NIHSS (National Institutes of Health Stroke Scale) Certification Test
The NIHSS (National Institutes of Health Stroke Scale) Certification is a crucial clinical credential for healthcare professionals involved in stroke care. Whether you’re a nurse, neurologist, physician assistant, EMT, or student in a medical program, this NIHSS Certification Practice Exam on Exam Sage will thoroughly prepare you to pass the NIH Stroke Scale assessment with excellence.
📘 What is the NIHSS Certification?
The NIHSS Certification is an industry-standard credential that verifies a healthcare provider’s ability to accurately assess stroke severity using a standardized neurological exam. It ensures consistent evaluation of acute stroke patients using the 15-item NIH Stroke Scale, which includes detailed assessments of consciousness, vision, motor skills, speech, and sensory response.
This certification is often required in stroke centers, emergency rooms, neurology departments, and rehabilitation units to ensure uniformity in diagnosing and documenting stroke deficits.
🎯 What You’ll Learn
This NIHSS Certification Practice Exam from Exam Sage will help you:
Understand every item of the NIH Stroke Scale
Accurately score patients on components like:
Level of Consciousness (LOC)
Best Gaze and Visual Fields
Facial Palsy and Limb Motor Strength
Sensory and Ataxia Responses
Language, Dysarthria, and Extinction
Interpret scenarios involving aphasia, hemianopia, neglect, and gaze deviation
Differentiate between aphasia and dysarthria
Recognize how underlying conditions (e.g., amputations, intubation) affect scoring
Avoid common scoring errors and confidently assign accurate point values
You’ll also learn why specific scores are assigned, with each question accompanied by concise, real-clinical explanations (50–70 characters), helping you reinforce your understanding quickly.
👥 Who Should Take This Practice Exam?
This exam is ideal for:
Registered Nurses (RNs) working in stroke units or critical care
Neurology residents and physicians
Medical and nursing students preparing for stroke training modules
Emergency Medical Technicians (EMTs) handling acute stroke cases
Allied health professionals needing stroke protocol certification
Whether you’re preparing for initial certification or recertification, this practice exam helps ensure you’re fully prepared to meet real-world expectations.
📝 What Topics Are Covered?
Our NIHSS Practice Test covers every aspect of the scale in-depth:
🔹 Level of Consciousness (LOC): orientation, command-following
🔹 Best Gaze & Visual Fields: detecting hemianopia, forced deviation
🔹 Facial Palsy: assessing symmetry and motor response
🔹 Motor Arm & Leg: evaluating drift, paralysis, and strength
🔹 Limb Ataxia: coordination testing for cerebellar deficits
🔹 Sensory Function: pain perception and sensory loss
🔹 Language & Speech: identifying aphasia and dysarthria
🔹 Extinction & Inattention: recognizing neglect or sensory omission
🔹 Special Scenarios: scoring untestable limbs, coma states, amputations, intubation
With 200+ clinically relevant multiple-choice questions and detailed rationale, this product gives you both practice and precision.
🔍 Why Choose Exam Sage for NIHSS Prep?
Exam Sage is a trusted name for high-quality exam preparation across the medical and nursing fields. Our NIHSS Certification Practice Exam is:
✅ Written by clinical experts with hands-on experience
✅ Updated for current stroke scale scoring guidelines
✅ Designed to mimic the real certification test closely
✅ Packed with realistic case-based scenarios
✅ Includes explanations for every question for fast learning
We don’t just help you memorize scores—we help you understand them in context so you’re prepared for both the test and real patient care.
📈 Boost Your Clinical Confidence
Passing the NIHSS Certification is more than a checkbox—it’s a demonstration of your ability to respond in life-saving moments. With this practice test, you’ll be ready to:
Accurately assess stroke severity
Make informed decisions during stroke code
Communicate effectively with the neuro team
Increase your value as a stroke-trained provider
🎓 Format & Delivery
🔸 Number of Questions: 200+ MCQs with explanations
🔸 Format: Multiple choice with clinical reasoning
🔸 Delivery: Instant digital download
🔸 Access: Lifetime access to PDF
🔸 Use: Self-study or group training
🔗 Get Started Now
Ready to pass your NIHSS certification with flying colors?
Download the NIHSS Certification Practice Exam from ExamSage.com and gain the confidence, knowledge, and clinical edge you need today.
1. What does the NIHSS primarily assess in patients?
A) Cognitive function
B) Stroke severity
C) Pain threshold
D) Blood pressure levels
Correct Answer: B
Explanation: NIHSS measures acute stroke severity level.
2. Which domain is NOT tested in NIHSS?
A) Facial palsy
B) Gaze
C) Deep tendon reflexes
D) Sensory response
Correct Answer: C
Explanation: Reflexes are not assessed in the NIHSS scale.
3. What is the maximum NIHSS score?
A) 32
B) 40
C) 42
D) 44
Correct Answer: C
Explanation: 42 is the highest possible NIHSS score.
4. A score of 0 on NIHSS implies:
A) Severe stroke
B) No stroke symptoms
C) Moderate disability
D) High risk of stroke
Correct Answer: B
Explanation: Score 0 means no observable stroke symptoms.
5. Which NIHSS item evaluates arm strength?
A) Limb Ataxia
B) Motor Arm
C) Best Gaze
D) Level of Consciousness
Correct Answer: B
Explanation: Motor Arm checks for arm drift/strength.
6. What does the “Best Gaze” item assess?
A) Visual field
B) Eye movements
C) Pupil reaction
D) Visual neglect
Correct Answer: B
Explanation: Best Gaze evaluates voluntary eye movement.
7. In NIHSS, dysarthria refers to:
A) Language loss
B) Speech slurring
C) Eye deviation
D) Motor weakness
Correct Answer: B
Explanation: Dysarthria is poor articulation of speech.
