NIH STROKE SCALE GROUP C PATIENTS 1–6
PRACTICE QUESTIONS AND ANSWERS WITH
RATIONALES
2026/2027 EDITION
Scoring and administration essentials
• NIHSS has 15 scored components across 11 numbered items;
total possible score is 0–42.
• Score the behavior seen, in prescribed sequence; do not infer
what the patient could do or coach beyond the allowed prompts.
• For limb motor items, arm is observed for 10 seconds and leg
for 5 seconds; use the proper starting position.
• Item 10 (dysarthria) can be UN for a physical speech barrier
such as an endotracheal tube.
• Six practice sets below are NOT representations of actual Group
C certification patients.
Core domains
1a. Level of consciousness; 1b. LOC questions; 1c. LOC
commands; 2. Best gaze; 3. Visual fields; 4. Facial palsy; 5a. Left
arm motor; 5b. Right arm motor; 6a. Left leg motor; 6b. Right leg
motor; 7. Limb ataxia; 8. Sensory; 9. Best language; 10.
Dysarthria; 11. Extinction/inattention
Simulated Practice Patient Set 1 — Questions 1–25
1. [5a. Left arm motor] A patient is assessed as follows: No
antigravity effort; left arm moves along bed. What is the
appropriate NIHSS item score?
A. 4 — score 4
B. 2 — score 2
C. 3 — score 3
Original practice material • Not an official Group C answer key
,D. 1 — score 1
E. 0 — score 0
Correct answer: C (3). Rationale: Movement without antigravity
effort earns 3. Apply the standardized item instruction and score
the actual observed finding.
2. [10. Dysarthria] A patient is assessed as follows: Intubated
and physically unable to produce speech. What is the
appropriate NIHSS item score?
A. 0 — normal articulation
B. 2 — severe dysarthria
C. UN — untestable
D. 1 — mild/moderate dysarthria
Correct answer: C (UN). Rationale: Mechanical barrier to speech
is recorded as untestable for dysarthria. Apply the standardized
item instruction and score the actual observed finding.
3. [7. Limb ataxia] A patient is assessed as follows: Two upper
limbs show unequivocal dysmetria. What is the appropriate
NIHSS item score?
A. 2 — two limbs
B. 4 — no movement
C. 0 — no scored ataxia
D. 1 — one limb
Correct answer: A (2). Rationale: Two limbs affected earns 2.
Apply the standardized item instruction and score the actual
observed finding.
4. [10. Dysarthria] A patient is assessed as follows: Slowed but
clearly articulated speech. What is the appropriate NIHSS
item score?
A. 1 — mild/moderate dysarthria
B. 2 — severe dysarthria
Original practice material • Not an official Group C answer key
,C. UN — untestable
D. 0 — normal articulation
Correct answer: D (0). Rationale: Slow speech without
articulation defect earns 0. Apply the standardized item instruction
and score the actual observed finding.
5. [5b. Right arm motor] A patient is assessed as follows: Right
arm maintains elevation without drift. What is the appropriate
NIHSS item score?
A. 1 — score 1
B. 4 — score 4
C. 3 — score 3
D. 0 — score 0
E. 2 — score 2
Correct answer: D (0). Rationale: Full 10-second hold scores 0.
Apply the standardized item instruction and score the actual
observed finding.
6. [5a. Left arm motor] A patient is assessed as follows: Left
arm drifts before 10 seconds but does not hit bed. What is the
appropriate NIHSS item score?
A. 2 — score 2
B. 4 — score 4
C. 1 — score 1
D. 3 — score 3
E. 0 — score 0
Correct answer: C (1). Rationale: Drift without touching support
earns 1. Apply the standardized item instruction and score the
actual observed finding.
Original practice material • Not an official Group C answer key
, 7. [10. Dysarthria] A patient is assessed as follows: Speech
clear and articulated normally. What is the appropriate
NIHSS item score?
A. 1 — mild/moderate dysarthria
B. 2 — severe dysarthria
C. 0 — normal articulation
D. UN — untestable
Correct answer: C (0). Rationale: Normal articulation earns 0.
Apply the standardized item instruction and score the actual
observed finding.
8. [2. Best gaze] A patient is assessed as follows: Gaze is
asymmetric due to an isolated peripheral ocular movement
palsy. What is the appropriate NIHSS item score?
A. 2 — score 2
B. 1 — score 1
C. 0 — score 0
D. 3 — score 3
Correct answer: B (1). Rationale: Partial gaze palsy can score 1.
Apply the standardized item instruction and score the actual
observed finding.
9. [3. Visual fields] A patient is assessed as follows: Visual
fields intact in both eyes to confrontation. What is the
appropriate NIHSS item score?
A. 0 — score 0
B. 3 — score 3
C. 1 — score 1
D. 2 — score 2
Correct answer: A (0). Rationale: No visual loss scores 0. Apply
the standardized item instruction and score the actual observed
finding.
