NIH STROKE SCALE GROUP B - COMPLETE 100
QUESTIONS & ANSWERS
2024/2025 CERTIFICATION TEST BANK ALREADY
GRADED A+
SECTION 1: CORE KNOWLEDGE & FUNDAMENTALS (Questions 1-20)
1. What is the maximum total score on the NIH Stroke Scale?
A. 32
B. 38
C. 42
D. 48
Answer: C (42)
Rationale: The NIHSS has 11 items with scores ranging from 0 to a maximum total of 42 points.
Higher scores indicate more severe stroke deficits. Scores 0-4 = mild stroke, 5-14 = moderate,
15-20 = severe, 21-42 = very severe.
2. Which item carries the HIGHEST number of possible points on the NIHSS?
A. Level of Consciousness (1a)
B. Motor Arm (5a/5b)
C. Best Language (9)
D. Extinction/Inattention (11)
Answer: B (Motor Arm)
Rationale: Each arm (5a and 5b) is scored 0-4, with a maximum of 4 points each. Motor Leg
(6a/6b) also carries 4 points each. Language (9) is scored 0-3. This makes motor function the
highest-weighted category.
3. A patient scores 0 on item 1a (Level of Consciousness). What does this indicate?
,A. The patient is comatose
B. The patient is alert and responsive
C. The patient requires tactile stimulation to respond
D. The patient is confused
Answer: B (Alert and responsive)
Rationale: Item 1a scores: 0 = Alert, keenly responsive; 1 = Arousable by minor stimulation; 2 =
Arousable only by repeated/painful stimulation; 3 = Unresponsive/postures/reflexes only.
4. What are the two questions asked for item 1b (LOC Questions)?
A. "What is your name?" and "Where are you?"
B. "What month is it?" and "How old are you?"
C. "Who is the president?" and "What day is it?"
D. "What is your address?" and "What is today's date?"
Answer: B ("What month is it?" and "How old are you?")
Rationale: The patient is asked their age and the current month. These questions assess
orientation and language comprehension. Only the first answer is scored for each question.
5. For item 1c (LOC Commands), what two commands are given?
A. "Lift your arms" and "Show me your teeth"
B. "Blink your eyes" and "Squeeze my hands"
C. "Open your eyes" and "Say 'No ifs ands or buts'"
D. "Touch your nose" and "Show me your tongue"
Answer: B ("Blink your eyes" and "Squeeze my hands")
Rationale: The patient is asked to perform two simple commands. Scored 0 if both correct, 1 if
one correct, 2 if neither correct. This assesses comprehension and motor function.
6. Which scoring range indicates a MILD stroke on the NIHSS?
A. 0
B. 1-4
C. 5-14
D. 15-20
,Answer: B (1-4)
Rationale: Stroke severity classification: 0 = No stroke; 1-4 = Mild; 5-14 = Moderate/Moderately
severe; 15-20 = Severe; 21-42 = Very severe. A score of 0 indicates no stroke symptoms.
7. How long should the patient hold their arm up for item 5 (Motor Arm)?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 30 seconds
Answer: B (10 seconds)
Rationale: For arm motor testing (5a and 5b), the arm is held at 90° (sitting) or 45° (supine) for
10 seconds. Scoring: 0 = No drift; 1 = Drift before 10 seconds; 2 = Some effort against gravity; 3 =
No effort against gravity; 4 = No movement.
8. How long should the patient hold their leg up for item 6 (Motor Leg)?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: A (5 seconds)
Rationale: For leg motor testing (6a and 6b), the leg is held at 30° for 5 seconds. Scoring: 0 = No
drift; 1 = Drift before 5 seconds; 2 = Some effort against gravity; 3 = No effort against gravity; 4 =
No movement.
9. What does a score of "1" on item 4 (Facial Palsy) indicate?
A. Normal facial symmetry
B. Minor paralysis (asymmetric smile)
C. Partial paralysis (complete or near-complete)
D. Complete paralysis
Answer: B (Minor paralysis)
, Rationale: Item 4 scoring: 0 = Normal symmetrical movement; 1 = Minor paralysis (flattened
nasolabial fold, asymmetry on smile); 2 = Partial paralysis (total or near-total lower face); 3 =
Complete paralysis (one or both sides absent).
10. Ataxia (item 7) should only be scored if:
A. The patient is alert
B. The limb is not paralyzed
C. The patient is over 65
D. The patient has a previous stroke history
Answer: B (The limb is not paralyzed)
Rationale: Ataxia is scored as 0 = Absent; 1 = Present in one limb; 2 = Present in two limbs. It is
scored only if the limb is not weak. If the patient is aphasic, the examiner can test finger-nose
and heel-shin.
11. Visual field testing (item 3) should be performed using:
A. Bedside light and pencil
B. Confrontation testing with finger counting
C. Standard Snellen eye chart
D. Automated perimetry
Answer: B (Confrontation testing with finger counting)
Rationale: Visual fields are tested by confrontation with finger counting or visual threat, moving
fingers in all quadrants. The patient must look straight ahead. Scored as: 0 = Normal; 1 = Partial
hemianopia; 2 = Complete hemianopia; 3 = Bilateral blindness.
