NIHSS Level of Consciousness 3 — Questions and Answers
Question 1: A stroke patient is intubated and cannot speak. How should the examiner score NIHSS Item 1b (LOC Questions)?
- Score 0 because intubation is a barrier, not a neurological deficit
- Score 1 automatically for any intubated patient
- Score 2 because the patient cannot answer either question (Correct answer)
- Skip the item entirely and leave it blank
Correct answer: Score 2 because the patient cannot answer either question
Intubated patients who cannot verbally respond to either orientation question receive a score of 2 on Item 1b.
Question 2: Which of the following patients would receive a score of 0 on NIHSS Item 1a?
- A patient who opens eyes only to voice
- A patient who is alert and responsive throughout the examination (Correct answer)
- A patient requiring sternal rub to respond
- A patient who only withdraws from pain
Correct answer: A patient who is alert and responsive throughout the examination
A score of 0 on Item 1a means the patient is fully alert and keenly responsive.
Question 3: The NIHSS LOC section (Items 1a, 1b, 1c) assesses three distinct aspects. Which combination is correct?
- Arousal level, orientation questions, motor commands (Correct answer)
- Pupil reactivity, speech clarity, motor commands
- Arousal level, pupil reactivity, orientation questions
- Gaze preference, orientation questions, limb commands
Correct answer: Arousal level, orientation questions, motor commands
Items 1a, 1b, and 1c assess arousal/alertness, verbal orientation, and ability to follow commands, respectively.
Question 4: A patient with severe aphasia attempts to follow commands on Item 1c but cannot communicate verbally. The examiner should:
- Score 2 because the patient cannot speak
- Accept pantomime or non-verbal attempts as valid responses (Correct answer)
- Skip Item 1c for aphasic patients
- Score 1 regardless of actual performance
Correct answer: Accept pantomime or non-verbal attempts as valid responses
For aphasic patients, the NIHSS allows non-verbal or pantomimed responses to be scored as valid on Item 1c.
Question 5: On NIHSS Item 1b, what is scored if the patient gives a partially correct answer (e.g., states correct month but wrong year for age)?
- 0 - both answers considered correct
- 1 - only one answer correct (Correct answer)
- 2 - both answers incorrect
- The item is left unscored
Correct answer: 1 - only one answer correct
Only fully correct answers count; an incorrect age with a correct month means only one of two is correct, scoring a 1.
Question 6: Why is Level of Consciousness evaluated first in the NIHSS examination sequence?
- It is the easiest item to score
- LOC determines how reliably subsequent items can be assessed (Correct answer)
- Federal guidelines require LOC to be first
- It has the highest point value in the scale
Correct answer: LOC determines how reliably subsequent items can be assessed
Assessing LOC first establishes the patient's baseline responsiveness, which affects the validity of all subsequent NIHSS items.
Question 7: A trauma patient is brought in after a car accident with suspected stroke. They respond to their name but quickly fall back asleep. NIHSS Item 1a score is most likely:
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Responding to name (minor stimulation) but not maintaining alertness corresponds to a score of 1 on Item 1a.
NIHSS Level of Consciousness 3
A stroke patient is intubated and cannot speak.
How should the examiner score NIHSS Item 1b (LOC Questions)?