NIHSS Level of Consciousness 2

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?

Accepted Answer

2 - Not alert, requires repeated or painful stimulation

Answer

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)?

Accepted Answer

Patient is not alert but responds to minor stimulation such as voice or touch

Answer

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)?

Accepted Answer

To prevent biased scoring by keeping questions unassisted

Answer

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:

Accepted Answer

Showing only reflex posturing or autonomic responses to stimuli

Answer

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?

Accepted Answer

Item 1b - LOC Questions

Answer

Item 1b tests orientation by asking the patient their age and the current month.

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