2026 NIH Stroke Scale (NIHSS) Certification: Answer Key for
Test Groups A–F (Patients 1–6)
200 Practice Questions & Verified Answers | A+ Graded Guide
SECTION 1: INTRODUCTION TO THE NIH STROKE SCALE (Questions 1–20)
1. The National Institutes of Health Stroke Scale (NIHSS) is a standardized tool used to:
A) Diagnose the type of stroke
B) Quantify the severity of strokerelated neurological deficits
C) Determine the cause of a stroke
D) Measure blood flow to the brain
Correct Answer: B
Rationale: The NIHSS is a 15item neurological examination used to objectively quantify the severity of
strokerelated deficits. It is not a diagnostic tool for stroke type or cause, nor does it measure cerebral
blood flow. A higher score indicates more severe neurological impairment.
2. The NIHSS consists of how many items?
A) 10
B) 11
C) 15
D) 20
Correct Answer: C
,Rationale: The NIHSS consists of 15 items that assess various aspects of neurological function, including
level of consciousness, visual fields, motor function, language, and sensory perception. Each item is
scored, and the total score ranges from 0 to 42.
3. The maximum possible score on the NIHSS is:
A) 30
B) 35
C) 42
D) 50
Correct Answer: C
Rationale: The NIHSS total score ranges from 0 (normal) to a maximum of 42 (severe neurological
deficit). Scores are calculated by summing the individual item scores across all 15 categories.
4. A score of 0 on the NIHSS indicates:
A) Severe stroke
B) Moderate stroke
C) No stroke symptoms
D) Mild stroke
Correct Answer: C
Rationale: A score of 0 on the NIHSS indicates no detectable strokerelated neurological deficits. The
scale is designed so that higher scores reflect more severe impairment.
,5. Generally, a total NIHSS score greater than 22 indicates:
A) A mild stroke
B) A moderate stroke
C) A severe deficit
D) A normal examination
Correct Answer: C
Rationale: A score greater than 22 on the NIHSS indicates a severe deficit. Scores are typically
interpreted as: 0 = no stroke, 1–4 = mild stroke, 5–15 = moderate stroke, 16–20 = moderate to severe
stroke, and 21–42 = severe stroke.
6. Which of the following is true about administering the NIHSS?
A) Items may be administered in any order
B) The examiner may go back and change scores
C) Scores should reflect what the patient does, not what the clinician thinks the patient can do
D) The scale is only administered by physicians
Correct Answer: C
Rationale: A critical principle of NIHSS administration is that scores should reflect what the patient
actually does, not what the examiner believes the patient can do. Items must be administered in the
specified order, and examiners should not go back and change scores.
, 7. The NIHSS is most commonly used in which clinical setting?
A) Outpatient clinics
B) Emergency departments and stroke units
C) Rehabilitation centers
D) Primary care offices
Correct Answer: B
Rationale: The NIHSS is most frequently used in emergency departments and stroke units to assess
stroke severity, guide treatment decisions (such as thrombolytic therapy), and monitor neurological
changes over time.
8. A patient opens their eyes spontaneously, follows commands accurately, and answers questions
correctly. According to the NIHSS, what is the score for Level of Consciousness (Item 1a–1c)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: A
Rationale: A fully alert patient who opens eyes spontaneously, follows commands, and answers
questions correctly receives the lowest (best) score of 0 for Level of Consciousness items.
9. The NIHSS is considered a valid and reliable tool for assessing stroke severity. Which of the following
best describes its interrater reliability?
Test Groups A–F (Patients 1–6)
200 Practice Questions & Verified Answers | A+ Graded Guide
SECTION 1: INTRODUCTION TO THE NIH STROKE SCALE (Questions 1–20)
1. The National Institutes of Health Stroke Scale (NIHSS) is a standardized tool used to:
A) Diagnose the type of stroke
B) Quantify the severity of strokerelated neurological deficits
C) Determine the cause of a stroke
D) Measure blood flow to the brain
Correct Answer: B
Rationale: The NIHSS is a 15item neurological examination used to objectively quantify the severity of
strokerelated deficits. It is not a diagnostic tool for stroke type or cause, nor does it measure cerebral
blood flow. A higher score indicates more severe neurological impairment.
2. The NIHSS consists of how many items?
A) 10
B) 11
C) 15
D) 20
Correct Answer: C
,Rationale: The NIHSS consists of 15 items that assess various aspects of neurological function, including
level of consciousness, visual fields, motor function, language, and sensory perception. Each item is
scored, and the total score ranges from 0 to 42.
3. The maximum possible score on the NIHSS is:
A) 30
B) 35
C) 42
D) 50
Correct Answer: C
Rationale: The NIHSS total score ranges from 0 (normal) to a maximum of 42 (severe neurological
deficit). Scores are calculated by summing the individual item scores across all 15 categories.
4. A score of 0 on the NIHSS indicates:
A) Severe stroke
B) Moderate stroke
C) No stroke symptoms
D) Mild stroke
Correct Answer: C
Rationale: A score of 0 on the NIHSS indicates no detectable strokerelated neurological deficits. The
scale is designed so that higher scores reflect more severe impairment.
,5. Generally, a total NIHSS score greater than 22 indicates:
A) A mild stroke
B) A moderate stroke
C) A severe deficit
D) A normal examination
Correct Answer: C
Rationale: A score greater than 22 on the NIHSS indicates a severe deficit. Scores are typically
interpreted as: 0 = no stroke, 1–4 = mild stroke, 5–15 = moderate stroke, 16–20 = moderate to severe
stroke, and 21–42 = severe stroke.
6. Which of the following is true about administering the NIHSS?
A) Items may be administered in any order
B) The examiner may go back and change scores
C) Scores should reflect what the patient does, not what the clinician thinks the patient can do
D) The scale is only administered by physicians
Correct Answer: C
Rationale: A critical principle of NIHSS administration is that scores should reflect what the patient
actually does, not what the examiner believes the patient can do. Items must be administered in the
specified order, and examiners should not go back and change scores.
, 7. The NIHSS is most commonly used in which clinical setting?
A) Outpatient clinics
B) Emergency departments and stroke units
C) Rehabilitation centers
D) Primary care offices
Correct Answer: B
Rationale: The NIHSS is most frequently used in emergency departments and stroke units to assess
stroke severity, guide treatment decisions (such as thrombolytic therapy), and monitor neurological
changes over time.
8. A patient opens their eyes spontaneously, follows commands accurately, and answers questions
correctly. According to the NIHSS, what is the score for Level of Consciousness (Item 1a–1c)?
A) 0
B) 1
C) 2
D) 3
Correct Answer: A
Rationale: A fully alert patient who opens eyes spontaneously, follows commands, and answers
questions correctly receives the lowest (best) score of 0 for Level of Consciousness items.
9. The NIHSS is considered a valid and reliable tool for assessing stroke severity. Which of the following
best describes its interrater reliability?
