NIHSS Level of Consciousness 2 — Questions and Answers
Question 1: A patient opens their eyes only when the examiner applies a painful stimulus. How is their level of consciousness scored on NIHSS Item 1a?
- 0 - Alert
- 1 - Not alert but arousable by minor stimulation
- 2 - Not alert, requires repeated or painful stimulation (Correct answer)
- 3 - Responds only with reflex motor or autonomic effects
Correct answer: 2 - Not alert, requires repeated or painful stimulation
A patient requiring painful stimulation to respond scores a 2 on NIHSS Item 1a.
Question 2: During NIHSS assessment, which of the following best describes a score of 1 on Item 1a (Level of Consciousness)?
- Patient is fully awake and responds normally
- Patient is not alert but responds to minor stimulation such as voice or touch (Correct answer)
- Patient requires noxious stimulation to make any movement
- Patient is unresponsive to all stimuli
Correct answer: Patient is not alert but responds to minor stimulation such as voice or touch
A score of 1 indicates the patient is not fully alert but can be aroused by minor stimulation like voice or light touch.
Question 3: Why does the NIHSS instruct examiners NOT to coach patients during the LOC questions (Items 1b and 1c)?
- To save examination time
- To prevent biased scoring by keeping questions unassisted (Correct answer)
- Because coaching is allowed only in pediatric patients
- Because LOC items are optional and coaching is irrelevant
Correct answer: To prevent biased scoring by keeping questions unassisted
Coaching would artificially inflate scores; the NIHSS requires unassisted responses to accurately reflect neurological status.
Question 4: A patient with NIHSS Item 1a score of 3 would most likely present as:
- Drowsy but responding to voice
- Lethargic but opening eyes to touch
- Making purposeful movements to painful stimulation
- Showing only reflex posturing or autonomic responses to stimuli (Correct answer)
Correct answer: Showing only reflex posturing or autonomic responses to stimuli
A score of 3 on Item 1a means the patient responds only with reflex motor or autonomic effects, or is totally unresponsive.
Question 5: Which NIHSS item specifically tests whether the patient can correctly state their age and the current month?
- Item 1a - Level of Consciousness
- Item 1b - LOC Questions (Correct answer)
- Item 1c - LOC Commands
- Item 2 - Best Gaze
Correct answer: Item 1b - LOC Questions
Item 1b tests orientation by asking the patient their age and the current month.
Question 6: A patient answers one of the two LOC orientation questions (Item 1b) correctly. What score is recorded?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
On Item 1b, answering only one of the two questions correctly earns a score of 1.
Question 7: On NIHSS Item 1c (LOC Commands), the patient is asked to open and close their eyes and then grip and release their hand. The patient correctly performs only the first command. What is the score?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Performing only one of the two commands correctly results in a score of 1 on Item 1c.
NIHSS Level of Consciousness 2
A patient opens their eyes only when the examiner applies a painful stimulus.
How is their level of consciousness scored on NIHSS Item 1a?