NIHSS Level of Consciousness 3

Question 1

A stroke patient is intubated and cannot speak. How should the examiner score NIHSS Item 1b (LOC Questions)?

Accepted Answer

Score 2 because the patient cannot answer either question

Answer

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?

Accepted Answer

A patient who is alert and responsive throughout the examination

Answer

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?

Accepted Answer

Arousal level, orientation questions, motor commands

Answer

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:

Accepted Answer

Accept pantomime or non-verbal attempts as valid responses

Answer

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)?

Accepted Answer

1 - only one answer correct

Answer

Only fully correct answers count; an incorrect age with a correct month means only one of two is correct, scoring a 1.

NIHSS - National Institutes of Health Stroke Scale Practice Test