,NIH Stroke Scale and Neurology
Certification Practice Exam questions and
correct answers – Updated 2026 (Graded A+)
instant download pdf
Subject: NIH Stroke Scale (NIHSS)
Subtopic: Level of Consciousness (LOC) and Orientation (Items 1a, 1b, 1c)
Question 1: During the assessment of a patient who is lethargic and requires strong physical
stimulation to follow commands, the NIHSS Item 1a (LOC) score is determined. Which score is
most appropriate if the patient is not fully alert but arouses to minor stimulation, following
commands?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B - 1
Rationale: A score of 0 is assigned to patients who are alert and fully responsive. A score of 1 is
assigned to patients who are not alert but are arousable with minor stimulation to obey, answer,
or respond. A score of 2 is reserved for patients who require strong or painful stimulation for
non-stereotyped movements, and 3 is for patients who respond only with reflex motor/autonomic
effects or are unresponsive.
Question 2: In the assessment of orientation (Item 1b), the patient is asked for the current month
and their age. If the patient answers the month correctly but provides the wrong age, what is the
correct scoring?
A) 0
B) 1
C) 2
D) 3
, Correct Answer: B - 1
Rationale: Item 1b scores orientation to month and age. A score of 0 is given if the patient
answers both correctly. A score of 1 is given if the patient answers one question correctly. A
score of 2 is given if the patient answers neither correctly. Since this patient answered one out of
two correctly, 1 is the appropriate score.
Question 3: For the commands item (Item 1c), a patient with a documented right-sided
hemiplegia is asked to "close your eyes" and "make a fist with your left hand." If the patient
cannot move the right side but successfully makes a fist with the left, what is the score?
A) 0
B) 1
C) 2
D) The item cannot be scored
Correct Answer: A - 0
Rationale: Scoring for Item 1c is 0 if the patient performs both tasks correctly, 1 if they perform
one task correctly, and 2 if they perform neither. If the patient has a physical deficit like
paralysis, the instructions allow for substituting a movement. If the patient successfully
completes both requested tasks (even if one is a substitute), the score is 0.
Subtopic: Gaze, Visual Fields, and Facial Palsy (Items 2, 3, 4)
Question 4: During Item 2 (Best Gaze), the clinician observes that the patient’s eyes are deviated
to the left. The patient does not track the examiner's finger into the right visual field despite
testing. What is the NIHSS score for Item 2?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C - 2
Rationale: A score of 0 is normal. A score of 1 is given for partial gaze palsy (gaze is abnormal
in one or both eyes but can be overcome). A score of 2 is given for forced deviation or total gaze
paresis not overcome by the oculocephalic maneuver. Because the eyes are deviated and do not
track, it is classified as forced deviation.
Certification Practice Exam questions and
correct answers – Updated 2026 (Graded A+)
instant download pdf
Subject: NIH Stroke Scale (NIHSS)
Subtopic: Level of Consciousness (LOC) and Orientation (Items 1a, 1b, 1c)
Question 1: During the assessment of a patient who is lethargic and requires strong physical
stimulation to follow commands, the NIHSS Item 1a (LOC) score is determined. Which score is
most appropriate if the patient is not fully alert but arouses to minor stimulation, following
commands?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B - 1
Rationale: A score of 0 is assigned to patients who are alert and fully responsive. A score of 1 is
assigned to patients who are not alert but are arousable with minor stimulation to obey, answer,
or respond. A score of 2 is reserved for patients who require strong or painful stimulation for
non-stereotyped movements, and 3 is for patients who respond only with reflex motor/autonomic
effects or are unresponsive.
Question 2: In the assessment of orientation (Item 1b), the patient is asked for the current month
and their age. If the patient answers the month correctly but provides the wrong age, what is the
correct scoring?
A) 0
B) 1
C) 2
D) 3
, Correct Answer: B - 1
Rationale: Item 1b scores orientation to month and age. A score of 0 is given if the patient
answers both correctly. A score of 1 is given if the patient answers one question correctly. A
score of 2 is given if the patient answers neither correctly. Since this patient answered one out of
two correctly, 1 is the appropriate score.
Question 3: For the commands item (Item 1c), a patient with a documented right-sided
hemiplegia is asked to "close your eyes" and "make a fist with your left hand." If the patient
cannot move the right side but successfully makes a fist with the left, what is the score?
A) 0
B) 1
C) 2
D) The item cannot be scored
Correct Answer: A - 0
Rationale: Scoring for Item 1c is 0 if the patient performs both tasks correctly, 1 if they perform
one task correctly, and 2 if they perform neither. If the patient has a physical deficit like
paralysis, the instructions allow for substituting a movement. If the patient successfully
completes both requested tasks (even if one is a substitute), the score is 0.
Subtopic: Gaze, Visual Fields, and Facial Palsy (Items 2, 3, 4)
Question 4: During Item 2 (Best Gaze), the clinician observes that the patient’s eyes are deviated
to the left. The patient does not track the examiner's finger into the right visual field despite
testing. What is the NIHSS score for Item 2?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C - 2
Rationale: A score of 0 is normal. A score of 1 is given for partial gaze palsy (gaze is abnormal
in one or both eyes but can be overcome). A score of 2 is given for forced deviation or total gaze
paresis not overcome by the oculocephalic maneuver. Because the eyes are deviated and do not
track, it is classified as forced deviation.
