NIH Stroke Scale Group D Patient 1-6
Complete () |
(100%Verified)
NIH Stroke Scale Group D Patient 1-6 Complete () (100% Verified) — 200-Question
Professional Examination
Examination Overview
This comprehensive 200-question examination is designed for healthcare professionals preparing for
NIH Stroke Scale (NIHSS) certification and recertification. The examination covers all 11 NIHSS
assessment items across Group D Patient scenarios 1 through 6, including Level of Consciousness
(1a, 1b, 1c), Best Gaze, Visual Fields, Facial Palsy, Motor Arm (5a, 5b), Motor Leg (6a, 6b), Limb
Ataxia, Sensory, Best Language, Dysarthria, and Extinction/Inattention. Questions range from
foundational knowledge to advanced clinical application, emphasizing accurate scoring, patient
assessment techniques, and interpretation of neurological findings in acute stroke scenarios.
Note: This is an independently created educational test bank based on the standardized NIHSS
framework. It is not an official NIH, NINDS, or AHA publication and does not claim to reproduce
proprietary examination content.
Table of Contents
1. Section I: Level of Consciousness (Items 1a, 1b, 1c) — Q1–Q36
2. Section II: Best Gaze (Item 2) — Q37–Q54
3. Section III: Visual Fields (Item 3) — Q55–Q72
4. Section IV: Facial Palsy (Item 4) — Q73–Q90
5. Section V: Motor Arm (Item 5a, 5b) — Q91–Q126
6. Section VI: Motor Leg (Item 6a, 6b) — Q127–Q162
7. Section VII: Limb Ataxia (Item 7) — Q163–Q174
8. Section VIII: Sensory (Item 8) — Q175–Q182
9. Section IX: Best Language (Item 9) — Q183–Q190
10. Section X: Dysarthria (Item 10) — Q191–Q194
11. Section XI: Extinction and Inattention (Item 11) — Q195–Q198
pg. 1
, 12. Section XII: Comprehensive Application — Q199–Q200
SECTION I: LEVEL OF CONSCIOUSNESS (ITEMS 1a, 1b, 1c) — Q1–Q36
Q1. A 75-year-old male with suspected acute ischemic stroke is brought to the emergency
department. Upon examination, he is alert, keenly responsive, and answers all questions
appropriately. What is the correct NIHSS score for Item 1a (Level of Consciousness)?
A. 1 — Not alert, but arousable by minor stimulation
B. 2 — Not alert, requires repeated stimulation
C. 0 — Alert; keenly responsive
D. 3 — Unresponsive or reflexive posturing only
Correct Answer: C. 0 — Alert; keenly responsive
Rationale: Item 1a scores 0 when the patient is alert and keenly responsive to examination. A score
of 1 indicates drowsiness requiring minor stimulation to respond, 2 indicates stupor requiring
repeated or strong stimulation, and 3 indicates coma with only reflexive responses. This patient's
alert and responsive state directly meets the criteria for a score of 0.
Q2. A patient with acute stroke is drowsy but arouses when you call their name. They respond
appropriately once aroused. What score should be assigned for NIHSS Item 1a?
A. 0 — Alert
B. 1 — Not alert, but arousable by minor stimulation
C. 2 — Not alert, requires repeated stimulation
D. 3 — Unresponsive
Correct Answer: B. 1 — Not alert, but arousable by minor stimulation
Rationale: Minor stimulation (such as calling the patient's name) that successfully arouses the
patient indicates a score of 1 for Item 1a. A score of 0 requires the patient to be alert and keenly
responsive without stimulation. The key distinction is that the patient is not spontaneously alert but
responds to minimal prompting.
Q3. A stroke patient requires repeated shouting and physical shaking to elicit any response. When
aroused, the patient opens their eyes but does not follow commands. What NIHSS Item 1a score is
appropriate?
A. 1
B. 2
C. 3
D. 0
Correct Answer: B. 2
pg. 2
,Rationale: A score of 2 for Item 1a indicates that the patient is not alert and requires repeated
stimulation or strong stimulation to respond. The requirement for repeated shouting and physical
shaking clearly exceeds "minor stimulation" (score 1) but does not meet the criterion for
unresponsiveness (score 3). The patient's ability to open eyes upon strong stimulation confirms
some responsiveness.
Q4. During NIHSS assessment, a patient shows no response to verbal or physical stimulation. The
examiner observes only reflexive posturing. What is the correct Item 1a score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D. 3
Rationale: A score of 3 is assigned for Item 1a when the patient is unresponsive or exhibits only
reflexive responses (such as decerebrate or decorticate posturing). This represents the most severe
level of consciousness impairment on the NIHSS. The absence of any purposeful response to
stimulation confirms this score.
Q5. In the NIHSS Item 1a assessment, which of the following best describes the level of stimulation
required for a score of 1?
A. No stimulation required — patient is alert
B. Minor stimulation (e.g., verbal prompting, light touch)
C. Repeated or strong stimulation (e.g., shaking, sternal rub)
D. Painful stimulation only
Correct Answer: B. Minor stimulation (e.g., verbal prompting, light touch)
Rationale: A score of 1 on Item 1a requires that the patient is not alert but is arousable by minor
stimulation. Examples of minor stimulation include calling the patient's name or light touch. This
distinguishes it from a score of 2, which requires repeated or strong stimulation. The NIHSS
examiner should use the least amount of stimulation necessary to elicit a response.
