NIHSS Motor Function Assessment 5 — Questions and Answers
Question 1: A patient scores 2 on right arm motor, 1 on left arm motor, 2 on right leg motor, and 1 on left leg motor. What is the total motor subscore?
- 4
- 5
- 6 (Correct answer)
- 7
Correct answer: 6
Adding the four motor scores: 2+1+2+1 = 6 total motor subscore.
Question 2: During NIHSS testing, a patient with right-sided weakness asks to use the left arm to 'show' what to do. How should the examiner respond?
- Allow demonstration with the unaffected arm
- Demonstrate using the patient's affected arm only
- Give verbal instruction and test the affected arm directly (Correct answer)
- Score the item as untestable
Correct answer: Give verbal instruction and test the affected arm directly
The examiner should provide verbal instructions and test the affected limb directly, not allow the patient to demonstrate with the unaffected side.
Question 3: What happens to NIHSS motor scores if a patient spontaneously improves and holds the arm fully for 10 seconds on repeat testing?
- The worst score is kept permanently
- The current best score is documented (Correct answer)
- Both scores are averaged
- Only the admission score is used
Correct answer: The current best score is documented
Serial NIHSS scoring reflects the patient's current neurological status at the time of assessment.
Question 4: In a patient with bilateral motor weakness from basilar artery occlusion, how are both sides scored on NIHSS motor items?
- Only the worse side is scored
- Both sides are scored independently (Correct answer)
- One side is marked UN
- The total is halved
Correct answer: Both sides are scored independently
All four motor items (right arm, left arm, right leg, left leg) are scored independently regardless of bilateral involvement.
Question 5: A nurse performs NIHSS and notes the arm drifts to the bed in 4 seconds. A physician retests and the arm holds for 6 seconds. Which score is correct for documentation?
- The nurse's score (worse finding)
- The physician's score (most recent)
- Both scores should be averaged
- The most recent examiner's finding is used (Correct answer)
Correct answer: The most recent examiner's finding is used
NIHSS scores reflect the most recent standardized assessment; serial exams replace prior scores for that time point.
Question 6: Which of the following correctly describes the NIHSS scoring convention for motor items when a patient has a prior stroke with residual weakness?
- Score baseline deficits as 0 and only count new deficits
- Score what is observed at the time of examination regardless of prior history (Correct answer)
- Subtract the baseline NIHSS from current scores
- Mark all items with prior deficits as UN
Correct answer: Score what is observed at the time of examination regardless of prior history
NIHSS scores what is observed on examination; prior deficits are noted but the current exam drives the score.
Question 7: A patient with a right MCA stroke holds the right leg at 30° and it drifts down but doesn't hit the bed after 5 seconds. What is Item 6a?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Drift without touching the bed within the 5-second window earns a score of 1 on the leg motor item.
NIHSS Motor Function Assessment 5
A patient scores 2 on right arm motor, 1 on left arm motor, 2 on right leg motor, and 1 on left leg motor.
What is the total motor subscore?