Original practice material • Not an official Group C answer key
PRACTICE QUESTIONS AND ANSWERS WITH
RATIONALES
2026/2027 EDITION
Scoring and administration essentials
• NIHSS has 15 scored components across 11 numbered items;
total possible score is 0–42.
• Score the behavior seen, in prescribed sequence; do not infer
what the patient could do or coach beyond the allowed prompts.
• For limb motor items, arm is observed for 10 seconds and leg
for 5 seconds; use the proper starting position.
• Item 10 (dysarthria) can be UN for a physical speech barrier
such as an endotracheal tube.
• Six practice sets below are NOT representations of actual Group
C certification patients.
Core domains
1a. Level of consciousness; 1b. LOC questions; 1c. LOC
commands; 2. Best gaze; 3. Visual fields; 4. Facial palsy; 5a. Left
arm motor; 5b. Right arm motor; 6a. Left leg motor; 6b. Right leg
motor; 7. Limb ataxia; 8. Sensory; 9. Best language; 10.
Dysarthria; 11. Extinction/inattention
Simulated Practice Patient Set 1 — Questions 1–25
1. [5a. Left arm motor] A patient is assessed as follows: No
antigravity effort; left arm moves along bed. What is the
appropriate NIHSS item score?
A. 4 — score 4
B. 2 — score 2
C. 3 — score 3
Original practice material • Not an official Group C answer key
,D. 1 — score 1
E. 0 — score 0
Correct answer: C (3). Rationale: Movement without antigravity
effort earns 3. Apply the standardized item instruction and score
the actual observed finding.
2. [10. Dysarthria] A patient is assessed as follows: Intubated
and physically unable to produce speech. What is the
appropriate NIHSS item score?
A. 0 — normal articulation
B. 2 — severe dysarthria
C. UN — untestable
D. 1 — mild/moderate dysarthria
Correct answer: C (UN). Rationale: Mechanical barrier to speech
is recorded as untestable for dysarthria. Apply the standardized
item instruction and score the actual observed finding.
3. [7. Limb ataxia] A patient is assessed as follows: Two upper
limbs show unequivocal dysmetria. What is the appropriate
NIHSS item score?
A. 2 — two limbs
B. 4 — no movement
C. 0 — no scored ataxia
D. 1 — one limb
Correct answer: A (2). Rationale: Two limbs affected earns 2.
Apply the standardized item instruction and score the actual
observed finding.
4. [10. Dysarthria] A patient is assessed as follows: Slowed but
clearly articulated speech. What is the appropriate NIHSS
item score?
A. 1 — mild/moderate dysarthria
B. 2 — severe dysarthria
Original practice material • Not an official Group C answer key
,C. UN — untestable
D. 0 — normal articulation
Correct answer: D (0). Rationale: Slow speech without
articulation defect earns 0. Apply the standardized item instruction
and score the actual observed finding.
5. [5b. Right arm motor] A patient is assessed as follows: Right
arm maintains elevation without drift. What is the appropriate
NIHSS item score?
A. 1 — score 1
B. 4 — score 4
C. 3 — score 3
D. 0 — score 0
E. 2 — score 2
Correct answer: D (0). Rationale: Full 10-second hold scores 0.
Apply the standardized item instruction and score the actual
observed finding.
6. [5a. Left arm motor] A patient is assessed as follows: Left
arm drifts before 10 seconds but does not hit bed. What is the
appropriate NIHSS item score?
A. 2 — score 2
B. 4 — score 4
C. 1 — score 1
D. 3 — score 3
E. 0 — score 0
Correct answer: C (1). Rationale: Drift without touching support
earns 1. Apply the standardized item instruction and score the
actual observed finding.
Original practice material • Not an official Group C answer key
, 7. [10. Dysarthria] A patient is assessed as follows: Speech
clear and articulated normally. What is the appropriate
NIHSS item score?
A. 1 — mild/moderate dysarthria
B. 2 — severe dysarthria
C. 0 — normal articulation
D. UN — untestable
Correct answer: C (0). Rationale: Normal articulation earns 0.
Apply the standardized item instruction and score the actual
observed finding.
8. [2. Best gaze] A patient is assessed as follows: Gaze is
asymmetric due to an isolated peripheral ocular movement
palsy. What is the appropriate NIHSS item score?
A. 2 — score 2
B. 1 — score 1
C. 0 — score 0
D. 3 — score 3
Correct answer: B (1). Rationale: Partial gaze palsy can score 1.
Apply the standardized item instruction and score the actual
observed finding.
9. [3. Visual fields] A patient is assessed as follows: Visual
fields intact in both eyes to confrontation. What is the
appropriate NIHSS item score?
A. 0 — score 0
B. 3 — score 3
C. 1 — score 1
D. 2 — score 2
Correct answer: A (0). Rationale: No visual loss scores 0. Apply
the standardized item instruction and score the actual observed
finding.
Original practice material • Not an official Group C answer key
