NIH Stroke Scale (NIHSS) Certification — Questions and Answers

Question 1: The NIHSS visual fields item (Item 3) is scored as 2 when which finding is present?

Bilateral blindness
Partial hemianopia
Monocular blindness
Complete hemianopia (Correct answer)

Correct answer: Complete hemianopia

A score of 2 on Item 3 corresponds to complete hemianopia in one visual half-field.

Question 2: For item 1b (LOC Questions), the examiner asks the patient the month. The patient says the correct month but with a speech impediment that makes it hard to understand. The response is scored as:

1 — give partial credit for an attempt
Correct — if the intent is clearly the right answer despite dysarthria (Correct answer)
UN — untestable due to speech impairment
Incorrect — unintelligible responses do not count

Correct answer: Correct — if the intent is clearly the right answer despite dysarthria

LOC Questions (1b) tests orientation, not speech quality. If the examiner can determine that the patient's response is the correct answer despite dysarthria or slurred speech, it is scored as correct. Dysarthria is assessed separately on item 10.

Question 3: Which approach is most effective for mastering level of consciousness in National Institutes of Health Stroke Scale?

Relying solely on on-the-job experience
Combining theoretical study with practical application and regular review (Correct answer)
Studying only immediately before examinations
Memorizing textbook definitions without understanding

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 4: Which NIHSS item evaluates dysarthria separately from aphasia?

Item 8
Item 9 (Correct answer)
Item 10
Item 11

Correct answer: Item 9

Item 9 specifically assesses dysarthria by asking the patient to read or repeat words.

Question 5: Read list of words

visual Field test
extinction/inattention
Speech (Dysarthria) (Correct answer)
wakefulness

Correct answer: Speech (Dysarthria)

read list of word in the context of speech (Dysarthria) refers to a task where a patient reads a predetermined list of words aloud. <br>This helps assess and diagnose speech and language issues, such as Dysarthria, which is characterized by poor articulation.

Question 6: What is the difference between reliability and validity in National Institutes of Health Stroke Scale assessment?

Reliability is about speed; validity is about cost
Reliability applies only to written tests; validity applies only to practical tests
Reliability refers to consistency of results; validity refers to accuracy of measurement (Correct answer)
They are synonymous terms with identical meanings

Correct answer: Reliability refers to consistency of results; validity refers to accuracy of measurement

Reliability means the assessment produces consistent, stable results across repeated administrations. Validity means the assessment accurately measures what it is intended to measure. Both are needed for quality assessment.

Question 7: What is a rubric used for in National Institutes of Health Stroke Scale assessment?

To schedule assessment dates
To calculate statistical averages
To record attendance data
To define criteria and performance levels for evaluating work quality (Correct answer)

Correct answer: To define criteria and performance levels for evaluating work quality

A rubric is a scoring guide that defines specific criteria and describes performance levels for each criterion, providing consistent and transparent evaluation standards.

Question 8: What is the relationship between theory and practice in National Institutes of Health Stroke Scale sensory testing?

Theory provides the foundation and framework that guides effective practical application (Correct answer)
Theory replaces the need for any practical experience
Practice is only important; theory is unnecessary
Theory and practice are completely unrelated

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 9: For NIHSS item 1c (LOC Commands), which two commands must the examiner give?

Raise your arm; stick out your tongue
Open and close your eyes; make a fist and release (or grip and release) (Correct answer)
Squeeze my hand; open your mouth
Look to the right; then look to the left

Correct answer: Open and close your eyes; make a fist and release (or grip and release)

The NIHSS specifies two commands: (1) open and close the eyes, and (2) make a fist (grip) and release. These exact commands must be used. If the patient cannot use one hand, another single-step command may substitute, but the structure is fixed.

Question 10: Which approach is most effective for mastering limb ataxia in National Institutes of Health Stroke Scale?

Studying only immediately before examinations
Memorizing textbook definitions without understanding
Relying solely on on-the-job experience
Combining theoretical study with practical application and regular review (Correct answer)

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 11: How is the patient's ability to understand and use language evaluated in the NIHSS?

By asking the patient to name objects and describe a picture (Correct answer)
By checking the patient's reflexes
By asking the patient to count backward
By observing the patient’s walking gait

Correct answer: By asking the patient to name objects and describe a picture

The language section assesses comprehension and expression by having the patient name objects and describe a picture.

