NIH Stroke Scale - All Test Groups A-F (Patients 1-6) |
Complete Answer Key | Verified and Fully Updated for
2026/2027
This exam covers the administration and scoring of the NIH Stroke Scale across
all test groups A through F for patients 1 through 6, including a complete
verified answer key updated for 2026/2027. It is intended for healthcare
professionals, trainees, and certification candidates who need to demonstrate
competency in performing and interpreting the NIHSS.
[Q-001]
A patient is asked to describe the picture on the NIH Stroke Scale card and to
name the items shown. Which item of the scale is being assessed?
A. Best language
B. Best gaze
C. Level of consciousness
D. Dysarthria
Correct Answer: A
Rationale: Best language is assessed by asking the patient to describe the
picture, name the items on the naming card, and read the sentences; this item
evaluates aphasia, so it is the correct choice.
[Q-002]
During the level of consciousness questions, a patient correctly states his age
but cannot recall the current month. How is this scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: One correct answer out of two is scored 1; a score of 0 requires both
answers to be correct, and a score of 2 is given only when neither answer is
correct.
[Q-003]
A patient's eyes do not open spontaneously, do not open to verbal command,
and do not open to a noxious stimulus, but the examiner sees the eyes move to
,the examiner's side. What is the best gaze score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: When eye opening is absent, gaze is scored on the basis of the
observed eye movements; a patient who tracks the examiner has a forced
deviation or total gaze paresis and is scored 2.
[Q-004]
The examiner holds up one finger in front of the patient and asks the patient to
look at it. The patient's eyes follow the finger fully to both sides. What is the best
gaze score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: Full, normal eye movement to both sides with the ability to follow the
examiner's finger is scored 0 for best gaze.
[Q-005]
A patient's visual fields are tested by confrontation. The patient sees the
examiner's moving fingers in all four quadrants of both eyes. What is the visual
score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: No visual loss, with the patient seeing in all four quadrants, is scored
0 on the visual item.
[Q-006]
A patient has a dense left homonymous hemianopia on confrontation testing.
What is the visual score?
A. 0
,B. 1
C. 2
D. 3
Correct Answer: C
Rationale: A dense homonymous hemianopia is scored 2; a score of 1 indicates
partial hemianopia, and a score of 3 indicates bilateral blindness including
cortical blindness.
[Q-007]
Which finding is required to score 3 on the visual item of the NIH Stroke Scale?
A. Partial hemianopia in one eye
B. Dense hemianopia in one field
C. Bilateral blindness, including cortical blindness
D. Extinction to simultaneous stimulation
Correct Answer: C
Rationale: A score of 3 on the visual item is reserved for bilateral blindness,
including cortical blindness; partial and dense hemianopias are scored 1 and 2
respectively.
[Q-008]
The examiner asks the patient to hold the arms out for 10 seconds. The right
arm drifts downward before the full 10 seconds but does not touch the bed.
What is the motor score for the right arm?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: Drift of the limb before the full 10 seconds without hitting the bed is
scored 1; a score of 0 requires no drift for the full 10 seconds.
[Q-009]
During motor testing of the left leg, the patient's leg drifts downward and
touches the bed within the 5-second observation period, but the patient makes
some effort against gravity. What is the motor score for the left leg?
A. 0
B. 1
C. 2
, D. 3
Correct Answer: C
Rationale: Some effort against gravity with the limb falling to the bed is scored
2; a score of 1 indicates drift without reaching the bed, and a score of 3
indicates no effort against gravity.
[Q-010]
A patient with an amputation of the left leg is assessed. How is the motor item
for the left leg recorded?
A. 0
B. 1
C. X, and it is excluded from the total
D. UN, and it is excluded from the total
Correct Answer: C
Rationale: When a limb cannot be tested because of amputation or joint fusion,
the examiner records X and does not include that score in the total.
[Q-011]
The examiner tests limb ataxia by having the patient perform the
finger-nose-finger test and the heel-to-shin test. The patient has ataxia in one
limb. What is the ataxia score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: Ataxia present in one limb is scored 1; a score of 2 indicates ataxia in
two or more limbs, and a score of 0 indicates absence of ataxia.
[Q-012]
A patient is unable to understand the command to perform the
finger-nose-finger test and does not follow any commands. How is the ataxia
item scored?
