NIHSS Level of Consciousness 5

Question 1

A patient with severe dysarthria attempts to answer orientation questions but speech is completely unintelligible. NIHSS Item 1b should be scored as:

Accepted Answer

2 - unable to provide scoreable verbal response

Answer

If the patient cannot produce intelligible answers due to dysarthria, both questions are considered unanswered, scoring a 2 on Item 1b.

Question 2

A nurse asks whether the NIHSS LOC section can be skipped if the patient is clearly alert. The correct response is:

Accepted Answer

No, all three LOC items must be completed and documented for every assessment

Answer

All NIHSS items including 1a, 1b, and 1c must be completed and documented for every formal assessment regardless of apparent alertness.

Question 3

Which stimulus is considered appropriate to use when testing LOC arousal (Item 1a) for a patient who does not respond to voice?

Accepted Answer

Noxious stimulus such as nail bed pressure

Answer

Noxious stimuli such as nail bed pressure or sternal rub are appropriate for assessing arousal when the patient doesn't respond to voice.

Question 4

A patient who is post-ictal after a seizure opens eyes to voice but is confused about the month. For Item 1a they score 1, and for Item 1b they score 1. What is the combined LOC sub-score for items 1a and 1b?

Accepted Answer

2

Answer

1a=1 plus 1b=1 equals a combined LOC sub-score of 2 for those two items.

Question 5

NIHSS Item 1c requires the patient to perform two motor commands. If a patient has a hand amputation, the examiner should:

Accepted Answer

Substitute another one-step command for the hand grip

Answer

If a physical limitation like amputation prevents the standard command, the examiner substitutes another appropriate one-step motor command.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Level of Consciousness 5