Q6. A 68-year-old female with acute stroke is assessed for Item 1b (LOC Questions). She correctly
states the current month but incorrectly states her age. What score should be assigned?
A. 0 — Answers both correctly
B. 1 — Answers one correctly
C. 2 — Answers neither correctly
D. 3 — Aphasic and unable to answer
Correct Answer: B. 1 — Answers one correctly
Rationale: Item 1b scores 1 when the patient answers one of the two orientation questions correctly
(month and age). Since the patient correctly identified the month but not her age, the score is 1. A
pg. 3
, score of 0 requires both answers to be correct, and a score of 2 indicates that neither answer is
correct or the patient cannot respond due to aphasia or stupor.
Q7. During NIHSS Item 1b assessment, a patient answers neither the month nor their age
correctly. The patient appears awake and attempting to answer. What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C. 2
Rationale: A score of 2 on Item 1b is assigned when the patient answers neither orientation
question correctly. It is critical to grade only the patient's initial response and not to provide any
assistance or cues. The patient's apparent wakefulness does not change the score if both answers
are incorrect; the scoring is based strictly on answer accuracy.
Q8. In administering NIHSS Item 1b, which two questions must be asked?
A. Name and location
B. Month and age
C. Date and current president
D. Year and birthplace
Correct Answer: B. Month and age
Rationale: The NIHSS Item 1b specifically requires the examiner to ask the patient the current month
and their age. These questions assess orientation to time and self. Only the initial answer is graded,
and there is no partial credit for being close. Using any other orientation questions would deviate
from the standardized administration protocol.
Q9. An aphasic patient cannot comprehend the NIHSS Item 1b orientation questions and therefore
does not respond. How should the examiner score Item 1b?
A. 0 — Assume answers would be correct
B. 1 — Score as one correct
C. 2 — Aphasic or stuporous patients who do not comprehend score 2
D. 3 — Cannot be scored
Correct Answer: C. 2 — Aphasic or stuporous patients who do not comprehend score 2
Rationale: The NIHSS administration guidelines specify that aphasic and stuporous patients who do
not comprehend the questions will score 2 on Item 1b. The examiner should not assume or infer
answers. This rule ensures consistent scoring across patients with language barriers or severe
consciousness impairment.
pg. 4
Complete () |
(100%Verified)
NIH Stroke Scale Group D Patient 1-6 Complete () (100% Verified) — 200-Question
Professional Examination
Examination Overview
This comprehensive 200-question examination is designed for healthcare professionals preparing for
NIH Stroke Scale (NIHSS) certification and recertification. The examination covers all 11 NIHSS
assessment items across Group D Patient scenarios 1 through 6, including Level of Consciousness
(1a, 1b, 1c), Best Gaze, Visual Fields, Facial Palsy, Motor Arm (5a, 5b), Motor Leg (6a, 6b), Limb
Ataxia, Sensory, Best Language, Dysarthria, and Extinction/Inattention. Questions range from
foundational knowledge to advanced clinical application, emphasizing accurate scoring, patient
assessment techniques, and interpretation of neurological findings in acute stroke scenarios.
Note: This is an independently created educational test bank based on the standardized NIHSS
framework. It is not an official NIH, NINDS, or AHA publication and does not claim to reproduce
proprietary examination content.
Table of Contents
1. Section I: Level of Consciousness (Items 1a, 1b, 1c) — Q1–Q36
2. Section II: Best Gaze (Item 2) — Q37–Q54
3. Section III: Visual Fields (Item 3) — Q55–Q72
4. Section IV: Facial Palsy (Item 4) — Q73–Q90
5. Section V: Motor Arm (Item 5a, 5b) — Q91–Q126
6. Section VI: Motor Leg (Item 6a, 6b) — Q127–Q162
7. Section VII: Limb Ataxia (Item 7) — Q163–Q174
8. Section VIII: Sensory (Item 8) — Q175–Q182
9. Section IX: Best Language (Item 9) — Q183–Q190
10. Section X: Dysarthria (Item 10) — Q191–Q194
11. Section XI: Extinction and Inattention (Item 11) — Q195–Q198
pg. 1
, 12. Section XII: Comprehensive Application — Q199–Q200
SECTION I: LEVEL OF CONSCIOUSNESS (ITEMS 1a, 1b, 1c) — Q1–Q36
Q1. A 75-year-old male with suspected acute ischemic stroke is brought to the emergency
department. Upon examination, he is alert, keenly responsive, and answers all questions
appropriately. What is the correct NIHSS score for Item 1a (Level of Consciousness)?
