
seconds, score 2 requires some effort against gravity but the arm cannot maintain the position, and scores 3 and 4 indicate
progressively less voluntary effort. The correct answer is B.
Q8: [Group A - Patient 1 - NIHSS Item 5b: Motor Arm - Right] You ask the patient to hold his right
(nonparetic) arm extended at 90 degrees for 10 seconds. The arm remains steady in the full extended
position for the entire 10 seconds. What is the NIHSS score for Item 5b?
A. 0 - No drift [CORRECT]
B. 1 - Drift
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: A
Rationale: The right arm holds the extended position for the full 10 seconds without any downward drift, earning a score
of 0 (No drift). Drift (1) is scored when the arm drifts down but does not hit the bed, and higher scores reflect increasing
inability to maintain the position against gravity or to generate any movement. The correct answer is A.
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, NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
Q9: [Group A - Patient 1 - NIHSS Item 6a: Motor Leg - Left] You ask the patient to hold his left leg
extended at 30 degrees for 5 seconds. The leg holds the position briefly but drifts down toward the bed
after about 3 seconds without falling completely. What is the NIHSS score for Item 6a?
A. 0 - No drift
B. 1 - Drift [CORRECT]
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: B
Rationale: The left leg drifts downward after being placed in the extended position but does not fall immediately to the
bed, which corresponds to a score of 1 (Drift). A score of 0 requires the leg to remain elevated for the full 5 seconds, score
2 is given when there is some effort against gravity but the leg falls immediately, and scores 3 and 4 indicate absent effort
or movement. The correct answer is B.
Q10: [Group A - Patient 1 - NIHSS Item 6b: Motor Leg - Right] You ask the patient to hold his right
(nonparetic) leg extended at 30 degrees for 5 seconds. The leg remains steady in the elevated position
for the full 5 seconds. What is the NIHSS score for Item 6b?
A. 0 - No drift [CORRECT]
B. 1 - Drift
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: A
Rationale: The right leg maintains the extended position for the full 5 seconds without drifting, scoring 0 (No drift). Drift
(1) requires the leg to drift downward before the time limit, and higher scores reflect progressive inability to maintain the
position against gravity. The correct answer is A.
Q11: [Group A - Patient 1 - NIHSS Item 7: Limb Ataxia] You perform the finger-to-nose and
heel-to-shin testing on both the left and right limbs. The patient performs these tasks smoothly and
accurately without any dysmetria or overshoot. What is the NIHSS score for Item 7?
A. 0 - Absent [CORRECT]
B. 1 - Present in one limb
C. 2 - Present in two or more limbs
D. UN - Amputation/joint fusion
Correct Answer: A
Rationale: The patient performs finger-to-nose and heel-to-shin testing smoothly without dysmetria, ataxia, or overshoot,
indicating that ataxia is absent and scoring 0. Score 1 is assigned when ataxia is present in one limb, score 2 is assigned
when ataxia is present in two or more limbs, and UN is used only for amputation or joint fusion that precludes testing. The
correct answer is A.
GROUP A - PATIENT 2
The patient is a 68-year-old female presenting 4 hours after onset of right-sided weakness and mild difficulty
speaking consistent with a moderate left middle cerebral artery (MCA) stroke. She is alert with mild expressive
aphasia, partial gaze palsy, no visual field loss, partial right facial palsy, right arm weakness with some effort
against gravity, right leg drift, and right limb ataxia.
Q12: [Group A - Patient 2 - NIHSS Item 1a: Level of Consciousness - Alertness] The patient is a
68-year-old female who presents 4 hours after onset of right-sided weakness. She is awake, makes eye
contact as you enter the room, and responds verbally without requiring any stimulation. What is the
NIHSS Certification Exam - Complete Answer Key Page 4
NIH Stroke Scale — All Test Groups A–F
(Patients 1–6)
Complete Answer Key — Verified and Fully Updated for 2026/2027
396 Questions — 6 Groups × 6 Patients × 11 NIHSS Items
Examination Overview: This comprehensive exam contains 396 multiple-choice questions covering the NIH
Stroke Scale (NIHSS) certification and recertification across all six test groups (A through F). Each group
presents 6 unique patient scenarios, and each patient is assessed on 11 NIHSS items: Level of Consciousness
(1a Alertness, 1b Questions, 1c Commands), Best Gaze (2), Visual Fields (3), Facial Palsy (4), Motor Arm
Left/Right (5a/5b), Motor Leg Left/Right (6a/6b), and Limb Ataxia (7). Each question presents four options
(A–D) with one correct answer identified by [CORRECT] and is followed by a detailed rationale based on the
standardized NIHSS examination protocol.
Cognitive Level Distribution: Approximately 30% of questions target recall of NIHSS scoring definitions,
50% require application of scoring criteria to patient scenarios, and 20% demand analysis to differentiate
subtle neurological findings. All questions are scenario-based patient assessments with verified scoring.