8. What does a score of 2 in LOC questions indicate?
A) Correct response
B) Incorrect or no response
C) Verbal cue needed
D) Partial response
Correct Answer: B
Explanation: Score 2 means both LOC questions missed.
9. Which limb movement is tested in NIHSS?
A) Toe curls
B) Shoulder rotation
C) Arm and leg lift
D) Head tilt
Correct Answer: C
Explanation: Motor arm/leg assess limb strength/lift.
10. How is visual field loss tested in NIHSS?
A) Blink reflex
B) Confrontation method
C) Pupil light reflex
D) Gaze deviation
Correct Answer: B
Explanation: Confrontation tests for visual field defects.
11. What type of scale is the NIHSS?
A) Ordinal
B) Nominal
C) Ratio
D) Interval
Correct Answer: A
Explanation: NIHSS uses ordinal scoring system.
12. Aphasia is tested through:
A) Visual tasks
B) Naming and commands
C) Reflex checks
D) Hearing tests
Correct Answer: B
Explanation: Aphasia is assessed via naming/commands.
13. Best Motor Leg score of 3 means:
A) No drift
B) Drifts but hits bed
C) Some effort
D) No movement
Correct Answer: D
Explanation: Score 3 shows no voluntary movement.
14. Facial palsy in NIHSS is scored on:
A) Blink response
B) Voluntary movement
C) Smiling and grimace
D) Eyelid strength
Correct Answer: C
Explanation: Palsy scored using smile/grimace response.
15. Inattention is measured under:
A) Level of Consciousness
B) Sensory
C) Extinction and Inattention
D) Best Language
Correct Answer: C
Explanation: Neglect/inattention scored under extinction.
16. A right hemiparesis suggests a stroke in:
A) Left cerebellum
B) Left hemisphere
C) Right hemisphere
D) Brainstem
Correct Answer: B
Explanation: Left brain affects right body side.
17. LOC Questions test:
A) Balance and vision
B) Name and age recall
C) Limb strength
D) Orientation
Correct Answer: B
Explanation: LOC questions ask name and current age.
18. What is scored in limb ataxia?
A) Drift
B) Weakness
C) Coordination
D) Reflex
Correct Answer: C
Explanation: Limb Ataxia tests cerebellar coordination.
19. Sensory testing uses:
A) Reflex hammer
B) Vibration
C) Pinprick
D) Muscle strength
Correct Answer: C
Explanation: Pinprick used for sensory evaluation.
20. What score is given for coma?
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Explanation: Score 3 in LOC means patient unresponsive.
21. Dysarthria scoring depends on:
A) Visual cues
B) Tongue deviation
C) Clarity of speech
D) Comprehension
Correct Answer: C
Explanation: Speech clarity determines dysarthria score.
22. A score of 1 in Best Language suggests:
A) Fluent speech
B) Some difficulty
C) No comprehension
D) Global aphasia
Correct Answer: B
Explanation: Score 1 indicates mild aphasia symptoms.
23. In NIHSS, extinction occurs when:
A) Patient denies limbs
B) Reflexes are hyperactive
C) Both stimuli felt
D) Vision is normal
Correct Answer: A
Explanation: Extinction means ignoring affected side.
24. What is assessed under LOC commands?
A) Eye tracking
B) Verbal memory
C) Following instructions
D) Reflex action
Correct Answer: C
Explanation: LOC commands check simple task following.
25. Which stroke type most impacts language?
A) Cerebellar
B) Brainstem
C) Left hemisphere
D) Occipital
Correct Answer: C
Explanation: Left hemisphere houses language centers.
26. NIHSS score used in:
A) Predicting bleeding
B) Planning surgery
C) Stroke severity and outcome
D) Measuring heart rate
Correct Answer: C
Explanation: NIHSS predicts stroke impact and recovery.
27. If both arms drift but touch bed, the score is:
A) 1
B) 2
C) 3
D) 0
Correct Answer: B
Explanation: Score 2 means drift and contact with bed.
28. What is used to test visual field cuts?
A) Gaze deviation
B) Arm lifting
C) Confrontation
D) CT scan
Correct Answer: C
Explanation: Confrontation test shows field losses.
29. Patients who don’t respond get:
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Explanation: Non-responsive patients score highest in LOC.
30. Total NIHSS score predicts:
A) Blood sugar level
B) Risk of AFib
C) Stroke prognosis
D) Eye movement issues
Correct Answer: C
Explanation: NIHSS correlates with stroke outcomes.
31. What does “Best Language” scoring ignore?
A) Aphasia
B) Dysarthria
C) Comprehension
D) Repetition
Correct Answer: B
Explanation: Dysarthria is scored separately, not in language.
32. An NIHSS score of 20 typically suggests:
A) Minor stroke
B) Severe stroke
C) No stroke
D) Eye disorder
Correct Answer: B
Explanation: Scores 20+ reflect severe stroke symptoms.
33. Which NIHSS item uses finger-nose-finger test?
A) Motor Leg
B) Facial Palsy
C) Limb Ataxia
D) Best Gaze
Correct Answer: C
Explanation: Limb Ataxia uses coordination tasks like this.
34. Sensory testing is scored based on:
A) Pinprick comparison
B) Reflex timing
C) Grip strength
D) Eye movement
Correct Answer: A
Explanation: Pinprick sensations compared side-to-side.
35. What is the score if a patient answers one LOC question?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: One correct answer earns a score of 1.
36. What indicates hemianopia in visual testing?
A) Normal fields
B) Double vision
C) Half-field blindness
D) Full blindness
Correct Answer: C
Explanation: Hemianopia = loss of half visual field.
