NIH Stroke Scale Group D Patients 1-6 Assessment Actual Exam 2026/2027 –
Comprehensive Test with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section 1: Level of Consciousness (LOC) & Orientation (10 Questions)
Q1: A patient arrives in the emergency department after sudden onset of left-sided
weakness. The patient opens eyes spontaneously, is fully oriented to person, place, and
time, and follows commands appropriately. What is the correct NIHSS score for item 1a
(Level of Consciousness)?
A. 1 - Not alert, but arousable by minor stimulation
B. 2 - Not alert, requires repeated stimulation
C. 0 - Alert, keenly responsive [CORRECT]
D. 3 - Coma, unresponsive
Correct Answer: C
Rationale: A patient who opens eyes spontaneously, is fully oriented, and follows
commands appropriately scores 0 on item 1a, indicating normal level of consciousness.
Option A describes a drowsy patient. Option B describes a stuporous patient. Option D
describes a comatose patient.
Q2: During NIHSS assessment, the patient is lethargic and requires verbal stimulation to
open eyes. Once aroused, the patient is oriented to person but not place or time. What is
the correct score for item 1a (Level of Consciousness)?
A. 0 - Alert, keenly responsive
,B. 1 - Not alert, but arousable by minor stimulation [CORRECT]
C. 2 - Not alert, requires repeated stimulation
D. 3 - Coma, unresponsive
Correct Answer: B
Rationale: A patient who requires minor stimulation to arouse but is not fully alert
scores 1 on item 1a. The patient is drowsy but arousable with verbal cues. Option A
describes a fully alert patient. Option C requires repeated or painful stimulation. Option
D describes no response to stimulation.
Q3: A patient with acute stroke is asked, "What month is it?" and "How old are you?" The
patient answers both questions correctly without hesitation. What is the correct NIHSS
score for item 1b (LOC Questions)?
A. 1 - Answers one question correctly
B. 2 - Answers neither question correctly
C. 0 - Answers both questions correctly [CORRECT]
D. 3 - Unable to respond due to aphasia
Correct Answer: C
Rationale: Item 1b scores 0 when the patient answers both questions correctly. The
questions assess orientation and are scored based on initial response without
coaching. Option A describes one correct answer. Option B describes neither correct.
Option D is not a valid score for item 1b; aphasic patients are scored based on best
verbal or nonverbal response.
Q4: A patient with acute stroke is asked their age and the current month. The patient
correctly states their age but says the wrong month (states July when it is December).
,The patient is not aphasic. What is the correct NIHSS score for item 1b (LOC
Questions)?
A. 0 - Answers both questions correctly
B. 1 - Answers one question correctly [CORRECT]
C. 2 - Answers neither question correctly
D. 3 - Unable to assess due to intubation
Correct Answer: B
Rationale: Item 1b scores 1 when the patient answers one of the two questions
correctly. The patient correctly stated age but was incorrect about the month. Option A
requires both correct. Option C requires neither correct. Option D is scored as 2 if the
patient cannot respond due to intubation or trauma.
Q5: A patient with acute stroke is asked to "Open and close your eyes" and "Grip and
release your hands." The patient performs both commands correctly and symmetrically.
What is the correct NIHSS score for item 1c (LOC Commands)?
A. 1 - Performs one command correctly
B. 2 - Performs neither command correctly
C. 0 - Performs both commands correctly [CORRECT]
D. 3 - Unable to perform due to paralysis
Correct Answer: C
Rationale: Item 1c scores 0 when the patient performs both commands correctly. These
commands assess comprehension and motor execution. Option A describes one
correct command. Option B describes neither correct. Option D is not a valid score; if
paralysis prevents performance, the patient is scored based on understanding (eye
closure if possible, or other appropriate response).
, Q6: A patient with right hemiparesis is asked to open and close their eyes and
make/release a fist. The patient opens and closes eyes correctly but cannot make a fist
with the right hand due to weakness. The left hand performs correctly. What is the
correct NIHSS score for item 1c (LOC Commands)?
A. 0 - Performs both commands correctly
B. 1 - Performs one command correctly
C. 2 - Performs neither command correctly
D. 1 - Performs one command correctly, but only because paralysis prevents the other
[CORRECT]
Correct Answer: D
Rationale: The correct score is 1 because the patient performed one command correctly
(eye opening/closing) and the other was prevented by paralysis, not by lack of
comprehension. If the patient understood but could not execute due to motor deficit, the
score reflects that limitation. Option A is incorrect because the fist command was not
performed. Option C is incorrect because one command was performed. The scoring
accounts for motor limitation versus cognitive impairment.
Q7: A patient with acute stroke is stuporous and requires repeated painful stimulation to
arouse. When aroused, the patient mumbles incoherently and does not follow
commands. What is the correct NIHSS score for item 1a (Level of Consciousness)?
