SENILEDIUG SSHIN
NIH
National Institutes of Health
NINDS
National Institute of Neurological Disorders and Stroke
T U R N I N G D I S C O V E R Y I N T O H E A LT H
EST. 1887
NIH Stroke Scale — Administration Guidelines
I T E M - BY- I T E M S CO R I N G C R I T E R I A · E X A M I N AT I O N P R OTO CO L · STA N D A R D I Z E D A SS E SS M E N T
INSTITUTION National Institutes of Health (NIH) / NINDS COURSE CODE NIHSS-ADMIN-2026
PROGRAM Nursing / Neurology / Stroke Team ACADEMIC YEAR
Certification
EXAM TITLE NIH Stroke Scale — Administration & TOTAL QUESTIONS 30 Questions
Scoring Proficiency
COURSE TITLE Standardized Neurological Assessment · FORMAT Multiple Choice — Select the Single Best
NIHSS Certification Answer per NIHSS Protocol
EXAMINATION INSTRUCTIONS
▸ Questions cover the NIHSS administration protocol, item-by-item scoring criteria, and standardized examination procedures.
▸ Select the single best answer based on the official NIH Stroke Scale certification training materials.
▸ Pay careful attention to scoring rules for patients unable to be tested (coma, intubated, aphasic, amputee).
▸ Correct answers and detailed rationales appear below each question for comprehensive NIHSS certification preparation.
LOC · GAZE · VISUAL · FACIAL PALSY · MOTOR · ATAXIA · SENSORY · Questions
LANGUAGE · DYSARTHRIA · EXTINCTION 1 – 30
1. Item 1a: Level of Consciousness — The patient is alert and keenly responsive. What is the correct score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER A. 0
RATIONALE Item 1a LOC scoring: 0 = Alert; keenly responsive. 1 = Not alert; but arousable by minor stimulation to obey,
answer, or respond. 2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong
or painful stimulation to make movements. 3 = Responds only with reflex motor or autonomic effects, or
totally unresponsive, flaccid, and areflexic. The investigator must choose a response even if a full evaluation is
prevented by obstacles such as an endotracheal tube, language barrier, or orotracheal trauma/bandages. A
score of 3 should be used only if the patient makes no movement (other than reflexive posturing) in response
to noxious stimulation.
, 2. Item 1a: The patient is not alert but arousable by minor stimulation to obey, answer, or respond. What score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER B. 1
RATIONALE Score 1 = Not alert; but arousable by minor stimulation to obey, answer, or respond. The patient is drowsy but
can be awakened with verbal stimulation or light touch and can follow commands or answer questions. Score
2 requires repeated stimulation; score 3 indicates reflex responses only or total unresponsiveness. This is a
critical clinical distinction reflecting the level of neurological depression.
3. Item 1b (LOC Questions): The patient is asked the month and their age. The patient answers both correctly. What
score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER A. 0
RATIONALE Item 1b scoring: 0 = Answers both questions correctly. 1 = Answers one question correctly. 2 = Answers neither
question correctly. The answer must be CORRECT—there is no partial credit for being close. Patients unable to
speak due to intubation, orotracheal trauma, severe dysarthria, language barrier, or any other problem not
secondary to aphasia are given a score of 1. Only the initial answer is scored—do not help the patient with
verbal or non-verbal cues.
4. Item 1b: The patient answers one question correctly. What score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER B. 1
RATIONALE Score 1 = Answers one question correctly. This includes patients unable to speak due to intubation,
orotracheal trauma, severe dysarthria, language barrier, or any other problem not secondary to aphasia. A
patient with severe aphasia who cannot answer either question scores 2. The examiner should write the
patient's exact response. Do not coach or prompt the patient.
NIH
National Institutes of Health
NINDS
National Institute of Neurological Disorders and Stroke
T U R N I N G D I S C O V E R Y I N T O H E A LT H
EST. 1887
NIH Stroke Scale — Administration Guidelines
I T E M - BY- I T E M S CO R I N G C R I T E R I A · E X A M I N AT I O N P R OTO CO L · STA N D A R D I Z E D A SS E SS M E N T
INSTITUTION National Institutes of Health (NIH) / NINDS COURSE CODE NIHSS-ADMIN-2026
PROGRAM Nursing / Neurology / Stroke Team ACADEMIC YEAR
Certification
EXAM TITLE NIH Stroke Scale — Administration & TOTAL QUESTIONS 30 Questions
Scoring Proficiency
COURSE TITLE Standardized Neurological Assessment · FORMAT Multiple Choice — Select the Single Best
NIHSS Certification Answer per NIHSS Protocol
EXAMINATION INSTRUCTIONS
▸ Questions cover the NIHSS administration protocol, item-by-item scoring criteria, and standardized examination procedures.
▸ Select the single best answer based on the official NIH Stroke Scale certification training materials.
▸ Pay careful attention to scoring rules for patients unable to be tested (coma, intubated, aphasic, amputee).
▸ Correct answers and detailed rationales appear below each question for comprehensive NIHSS certification preparation.
LOC · GAZE · VISUAL · FACIAL PALSY · MOTOR · ATAXIA · SENSORY · Questions
LANGUAGE · DYSARTHRIA · EXTINCTION 1 – 30
1. Item 1a: Level of Consciousness — The patient is alert and keenly responsive. What is the correct score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER A. 0
RATIONALE Item 1a LOC scoring: 0 = Alert; keenly responsive. 1 = Not alert; but arousable by minor stimulation to obey,
answer, or respond. 2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong
or painful stimulation to make movements. 3 = Responds only with reflex motor or autonomic effects, or
totally unresponsive, flaccid, and areflexic. The investigator must choose a response even if a full evaluation is
prevented by obstacles such as an endotracheal tube, language barrier, or orotracheal trauma/bandages. A
score of 3 should be used only if the patient makes no movement (other than reflexive posturing) in response
to noxious stimulation.
, 2. Item 1a: The patient is not alert but arousable by minor stimulation to obey, answer, or respond. What score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER B. 1
RATIONALE Score 1 = Not alert; but arousable by minor stimulation to obey, answer, or respond. The patient is drowsy but
can be awakened with verbal stimulation or light touch and can follow commands or answer questions. Score
2 requires repeated stimulation; score 3 indicates reflex responses only or total unresponsiveness. This is a
critical clinical distinction reflecting the level of neurological depression.
3. Item 1b (LOC Questions): The patient is asked the month and their age. The patient answers both correctly. What
score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER A. 0
RATIONALE Item 1b scoring: 0 = Answers both questions correctly. 1 = Answers one question correctly. 2 = Answers neither
question correctly. The answer must be CORRECT—there is no partial credit for being close. Patients unable to
speak due to intubation, orotracheal trauma, severe dysarthria, language barrier, or any other problem not
secondary to aphasia are given a score of 1. Only the initial answer is scored—do not help the patient with
verbal or non-verbal cues.
4. Item 1b: The patient answers one question correctly. What score?
A. 0
B. 1
C. 2
D. 3
CORRECT ANSWER B. 1
RATIONALE Score 1 = Answers one question correctly. This includes patients unable to speak due to intubation,
orotracheal trauma, severe dysarthria, language barrier, or any other problem not secondary to aphasia. A
patient with severe aphasia who cannot answer either question scores 2. The examiner should write the
patient's exact response. Do not coach or prompt the patient.