37. In neglect testing, a normal result is scored:
A) 1
B) 2
C) 0
D) 3
Correct Answer: C
Explanation: Normal response scores 0 on inattention.
38. Which command is used in LOC assessment?
A) “Raise your leg”
B) “Open and close your eyes”
C) “Count to ten”
D) “Touch your ear”
Correct Answer: B
Explanation: One common LOC command is eye movement.
39. If a patient needs repeated prompts, score is:
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Requiring effort or repetition earns 1.
40. Slurred but understandable speech scores:
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Slurred yet clear = mild dysarthria (1).
41. In aphasia test, which task is NOT included?
A) Naming objects
B) Following commands
C) Eye tracking
D) Sentence reading
Correct Answer: C
Explanation: Eye tracking is for Best Gaze, not aphasia.
42. Eye deviation on command affects:
A) LOC
B) Best Gaze
C) Vision
D) Reflexes
Correct Answer: B
Explanation: Gaze deviation is assessed in Best Gaze.
43. Purpose of NIHSS in acute stroke:
A) Blood diagnosis
B) Eye care
C) Severity assessment
D) Kidney function
Correct Answer: C
Explanation: NIHSS evaluates stroke severity, fast.
44. If patient gives wrong name but correct age:
A) Score 0
B) Score 1
C) Score 2
D) Score 3
Correct Answer: B
Explanation: One incorrect LOC question earns score 1.
45. Which tool is NOT used during NIHSS testing?
A) Reflex hammer
B) Safety pin
C) NIHSS script
D) Visual card
Correct Answer: A
Explanation: Reflex hammer not required in NIHSS.
46. Purpose of confrontation method?
A) Vision clarity
B) Speech clarity
C) Eye deviation
D) Visual field testing
Correct Answer: D
Explanation: Confrontation checks side vision loss.
47. In NIHSS, limb ataxia is scored only if:
A) No strength
B) Weakness present
C) Movement visible
D) Strength is ≥ 4/5
Correct Answer: D
Explanation: Coordination tested only if limb strength allows.
48. Extinction is present if:
A) No arm drift
B) Normal vision
C) Ignores one side
D) Good memory
Correct Answer: C
Explanation: Extinction means neglect of one side stimuli.
49. Maximum dysarthria score is:
A) 1
B) 2
C) 3
D) 4
Correct Answer: B
Explanation: 2 is highest score for dysarthria symptoms.
50. Eye deviation in stroke is usually:
A) Toward lesion side
B) Opposite of lesion
C) Random
D) Upward
Correct Answer: A
Explanation: Eyes deviate toward the stroke side.
51. Mild stroke NIHSS score range:
A) 16–25
B) 1–4
C) 5–10
D) 0–2
Correct Answer: B
Explanation: 1–4 indicates mild stroke severity.
52. Neglect is common with stroke in:
A) Right hemisphere
B) Cerebellum
C) Occipital lobe
D) Left brain
Correct Answer: A
Explanation: Right hemisphere stroke often causes neglect.
53. What is “drift” in NIHSS terms?
A) Reflex delay
B) Visual slowness
C) Limb drops within 10s
D) Abnormal gait
Correct Answer: C
Explanation: Drift = limb falls before 10 seconds.
54. Severe aphasia scores:
A) 1
B) 2
C) 0
D) 3
Correct Answer: B
Explanation: Moderate to severe aphasia = score 2.
55. What task is given for best language?
A) Raise arm
B) Draw clock
C) Describe picture
D) Blink eyes
Correct Answer: C
Explanation: Picture description tests expressive language.
56. A score of 0 in motor arm test means:
A) Paralysis
B) Full strength
C) No drift
D) No movement
Correct Answer: C
Explanation: 0 = no drift; full motor control.
57. Facial palsy scoring checks:
A) Blink reflex
B) Full facial strength
C) Symmetry on command
D) Tongue deviation
Correct Answer: C
Explanation: Smile/grimace tests face symmetry and strength.
58. Double simultaneous stimulation tests:
A) Hearing
B) Reflex
C) Extinction
D) Motor coordination
Correct Answer: C
Explanation: Double stimuli used to detect neglect/extinction.
59. NIHSS most useful in:
A) Seizure disorders
B) TIA
C) Ischemic stroke
D) Depression
Correct Answer: C
Explanation: NIHSS is designed for acute ischemic stroke.
60. “No effort against gravity” in leg = score:
A) 0
B) 1
C) 3
D) 4
Correct Answer: C
Explanation: 3 means no antigravity leg movement.
61. What does a Motor Arm score of 2 indicate?
A) No movement
B) Arm falls to bed
C) Arm drifts, doesn’t hit bed
D) Normal strength
Correct Answer: C
Explanation: Score 2 = arm drifts but not full paralysis.
62. What is tested in the LOC command “Close your eyes”?
A) Visual field
B) Eye response
C) Comprehension and motor
D) Balance
Correct Answer: C
Explanation: This task checks both understanding and action.
63. Why is scoring consistency important in NIHSS?
A) For medication dose
B) For diagnosis
C) For reliable communication
D) For discharge
Correct Answer: C
Explanation: Consistent scoring ensures accurate reporting.
64. What’s assessed when patient names two objects?
A) Vision
B) Best Language
C) Facial palsy
D) LOC
Correct Answer: B
Explanation: Naming objects checks for aphasia signs.
65. Purpose of NIHSS in thrombolysis decision?
A) Stroke location
B) Stroke severity
C) Drug absorption
D) Coma scale
Correct Answer: B
Explanation: NIHSS guides treatment like tPA use.
66. Why test vertical gaze in stroke assessment?
A) For language
B) For LOC
C) For brainstem damage
D) For cerebellar reflex
Correct Answer: C
Explanation: Vertical gaze loss = possible brainstem stroke.
