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NIH STROKE SCALE ACTUAL FINAL EXAM
STUDY GUIDE QUESTIONS AND CORRECT
ANSWERS
NIH scale item 8 is - ANSWER sensory perception
item 8 is tested using a series of...
for the obtunded or aphasic patient, withdrawal from... - ANSWER pin
pricks noxious stimulus is used
for item 8, what should be used? what should not be used? - ANSWER
safety or seamstress pin
DO NOT USE paperclips, broken sticks or ballpoint pins
item 8: examine patient with pin in what areas of what?
ask patient what?
do eyes need to be closed
ask patient if there is what between right and left sides - ANSWER
proximal portions of all 4 limbs
ask if they feel the stimulus
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no, eyes do not need to be closed
ask if there is asymmetry- DO NOT ASK IF SHARP OR DULL - as only to
compare the sides and tell if there is a difference
item 8 - in confused, obtunded or aphasic patients, look for symmetry
of grimace in response to - ANSWER noxious stimulus
only sensation loss attributed to what is scored - ANSWER stroke
should we test as many body areas as needed to assess for hemisensory
loss?
what areas? - ANSWER yes
arms, legs, trunk, face
item 8 - what area should NOT be tested? why? - ANSWER limb
extremities: hands and feet
these areas may have sensation confounded by unrelated neuropathy
item 8 - test through clothing? - ANSWER not unless absolutely
necessary
Item 8 Sensory Scoring
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0 - ANSWER 0 - normal - no evidence of sensory loss
1- mild or moderate sensory loss
2- severe or total sensory loss - also patients with bilateral loss from
brain stem stroke
is item 8 ever not tested? what to do to determine 0 or 1 - ANSWER
NO, test stuporous of aphasic patients w/ vigorous noxious stimulus
such as nail bed pressure and then decide between a one or zero based
on whether any response appears
if patient scores 3 on 1a, they automatically score what on item 8 -
ANSWER 2
NIH item 9 is - ANSWER Best Language
what should examiner be doing throughout exam to determine item 9
score - ANSWER listen to patient
always wise to use what for item 9? - ANSWER formal testing tools
provided
is item 9 an exception to rule of scoring only first impressions? what do
we encourage? - ANSWER yes
NIH STROKE SCALE ACTUAL FINAL EXAM
STUDY GUIDE QUESTIONS AND CORRECT
ANSWERS
NIH scale item 8 is - ANSWER sensory perception
item 8 is tested using a series of...
for the obtunded or aphasic patient, withdrawal from... - ANSWER pin
pricks noxious stimulus is used
for item 8, what should be used? what should not be used? - ANSWER
safety or seamstress pin
DO NOT USE paperclips, broken sticks or ballpoint pins
item 8: examine patient with pin in what areas of what?
ask patient what?
do eyes need to be closed
ask patient if there is what between right and left sides - ANSWER
proximal portions of all 4 limbs
ask if they feel the stimulus
,2|Page
no, eyes do not need to be closed
ask if there is asymmetry- DO NOT ASK IF SHARP OR DULL - as only to
compare the sides and tell if there is a difference
item 8 - in confused, obtunded or aphasic patients, look for symmetry
of grimace in response to - ANSWER noxious stimulus
only sensation loss attributed to what is scored - ANSWER stroke
should we test as many body areas as needed to assess for hemisensory
loss?
what areas? - ANSWER yes
arms, legs, trunk, face
item 8 - what area should NOT be tested? why? - ANSWER limb
extremities: hands and feet
these areas may have sensation confounded by unrelated neuropathy
item 8 - test through clothing? - ANSWER not unless absolutely
necessary
Item 8 Sensory Scoring
, 3|Page
0 - ANSWER 0 - normal - no evidence of sensory loss
1- mild or moderate sensory loss
2- severe or total sensory loss - also patients with bilateral loss from
brain stem stroke
is item 8 ever not tested? what to do to determine 0 or 1 - ANSWER
NO, test stuporous of aphasic patients w/ vigorous noxious stimulus
such as nail bed pressure and then decide between a one or zero based
on whether any response appears
if patient scores 3 on 1a, they automatically score what on item 8 -
ANSWER 2
NIH item 9 is - ANSWER Best Language
what should examiner be doing throughout exam to determine item 9
score - ANSWER listen to patient
always wise to use what for item 9? - ANSWER formal testing tools
provided
is item 9 an exception to rule of scoring only first impressions? what do
we encourage? - ANSWER yes
