NIH Stroke Scale Certification Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. A patient presents with sudden right-sided weakness and slurred
speech. During the NIH Stroke Scale (NIHSS) assessment, which item
specifically evaluates the patient’s level of consciousness
responsiveness through simple questions such as age and month?
A. Best gaze
B. Level of consciousness commands
C. Level of consciousness questions
D. Facial palsy
The level of consciousness questions component assesses orientation
by asking the patient to state the current month and their age, which
helps evaluate cognitive awareness and responsiveness.
,2. During an NIHSS exam, a patient is unable to open and close their eyes
on command but appears awake. How should this finding be scored
under the LOC commands category?
A. 0
B. 1
C. 2
D. 3
A score of 2 indicates that the patient performs neither of the
commands correctly, demonstrating impaired ability to follow simple
instructions despite being awake.
3. Which NIHSS component assesses horizontal eye movements and
detects abnormalities such as gaze deviation?
A. Visual fields
B. Best gaze
C. Limb ataxia
D. Sensory
The best gaze item evaluates voluntary and reflex horizontal eye
movements, identifying gaze palsy or forced deviation, which are
common in stroke.
4. A patient demonstrates complete inability to move their eyes
horizontally. What NIHSS score should be assigned for best gaze?
A. 0
B. 1
, C. 2
D. 3
A score of 2 indicates forced deviation or total gaze paresis,
representing a severe deficit in eye movement control.
5. Which NIHSS item evaluates the presence of visual field loss such as
hemianopia?
A. Best gaze
B. Sensory
C. Visual fields
D. Language
The visual fields item assesses for partial or complete loss of vision in
one or both fields, indicating possible cortical or optic pathway
damage.
6. A patient has complete loss of vision in one half of both eyes. What
NIHSS score applies?
A. 1
B. 2
C. 3
D. 4
A score of 2 represents complete hemianopia, indicating significant
visual field deficit affecting both eyes on one side.
7. Which NIHSS component assesses facial muscle symmetry during
movement such as smiling or grimacing?
, A. Motor arm
B. Facial palsy
C. Dysarthria
D. Extinction
Facial palsy evaluates symmetry and strength of facial muscles,
identifying weakness due to stroke affecting cranial nerve VII.
8. A patient shows minor flattening of the nasolabial fold. What is the
NIHSS facial palsy score?
A. 1
B. 2
C. 3
D. 0
A score of 1 indicates minor facial weakness, such as slight
asymmetry without complete paralysis.
9. Which NIHSS section evaluates arm strength by having the patient
hold their arm up for 10 seconds?
A. Limb ataxia
B. Sensory
C. Motor arm
D. Language
Motor arm assesses strength and drift by requiring the patient to
maintain arm elevation, detecting weakness or paralysis.
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. A patient presents with sudden right-sided weakness and slurred
speech. During the NIH Stroke Scale (NIHSS) assessment, which item
specifically evaluates the patient’s level of consciousness
responsiveness through simple questions such as age and month?
A. Best gaze
B. Level of consciousness commands
C. Level of consciousness questions
D. Facial palsy
The level of consciousness questions component assesses orientation
by asking the patient to state the current month and their age, which
helps evaluate cognitive awareness and responsiveness.
,2. During an NIHSS exam, a patient is unable to open and close their eyes
on command but appears awake. How should this finding be scored
under the LOC commands category?
A. 0
B. 1
C. 2
D. 3
A score of 2 indicates that the patient performs neither of the
commands correctly, demonstrating impaired ability to follow simple
instructions despite being awake.
3. Which NIHSS component assesses horizontal eye movements and
detects abnormalities such as gaze deviation?
A. Visual fields
B. Best gaze
C. Limb ataxia
D. Sensory
The best gaze item evaluates voluntary and reflex horizontal eye
movements, identifying gaze palsy or forced deviation, which are
common in stroke.
4. A patient demonstrates complete inability to move their eyes
horizontally. What NIHSS score should be assigned for best gaze?
A. 0
B. 1
, C. 2
D. 3
A score of 2 indicates forced deviation or total gaze paresis,
representing a severe deficit in eye movement control.
5. Which NIHSS item evaluates the presence of visual field loss such as
hemianopia?
A. Best gaze
B. Sensory
C. Visual fields
D. Language
The visual fields item assesses for partial or complete loss of vision in
one or both fields, indicating possible cortical or optic pathway
damage.
6. A patient has complete loss of vision in one half of both eyes. What
NIHSS score applies?
A. 1
B. 2
C. 3
D. 4
A score of 2 represents complete hemianopia, indicating significant
visual field deficit affecting both eyes on one side.
7. Which NIHSS component assesses facial muscle symmetry during
movement such as smiling or grimacing?
, A. Motor arm
B. Facial palsy
C. Dysarthria
D. Extinction
Facial palsy evaluates symmetry and strength of facial muscles,
identifying weakness due to stroke affecting cranial nerve VII.
8. A patient shows minor flattening of the nasolabial fold. What is the
NIHSS facial palsy score?
A. 1
B. 2
C. 3
D. 0
A score of 1 indicates minor facial weakness, such as slight
asymmetry without complete paralysis.
9. Which NIHSS section evaluates arm strength by having the patient
hold their arm up for 10 seconds?
A. Limb ataxia
B. Sensory
C. Motor arm
D. Language
Motor arm assesses strength and drift by requiring the patient to
maintain arm elevation, detecting weakness or paralysis.
