NIH STROKE SCALE GROUP C PATIENTS 1 TO 6 EXAM 2026/2027
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
1. Level of Consciousness and Orientation
2. Best Gaze and Visual Fields
3. Facial Palsy and Motor Function
4. Limb Ataxia and Sensory Assessment
5. Language, Dysarthria, and Neglect
INTRODUCTION
This comprehensive assessment evaluates proficiency in
administering and scoring the NIH Stroke Scale (NIHSS) Group C
certification examination. It tests understanding of standardized
scoring criteria across all 11 NIHSS items for six distinct patient
scenarios. The exam emphasizes real-world application through
scenario-based multiple-choice questions covering level of
consciousness, gaze, visual fields, motor function, ataxia, sensory,
language, dysarthria, and extinction. Each item requires critical
thinking and precise clinical judgment aligned with official NIHSS
certification standards.
SECTION ONE: PATIENT 1 — QUESTIONS 1–25
1. A 72-year-old female is evaluated for acute stroke symptoms.
She is drowsy but opens her eyes and responds appropriately to
verbal questions. When asked her name, she answers correctly
but cannot state the current month or year. What is the NIHSS
score for Item 1a (Level of Consciousness)?
A. 0 (Alert)
B. 1 (Drowsy, responds to verbal stimuli)
,C. 2 (Stuporous, responds to pain)
D. 3 (Coma)
🟢 B. 1 (Drowsy, responds to verbal stimuli)
🔴 RATIONALE: The patient is drowsy but responds to verbal
stimuli, which corresponds to NIHSS Item 1a score of 1. She is not
fully alert (0), does not require pain to arouse (2), and is not
comatose (3).
2. A patient is alert but cannot state their age or the current
month. What is the Item 1b (LOC Questions) score?
A. 0 (Answers both correctly)
B. 1 (Answers one correctly)
C. 2 (Answers neither correctly)
D. 3 (Unresponsive)
🟢 C. 2 (Answers neither correctly)
🔴 RATIONALE: Disorientation to both person (age) and time
(month) scores 2 for Item 1b. The patient is not oriented to either
item.
3. During assessment, a patient performs one of the two
requested tasks correctly (e.g., opens eyes but does not grip and
release). What is the Item 1c (LOC Commands) score?
A. 0
B. 1
C. 2
D. 3
🟢 B. 1
,🔴 RATIONALE: Performing one task correctly scores 1 for Item
1c. Performing both tasks correctly scores 0, and performing
neither scores 2.
4. Which of the following best describes the correct
administration of Item 1c (LOC Commands)?
A. Ask the patient to state their name and location
B. Ask the patient to open and close their eyes, then grip and
release the non-paretic hand
C. Ask the patient to count backward from 20
D. Ask the patient to follow a two-step verbal command
🟢 B. Ask the patient to open and close their eyes, then grip and
release the non-paretic hand
🔴 RATIONALE: Item 1c requires the patient to perform two tasks:
open and close eyes, then grip and release the non-paretic hand.
Substitute pantomime if hands are not functional.
5. A patient is assessed for best gaze. The patient's eyes remain
fixed on the examiner's face and do not move to follow the
examiner's finger. What is the correct Item 2 score?
A. 0 (Normal)
B. 1 (Partial gaze palsy)
C. 2 (Forced deviation)
D. 3 (Not assessable)
🟢 B. 1 (Partial gaze palsy)
🔴 RATIONALE: Partial gaze palsy (score 1) is assigned when gaze
is abnormal in one or both eyes but there is no forced deviation
or total paresis.
, 6. For a patient with a complete gaze palsy that cannot be
overcome by voluntary or reflexive activity, what is the Item 2
score?
A. 0
B. 1
C. 2
D. 3
🟢 C. 2
🔴 RATIONALE: A forced deviation or total gaze paresis that
cannot be overcome is scored as 2 for Item 2.
7. A patient is assessed for visual fields. Testing reveals dense,
complete hemianopia. What is the correct Item 3 score?
A. 0 (No visual loss)
B. 1 (Partial hemianopia)
C. 2 (Complete hemianopia)
D. 3 (Bilateral hemianopia)
🟢 C. 2 (Complete hemianopia)
🔴 RATIONALE: Complete hemianopia is scored as 2 for Item 3.
Partial hemianopia or quadrantanopia scores 1, and bilateral
hemianopia scores 3.
8. During visual field testing, a patient has a quadrantanopia
(quadrant visual loss). What is the Item 3 score?