67. What does a visual field score of 2 mean?
A) No deficit
B) Partial field loss
C) Complete hemianopia
D) Inattention
Correct Answer: C
Explanation: Score 2 = severe field loss in one/both sides.
68. In aphasia, the inability to follow commands is:
A) Global aphasia
B) Expressive aphasia
C) Dysarthria
D) Hemineglect
Correct Answer: A
Explanation: Global aphasia affects understanding and speech.
69. Sensory score of 1 means:
A) No feeling
B) Normal sensation
C) Mild to moderate loss
D) Unconscious
Correct Answer: C
Explanation: 1 indicates partial sensation loss.
70. Which item evaluates upper motor function?
A) LOC questions
B) Dysarthria
C) Motor Arm
D) Extinction
Correct Answer: C
Explanation: Motor Arm tests strength, drift in upper limb.
71. Neglect is more common with damage to:
A) Right parietal lobe
B) Left frontal lobe
C) Brainstem
D) Occipital lobe
Correct Answer: A
Explanation: Right parietal stroke often leads to neglect.
72. What does a score of 1 in Visual field mean?
A) No deficit
B) Partial loss
C) Severe bilateral loss
D) Inattention
Correct Answer: B
Explanation: Score 1 = partial hemianopia or field cut.
73. Which area is NOT scored in NIHSS?
A) Eye movement
B) Language
C) Deep tendon reflex
D) Neglect
Correct Answer: C
Explanation: Reflexes are not evaluated in NIHSS.
74. Which two items use the same commands?
A) Best Language & LOC Questions
B) Motor Arm & Leg
C) Visual & Gaze
D) LOC Commands & Best Language
Correct Answer: D
Explanation: Both assess comprehension via simple tasks.
75. Stroke in left hemisphere affects:
A) Right side & speech
B) Left side & memory
C) Vision only
D) Consciousness
Correct Answer: A
Explanation: Left brain controls right body and speech.
76. NIHSS is typically performed:
A) Only after MRI
B) During stroke onset
C) After 24 hours
D) At discharge
Correct Answer: B
Explanation: NIHSS is used early during stroke signs.
77. A score of 4 on Motor Leg test implies:
A) Full strength
B) Mild weakness
C) Severe weakness
D) No movement
Correct Answer: A
Explanation: Score 4 = limb holds fully against gravity.
78. What would be a Motor Leg score if leg falls to bed?
A) 1
B) 2
C) 3
D) 4
Correct Answer: B
Explanation: Score 2 = limb drifts and hits bed.
79. If patient is unresponsive, language score is:
A) 2
B) 3
C) UN
D) 1
Correct Answer: C
Explanation: “UN” is used if unable to assess due to coma.
80. Which test differentiates aphasia vs dysarthria?
A) Motor test
B) Naming and reading
C) Reflex check
D) Gaze testing
Correct Answer: B
Explanation: Aphasia affects language, not speech muscles.
81. If patient can’t move eyes voluntarily, score in gaze?
A) 0
B) 1
C) 2
D) 3
Correct Answer: C
Explanation: Score 2 = forced deviation or gaze palsy.
82. Which test does NOT require verbal response?
A) LOC Questions
B) LOC Commands
C) Best Gaze
D) Best Language
Correct Answer: C
Explanation: Gaze uses physical response, not speech.
83. Limb Ataxia is assessed only when:
A) Strength is 0
B) Patient unconscious
C) Strength is adequate
D) Reflexes are intact
Correct Answer: C
Explanation: Must have movement to test for coordination.
84. What task is used to test for extinction?
A) Eye blink
B) Dual sensory stimulation
C) Reflex hammer
D) Naming objects
Correct Answer: B
Explanation: Double stimuli reveal neglect or extinction.
85. Visual field defect on one side is called:
A) Quadrantanopia
B) Hemianopia
C) Diplopia
D) Cortical blindness
Correct Answer: B
Explanation: Hemianopia = loss of half the visual field.
86. Patient can raise arm but not maintain for 10 seconds.
A) Score 0
B) Score 1
C) Score 2
D) Score 3
Correct Answer: B
Explanation: Falls before 10 seconds = score 1.
87. In LOC, asking patient’s age tests:
A) Consciousness
B) Long-term memory
C) Orientation
D) Receptive speech
Correct Answer: C
Explanation: Age/Name check orientation and awareness.
88. If aphasia and dysarthria co-exist, which is scored?
A) Both
B) Only dysarthria
C) Only aphasia
D) Gaze
Correct Answer: A
Explanation: Each item is scored independently.
89. Why test naming and repetition in aphasia item?
A) To assess reflex
B) To assess grammar
C) To check comprehension and output
D) To check eye contact
Correct Answer: C
Explanation: Tasks reflect language understanding and use.
90. Severe stroke with coma likely scores:
A) 5–10
B) 0
C) 20–30+
D) Under 15
Correct Answer: C
Explanation: Coma often correlates with scores >20.
91. What is scored if patient can’t repeat a sentence?
A) 1
B) 2
C) 0
D) 3
Correct Answer: B
Explanation: Failed sentence repetition = moderate aphasia.
92. Which item evaluates brainstem stroke signs?
A) Dysarthria
B) Facial palsy
C) Limb ataxia
D) Best gaze
Correct Answer: D
Explanation: Gaze palsy indicates brainstem involvement.
93. What’s the score for facial asymmetry only with effort?
A) 1
B) 2
C) 3
D) 0
Correct Answer: A
Explanation: Minor facial weakness on effort = score 1.
94. When is “UN” used in NIHSS scoring?
A) If answer is wrong
B) If test is refused
C) If item cannot be assessed
D) If patient is non-compliant
Correct Answer: C
Explanation: “UN” means item is untestable or obstructed.
