NIHSS Neurological 5 — Questions and Answers
Question 1: A patient has no verbal output, does not follow commands, and eyes open only to pain. What LOC (Item 1a) score is most appropriate?
- 0
- 1
- 2 (Correct answer)
- 3
Correct answer: 2
Score 2 reflects stupor — the patient requires repeated or painful stimulation to make non-stereotyped movements.
Question 2: The NIHSS Item 10 (Best Language/Aphasia) asks the patient to describe a picture, name items, and read sentences. What does the picture description primarily test?
- Articulation
- Comprehension and expression (Correct answer)
- Visual acuity
- Attention span
Correct answer: Comprehension and expression
Describing the cookie theft picture tests both language comprehension and expressive language simultaneously.
Question 3: On the NIHSS, which item can a trained non-physician certified examiner administer?
- Only Level of Consciousness items
- Only motor items
- All 15 items after certification (Correct answer)
- Only sensory and neglect items
Correct answer: All 15 items after certification
After completing NIHSS certification training, nurses, therapists, and other allied health professionals can administer all 15 items.
Question 4: A patient repeatedly ignores objects presented on the left side when both sides are stimulated simultaneously. Which NIHSS item captures this finding?
- Item 8 (Sensory)
- Item 9 (Dysarthria)
- Item 10 (Aphasia)
- Item 11 (Extinction/Inattention) (Correct answer)
Correct answer: Item 11 (Extinction/Inattention)
Item 11 specifically measures extinction and inattention detected by simultaneous bilateral sensory or visual stimulation.
Question 5: What is the correct arm position for testing NIHSS Item 5 (Motor Arm) in a supine patient unable to sit?
- 45 degrees (Correct answer)
- 30 degrees
- 90 degrees
- 60 degrees
Correct answer: 45 degrees
In a supine patient, the arm is held at 45 degrees; if sitting, 90 degrees is used for the motor arm test.
Question 6: An NIHSS score of 0 at 24 hours post-stroke thrombolysis most likely indicates:
- Hemorrhagic transformation
- Complete neurological recovery (Correct answer)
- Measurement error
- Cerebellar involvement
Correct answer: Complete neurological recovery
An NIHSS score of 0 indicates no detectable neurological deficit and reflects complete or near-complete clinical recovery.
Question 7: When a patient's baseline deficit prevents accurate assessment of a specific NIHSS item, the examiner should:
- Skip the item and leave it blank
- Score it as 0 assuming normal baseline
- Document the reason and assign the most accurate score possible (Correct answer)
- Always score it as the maximum
Correct answer: Document the reason and assign the most accurate score possible
Examiners should document the reason for difficulty and score the item as accurately as possible given the circumstances.
NIHSS Neurological 5
A patient has no verbal output, does not follow commands, and eyes open only to pain.
What LOC (Item 1a) score is most appropriate?