A. 1 — Not alert, but arousable by minor stimulation
B. 2 — Not alert, requires repeated stimulation
C. 0 — Alert; keenly responsive
D. 3 — Unresponsive or reflexive posturing only
Correct Answer: C. 0 — Alert; keenly responsive
Rationale: Item 1a scores 0 when the patient is alert and keenly responsive to examination. A score
of 1 indicates drowsiness requiring minor stimulation to respond, 2 indicates stupor requiring
repeated or strong stimulation, and 3 indicates coma with only reflexive responses. This patient's
alert and responsive state directly meets the criteria for a score of 0.
Q2. A patient with acute stroke is drowsy but arouses when you call their name. They respond
appropriately once aroused. What score should be assigned for NIHSS Item 1a?
A. 0 — Alert
B. 1 — Not alert, but arousable by minor stimulation
C. 2 — Not alert, requires repeated stimulation
D. 3 — Unresponsive
Correct Answer: B. 1 — Not alert, but arousable by minor stimulation
Rationale: Minor stimulation (such as calling the patient's name) that successfully arouses the
patient indicates a score of 1 for Item 1a. A score of 0 requires the patient to be alert and keenly
responsive without stimulation. The key distinction is that the patient is not spontaneously alert but
responds to minimal prompting.
Q3. A stroke patient requires repeated shouting and physical shaking to elicit any response. When
aroused, the patient opens their eyes but does not follow commands. What NIHSS Item 1a score is
appropriate?
A. 1
B. 2
C. 3
D. 0
Correct Answer: B. 2
pg. 2
,Rationale: A score of 2 for Item 1a indicates that the patient is not alert and requires repeated
stimulation or strong stimulation to respond. The requirement for repeated shouting and physical
shaking clearly exceeds "minor stimulation" (score 1) but does not meet the criterion for
unresponsiveness (score 3). The patient's ability to open eyes upon strong stimulation confirms
some responsiveness.
Q4. During NIHSS assessment, a patient shows no response to verbal or physical stimulation. The
examiner observes only reflexive posturing. What is the correct Item 1a score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: D. 3
Rationale: A score of 3 is assigned for Item 1a when the patient is unresponsive or exhibits only
reflexive responses (such as decerebrate or decorticate posturing). This represents the most severe
level of consciousness impairment on the NIHSS. The absence of any purposeful response to
stimulation confirms this score.
Q5. In the NIHSS Item 1a assessment, which of the following best describes the level of stimulation
required for a score of 1?
A. No stimulation required — patient is alert
B. Minor stimulation (e.g., verbal prompting, light touch)
C. Repeated or strong stimulation (e.g., shaking, sternal rub)
D. Painful stimulation only
Correct Answer: B. Minor stimulation (e.g., verbal prompting, light touch)
Rationale: A score of 1 on Item 1a requires that the patient is not alert but is arousable by minor
stimulation. Examples of minor stimulation include calling the patient's name or light touch. This
distinguishes it from a score of 2, which requires repeated or strong stimulation. The NIHSS
examiner should use the least amount of stimulation necessary to elicit a response.
Q6. A 68-year-old female with acute stroke is assessed for Item 1b (LOC Questions). She correctly
states the current month but incorrectly states her age. What score should be assigned?
A. 0 — Answers both correctly
B. 1 — Answers one correctly
C. 2 — Answers neither correctly
D. 3 — Aphasic and unable to answer
Correct Answer: B. 1 — Answers one correctly
Rationale: Item 1b scores 1 when the patient answers one of the two orientation questions correctly
(month and age). Since the patient correctly identified the month but not her age, the score is 1. A
pg. 3
, score of 0 requires both answers to be correct, and a score of 2 indicates that neither answer is
correct or the patient cannot respond due to aphasia or stupor.
Q7. During NIHSS Item 1b assessment, a patient answers neither the month nor their age
correctly. The patient appears awake and attempting to answer. What is the appropriate score?
A. 0
B. 1
C. 2
D. 3
Correct Answer: C. 2
Rationale: A score of 2 on Item 1b is assigned when the patient answers neither orientation
question correctly. It is critical to grade only the patient's initial response and not to provide any
assistance or cues. The patient's apparent wakefulness does not change the score if both answers
are incorrect; the scoring is based strictly on answer accuracy.
Q8. In administering NIHSS Item 1b, which two questions must be asked?
A. Name and location
B. Month and age
C. Date and current president
D. Year and birthplace
Correct Answer: B. Month and age
Rationale: The NIHSS Item 1b specifically requires the examiner to ask the patient the current month
and their age. These questions assess orientation to time and self. Only the initial answer is graded,
and there is no partial credit for being close. Using any other orientation questions would deviate
from the standardized administration protocol.
Q9. An aphasic patient cannot comprehend the NIHSS Item 1b orientation questions and therefore
does not respond. How should the examiner score Item 1b?
A. 0 — Assume answers would be correct
B. 1 — Score as one correct
C. 2 — Aphasic or stuporous patients who do not comprehend score 2
D. 3 — Cannot be scored
Correct Answer: C. 2 — Aphasic or stuporous patients who do not comprehend score 2
Rationale: The NIHSS administration guidelines specify that aphasic and stuporous patients who do
not comprehend the questions will score 2 on Item 1b. The examiner should not assume or infer
answers. This rule ensures consistent scoring across patients with language barriers or severe
consciousness impairment.
pg. 4
