NIHSS Cheat Sheet 2026

The 30 highest-yield NIHSS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A patient cannot read but is conversational with mildly slurred speech. How should NIHSS dysarthria be scored? → 1 – based on conversational speech assessment
2. A stroke patient is intubated and cannot speak. How should the examiner score NIHSS Item 1b (LOC Questions)? → Score 2 because the patient cannot answer either question
3. On the NIHSS, how is Item 1b (Level of Consciousness Questions) scored when the patient answers both questions correctly? → 0
4. A comatose patient is being assessed with NIHSS. For Item 11 (Extinction and Inattention), the score should be: → 2 — profound neglect is assumed given unresponsiveness
5. In National Institutes of Health Stroke Scale, what role does continuing education play in visual field testing? → To keep professionals current with evolving standards, technologies, and best practices
6. When scoring NIHSS Item 9, which of the following patient behaviors would most likely result in a score of 2? → Patient speaks in jargon and cannot follow any verbal instructions
7. Which phrase from the standard NIHSS word list specifically tests lingual (tongue) articulation? → 'Huckleberry'
8. What is the primary objective of limb ataxia in National Institutes of Health Stroke Scale? → To ensure competence and proficiency in core limb ataxia concepts
9. Which of the following would correctly justify a score of 0 for NIHSS Item 8? → Patient identifies pinprick as equally sharp on both sides
10. An aphasic patient cannot verbally report sensory changes. How should the NIHSS sensory item be administered? → Observe grimace or withdrawal to pinprick as a response
11. On NIHSS Item 8 (Sensory), how should the examiner test sensation in an aphasic patient? → Observe grimace or withdrawal to noxious stimuli
12. A score of 3 on the NIHSS Facial Palsy item indicates: → Complete palsy with no movement on one or both sides of the face
13. A patient makes no attempt to raise their arm against gravity and it falls immediately when released. The Motor Arm score is: → 3 — no effort against gravity
14. A patient scores 3 on NIHSS Item 9. Which clinical presentation matches this score? → Mute, no usable speech or auditory comprehension
15. Which clinical scenario would yield a score of 2 on NIHSS Item 1b? → Patient cannot answer either the age or month question
16. What is the relationship between theory and practice in National Institutes of Health Stroke Scale extinction and inattention? → Theory provides the foundation and framework that guides effective practical application
17. On NIHSS item 3, a patient has a right superior quadrantanopia ('pie in the sky' defect). What score is assigned? → 1
18. In National Institutes of Health Stroke Scale, what is the purpose of baseline assessment? → To establish a starting point for measuring future progress
19. When should the NIHSS Facial Palsy item be reassessed after the initial stroke evaluation? → At each serial NIHSS assessment per institutional and trial protocol
20. In the Group A patient scenario, the patient correctly identifies the month but gives the wrong year when asked Item 1b questions. What is the score? → 1 — one correct
21. When the NIHSS examiner reads a sentence and asks the patient to repeat it, which specific language function is being primarily tested? → Auditory processing and verbal output pathway integrity
22. During the limb ataxia item, the examiner notes the patient cannot move her arm due to paralysis. The correct score is: → 0 — scored as absent because weakness explains the finding
23. A patient scores 1 on NIHSS item 3 due to left inferior quadrantanopia after an acute stroke. Which cortical area is most likely affected? → Right parietal-occipital junction (superior optic radiation)
24. A NIHSS Facial Palsy score of 1 is BEST described as: → Slight flattening of the nasolabial fold or minor asymmetry on smiling
25. During NIHSS testing, a bilingual patient speaks only Spanish and the examiner speaks only English. How should dysarthria be handled? → Use a translator or assess articulation quality without language content
26. A patient repeatedly ignores objects presented on the left side when both sides are stimulated simultaneously. Which NIHSS item captures this finding? → Item 11 (Extinction/Inattention)
27. What is a best practice in National Institutes of Health Stroke Scale facial palsy? → A method or technique recognized as superior based on evidence and expert consensus
28. Which approach is most effective for mastering visual field testing in National Institutes of Health Stroke Scale? → Combining theoretical study with practical application and regular review
29. For NIHSS Motor Arm testing, the patient is sitting up. At what angle and for how many seconds must the arm be held to receive a score of 0? → 90° for 10 seconds
30. In the NIHSS, which score indicates that a patient has NO sensory loss? → 0