NIHSS Practice Test

The NIHSS test is a tool to check how severe a patient’s stroke is. It’s used by many in the medical field. This includes emergency doctors, brain specialists, nurses, and those studying medicine. Practice with the free NIHSS - National Institutes of Health Stroke Scale practice test on PracticeTestGeeks (11 questions with answer explanations).

This test is detailed and helps doctors and others. They understand how a stroke affects someone’s brain. This is very important for choosing the best treatment and knowing what might happen next.

NIHSS Exam at a Glance

Free NIHSS - National Institutes of Health Stroke Scale Study Tools

Interactive NIHSS - National Institutes of Health Stroke Scale resources on PracticeTestGeeks, free to start:

• Free NIHSS Neurological Questions and Answers — 11 questions with instant scoring and answer explanations
• NIHSS - National Institutes of Health Stroke Scale flashcards — review key terms and concepts card by card
• NIHSS - National Institutes of Health Stroke Scale study guide — topic-by-topic overview of what the exam covers
• NIHSS - National Institutes of Health Stroke Scale cheat sheet — one-page printable summary for last-minute review

According to American Heart Association / American Stroke Association, developed with the American Academy of Neurology, “Using a numerical scale to determine stroke severity, health care providers record the person’s performance in 11 categories, such as sensory and motor ability.”^[1]

Worked examples: how to reason through NIHSS questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: A patient holds their arm at 90° but it drifts downward before 10 seconds — however, it does not hit the bed or their lap. How is Motor Arm scored?

1. 0 — the arm was held partially
2. 1 — the arm drifts before 10 seconds but does not fall
3. 2 — the arm falls before 10 seconds
4. 3 — no effort against gravity

Answer: B. 1 — the arm drifts before 10 seconds but does not fall

Explanation:

B is correct. On Motor Arm, a score of 1 means the arm starts at 90° but drifts downward before 10 seconds without reaching the bed or the patient's lap. That is exactly what happened here.

• A (0) is only for an arm that holds its position for the full 10 seconds with no drift. Holding it partway is still drift.
• C (2) is for an arm that cannot keep up against gravity and falls to the bed before 10 seconds. This arm never landed.
• D (3) means the patient makes no effort against gravity at all. This patient lifted and held the arm.

Rule to remember: watch where the arm ends up. If it drifts but stays up, score 1. If it falls to the surface, score 2. If there is no lift against gravity, score 3.

Example 2

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

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

Answer: D. Mark the item as UN (untestable) and do not penalize the patient

Explanation:

D is correct. Scoring dysarthria means listening to how clearly the patient speaks. A breathing tube makes that impossible, so the protocol marks the item UN (untestable), and that mark is not counted against the patient.

• A (0) claims normal speech without testing it. A protected airway tells you nothing about articulation.
• B (2) adds severe points just because of a device, which makes the patient look worse than you have shown.
• C (1) is a guess. The scale does not let you approximate an item you could not observe.

Rule to remember: when a physical barrier stops you from testing an item, mark it untestable and write down why. Do not fill in a score you did not observe. Score every other item that you can still test.

Example 3

Question: What is the relationship between theory and practice in National Institutes of Health Stroke Scale best gaze?

1. Theory provides the foundation and framework that guides effective practical application
2. Theory and practice are completely unrelated
3. Practice is only important; theory is unnecessary
4. Theory replaces the need for any practical experience

Answer: A. Theory provides the foundation and framework that guides effective practical application

Explanation:

A is correct. Knowing what an item is meant to measure tells you what to look for at the bedside. For Best Gaze, understanding which eye movements the item checks, and how a gaze problem shows up, is what lets you see and score the finding accurately.

• B is wrong because the scoring definitions are the theory. You cannot score consistently without them.
• C is wrong because practice alone leads to drift between examiners, which a standard scale is designed to prevent.
• D is wrong because reading the definitions does not train your eye. You still need to watch real or simulated patients.

Rule to remember: learn the written definition of each item, then test yourself against it on cases until what you see matches what the definition says.

How to use these practice tests

Start with the official course material on AHA eLearning, because the test groups are scored against its definitions. Read how each item is tested and scored before you practise.

Next, work through the items in the order the scale uses. Begin with Level of Consciousness, then Best Gaze, Visual Field Testing and Facial Palsy. Move on to Motor Function, Limb Ataxia and Sensory Testing. Finish with Language and Aphasia, Dysarthria and Extinction and Inattention. For every question you miss, write down the boundary you got wrong, such as drift versus fall, or untestable versus abnormal.

Then take Score Administration and Interpretation to practise the rules that cover every item, like when to mark an item untestable. Use the mixed Group A Patient and Neurological sets to score whole cases from start to finish.

In the days before your test group, go back over your list of missed boundaries and re-read those definitions in the official material.

