NIH Stroke Scale Test Groups A–F Patients 1–6-
Certified Scoring Guide & Clinical Training Materials
Graded A+
This definitive clinical reference guide contains the complete set of all National Institutes
of Health Stroke Scale (NIHSS) Test Groups A through F, covering patient case
scenarios 1 through 6. It provides updated clinical training metrics, official scoring
criteria, and differential diagnosis rationales for evaluating acute neurological deficits,
including gaze, visual fields, motor function, ataxia, sensory loss, and language.
Healthcare practitioners, emergency nurses, and neurologists will master the standard
physical assessment protocols required to eliminate scoring variability and successfully
pass their official certification track.
1. When administering the NIHSS, the examiner should test the unaffected limb
first during motor assessment. What is the primary reason for this approach?
A. To save time during the examination
B. To establish a baseline and avoid cueing the patient about the affected side
C. To reduce patient fatigue
D. To comply with Joint Commission requirements
Answer: B. To establish a baseline and avoid cueing the patient about the affected
side
Rationale: Testing the unaffected limb first allows the examiner to observe normal
strength and coordination, and it prevents the patient from anticipating which side is
being tested, which could influence effort.
2. A patient is intubated and cannot speak. How should Item 9 (Best Language) be
scored?
A. 0
B. 1
C. 2
D. 3
,Answer: C. 2
Rationale: For intubated patients, Item 9 is scored 2 because the examiner cannot fully
assess language. A score of 3 is reserved for mute or global aphasia, but intubation is a
physical barrier, not a neurological deficit.
3. What is the maximum score for Item 5 (Motor Arm) for each arm?
A. 2
B. 3
C. 4
D. 5
Answer: C. 4
Rationale: Each arm is scored 0–4 on Item 5, with 0 = no drift, 1 = drift, 2 = drifts to bed, 3
= no effort against gravity, 4 = no movement. The total for both arms can range from 0 to
8.
4. During assessment of Item 6 (Motor Leg), how long should the examiner hold
the leg at 30 degrees?
A. 3 seconds
B. 5 seconds
C. 10 seconds
D. 15 seconds
Answer: B. 5 seconds
Rationale: The leg is held at 30 degrees for 5 seconds. If it drifts and hits the bed within 5
seconds, the score is 2.
5. For Item 5 (Motor Arm), the arm is held at what angle?
,A. 45 degrees
B. 60 degrees
C. 90 degrees
D. 180 degrees
Answer: C. 90 degrees
Rationale: The arm is held at 90 degrees (or 45 degrees if the patient is sitting) for 10
seconds. Drift within 10 seconds is scored accordingly.
6. A patient has a score of 0 on Item 7 (Limb Ataxia). Which of the following is the
most likely explanation?
A. The patient has severe ataxia in all limbs
B. The patient is paralyzed or in a coma
C. The patient has mild ataxia in one limb
D. The patient has ataxia in two limbs
Answer: B. The patient is paralyzed or in a coma
Rationale: If the patient is paralyzed or in a coma, Item 7 is scored 0 because ataxia
cannot be assessed. A score of 0 does not necessarily mean absence of ataxia.
7. What is the correct score for Item 10 (Dysarthria) if the patient is intubated?
A. 0
B. 1
C. 2
D. Not assessed
Answer: A. 0
Rationale: If the patient is intubated or has a physical barrier to speech, Item 10 is scored 0
(not assessed) because dysarthria cannot be evaluated.
, 8. During assessment of Item 1c (LOC Commands), the examiner should use which
type of command?
A. Verbal command only
B. Pantomime in addition to verbal command
C. Painful stimulation only
D. Written command
Answer: B. Pantomime in addition to verbal command
Rationale: The examiner should use verbal command and pantomime. If the patient does
not respond, the examiner may use noxious stimulation, but pantomime is part of the
standard administration.
9. A patient has a score of 2 on Item 3 (Visual Fields). What does this indicate?
A. Partial hemianopia
B. Complete hemianopia
C. Bilateral hemianopia
D. Normal visual fields
Answer: B. Complete hemianopia
Rationale: Item 3 scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete
hemianopia, 3 = bilateral hemianopia.