A. 0
B. 1
C. 2
D. 3
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
1. Level of Consciousness and Orientation
2. Best Gaze and Visual Fields
3. Facial Palsy and Motor Function
4. Limb Ataxia and Sensory Assessment
5. Language, Dysarthria, and Neglect
INTRODUCTION
This comprehensive assessment evaluates proficiency in
administering and scoring the NIH Stroke Scale (NIHSS) Group C
certification examination. It tests understanding of standardized
scoring criteria across all 11 NIHSS items for six distinct patient
scenarios. The exam emphasizes real-world application through
scenario-based multiple-choice questions covering level of
consciousness, gaze, visual fields, motor function, ataxia, sensory,
language, dysarthria, and extinction. Each item requires critical
thinking and precise clinical judgment aligned with official NIHSS
certification standards.
SECTION ONE: PATIENT 1 — QUESTIONS 1–25
1. A 72-year-old female is evaluated for acute stroke symptoms.
She is drowsy but opens her eyes and responds appropriately to
verbal questions. When asked her name, she answers correctly
but cannot state the current month or year. What is the NIHSS
score for Item 1a (Level of Consciousness)?
A. 0 (Alert)
B. 1 (Drowsy, responds to verbal stimuli)
,C. 2 (Stuporous, responds to pain)
D. 3 (Coma)
🟢 B. 1 (Drowsy, responds to verbal stimuli)
🔴 RATIONALE: The patient is drowsy but responds to verbal
stimuli, which corresponds to NIHSS Item 1a score of 1. She is not
fully alert (0), does not require pain to arouse (2), and is not
comatose (3).
2. A patient is alert but cannot state their age or the current
month. What is the Item 1b (LOC Questions) score?
A. 0 (Answers both correctly)
B. 1 (Answers one correctly)
C. 2 (Answers neither correctly)
D. 3 (Unresponsive)
🟢 C. 2 (Answers neither correctly)
🔴 RATIONALE: Disorientation to both person (age) and time
(month) scores 2 for Item 1b. The patient is not oriented to either
item.
3. During assessment, a patient performs one of the two
requested tasks correctly (e.g., opens eyes but does not grip and
release). What is the Item 1c (LOC Commands) score?
A. 0
B. 1
C. 2
D. 3
🟢 B. 1
,🔴 RATIONALE: Performing one task correctly scores 1 for Item
1c. Performing both tasks correctly scores 0, and performing
neither scores 2.
4. Which of the following best describes the correct
administration of Item 1c (LOC Commands)?
A. Ask the patient to state their name and location
B. Ask the patient to open and close their eyes, then grip and
release the non-paretic hand
C. Ask the patient to count backward from 20
D. Ask the patient to follow a two-step verbal command
🟢 B. Ask the patient to open and close their eyes, then grip and
release the non-paretic hand
🔴 RATIONALE: Item 1c requires the patient to perform two tasks:
open and close eyes, then grip and release the non-paretic hand.
Substitute pantomime if hands are not functional.
5. A patient is assessed for best gaze. The patient's eyes remain
fixed on the examiner's face and do not move to follow the
examiner's finger. What is the correct Item 2 score?
A. 0 (Normal)
B. 1 (Partial gaze palsy)
C. 2 (Forced deviation)
D. 3 (Not assessable)
🟢 B. 1 (Partial gaze palsy)
🔴 RATIONALE: Partial gaze palsy (score 1) is assigned when gaze
is abnormal in one or both eyes but there is no forced deviation
or total paresis.
, 6. For a patient with a complete gaze palsy that cannot be
overcome by voluntary or reflexive activity, what is the Item 2
score?
A. 0
B. 1
C. 2
D. 3
🟢 C. 2
🔴 RATIONALE: A forced deviation or total gaze paresis that
cannot be overcome is scored as 2 for Item 2.
7. A patient is assessed for visual fields. Testing reveals dense,
complete hemianopia. What is the correct Item 3 score?
A. 0 (No visual loss)
B. 1 (Partial hemianopia)
C. 2 (Complete hemianopia)
D. 3 (Bilateral hemianopia)
🟢 C. 2 (Complete hemianopia)
🔴 RATIONALE: Complete hemianopia is scored as 2 for Item 3.
Partial hemianopia or quadrantanopia scores 1, and bilateral
hemianopia scores 3.
8. During visual field testing, a patient has a quadrantanopia
(quadrant visual loss). What is the Item 3 score?
A. 0
B. 1
C. 2
D. 3