Distractors represent common NIHSS scoring errors including confusing drift severity (1 vs. 2), misclassifying
aphasia vs. dysarthria, missing subtle neglect, incorrect visual field scoring, confusing gaze preference vs.
partial gaze palsy, and misidentifying ataxia vs. weakness.
GROUP A - Patients 1-6 (Q1-Q66)
NIHSS Items 1a, 1b, 1c, 2, 3, 4, 5a, 5b, 6a, 6b, 7 (11 items per patient)
GROUP A - PATIENT 1
The patient is a 72-year-old male presenting 3 hours after onset of left-sided weakness consistent with a mild
right middle cerebral artery (MCA) stroke. He is alert and oriented, with a mild gaze preference, partial left
homonymous hemianopia, mild left facial droop, left arm and leg drift, and no limb ataxia.
Q1: [Group A - Patient 1 - NIHSS Item 1a: Level of Consciousness - Alertness] The patient is a
72-year-old male who presents 3 hours after onset of left-sided weakness. When you approach the
bedside, he opens his eyes spontaneously, makes eye contact, and converses with you without any
stimulation. What is the NIHSS score for Item 1a?
A. 0 - Alert [CORRECT]
B. 1 - Not alert, but arousable by minor stimulation
C. 2 - Not alert, requires repeated stimulation
NIHSS Certification Exam - Complete Answer Key Page 1
,NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
D. 3 - Coma/unresponsive
Correct Answer: A
Rationale: The patient opens his eyes spontaneously and responds verbally without any external stimulation, which meets
the criteria for a score of 0 (Alert). Score 1 requires that the patient not be fully alert but arousable with minor stimulation,
score 2 requires repeated or strong/painful stimulation to attend, and score 3 is reserved for coma or unresponsiveness.
The correct answer is A.
Q2: [Group A - Patient 1 - NIHSS Item 1b: Level of Consciousness - Questions] You ask the patient to
state the current month and his age. He promptly answers both questions correctly. What is the NIHSS
score for Item 1b?
A. 0 - Both correct [CORRECT]
B. 1 - One correct
C. 2 - Neither correct
D. 3 - Unable to assess due to severe aphasia or intubation
Correct Answer: A
Rationale: The patient correctly answers both the month and his age, which corresponds to a score of 0 (Both correct). A
score of 1 is assigned when only one answer is correct, and a score of 2 is assigned when neither answer is correct; only the
initial response counts and errors cannot be corrected. The correct answer is A.
Q3: [Group A - Patient 1 - NIHSS Item 1c: Level of Consciousness - Commands] You ask the patient to
open and close his eyes, and then to grip and release his nonparetic hand. He performs both tasks
correctly on the first attempt. What is the NIHSS score for Item 1c?
A. 0 - Both correct [CORRECT]
B. 1 - One correct
C. 2 - Neither correct
D. 3 - Unable to assess due to severe aphasia or intubation
Correct Answer: A
Rationale: The patient successfully completes both the eye open/close command and the grip/release command, earning a
score of 0 (Both correct). A score of 1 is given when only one command is followed, and a score of 2 is given when
neither is followed; only the first attempt is scored. The correct answer is A.
Q4: [Group A - Patient 1 - NIHSS Item 2: Best Gaze] On examination, the patient shows a mild gaze
preference toward the right side but is able to voluntarily move both eyes fully to the left with effort.
There is no forced deviation. What is the NIHSS score for Item 2?
A. 0 - Normal horizontal gaze
B. 1 - Partial gaze palsy [CORRECT]
C. 2 - Forced deviation
D. 3 - Bilateral gaze palsy (forced deviation in both directions)
Correct Answer: B
Rationale: The patient has a partial gaze palsy with a mild gaze preference but retains the ability to move the eyes
voluntarily to the contralateral side, which scores 1. A score of 0 requires full normal horizontal gaze in both directions,
and a score of 2 is assigned only when there is forced deviation that cannot be overcome by the oculocephalic maneuver.
The correct answer is B.
Q5: [Group A - Patient 1 - NIHSS Item 3: Visual Fields] On confrontation visual field testing, the
patient has a partial loss of vision in the left hemifield of both eyes that does not respect the full
vertical midline. What is the NIHSS score for Item 3?
A. 0 - No visual loss
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,NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
B. 1 - Partial hemianopia [CORRECT]
C. 2 - Complete hemianopia
D. 3 - Bilateral hemianopia
Correct Answer: B
Rationale: A partial loss of vision in the left hemifield that does not constitute a complete hemianopia corresponds to a
score of 1 (Partial hemianopia). A score of 0 requires no visual loss, score 2 requires a complete hemianopia with full loss
of one half of the visual field, and score 3 is reserved for bilateral hemianopia including cortical blindness. The correct
answer is B.
Q6: [Group A - Patient 1 - NIHSS Item 4: Facial Palsy] When you ask the patient to smile, show teeth,
raise eyebrows, and close his eyes, you note a slight asymmetry with flattening of the left nasolabial
fold but symmetric forehead wrinkling and full eye closure. What is the NIHSS score for Item 4?
