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.
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Interactive NIHSS - National Institutes of Health Stroke Scale resources on PracticeTestGeeks, free to start:
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]
Prepare for the NIHSS - National Institutes of Health Stroke Scale exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.
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.
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?
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.
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.
Question: When administering the NIHSS to an intubated patient, how should the examiner score the Dysarthria item?
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.
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.
Question: What is the relationship between theory and practice in National Institutes of Health Stroke Scale best gaze?
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.
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.
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.
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.
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.
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.
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.
| NIHSS Test Component | Scoring Options |
|---|---|
| Level of Consciousness (LOC) | 0 (Alert), 1 (Not alert but arousable by minor stimulation), 2 (Requires repeated stimulation to attend or is obtunded), 3 (Responds only with reflex motor or autonomic effects or totally unresponsive) |
| LOC Questions | 0 (Answers both questions correctly), 1 (Answers one question correctly), 2 (Answers neither question correctly) |
| Best Gaze | 0 (Normal), 1 (Partial gaze palsy), 2 (Forced deviation or total gaze paresis not overcome by the oculocephalic maneuver) |
| Visual Fields | 0 (No visual loss), 1 (Partial hemianopia), 2 (Complete hemianopia), 3 (Bilateral hemianopia including cortical blindness) |
| Facial Palsy | 0 (Normal symmetrical movements), 1 (Minor paralysis), 2 (Partial paralysis), 3 (Complete paralysis of one or both sides) |
| Motor Arm | Scoring from 0 to 4 based on the patient’s response |
| Motor Leg | Scoring from 0 to 4 based on the patient’s response |
| Limb Ataxia | Absent, present in one limb, or present in two limbs |
| Sensory | 0 (Normal; no sensory loss), 1 (Mild-to-moderate sensory loss), 2 (Severe or total sensory loss) |
Try these questions from our free NIHSS - National Institutes of Health Stroke Scale practice tests. The correct answer and an explanation follow each question.
Which NIHSS item is scored differently for patients who are intubated versus non-intubated?
Answer: C. Item 9 (Dysarthria)
Item 9 has a specific notation (score 3 = UN) for intubated patients who cannot be tested for dysarthria.
A stroke patient produces no intelligible sounds but is fully awake and not aphasic. What NIHSS dysarthria score is correct?
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.
A patient scores 2 on dysarthria. Which clinical finding is most consistent with this score?
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.
A patient with acute stroke has gaze that is abnormal in one eye but the other eye moves normally. There is no forced deviation. What is the NIHSS Best Gaze score?
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.
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