10. What is the score for Item 11 (Extinction/Inattention) if the patient has
profound hemi-inattention?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
Certified Scoring Guide & Clinical Training Materials
Graded A+
This definitive clinical reference guide contains the complete set of all National Institutes
of Health Stroke Scale (NIHSS) Test Groups A through F, covering patient case
scenarios 1 through 6. It provides updated clinical training metrics, official scoring
criteria, and differential diagnosis rationales for evaluating acute neurological deficits,
including gaze, visual fields, motor function, ataxia, sensory loss, and language.
Healthcare practitioners, emergency nurses, and neurologists will master the standard
physical assessment protocols required to eliminate scoring variability and successfully
pass their official certification track.
1. When administering the NIHSS, the examiner should test the unaffected limb
first during motor assessment. What is the primary reason for this approach?
A. To save time during the examination
B. To establish a baseline and avoid cueing the patient about the affected side
C. To reduce patient fatigue
D. To comply with Joint Commission requirements
Answer: B. To establish a baseline and avoid cueing the patient about the affected
side
Rationale: Testing the unaffected limb first allows the examiner to observe normal
strength and coordination, and it prevents the patient from anticipating which side is
being tested, which could influence effort.
2. A patient is intubated and cannot speak. How should Item 9 (Best Language) be
scored?
A. 0
B. 1
C. 2
D. 3
,Answer: C. 2
Rationale: For intubated patients, Item 9 is scored 2 because the examiner cannot fully
assess language. A score of 3 is reserved for mute or global aphasia, but intubation is a
physical barrier, not a neurological deficit.
3. What is the maximum score for Item 5 (Motor Arm) for each arm?
A. 2
B. 3
C. 4
D. 5
Answer: C. 4
Rationale: Each arm is scored 0–4 on Item 5, with 0 = no drift, 1 = drift, 2 = drifts to bed, 3
= no effort against gravity, 4 = no movement. The total for both arms can range from 0 to
8.
4. During assessment of Item 6 (Motor Leg), how long should the examiner hold
the leg at 30 degrees?
A. 3 seconds
B. 5 seconds
C. 10 seconds
D. 15 seconds
Answer: B. 5 seconds
Rationale: The leg is held at 30 degrees for 5 seconds. If it drifts and hits the bed within 5
seconds, the score is 2.
5. For Item 5 (Motor Arm), the arm is held at what angle?
,A. 45 degrees
B. 60 degrees
C. 90 degrees
D. 180 degrees
Answer: C. 90 degrees
Rationale: The arm is held at 90 degrees (or 45 degrees if the patient is sitting) for 10
seconds. Drift within 10 seconds is scored accordingly.
6. A patient has a score of 0 on Item 7 (Limb Ataxia). Which of the following is the
most likely explanation?
A. The patient has severe ataxia in all limbs
B. The patient is paralyzed or in a coma
C. The patient has mild ataxia in one limb
D. The patient has ataxia in two limbs
Answer: B. The patient is paralyzed or in a coma
Rationale: If the patient is paralyzed or in a coma, Item 7 is scored 0 because ataxia
cannot be assessed. A score of 0 does not necessarily mean absence of ataxia.
7. What is the correct score for Item 10 (Dysarthria) if the patient is intubated?
A. 0
B. 1
C. 2
D. Not assessed
Answer: A. 0
Rationale: If the patient is intubated or has a physical barrier to speech, Item 10 is scored 0
(not assessed) because dysarthria cannot be evaluated.
, 8. During assessment of Item 1c (LOC Commands), the examiner should use which
type of command?
A. Verbal command only
B. Pantomime in addition to verbal command
C. Painful stimulation only
D. Written command
Answer: B. Pantomime in addition to verbal command
Rationale: The examiner should use verbal command and pantomime. If the patient does
not respond, the examiner may use noxious stimulation, but pantomime is part of the
standard administration.
9. A patient has a score of 2 on Item 3 (Visual Fields). What does this indicate?
A. Partial hemianopia
B. Complete hemianopia
C. Bilateral hemianopia
D. Normal visual fields
Answer: B. Complete hemianopia
Rationale: Item 3 scoring: 0 = no visual loss, 1 = partial hemianopia, 2 = complete
hemianopia, 3 = bilateral hemianopia.
10. What is the score for Item 11 (Extinction/Inattention) if the patient has
profound hemi-inattention?
A. 0
B. 1
C. 2
D. 3
Answer: C. 2