95. What is scored when drift starts at 8 seconds?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Drift before 10 seconds = score 1.
96. Which side is usually neglected in right brain stroke?
A) Right
B) Left
C) Bilateral
D) Frontal
Correct Answer: B
Explanation: Right hemisphere stroke causes left neglect.
97. The “Best Language” item includes all EXCEPT:
A) Naming
B) Repeating
C) Reading
D) Reflexes
Correct Answer: D
Explanation: Reflexes aren’t tested in language section.
98. Facial palsy score of 2 means:
A) Mild weakness
B) Normal symmetry
C) Complete paralysis
D) Partial weakness
Correct Answer: D
Explanation: Score 2 = partial lower facial weakness.
99. What if patient answers both LOC questions correctly?
A) Score 0
B) Score 1
C) Score 2
D) Score 3
Correct Answer: A
Explanation: Full orientation earns 0 (normal).
100. Extinction is often seen with:
A) Brainstem lesions
B) Left frontal lobe stroke
C) Right parietal damage
D) Cerebellar atrophy
Correct Answer: C
Explanation: Extinction due to neglect is parietal-based.
101. If patient speaks clearly but softly, dysarthria score?
A) 0
B) 1
C) 2
D) UN
Correct Answer: A
Explanation: Clear articulation = no dysarthria.
102. Partial hemianopia scores:
A) 2
B) 1
C) 0
D) 3
Correct Answer: B
Explanation: Score 1 = incomplete field loss.
103. When should NIHSS ideally be administered?
A) During rehab
B) After CT scan
C) At stroke onset
D) Post-discharge
Correct Answer: C
Explanation: NIHSS is crucial during early stroke response.
104. The gaze test requires:
A) Verbal response
B) Vertical tracking
C) Horizontal eye movement
D) Motor testing
Correct Answer: C
Explanation: Gaze tests side-to-side eye control.
105. Severe dysarthria with unclear speech = score:
A) 0
B) 1
C) 2
D) UN
Correct Answer: C
Explanation: Score 2 = speech nearly unintelligible.
106. A neglect score of 2 reflects:
A) Normal response
B) Partial extinction
C) Profound neglect
D) Dysarthria
Correct Answer: C
Explanation: Score 2 = complete inattention to one side.
107. A drift that touches bed but not with effort scores:
A) 2
B) 1
C) 3
D) 0
Correct Answer: A
Explanation: Slow drift to bed = moderate weakness.
108. Why use picture description in language test?
A) Check memory
B) Measure grammar
C) Detect aphasia
D) Eye coordination
Correct Answer: C
Explanation: Describing picture reveals expressive language issues.
109. What does a Motor Arm score of 4 indicate?
A) No movement
B) Falls before 10 sec
C) Drifts but does not fall
D) Full strength
Correct Answer: D
Explanation: Score 4 = no drift, holds against gravity.
110. Patient misses left side stimuli on double touch test:
A) Vision loss
B) Extinction
C) Reflex loss
D) Aphasia
Correct Answer: B
Explanation: Missing one side’s input = sensory extinction.
111. Repeating “It is a sunny day in Cincinnati” tests:
A) Attention
B) Dysarthria
C) Memory
D) Language
Correct Answer: D
Explanation: This phrase assesses language fluency.
112. Which function is NOT scored in NIHSS?
A) Cognition
B) Eye gaze
C) Limb strength
D) Taste
Correct Answer: D
Explanation: Taste or smell are not assessed in NIHSS.
113. Patient closes eyes but doesn’t grip hands. Score?
A) 0
B) 1
C) 2
D) UN
Correct Answer: B
Explanation: Partial command following = score 1.
114. Patient has no limb drift but slurred speech. Total?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: Speech issues = 1 in dysarthria only.
115. Which two assessments rely heavily on motor function?
A) Language and Gaze
B) Motor Arm and Leg
C) Dysarthria and Vision
D) LOC and Extinction
Correct Answer: B
Explanation: Arm and Leg scores assess muscle strength.
116. “No aphasia but severe slurring” implies issue in:
A) Memory
B) Motor muscles
C) Language center
D) Reflexes
Correct Answer: B
Explanation: Dysarthria is motor-related, not aphasia.
117. Patient answers name but not age. LOC question score?
A) 0
B) 1
C) 2
D) 3
Correct Answer: B
Explanation: One correct = score 1 on LOC questions.
118. Which item would be omitted if patient is blind?
A) Gaze
B) Best Language
C) Visual Fields
D) Dysarthria
Correct Answer: C
Explanation: Visual fields untestable if patient is blind.
119. “Drift in leg within 5 seconds” means score:
A) 0
B) 2
C) 1
D) 3
Correct Answer: C
Explanation: Limb dropping early = mild motor loss.
120. Purpose of NIHSS is to:
A) Determine brain size
B) Assess stroke severity
C) Prescribe rehab
D) Diagnose tumor
Correct Answer: B
Explanation: NIHSS quantifies stroke impact for care planning.
121. Which score indicates global aphasia?
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Explanation: Score 3 = mute or unintelligible language.
122. Vertical gaze is tested in:
A) Best Gaze
B) Visual Fields
C) LOC Commands
D) Sensory
Correct Answer: A
Explanation: Gaze test includes vertical and horizontal.
123. Score for arm drifts but doesn’t touch bed?
A) 2
B) 3
C) 1
D) 4
Correct Answer: C
Explanation: Drifting without bed contact = score 1.
124. A patient repeats sentence clearly but can’t name objects:
A) No aphasia
B) Mild aphasia
C) Severe dysarthria
D) Normal
Correct Answer: B
Explanation: Difficulty naming = expressive aphasia.
