NIH Stroke Scale Certification Group D Exam (2025/2026) – Patient 1–6 Complete Questions and 100% Verified Correct Answers | Updated for Clinical Accuracy

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NIH Stroke Scale Certification Group D
Exam (2025/2026) – Patient 1–6 Complete
Questions and 100% Verified Correct
Answers | Updated for Clinical Accuracy

Patient 1: Caucasian Male, 75 years old

Scenario: The patient is alert, responds to questions accurately, but shows left-sided weakness
and mild gaze deviation.

1. 1a. Level of Consciousness
a) 0 – Alert; keenly responsive
b) 1 – Not alert, but arousable
c) 2 – Not alert, requires repeated stimulation
d) 3 – Unresponsive or reflexive posturing
Correct Answer: a) 0 – Alert; keenly responsive
Rationale: The patient is alert and responds appropriately, meeting the criteria for a score
of 0 (NINDS, 2025).
2. 1b. LOC Questions (Ask month and age)
a) 0 – Answers both correctly
b) 1 – Answers one correctly
c) 2 – Answers neither correctly
d) 1 – Dysarthric or intubated
Correct Answer: a) 0 – Answers both correctly
Rationale: The patient accurately states the month and age, earning a score of 0 (NINDS,
2025).
3. 1c. LOC Commands (Open/close eyes, grip/release hand)
a) 0 – Performs both tasks correctly
b) 1 – Performs one task correctly
c) 2 – Performs neither task correctly
d) 1 – Intubated or language barrier
Correct Answer: a) 0 – Performs both tasks correctly
Rationale: The patient follows both commands accurately, scoring 0 (NINDS, 2025).
4. 2. Best Gaze
a) 0 – Normal
b) 1 – Partial gaze palsy
c) 2 – Forced deviation or total gaze paresis
d) 3 – Unresponsive
Correct Answer: b) 1 – Partial gaze palsy

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Rationale: Mild gaze deviation to the right indicates partial gaze palsy, scoring 1
(NINDS, 2025).
5. 3. Visual Fields
a) 0 – No visual loss
b) 1 – Partial hemianopia
c) 2 – Complete hemianopia
d) 3 – Bilateral hemianopia
Correct Answer: a) 0 – No visual loss
Rationale: No visual field deficits are noted, scoring 0 (NINDS, 2025).
6. 4. Facial Palsy
a) 0 – Normal
b) 1 – Minor paralysis
c) 2 – Partial paralysis
d) 3 – Complete paralysis
Correct Answer: a) 0 – Normal
Rationale: The patient shows no facial asymmetry, scoring 0 (NINDS, 2025).
7. 5a. Motor Arm (Left)
a) 0 – No drift
b) 1 – Drift, does not hit bed
c) 2 – Drifts to hit bed
d) 3 – No effort against gravity
Correct Answer: c) 2 – Drifts to hit bed
Rationale: The left arm drifts and hits the bed within 10 seconds, scoring 2 (NINDS,
2025).
8. 5b. Motor Arm (Right)
a) 0 – No drift
b) 1 – Drift, does not hit bed
c) 2 – Drifts to hit bed
d) 3 – No effort against gravity
Correct Answer: a) 0 – No drift
Rationale: The right arm holds steady for 10 seconds, scoring 0 (NINDS, 2025).
9. 6a. Motor Leg (Left)
a) 0 – No drift
b) 1 – Drift, does not hit bed
c) 2 – Drifts to hit bed
d) 3 – No effort against gravity
Correct Answer: b) 1 – Drift, does not hit bed
Rationale: The left leg drifts but does not hit the bed, scoring 1 (NINDS, 2025).
10. 6b. Motor Leg (Right)
a) 0 – No drift
b) 1 – Drift, does not hit bed
c) 2 – Drifts to hit bed
d) 3 – No effort against gravity
Correct Answer: a) 0 – No drift
Rationale: The right leg holds steady for 5 seconds, scoring 0 (NINDS, 2025).

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11. 7. Limb Ataxia
a) 0 – Absent
b) 1 – Present in one limb
c) 2 – Present in two or more limbs
d) 3 – Untestable
Correct Answer: b) 1 – Present in one limb
Rationale: Ataxia is observed in the left arm, scoring 1 (NINDS, 2025).
12. 8. Sensory
a) 0 – Normal
b) 1 – Mild to moderate sensory loss
c) 2 – Severe to total sensory loss
d) 3 – Untestable
Correct Answer: a) 0 – Normal
Rationale: No sensory loss is noted with pinprick testing, scoring 0 (NINDS, 2025).
13. 9. Best Language
a) 0 – No aphasia
b) 1 – Mild to moderate aphasia
c) 2 – Severe aphasia
d) 3 – Mute or global aphasia
Correct Answer: a) 0 – No aphasia
Rationale: The patient communicates clearly, scoring 0 (NINDS, 2025).
14. 10. Dysarthria
a) 0 – Normal
b) 1 – Mild to moderate dysarthria
c) 2 – Severe dysarthria
d) 3 – Intubated or untestable
Correct Answer: a) 0 – Normal
Rationale: Speech is clear with no slurring, scoring 0 (NINDS, 2025).
15. 11. Extinction and Inattention
a) 0 – No abnormality
b) 1 – Visual, tactile, or spatial neglect
c) 2 – Profound hemi-inattention
d) 3 – Untestable
Correct Answer: b) 1 – Visual, tactile, or spatial neglect
Rationale: Mild inattention to the left side is observed, scoring 1 (NINDS, 2025).



Patient 2: African American Male, 62 years old

Scenario: The patient is alert but disoriented, with right-sided weakness and slurred speech.

16. 1a. Level of Consciousness
a) 0 – Alert; keenly responsive
b) 1 – Not alert, but arousable
c) 2 – Not alert, requires repeated stimulation