NIH Stroke Scale (NIHSS) Group B Certification Test PRACTICE EXAM Exam 200 Multiple Choice Questions with Answers and Italicized Rationales

NIH Stroke Scale (NIHSS) Group B Certification
Test PRACTICE EXAM Exam 200 Multiple Choice
Questions with Answers and Italicized Rationales


The NIH Stroke Scale (NIHSS) is a standardized tool used by healthcare providers to
objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11
items, each of which scores a specific ability between 0 and 4. For each item, a score of 0
typically indicates normal function, while a higher score indicates some level of
impairment. The individual scores from each item are summed to calculate a patient's
total NIHSS score. The maximum possible score is 42, with the minimum being 0. The
NIHSS is commonly used in clinical trials and to determine the appropriateness of
treatment with tissue plasminogen activator (tPA). This exam covers the 11 categories of
the NIHSS, as tested in Group B certification.




Level of Consciousness (LOC)
1. A patient is awake, alert, and responds appropriately to questions. What is the
correct score for Item 1a (Level of Consciousness)?

 A) 0
 B) 1
 C) 2
 D) 3

Answer: A) 0 — A score of 0 is given when the patient is alert and fully responsive. This
indicates no impairment in level of consciousness. Item 1a tests the patient's overall level
of alertness and response to stimulation.

, 2. A patient is drowsy but awakens with minimal verbal stimulation and follows
commands. What is the correct score for Item 1a (Level of Consciousness)?

 A) 0
 B) 1
 C) 2
 D) 3

Answer: B) 1 — A score of 1 indicates the patient is not alert but can be aroused by
minor verbal stimulation to obey, answer, or respond. This category is for patients who are
drowsy but responsive to voice.




3. A patient requires repeated painful stimulation to achieve any movement. What
is the correct score for Item 1a (Level of Consciousness)?

 A) 0
 B) 1
 C) 2
 D) 3

Answer: C) 2 — A score of 2 indicates the patient requires repeated or strong/painful
stimulation to move, or is obtunded and needs vigorous or painful stimulation to achieve a
motor response. The patient is not consistently responsive to voice.




4. A patient demonstrates no motor response to painful stimuli. What is the
correct score for Item 1a (Level of Consciousness)?

 A) 0
 B) 1
 C) 2
 D) 3

, Answer: D) 3 — A score of 3 indicates the patient is comatose and unresponsive, with no
motor response to painful stimulation or only reflexive posturing. This is the most severe
impairment in consciousness.




5. A patient is intubated and mechanically ventilated but opens eyes to voice and
follows commands. What is the correct score for Item 1a (Level of Consciousness)?

 A) 0
 B) 1
 C) 2
 D) 3

Answer: A) 0 — The presence of an endotracheal tube does not automatically change the
LOC score. If the patient is alert and follows commands despite being intubated, the score
remains 0. The intubation is noted but does not alter the score if the patient is responsive.




6. For Item 1b (LOC Questions), what are the two questions asked to assess
orientation?

 A) "What is your name?" and "Where are you?"
 B) "What month is it?" and "How old are you?"
 C) "What is your age?" and "What is today's date?"
 D) "What month is it?" and "What is your age?"

Answer: D) "What month is it?" and "What is your age?" — Item 1b assesses
orientation by asking two specific questions: the current month and the patient's age. Both
questions must be answered correctly for a score of 0. Answers must be exact (month and
age); approximate answers are considered incorrect.




7. A patient answers both LOC questions correctly. What is the score for Item 1b?

 A) 0

,  B) 1
 C) 2
 D) 3

Answer: A) 0 — A score of 0 is given when both questions are answered correctly. This
indicates the patient is fully oriented. Item 1b specifically tests the patient's ability to
answer two specific questions about month and age.




8. A patient answers one of the two LOC questions correctly. What is the score for
Item 1b?

 A) 0
 B) 1
 C) 2
 D) 3

Answer: B) 1 — A score of 1 is given when the patient answers one question correctly.
This indicates partial disorientation. The patient must get both correct for a score of 0. One
correct answer earns a score of 1.




9. A patient answers neither of the two LOC questions correctly. What is the score
for Item 1b?

 A) 0
 B) 1
 C) 2
 D) 3

Answer: C) 2 — A score of 2 is given when both questions are answered incorrectly. This
indicates significant disorientation. Aphasic or stuporous patients who are unable to
answer due to language barrier or intubation may score 1 or 2 based on their ability to
respond.