125. Sensory score of 2 means:
A) Mild loss
B) No feeling at all
C) Full sensation
D) Normal pain response
Correct Answer: B
Explanation: Score 2 = complete sensory loss on one side.
126. Score for complete leg paralysis?
A) 2
B) 3
C) 4
D) 0
Correct Answer: B
Explanation: Score 3 = leg does not move at all.
127. Extinction is tested with:
A) One stimulus
B) Command response
C) Double simultaneous stimuli
D) CT scan
Correct Answer: C
Explanation: Extinction requires double stimuli test.
128. A patient scores 1 in facial palsy. This means:
A) No movement
B) Normal symmetry
C) Minor asymmetry
D) Severe weakness
Correct Answer: C
Explanation: Slight droop on effort = score 1.
129. Which item might be affected by visual neglect?
A) Naming
B) Extinction
C) LOC
D) Sensory
Correct Answer: B
Explanation: Neglect can cause extinction on one side.
130. Purpose of scoring eye movement?
A) Assess brainstem
B) Test vision
C) Evaluate hearing
D) Check reflex
Correct Answer: A
Explanation: Gaze tests can indicate brainstem stroke.
131. Dysarthria affects:
A) Thought process
B) Muscle control
C) Vision
D) Language centers
Correct Answer: B
Explanation: Dysarthria = impaired motor speech control.
132. “No drift, holds 10 seconds” in leg test scores:
A) 2
B) 1
C) 0
D) 4
Correct Answer: D
Explanation: Holding leg 10 sec = score 4 (normal).
133. Best Language score of 1 indicates:
A) Normal
B) Global aphasia
C) Mild to moderate aphasia
D) Dysarthria only
Correct Answer: C
Explanation: Score 1 = some communication difficulty.
134. Which test evaluates coordination?
A) Sensory
B) Limb Ataxia
C) Gaze
D) Visual Field
Correct Answer: B
Explanation: Limb Ataxia detects coordination issues.
135. If patient is intubated and can’t speak:
A) Score 0
B) Score UN
C) Score 2
D) Score 1
Correct Answer: B
Explanation: “UN” used if language item untestable.
136. What’s the function of NIHSS in ER?
A) Identify tumor
B) Measure stroke severity
C) Evaluate dementia
D) Perform surgery
Correct Answer: B
Explanation: NIHSS helps grade stroke at admission.
137. Why assess limb strength separately?
A) Compare eyes
B) Check for coma
C) Detect asymmetry
D) Test balance
Correct Answer: C
Explanation: Left/right strength difference informs stroke side.
138. What’s assessed by “Hold out your arms”?
A) LOC
B) Best Language
C) Motor Arm
D) Visual
Correct Answer: C
Explanation: It tests arm drift and strength.
139. NIHSS score for complete left visual loss?
A) 1
B) 2
C) 3
D) 0
Correct Answer: B
Explanation: Complete hemianopia = score 2.
140. Extinction score of 1 means:
A) Normal
B) Full neglect
C) Partial extinction
D) Can’t assess
Correct Answer: C
Explanation: Slight inattention to one side = score 1.
141. Which of the following best defines hemianopia?
A) No eye movement
B) One side vision loss
C) Bilateral vision
D) Rapid blinking
Correct Answer: B
Explanation: Hemianopia = loss of half of visual field.
142. If patient fails both LOC commands:
A) Score 0
B) Score 2
C) Score 1
D) Score 3
Correct Answer: B
Explanation: Failure on both = score 2.
143. What is tested when patient repeats sentence?
A) Speech strength
B) Naming
C) Aphasia
D) Orientation
Correct Answer: C
Explanation: Tests sentence fluency and understanding.
144. Aphasia affects:
A) Muscle function
B) Comprehension/speech
C) Eye movement
D) Taste
Correct Answer: B
Explanation: Language processing is impaired.
145. LOC question “What month is it?” evaluates:
A) Long-term memory
B) Language
C) Orientation
D) Vision
Correct Answer: C
Explanation: Orientation to time and awareness.
146. If patient responds with correct gesture only:
A) Score 2
B) Score 0
C) Score 1
D) Score UN
Correct Answer: C
Explanation: Partial command following = score 1.
147. Cerebellar lesions mainly affect:
A) Language
B) Reflexes
C) Coordination
D) LOC
Correct Answer: C
Explanation: Cerebellum = coordination, not strength or speech.
148. Which score reflects both leg and arm paralysis?
A) 4
B) 3
C) 2
D) 0
Correct Answer: B
Explanation: Score 3 = no movement in limb.
149. NIHSS score range for mild stroke?
A) 21–30
B) 0–5
C) 10–15
D) 16–20
Correct Answer: B
Explanation: 0–5 = minor stroke symptoms.
150. Dysarthria item uses which test?
A) Repetition
B) Naming
C) Picture description
D) Word list
Correct Answer: A
Explanation: Phrase repetition reveals clarity of speech.
151. Patient scores 2 on Visual Fields. What does it mean?
A) Normal vision
B) Partial hemianopia
C) Complete hemianopia
D) Cortical blindness
Correct Answer: C
Explanation: Score 2 indicates complete field loss on one side.
152. What is tested when showing the patient objects to name?
A) Motor strength
B) Attention
C) Language function
D) Gaze
Correct Answer: C
Explanation: Naming tests expressive language ability.
153. A score of 0 in Dysarthria means:
A) Mute
B) Slurred speech
C) Normal articulation
D) Severe speech problem
Correct Answer: C
Explanation: 0 = no slurring, clear speech.
154. If arm falls immediately with no effort, score is:
A) 0
B) 1
C) 2
D) 3
Correct Answer: D
Explanation: No effort against gravity = score 3.