Question 12: What is the maximum possible total score on the NIHSS?

45
38
40
42 (Correct answer)

Correct answer: 42

The NIHSS has a maximum total score of 42, achieved when all 15 items receive the highest possible scores.

Question 13: When scoring NIHSS Item 5 (Motor Arm), the patient's arm drifts to the bed before 10 seconds but does not fall immediately. What is the correct score?

0
1 (Correct answer)
3
2

Correct answer: 1

Score 1 (drift) is assigned when the arm drifts before 10 seconds but does not fall to the bed immediately.

Question 14: What is the primary objective of sensory testing in National Institutes of Health Stroke Scale?

To generate revenue for testing organizations
To limit access to the profession
To replace practical experience entirely
To ensure competence and proficiency in core sensory testing concepts (Correct answer)

Correct answer: To ensure competence and proficiency in core sensory testing concepts

The primary objective of sensory testing knowledge is to ensure practitioners have the competence and proficiency needed to perform effectively and safely in their professional roles.

Question 15: When scoring Item 1a (Level of Consciousness) for Group A patient, the patient opens eyes only to painful stimuli but makes no purposeful movements. What score applies?

3 — responds only with reflex or totally unresponsive
1 — not alert, but arousable by minor stimulation
2 — not alert, requires repeated stimulation (Correct answer)
0 — alert, keenly responsive

Correct answer: 2 — not alert, requires repeated stimulation

Score 2 is assigned when the patient requires repeated stimulation or painful stimuli to make any movement and is not fully arousable.

Question 16: In National Institutes of Health Stroke Scale, what role does continuing education play in level of consciousness?

To increase testing frequency for compliance purposes
To prevent professionals from advancing in their careers
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)
To replace initial certification requirements

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 17: The Group A patient has a right-sided facial palsy with complete absence of movement in the lower face but preserved forehead movement. What Item 4 score is correct?

0 — normal
3 — complete paralysis of one or both sides
2 — partial paralysis of lower face (Correct answer)
1 — minor paralysis

Correct answer: 2 — partial paralysis of lower face

Partial paralysis (score 2) describes lower facial weakness with sparing of the forehead, consistent with an upper motor neuron lesion.

Question 18: A patient is blind in both eyes from pre-existing bilateral glaucoma. How should NIHSS item 3 be scored?

Score 0 because it is a pre-existing condition (Correct answer)
Score 2 for complete hemianopia
Score UN (untestable)
Score 3 for bilateral blindness

Correct answer: Score 0 because it is a pre-existing condition

Pre-existing conditions unrelated to the current stroke are not scored; the examiner records 0 and notes the prior baseline.

Question 19: When administering the NIHSS to an intubated patient, how should the examiner score the Dysarthria item?

Score 2 (severe dysarthria) by default for all intubated patients
Score 1 (mild dysarthria) as a standard approximation
Mark the item as UN (untestable) and do not penalize the patient (Correct answer)
Score 0 because the patient's airway is protected

Correct answer: Mark the item as UN (untestable) and do not penalize the patient

Dysarthria cannot be evaluated in an intubated patient. The NIHSS protocol requires marking the item as UN (untestable) in this case. UN items are not counted against the patient's score.

Question 20: In National Institutes of Health Stroke Scale, what role does continuing education play in limb ataxia?

To prevent professionals from advancing in their careers
To increase testing frequency for compliance purposes
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)
To replace initial certification requirements

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 21: Which approach is most effective for mastering sensory testing in National Institutes of Health Stroke Scale?

Studying only immediately before examinations
Combining theoretical study with practical application and regular review (Correct answer)
Relying solely on on-the-job experience
Memorizing textbook definitions without understanding

Correct answer: Combining theoretical study with practical application and regular review

The most effective approach combines theoretical understanding with practical application, reinforced by regular review and assessment, enabling deeper comprehension and long-term retention.

Question 22: A clinician is performing NIHSS serial assessments on a patient at 0, 2, and 24 hours post-stroke. On day 1, item 3 was scored 2 (complete hemianopia). At 24 hours the hemianopia has partially resolved to a quadrantanopia. What is the updated score?

3 — maximized due to fluctuation
1 — partial loss reflecting improvement (Correct answer)
Still 2, because recovery is not scored in NIHSS
0 — full recovery assumed

Correct answer: 1 — partial loss reflecting improvement

The NIHSS reflects the current neurological status at the time of testing; improvement to a quadrantanopia is recorded as 1.