Key Takeaways

Free NIHSS Practice Test Online

• The NIHSS test is a standardized way to look at how a stroke affects the brain.
• Many healthcare workers use it to decide on treatment and to guess what might happen.
• The test looks at things like if a patient is alert, if they can see clearly, move, or speak.
• It gives a number score that shows how bad the stroke’s effects are.
• It’s very important to do this test right away to help patients get the best care and get better.

Assessing Level of Consciousness

Understanding the NIHSS (National Institutes of Health Stroke Scale) Test

The NIHSS test is vital in the first steps of evaluating acute stroke patients. It helps healthcare workers pinpoint the severity of neurological problems. They do this by checking the patient’s reactions and responses. Firstly, they note down the patient’s information and the time of the examination. They also record when the stroke’s symptoms began.

The NIHSS test assigns a score to the patient’s consciousness level, from 0 to 3. Zero means the patient is alert and fully responsive. A score of 3 suggests the patient is barely or not at all responsive. This helps decide how serious the stroke is and what care the patient needs.

Testing Best Gaze and Visual Fields

This test also covers the patient’s vision and eye movements. It uses a 0 to 3 scale. A 0 means there’s no vision issue, while 3 represents complete loss of vision on both sides. Determining these scores helps healthcare staff know the extent of brain injury. It assists them in creating a personalized treatment plan.

Evaluating Facial Palsy and Motor Function

The NIHSS checks if the patient can move their face and limbs. Scoring for facial paralysis goes from 0 to 3. Zero is for normal movements, while 3 means complete paralysis. For limb movements, they use a 0 to 4 scale. Zero is for no movement detected, and 4 means no moving is possible. This information is crucial in understanding the patient’s nerve and muscle health. It helps in planning the recovery process.

Administering and Scoring the NIHSS Test

The NIHSS (National Institutes of Health Stroke Scale) test is done in a certain way. The person running the test keeps track of how well the patient does for each part. Changing scores later is not allowed. The person giving the test must stick to the directions for each part.

First, the examiner checks the patient’s Level of Consciousness (LOC). The LOC test has four scores. It ranges from 0 (Alert) to 3 (Totally unresponsive). Next, they ask the LOC Questions. The patient can get 0, 1, or 2 points based on the answers.

The examiner then looks at the patient’s Best Gaze. There are three possible scores, from 0 (Normal) to 2 (Total gaze paresis). After that, they test the patient’s Visual Fields. The scores range from 0 (No visual loss) to 3 (Cortical blindness).

Assessing Facial Palsy comes next. It can range from 0 (Normal) to 3 (Complete paralysis). The Motor Arm and Motor Leg evaluations are about muscle control. They’re scored from 0 to 4.

The Limb Ataxia test assesses limb coordination. It’s scored as absent, in one limb, or in two limbs. Lastly, the Sensory check has scores of 0 (Normal) to 2 (Total sensory loss).

The NIHSS test is key in evaluating acute stroke, neurological issues, and stroke outcomes. By looking at a patient’s deficits, healthcare pros can better triage and monitor stroke cases.

In short, the NIHSS offers a thorough way to gauge stroke seriousness. This helps doctors choose the best care and predict outcomes. With its detailed scoring on various deficits, the NIHSS is vital in acute stroke care and assessing neurological problems.

Sample NIHSS - National Institutes of Health Stroke Scale Practice Questions

Try these questions from our free NIHSS - National Institutes of Health Stroke Scale practice tests. The correct answer and an explanation follow each question.

1. Which NIHSS item is scored differently for patients who are intubated versus non-intubated?

   • A. Item 1b (LOC Questions)
   • B. Item 7 (Limb Ataxia)
   • C. Item 9 (Dysarthria)
   • D. Item 4 (Facial Palsy)

Answer: C. Item 9 (Dysarthria)

Item 9 has a specific notation (score 3 = UN) for intubated patients who cannot be tested for dysarthria.

Answer: C. 2

A patient who is alert and non-aphasic but produces no intelligible speech receives a score of 2 for severe dysarthria or anarthria.

Answer: C. Speech is completely unintelligible to the trained examiner

A score of 2 on NIHSS dysarthria indicates speech is so slurred it is unintelligible or the patient is mute.

Answer: B. 1

A score of 1 (partial gaze palsy) is assigned when gaze is abnormal in one or both eyes without forced deviation or total gaze paresis.

Take the full NIHSS - National Institutes of Health Stroke Scale practice test

Sources & last verified

1. ninds.nih.gov — number of questions (official source). “Using a numerical scale to determine stroke severity, health care providers record the person’s performance in 11 categories, such as sensory and motor ability.” Verified Oct 20, 2026.
2. American Heart Association / American Stroke Association, developed with the American Academy of Neurology — exam fee, validity, renewal, delivery (official source). “Price : $10.00” Verified Oct 20, 2026.
3. American Heart Association / American Stroke Association, developed with the American Academy of Neurology — retake fee, retake policy (official source). “Price : $10.00” Verified Oct 20, 2026.

How we verify: editorial & fact-checking policy. Report an error: contact us.