155. Which task is part of LOC commands?
A) Blinking
B) Smiling
C) Closing eyes and gripping
D) Naming picture
Correct Answer: C
Explanation: Close eyes and grip are standard LOC tasks.
156. What is the NIHSS range for moderate stroke?
A) 0–5
B) 6–15
C) 16–20
D) 21–42
Correct Answer: B
Explanation: NIHSS 6–15 = moderate stroke severity.
157. What indicates neglect in extinction test?
A) Patient sees both touches
B) Patient sees one side only
C) Patient can’t move limbs
D) Speech slurring
Correct Answer: B
Explanation: Neglect = unawareness of one stimulus side.
158. What causes errors in limb ataxia scoring?
A) Weakness
B) Vision problems
C) Inattention
D) Aphasia
Correct Answer: A
Explanation: Weakness may mimic coordination deficits.
159. Visual fields are tested using:
A) Snellen chart
B) Eye tracking
C) Finger counting
D) Flashlight
Correct Answer: C
Explanation: Wiggling fingers in field = standard test.
160. In global aphasia, the patient is usually:
A) Mute or incomprehensible
B) Partially responsive
C) Only dysarthric
D) Normal
Correct Answer: A
Explanation: Global aphasia = severely impaired language.
161. If patient shows arm drift only after 9 seconds:
A) Score 1
B) Score 0
C) Score 2
D) Score 3
Correct Answer: A
Explanation: Slight late drift = score 1.
162. NIHSS helps guide decisions on:
A) Chemotherapy
B) Physical therapy only
C) Stroke treatment planning
D) Tumor removal
Correct Answer: C
Explanation: NIHSS informs severity and treatment needs.
163. Which lobe damage causes aphasia?
A) Frontal
B) Occipital
C) Parietal
D) Temporal
Correct Answer: A
Explanation: Left frontal (Broca’s) = expressive aphasia.
164. Which condition affects NIHSS scoring accuracy?
A) Vision correction
B) Limb fractures
C) Fever
D) High cholesterol
Correct Answer: B
Explanation: Non-neuro conditions like fractures alter scoring.
165. Cortical blindness usually results in:
A) Score 2 on Visual Fields
B) Score 1 on Gaze
C) Score UN on Visual Fields
D) Score 0 on LOC
Correct Answer: A
Explanation: Complete visual loss = score 2.
166. A score of 1 in Sensory means:
A) Complete numbness
B) Slight pain difference
C) Normal response
D) Facial droop
Correct Answer: B
Explanation: Mild pain loss = sensory score 1.
167. Gaze palsy often results from damage to:
A) Medulla
B) Thalamus
C) Pons
D) Occipital lobe
Correct Answer: C
Explanation: Pons controls horizontal gaze.
168. Purpose of using UN in NIHSS?
A) Randomize answers
B) Avoid bias
C) Document untestable items
D) Penalize errors
Correct Answer: C
Explanation: “UN” marks items that can’t be tested.
169. Total NIHSS score ranges from:
A) 0 to 20
B) 0 to 30
C) 0 to 42
D) 0 to 50
Correct Answer: C
Explanation: Max NIHSS score is 42.
170. Slurred speech with normal language means:
A) Global aphasia
B) Hemianopia
C) Dysarthria
D) Sensory loss
Correct Answer: C
Explanation: Dysarthria = impaired motor speech, not language.
171. Which hemisphere commonly causes neglect?
A) Left
B) Right
C) Frontal
D) Temporal
Correct Answer: B
Explanation: Right parietal lobe damage = left neglect.
172. Neglect affects which sensory test?
A) Gaze
B) Dysarthria
C) Extinction
D) Motor Leg
Correct Answer: C
Explanation: Extinction uncovers neglect/inattention.
173. Severe aphasia score in Language is:
A) 1
B) 2
C) 3
D) 0
Correct Answer: B
Explanation: Score 2 = severe comprehension and expression issues.
174. Which function is NOT scored in NIHSS?
A) Coordination
B) Reflexes
C) Speech
D) Vision
Correct Answer: B
Explanation: Reflexes aren’t evaluated in NIHSS.
175. If patient can’t grip due to amputation:
A) Score 1
B) Score 3
C) Score UN
D) Score 0
Correct Answer: C
Explanation: UN used when limb is missing or untestable.
176. Eye deviation only at rest scores:
A) 2
B) 1
C) 0
D) 3
Correct Answer: A
Explanation: Forced deviation = gaze score 2.
177. Which NIHSS component uses sentence reading?
A) LOC
B) Gaze
C) Dysarthria
D) Language
Correct Answer: D
Explanation: Sentence repetition assesses language skills.
178. Which is used to evaluate aphasia?
A) Repetition and naming
B) Coordination test
C) Eye tracking
D) Motor strength
Correct Answer: A
Explanation: Language test includes repetition and naming.
179. Inability to name objects but repeats sentence =
A) Dysarthria
B) Neglect
C) Expressive aphasia
D) Visual loss
Correct Answer: C
Explanation: Naming issue = Broca’s expressive aphasia.
180. Which side is typically affected in left MCA stroke?
A) Left limbs
B) Right limbs
C) Both sides
D) Only facial nerves
Correct Answer: B
Explanation: Left MCA stroke affects right motor/sensory.
181. Patient follows commands but speaks unclearly. Score?
A) Aphasia 2
B) Dysarthria 1
C) Aphasia 1
D) Dysarthria 0
Correct Answer: B
Explanation: Slurred but intelligible speech = dysarthria 1.
182. Why is gaze tested before visual fields?
A) Easier to score
B) Ensures alertness
C) Detects ocular deviation
D) Reduces bias
Correct Answer: C
Explanation: Gaze reveals eye deviation, affecting vision test.