A. 0 - Normal
B. 1 - Minor paralysis [CORRECT]
C. 2 - Partial paralysis
D. 3 - Complete paralysis
Correct Answer: B
Rationale: The slight flattening of the left nasolabial fold with preserved forehead wrinkling and eye closure represents
minor paralysis, scoring 1. Score 0 requires completely symmetric facial movement, score 2 requires partial paralysis with
more pronounced asymmetry (often involving the lower face and some upper face weakness), and score 3 requires
complete unilateral or bilateral facial paralysis. The correct answer is B.
Q7: [Group A - Patient 1 - NIHSS Item 5a: Motor Arm - Left] You ask the patient to hold his left arm
extended at 90 degrees for 10 seconds. The arm initially holds the position but drifts downward after
about 5 seconds without falling to the bed. What is the NIHSS score for Item 5a?
A. 0 - No drift
B. 1 - Drift [CORRECT]
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: B
Rationale: The left arm holds the extended position briefly but drifts downward before the 10-second mark without
falling completely, which is scored as drift (1). Score 0 requires the arm to remain in the extended position for the full 10
seconds, score 2 requires some effort against gravity but the arm cannot maintain the position, and scores 3 and 4 indicate
progressively less voluntary effort. The correct answer is B.
Q8: [Group A - Patient 1 - NIHSS Item 5b: Motor Arm - Right] You ask the patient to hold his right
(nonparetic) arm extended at 90 degrees for 10 seconds. The arm remains steady in the full extended
position for the entire 10 seconds. What is the NIHSS score for Item 5b?
A. 0 - No drift [CORRECT]
B. 1 - Drift
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: A
Rationale: The right arm holds the extended position for the full 10 seconds without any downward drift, earning a score
of 0 (No drift). Drift (1) is scored when the arm drifts down but does not hit the bed, and higher scores reflect increasing
inability to maintain the position against gravity or to generate any movement. The correct answer is A.
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, NIH Stroke Scale - All Test Groups A-F (Patients 1-6) Complete Answer Key - Verified 2026/2027
Q9: [Group A - Patient 1 - NIHSS Item 6a: Motor Leg - Left] You ask the patient to hold his left leg
extended at 30 degrees for 5 seconds. The leg holds the position briefly but drifts down toward the bed
after about 3 seconds without falling completely. What is the NIHSS score for Item 6a?
A. 0 - No drift
B. 1 - Drift [CORRECT]
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: B
Rationale: The left leg drifts downward after being placed in the extended position but does not fall immediately to the
bed, which corresponds to a score of 1 (Drift). A score of 0 requires the leg to remain elevated for the full 5 seconds, score
2 is given when there is some effort against gravity but the leg falls immediately, and scores 3 and 4 indicate absent effort
or movement. The correct answer is B.
Q10: [Group A - Patient 1 - NIHSS Item 6b: Motor Leg - Right] You ask the patient to hold his right
(nonparetic) leg extended at 30 degrees for 5 seconds. The leg remains steady in the elevated position
for the full 5 seconds. What is the NIHSS score for Item 6b?
A. 0 - No drift [CORRECT]
B. 1 - Drift
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
Correct Answer: A
Rationale: The right leg maintains the extended position for the full 5 seconds without drifting, scoring 0 (No drift). Drift
(1) requires the leg to drift downward before the time limit, and higher scores reflect progressive inability to maintain the
position against gravity. The correct answer is A.
Q11: [Group A - Patient 1 - NIHSS Item 7: Limb Ataxia] You perform the finger-to-nose and
heel-to-shin testing on both the left and right limbs. The patient performs these tasks smoothly and
accurately without any dysmetria or overshoot. What is the NIHSS score for Item 7?
A. 0 - Absent [CORRECT]
B. 1 - Present in one limb
C. 2 - Present in two or more limbs
D. UN - Amputation/joint fusion
Correct Answer: A
Rationale: The patient performs finger-to-nose and heel-to-shin testing smoothly without dysmetria, ataxia, or overshoot,
indicating that ataxia is absent and scoring 0. Score 1 is assigned when ataxia is present in one limb, score 2 is assigned
when ataxia is present in two or more limbs, and UN is used only for amputation or joint fusion that precludes testing. The
correct answer is A.
GROUP A - PATIENT 2
The patient is a 68-year-old female presenting 4 hours after onset of right-sided weakness and mild difficulty
speaking consistent with a moderate left middle cerebral artery (MCA) stroke. She is alert with mild expressive
aphasia, partial gaze palsy, no visual field loss, partial right facial palsy, right arm weakness with some effort
against gravity, right leg drift, and right limb ataxia.
Q12: [Group A - Patient 2 - NIHSS Item 1a: Level of Consciousness - Alertness] The patient is a
68-year-old female who presents 4 hours after onset of right-sided weakness. She is awake, makes eye
contact as you enter the room, and responds verbally without requiring any stimulation. What is the
NIHSS Certification Exam - Complete Answer Key Page 4