A. 0
B. 1
C. 2
D. UN, because the patient is unable to understand or is paralyzed
Correct Answer: D
Complete Answer Key | Verified and Fully Updated for
2026/2027
This exam covers the administration and scoring of the NIH Stroke Scale across
all test groups A through F for patients 1 through 6, including a complete
verified answer key updated for 2026/2027. It is intended for healthcare
professionals, trainees, and certification candidates who need to demonstrate
competency in performing and interpreting the NIHSS.
[Q-001]
A patient is asked to describe the picture on the NIH Stroke Scale card and to
name the items shown. Which item of the scale is being assessed?
A. Best language
B. Best gaze
C. Level of consciousness
D. Dysarthria
Correct Answer: A
Rationale: Best language is assessed by asking the patient to describe the
picture, name the items on the naming card, and read the sentences; this item
evaluates aphasia, so it is the correct choice.
[Q-002]
During the level of consciousness questions, a patient correctly states his age
but cannot recall the current month. How is this scored?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: One correct answer out of two is scored 1; a score of 0 requires both
answers to be correct, and a score of 2 is given only when neither answer is
correct.
[Q-003]
A patient's eyes do not open spontaneously, do not open to verbal command,
and do not open to a noxious stimulus, but the examiner sees the eyes move to
,the examiner's side. What is the best gaze score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C
Rationale: When eye opening is absent, gaze is scored on the basis of the
observed eye movements; a patient who tracks the examiner has a forced
deviation or total gaze paresis and is scored 2.
[Q-004]
The examiner holds up one finger in front of the patient and asks the patient to
look at it. The patient's eyes follow the finger fully to both sides. What is the best
gaze score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: Full, normal eye movement to both sides with the ability to follow the
examiner's finger is scored 0 for best gaze.
[Q-005]
A patient's visual fields are tested by confrontation. The patient sees the
examiner's moving fingers in all four quadrants of both eyes. What is the visual
score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: A
Rationale: No visual loss, with the patient seeing in all four quadrants, is scored
0 on the visual item.
[Q-006]
A patient has a dense left homonymous hemianopia on confrontation testing.
What is the visual score?
A. 0
,B. 1
C. 2
D. 3
Correct Answer: C
Rationale: A dense homonymous hemianopia is scored 2; a score of 1 indicates
partial hemianopia, and a score of 3 indicates bilateral blindness including
cortical blindness.
[Q-007]
Which finding is required to score 3 on the visual item of the NIH Stroke Scale?
A. Partial hemianopia in one eye
B. Dense hemianopia in one field
C. Bilateral blindness, including cortical blindness
D. Extinction to simultaneous stimulation
Correct Answer: C
Rationale: A score of 3 on the visual item is reserved for bilateral blindness,
including cortical blindness; partial and dense hemianopias are scored 1 and 2
respectively.
[Q-008]
The examiner asks the patient to hold the arms out for 10 seconds. The right
arm drifts downward before the full 10 seconds but does not touch the bed.
What is the motor score for the right arm?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: Drift of the limb before the full 10 seconds without hitting the bed is
scored 1; a score of 0 requires no drift for the full 10 seconds.
[Q-009]
During motor testing of the left leg, the patient's leg drifts downward and
touches the bed within the 5-second observation period, but the patient makes
some effort against gravity. What is the motor score for the left leg?
A. 0
B. 1
C. 2
, D. 3
Correct Answer: C
Rationale: Some effort against gravity with the limb falling to the bed is scored
2; a score of 1 indicates drift without reaching the bed, and a score of 3
indicates no effort against gravity.
[Q-010]
A patient with an amputation of the left leg is assessed. How is the motor item
for the left leg recorded?
A. 0
B. 1
C. X, and it is excluded from the total
D. UN, and it is excluded from the total
Correct Answer: C
Rationale: When a limb cannot be tested because of amputation or joint fusion,
the examiner records X and does not include that score in the total.
[Q-011]
The examiner tests limb ataxia by having the patient perform the
finger-nose-finger test and the heel-to-shin test. The patient has ataxia in one
limb. What is the ataxia score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: B
Rationale: Ataxia present in one limb is scored 1; a score of 2 indicates ataxia in
two or more limbs, and a score of 0 indicates absence of ataxia.
[Q-012]
A patient is unable to understand the command to perform the
finger-nose-finger test and does not follow any commands. How is the ataxia
item scored?
A. 0
B. 1
C. 2
D. UN, because the patient is unable to understand or is paralyzed
Correct Answer: D