183. NIHSS helps predict:
A) Tumor risk
B) Dementia onset
C) Stroke outcome
D) Infection severity
Correct Answer: C
Explanation: NIHSS severity correlates with stroke prognosis.
184. Which item includes picture description?
A) Best Language
B) LOC Questions
C) Facial Palsy
D) Dysarthria
Correct Answer: A
Explanation: Language test includes picture description task.
185. LOC Commands assess:
A) Motor ability
B) Reflexes
C) Conscious response
D) Coordination
Correct Answer: C
Explanation: LOC commands test alertness and understanding.
186. Extinction test involves:
A) Naming objects
B) Hearing tones
C) Simultaneous bilateral touch
D) Repeating words
Correct Answer: C
Explanation: Touch on both sides tests for extinction.
187. If leg drifts, touches bed at 4 seconds:
A) Score 1
B) Score 2
C) Score 3
D) Score 0
Correct Answer: B
Explanation: Drifts to bed before 5 sec = score 2.
188. Which visual deficit is most severe?
A) Blurry vision
B) Partial field loss
C) Complete hemianopia
D) Double vision
Correct Answer: C
Explanation: Complete hemianopia = score 2 in Visual Fields.
189. Dysarthria is tested by:
A) Finger-nose-finger
B) Word repetition
C) Limb movement
D) Picture naming
Correct Answer: B
Explanation: Repeating words assesses clarity of speech.
190. Inattention in extinction is often caused by:
A) Right hemisphere stroke
B) Left hemisphere stroke
C) Brainstem infarct
D) Spinal lesion
Correct Answer: A
Explanation: Right hemisphere controls attention to both sides.
191. What is the score if only one limb is ataxic?
A) 1
B) 2
C) 0
D) UN
Correct Answer: A
Explanation: One-limb ataxia = score 1 in Limb Ataxia.
192. Dysarthria score of 2 means:
A) Clear speech
B) Mild slurring
C) Severe unintelligible speech
D) Unable to test
Correct Answer: C
Explanation: Severe slurring = score 2 for dysarthria.
193. Arm shows no movement. Score?
A) 2
B) 1
C) 3
D) 4
Correct Answer: C
Explanation: No movement against gravity = score 3.
194. Aphasia is not tested using:
A) Naming
B) Comprehension
C) Sentence repetition
D) Reflexes
Correct Answer: D
Explanation: Reflexes are not part of language evaluation.
195. Score 0 for Sensory means:
A) No feeling
B) Mild pain difference
C) Normal response
D) Severe neglect
Correct Answer: C
Explanation: Normal pain sensation = sensory score 0.
196. Facial Palsy score 2 indicates:
A) Normal
B) Minor asymmetry
C) Partial weakness
D) Complete paralysis
Correct Answer: D
Explanation: Total facial paralysis = score 2.
197. Right gaze preference suggests:
A) Left hemispheric stroke
B) Brainstem infarct
C) Right parietal lobe lesion
D) Right MCA stroke
Correct Answer: D
Explanation: Gaze toward lesion = same-side cortical stroke.
198. Severe aphasia patients score:
A) 1
B) 2
C) 3
D) 0
Correct Answer: B
Explanation: Severe comprehension and speech loss = score 2.
199. In LOC Questions, incorrect month gets:
A) Score 1
B) Score 2
C) Score 0
D) Score UN
Correct Answer: A
Explanation: One incorrect answer = LOC Questions score 1.
200. What differentiates dysarthria from aphasia?
A) Reflexes
B) Comprehension
C) Naming ability
D) Muscle control
Correct Answer: D
Explanation: Dysarthria is muscular, aphasia is linguistic.
201. Limb Ataxia scoring excludes:
A) Reflex test
B) Heel-shin test
C) Finger-nose-finger
D) Motor coordination
Correct Answer: A
Explanation: Reflexes not part of ataxia scoring.
202. If patient can’t do gaze test due to blindness:
A) Score 0
B) Score 1
C) Score 2
D) Score UN
Correct Answer: D
Explanation: Untestable due to visual impairment = UN.
203. What’s included in Best Gaze?
A) Reflexes
B) Vertical and horizontal eye movement
C) Visual fields
D) Naming
Correct Answer: B
Explanation: Best Gaze tests full eye tracking.
204. Coma patients often get which NIHSS LOC score?
A) 1
B) 2
C) 3
D) 0
Correct Answer: C
Explanation: No response to stimuli = LOC score 3.
205. Aphasia can result from damage to:
A) Occipital lobe
B) Brainstem
C) Left frontal lobe
D) Cerebellum
Correct Answer: C
Explanation: Broca’s area in left frontal lobe controls speech.
206. Patient answers all LOC questions incorrectly:
A) Score 0
B) Score 2
C) Score 1
D) Score UN
Correct Answer: B
Explanation: Failing both orientation questions = score 2.
207. Dysarthria item skipped due to intubation:
A) Score 0
B) Score 1
C) Score 2
D) Score UN
Correct Answer: D
Explanation: Not testable = UN due to mechanical ventilation.
208. Naming item in Language test uses:
A) Word list
B) Repetition task
C) Objects (e.g. key, bed)
D) Finger tapping
Correct Answer: C
Explanation: Patient asked to name real objects.
209. Patient drifts after 3 seconds, touches bed:
A) Score 1
B) Score 2
C) Score 3
D) Score 4
Correct Answer: B
Explanation: Touching bed before 5 sec = score 2.
210. Visual field deficit from occipital stroke likely is:
A) Blurred vision
B) Hemianopia
C) Gaze palsy
D) Eyelid droop
Correct Answer: B
Explanation: Occipital lobe damage causes visual field loss.
