NIHSS- GROUP A ACTUAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS
RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1-50
1. A patient is asked to show their teeth and close their eyes tightly. The response is asymmetric. This item is
assessing which component of the NIHSS?
A. Level of Consciousness
B. Motor Arm
C. Facial Palsy
D. Dysarthria
Correct Answer: C. Facial Palsy
*Rationale: * The NIHSS item "Facial Palsy" assesses the patient's ability to perform voluntary facial movements, such
as showing teeth, raising eyebrows, and closing eyes. Asymmetry in these movements indicates a facial nerve deficit,
which is a key finding in stroke. LOC (A) is assessed through responsiveness, Motor Arm (B) through arm elevation,
and Dysarthria (D) through speech clarity, not facial movement.
2. A patient is able to state their name, date of birth, and where they are. What is the correct score for Level of
Consciousness - Questions (Item 1a) on the NIHSS?
A. 0
B. 1
,C. 2
D. 3
Correct Answer: A. 0
*Rationale: * Item 1a scores the patient's ability to answer two specific questions correctly: their age and the current
month. A score of 0 is given if the patient answers both questions correctly. The scenario describes answering name
and DOB, but the exam specifically asks for age and month. However, since the patient is answering questions
correctly, they would likely perform this task correctly. This reinforces the principle of assessing the ability to answer
the specific questions. Scores of 1, 2, or 3 indicate varying degrees of incorrect answers, stupor, or unresponsiveness.
3. A patient follows a two-step command to close their eyes and then open them. According to NIHSS scoring,
this demonstrates:
A. Normal motor function
B. Intact level of consciousness
C. Correct scoring for Item 1b
D. Ability to follow a complex command
Correct Answer: D. Ability to follow a complex command
*Rationale: * The NIHSS Item 1b (LOC - Commands) assesses a patient's ability to follow simple commands. A two-
step command like "close your eyes and then open them" is considered a complex command. While following
commands is part of the LOC assessment, the specific scoring for Item 1b is based on the ability to perform the task,
,not just a general score. A score of 0 on this item means the patient performed both commands correctly. Options A
and B are broader categories and not the specific item being tested.
4. A patient is presented with a series of words to repeat. They are only able to produce a few recognizable words
and have significant difficulty with the naming task. What is the appropriate NIHSS score for "Best Language"
(Item 9)?
A. 0 - No aphasia
B. 1 - Mild to moderate aphasia
C. 2 - Severe aphasia
D. 3 - Mute or global aphasia
Correct Answer: B. 1 - Mild to moderate aphasia
*Rationale: * This scenario describes a patient who can produce some recognizable words but has significant
difficulty, which falls under "Mild to moderate aphasia." A score of 1 is given when the patient has noticeable
difficulty with naming or fluency but can still communicate. A score of 0 is for no aphasia. A score of 2 is for severe
aphasia where communication is fragmented, and a score of 3 is for mute or global aphasia, where the patient
cannot speak at all.
5. In a patient with a right-sided stroke, you notice a left-sided neglect. The patient fails to attend to stimuli on
the left side. This is scored under which NIHSS category?
A. Level of Consciousness
B. Best Language
, C. Extinction and Inattention
D. Motor Arm
Correct Answer: C. Extinction and Inattention
*Rationale: * Extinction and Inattention (Item 11) is specifically designed to assess for neglect, which is a failure to
respond to stimuli on one side of the body. The scenario describes a classic presentation of left-sided neglect
following a right-sided stroke. While LOC and Best Language are related, they do not specifically address this
inattention. Motor Arm (D) assesses motor strength, not sensory neglect.
6. A patient has trouble keeping their eyes open and is only responsive to vigorous and repeated stimulation.
What is the most appropriate score for Level of Consciousness - Arousal (Item 1a)?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D. 3
*Rationale: * Item 1a measures the patient's level of consciousness, specifically their arousal. A score of 3 is given
when the patient is "unresponsive, or responds only with reflex motor or autonomic effects, or is totally
unresponsive, flaccid, and areflexic." The description "responsive only to vigorous and repeated stimulation" fits this
definition. Scores of 1 or 2 indicate varying degrees of drowsiness or stupor where the patient is more responsive.
RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1-50
1. A patient is asked to show their teeth and close their eyes tightly. The response is asymmetric. This item is
assessing which component of the NIHSS?
A. Level of Consciousness
B. Motor Arm
C. Facial Palsy
D. Dysarthria
Correct Answer: C. Facial Palsy
*Rationale: * The NIHSS item "Facial Palsy" assesses the patient's ability to perform voluntary facial movements, such
as showing teeth, raising eyebrows, and closing eyes. Asymmetry in these movements indicates a facial nerve deficit,
which is a key finding in stroke. LOC (A) is assessed through responsiveness, Motor Arm (B) through arm elevation,
and Dysarthria (D) through speech clarity, not facial movement.
2. A patient is able to state their name, date of birth, and where they are. What is the correct score for Level of
Consciousness - Questions (Item 1a) on the NIHSS?
A. 0
B. 1
,C. 2
D. 3
Correct Answer: A. 0
*Rationale: * Item 1a scores the patient's ability to answer two specific questions correctly: their age and the current
month. A score of 0 is given if the patient answers both questions correctly. The scenario describes answering name
and DOB, but the exam specifically asks for age and month. However, since the patient is answering questions
correctly, they would likely perform this task correctly. This reinforces the principle of assessing the ability to answer
the specific questions. Scores of 1, 2, or 3 indicate varying degrees of incorrect answers, stupor, or unresponsiveness.
3. A patient follows a two-step command to close their eyes and then open them. According to NIHSS scoring,
this demonstrates:
A. Normal motor function
B. Intact level of consciousness
C. Correct scoring for Item 1b
D. Ability to follow a complex command
Correct Answer: D. Ability to follow a complex command
*Rationale: * The NIHSS Item 1b (LOC - Commands) assesses a patient's ability to follow simple commands. A two-
step command like "close your eyes and then open them" is considered a complex command. While following
commands is part of the LOC assessment, the specific scoring for Item 1b is based on the ability to perform the task,
,not just a general score. A score of 0 on this item means the patient performed both commands correctly. Options A
and B are broader categories and not the specific item being tested.
4. A patient is presented with a series of words to repeat. They are only able to produce a few recognizable words
and have significant difficulty with the naming task. What is the appropriate NIHSS score for "Best Language"
(Item 9)?
A. 0 - No aphasia
B. 1 - Mild to moderate aphasia
C. 2 - Severe aphasia
D. 3 - Mute or global aphasia
Correct Answer: B. 1 - Mild to moderate aphasia
*Rationale: * This scenario describes a patient who can produce some recognizable words but has significant
difficulty, which falls under "Mild to moderate aphasia." A score of 1 is given when the patient has noticeable
difficulty with naming or fluency but can still communicate. A score of 0 is for no aphasia. A score of 2 is for severe
aphasia where communication is fragmented, and a score of 3 is for mute or global aphasia, where the patient
cannot speak at all.
5. In a patient with a right-sided stroke, you notice a left-sided neglect. The patient fails to attend to stimuli on
the left side. This is scored under which NIHSS category?
A. Level of Consciousness
B. Best Language
, C. Extinction and Inattention
D. Motor Arm
Correct Answer: C. Extinction and Inattention
*Rationale: * Extinction and Inattention (Item 11) is specifically designed to assess for neglect, which is a failure to
respond to stimuli on one side of the body. The scenario describes a classic presentation of left-sided neglect
following a right-sided stroke. While LOC and Best Language are related, they do not specifically address this
inattention. Motor Arm (D) assesses motor strength, not sensory neglect.
6. A patient has trouble keeping their eyes open and is only responsive to vigorous and repeated stimulation.
What is the most appropriate score for Level of Consciousness - Arousal (Item 1a)?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D. 3
*Rationale: * Item 1a measures the patient's level of consciousness, specifically their arousal. A score of 3 is given
when the patient is "unresponsive, or responds only with reflex motor or autonomic effects, or is totally
unresponsive, flaccid, and areflexic." The description "responsive only to vigorous and repeated stimulation" fits this
definition. Scores of 1 or 2 indicate varying degrees of drowsiness or stupor where the patient is more responsive.