A. 0 - Alert, keenly responsive
B. 1 - Not alert, but arousable by minor stimulation
C. 2 - Not alert, requires repeated stimulation [CORRECT]
D. 3 - Coma, unresponsive
Correct Answer: C
Comprehensive Test with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section 1: Level of Consciousness (LOC) & Orientation (10 Questions)
Q1: A patient arrives in the emergency department after sudden onset of left-sided
weakness. The patient opens eyes spontaneously, is fully oriented to person, place, and
time, and follows commands appropriately. What is the correct NIHSS score for item 1a
(Level of Consciousness)?
A. 1 - Not alert, but arousable by minor stimulation
B. 2 - Not alert, requires repeated stimulation
C. 0 - Alert, keenly responsive [CORRECT]
D. 3 - Coma, unresponsive
Correct Answer: C
Rationale: A patient who opens eyes spontaneously, is fully oriented, and follows
commands appropriately scores 0 on item 1a, indicating normal level of consciousness.
Option A describes a drowsy patient. Option B describes a stuporous patient. Option D
describes a comatose patient.
Q2: During NIHSS assessment, the patient is lethargic and requires verbal stimulation to
open eyes. Once aroused, the patient is oriented to person but not place or time. What is
the correct score for item 1a (Level of Consciousness)?
A. 0 - Alert, keenly responsive
,B. 1 - Not alert, but arousable by minor stimulation [CORRECT]
C. 2 - Not alert, requires repeated stimulation
D. 3 - Coma, unresponsive
Correct Answer: B
Rationale: A patient who requires minor stimulation to arouse but is not fully alert
scores 1 on item 1a. The patient is drowsy but arousable with verbal cues. Option A
describes a fully alert patient. Option C requires repeated or painful stimulation. Option
D describes no response to stimulation.
Q3: A patient with acute stroke is asked, "What month is it?" and "How old are you?" The
patient answers both questions correctly without hesitation. What is the correct NIHSS
score for item 1b (LOC Questions)?
A. 1 - Answers one question correctly
B. 2 - Answers neither question correctly
C. 0 - Answers both questions correctly [CORRECT]
D. 3 - Unable to respond due to aphasia
Correct Answer: C
Rationale: Item 1b scores 0 when the patient answers both questions correctly. The
questions assess orientation and are scored based on initial response without
coaching. Option A describes one correct answer. Option B describes neither correct.
Option D is not a valid score for item 1b; aphasic patients are scored based on best
verbal or nonverbal response.
Q4: A patient with acute stroke is asked their age and the current month. The patient
correctly states their age but says the wrong month (states July when it is December).
,The patient is not aphasic. What is the correct NIHSS score for item 1b (LOC
Questions)?
A. 0 - Answers both questions correctly
B. 1 - Answers one question correctly [CORRECT]
C. 2 - Answers neither question correctly
D. 3 - Unable to assess due to intubation
Correct Answer: B
Rationale: Item 1b scores 1 when the patient answers one of the two questions
correctly. The patient correctly stated age but was incorrect about the month. Option A
requires both correct. Option C requires neither correct. Option D is scored as 2 if the
patient cannot respond due to intubation or trauma.
Q5: A patient with acute stroke is asked to "Open and close your eyes" and "Grip and
release your hands." The patient performs both commands correctly and symmetrically.
What is the correct NIHSS score for item 1c (LOC Commands)?
A. 1 - Performs one command correctly
B. 2 - Performs neither command correctly
C. 0 - Performs both commands correctly [CORRECT]
D. 3 - Unable to perform due to paralysis
Correct Answer: C
Rationale: Item 1c scores 0 when the patient performs both commands correctly. These
commands assess comprehension and motor execution. Option A describes one
correct command. Option B describes neither correct. Option D is not a valid score; if
paralysis prevents performance, the patient is scored based on understanding (eye
closure if possible, or other appropriate response).
, Q6: A patient with right hemiparesis is asked to open and close their eyes and
make/release a fist. The patient opens and closes eyes correctly but cannot make a fist
with the right hand due to weakness. The left hand performs correctly. What is the
correct NIHSS score for item 1c (LOC Commands)?
A. 0 - Performs both commands correctly
B. 1 - Performs one command correctly
C. 2 - Performs neither command correctly
D. 1 - Performs one command correctly, but only because paralysis prevents the other
[CORRECT]
Correct Answer: D
Rationale: The correct score is 1 because the patient performed one command correctly
(eye opening/closing) and the other was prevented by paralysis, not by lack of
comprehension. If the patient understood but could not execute due to motor deficit, the
score reflects that limitation. Option A is incorrect because the fist command was not
performed. Option C is incorrect because one command was performed. The scoring
accounts for motor limitation versus cognitive impairment.
Q7: A patient with acute stroke is stuporous and requires repeated painful stimulation to
arouse. When aroused, the patient mumbles incoherently and does not follow
commands. What is the correct NIHSS score for item 1a (Level of Consciousness)?
A. 0 - Alert, keenly responsive
B. 1 - Not alert, but arousable by minor stimulation
C. 2 - Not alert, requires repeated stimulation [CORRECT]
D. 3 - Coma, unresponsive
Correct Answer: C