12. What is the scoring for item 2 (Best Gaze) if the patient has forced deviation of gaze?
A. 0
B. 1
C. 2
D. 3
Answer: C (2)
QUESTIONS & ANSWERS
2024/2025 CERTIFICATION TEST BANK ALREADY
GRADED A+
SECTION 1: CORE KNOWLEDGE & FUNDAMENTALS (Questions 1-20)
1. What is the maximum total score on the NIH Stroke Scale?
A. 32
B. 38
C. 42
D. 48
Answer: C (42)
Rationale: The NIHSS has 11 items with scores ranging from 0 to a maximum total of 42 points.
Higher scores indicate more severe stroke deficits. Scores 0-4 = mild stroke, 5-14 = moderate,
15-20 = severe, 21-42 = very severe.
2. Which item carries the HIGHEST number of possible points on the NIHSS?
A. Level of Consciousness (1a)
B. Motor Arm (5a/5b)
C. Best Language (9)
D. Extinction/Inattention (11)
Answer: B (Motor Arm)
Rationale: Each arm (5a and 5b) is scored 0-4, with a maximum of 4 points each. Motor Leg
(6a/6b) also carries 4 points each. Language (9) is scored 0-3. This makes motor function the
highest-weighted category.
3. A patient scores 0 on item 1a (Level of Consciousness). What does this indicate?
,A. The patient is comatose
B. The patient is alert and responsive
C. The patient requires tactile stimulation to respond
D. The patient is confused
Answer: B (Alert and responsive)
Rationale: Item 1a scores: 0 = Alert, keenly responsive; 1 = Arousable by minor stimulation; 2 =
Arousable only by repeated/painful stimulation; 3 = Unresponsive/postures/reflexes only.
4. What are the two questions asked for item 1b (LOC Questions)?
A. "What is your name?" and "Where are you?"
B. "What month is it?" and "How old are you?"
C. "Who is the president?" and "What day is it?"
D. "What is your address?" and "What is today's date?"
Answer: B ("What month is it?" and "How old are you?")
Rationale: The patient is asked their age and the current month. These questions assess
orientation and language comprehension. Only the first answer is scored for each question.
5. For item 1c (LOC Commands), what two commands are given?
A. "Lift your arms" and "Show me your teeth"
B. "Blink your eyes" and "Squeeze my hands"
C. "Open your eyes" and "Say 'No ifs ands or buts'"
D. "Touch your nose" and "Show me your tongue"
Answer: B ("Blink your eyes" and "Squeeze my hands")
Rationale: The patient is asked to perform two simple commands. Scored 0 if both correct, 1 if
one correct, 2 if neither correct. This assesses comprehension and motor function.
6. Which scoring range indicates a MILD stroke on the NIHSS?
A. 0
B. 1-4
C. 5-14
D. 15-20
,Answer: B (1-4)
Rationale: Stroke severity classification: 0 = No stroke; 1-4 = Mild; 5-14 = Moderate/Moderately
severe; 15-20 = Severe; 21-42 = Very severe. A score of 0 indicates no stroke symptoms.
7. How long should the patient hold their arm up for item 5 (Motor Arm)?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 30 seconds
Answer: B (10 seconds)
Rationale: For arm motor testing (5a and 5b), the arm is held at 90° (sitting) or 45° (supine) for
10 seconds. Scoring: 0 = No drift; 1 = Drift before 10 seconds; 2 = Some effort against gravity; 3 =
No effort against gravity; 4 = No movement.
8. How long should the patient hold their leg up for item 6 (Motor Leg)?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: A (5 seconds)
Rationale: For leg motor testing (6a and 6b), the leg is held at 30° for 5 seconds. Scoring: 0 = No
drift; 1 = Drift before 5 seconds; 2 = Some effort against gravity; 3 = No effort against gravity; 4 =
No movement.
9. What does a score of "1" on item 4 (Facial Palsy) indicate?
A. Normal facial symmetry
B. Minor paralysis (asymmetric smile)
C. Partial paralysis (complete or near-complete)
D. Complete paralysis
Answer: B (Minor paralysis)
, Rationale: Item 4 scoring: 0 = Normal symmetrical movement; 1 = Minor paralysis (flattened
nasolabial fold, asymmetry on smile); 2 = Partial paralysis (total or near-total lower face); 3 =
Complete paralysis (one or both sides absent).
10. Ataxia (item 7) should only be scored if:
A. The patient is alert
B. The limb is not paralyzed
C. The patient is over 65
D. The patient has a previous stroke history
Answer: B (The limb is not paralyzed)
Rationale: Ataxia is scored as 0 = Absent; 1 = Present in one limb; 2 = Present in two limbs. It is
scored only if the limb is not weak. If the patient is aphasic, the examiner can test finger-nose
and heel-shin.
11. Visual field testing (item 3) should be performed using:
A. Bedside light and pencil
B. Confrontation testing with finger counting
C. Standard Snellen eye chart
D. Automated perimetry
Answer: B (Confrontation testing with finger counting)
Rationale: Visual fields are tested by confrontation with finger counting or visual threat, moving
fingers in all quadrants. The patient must look straight ahead. Scored as: 0 = Normal; 1 = Partial
hemianopia; 2 = Complete hemianopia; 3 = Bilateral blindness.
12. What is the scoring for item 2 (Best Gaze) if the patient has forced deviation of gaze?
A. 0
B. 1
C. 2
D. 3
Answer: C (2)