Question 23: In National Institutes of Health Stroke Scale, what is the difference between fluency and accuracy in language learning?

Fluency is smooth, natural communication; accuracy is correct use of grammar and vocabulary (Correct answer)
Accuracy refers only to pronunciation
Fluency applies only to written language
They are identical concepts with no meaningful difference

Correct answer: Fluency is smooth, natural communication; accuracy is correct use of grammar and vocabulary

Fluency refers to the ability to communicate smoothly, naturally, and without excessive hesitation. Accuracy refers to the correct use of grammar, vocabulary, and pronunciation. Both are important for language proficiency.

Question 24: What is the relationship between theory and practice in National Institutes of Health Stroke Scale visual field testing?

Theory and practice are completely unrelated
Theory provides the foundation and framework that guides effective practical application (Correct answer)
Theory replaces the need for any practical experience
Practice is only important; theory is unnecessary

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 25: For NIHSS item 1b (LOC Questions), the examiner asks the patient two questions. Which pair is correct?

What month is it? How old are you? (Correct answer)
What year is it? Where are you right now?
What is today's date? What is the name of this hospital?
What is your name? What city are we in?

Correct answer: What month is it? How old are you?

The standardized NIHSS protocol specifies exactly two questions: the current month and the patient's age. These specific questions must be used verbatim — substituting other orientation questions is not permitted.

Question 26: In National Institutes of Health Stroke Scale, why is extinction and inattention knowledge important for professional certification?

It demonstrates competence and ensures practitioners meet established standards (Correct answer)
It is important only for entry-level positions
It is only required for administrative purposes
It has no practical relevance to daily work

Correct answer: It demonstrates competence and ensures practitioners meet established standards

Professional certification in specific knowledge areas demonstrates that practitioners have met established competency standards, ensuring quality of service and public protection.

Question 27: In National Institutes of Health Stroke Scale, what role does continuing education play in sensory testing?

To prevent professionals from advancing in their careers
To increase testing frequency for compliance purposes
To replace initial certification requirements
To keep professionals current with evolving standards, technologies, and best practices (Correct answer)

Correct answer: To keep professionals current with evolving standards, technologies, and best practices

Continuing education ensures professionals stay current with new developments, evolving standards, and emerging best practices in their field, maintaining competence throughout their careers.

Question 28: What is a best practice in National Institutes of Health Stroke Scale sensory testing?

Any practice that is easy to implement
A method or technique recognized as superior based on evidence and expert consensus (Correct answer)
A practice used only by large organizations
The cheapest available approach

Correct answer: A method or technique recognized as superior based on evidence and expert consensus

Best practices are methods, techniques, or approaches that are recognized through evidence, research, and expert consensus as producing superior results and are recommended for adoption.

Question 29: What is the relationship between theory and practice in National Institutes of Health Stroke Scale extinction and inattention?

Theory and practice are completely unrelated
Theory provides the foundation and framework that guides effective practical application (Correct answer)
Theory replaces the need for any practical experience
Practice is only important; theory is unnecessary

Correct answer: Theory provides the foundation and framework that guides effective practical application

Theory and practice are complementary: theoretical knowledge provides the conceptual framework and understanding that guides effective, evidence-based practical application in professional settings.

Question 30: What is the primary objective of level of consciousness in National Institutes of Health Stroke Scale?

To replace practical experience entirely
To limit access to the profession
To generate revenue for testing organizations
To ensure competence and proficiency in core level of consciousness concepts (Correct answer)

Correct answer: To ensure competence and proficiency in core level of consciousness concepts

The primary objective of level of consciousness knowledge is to ensure practitioners have the competence and proficiency needed to perform effectively and safely in their professional roles.

NIH Stroke Scale (NIHSS) Certification

The NIH Stroke Scale (NIHSS) certification by the American Heart Association tests healthcare professionals' ability to accurately assess neurological deficits in stroke patients using the standardized 11-category, 15-item clinical scale. It is required for nurses, physicians, and allied health professionals in stroke care settings.

Questions

60 min

Time Limit

80%

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

ninds.nih.gov — Exam format · verified Oct 2026
elearning.heart.org — Test delivery, eligibility, fees, renewal, score validity, retake fee, retake policy · verified Oct 2026