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Nihss Healthstream Eden Test Actual 2026 Questions and Answers

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 5 pages. Originally published on StudyMerit.

Pages
5
Academic year
2025/2026
Language
English

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NIH Stroke Scale (NIHSS) & Glasgow Coma Scale (GCS) Cheat Sheet NIH STROKE SCALE (NIHSS) – Summary Purpose: Quantifies stroke severity (max score: 42; higher = worse) 1. LOC - Alert = 0 - Not alert but arousable = 1 - Requires repeated stimulation = 2 - Unresponsive = 3 2. LOC Questions (month & age) - 2 correct = 0, 1 correct = 1, 0 correct = 2 3. LOC Commands (open/close eyes, grip/release) - Both correct = 0, 1 = 1, none = 2 4. Gaze - Normal = 0, Partial = 1, Forced deviation = 2 5. Visual Fields - No loss = 0, Partial = 1, Complete = 2, Bilateral = 3 6. Facial Palsy - Normal = 0, Minor = 1, Partial = 2, Complete = 3 7. Motor Arm (each side, 10 seconds) - No drift = 0, Drift = 1, Falls = 2, No effort = 3, None = 4 8. Motor Leg (each side, 5 seconds) - Same scoring as arms 9. Limb Ataxia - Absent = 0, Present = 1, Both sides = 2 10. Sensory - Normal = 0, Mild loss = 1, Severe/total = 2 11. Language (naming, description, commands) - Normal = 0, Mild = 1, Severe = 2, Mute = 3 12. Dysarthria - Normal = 0, Mild = 1, Severe = 2 13. Extinction/Inattention - Normal = 0, Mild neglect = 1, Severe neglect = 2 Interpretation: - 0 = No stroke - 1–4 = Minor stroke - 5–15 = Moderate stroke - 16–20 = Moderate to severe - 21–42 = Severe stroke GLASGOW COMA SCALE (GCS) EYE OPENING (E) 4 – Spontaneous 3 – To voice 2 – To pain

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1 – None VERBAL RESPONSE (V) 5 – Oriented 4 – Confused 3 – Inappropriate words 2 – Incomprehensible sounds 1 – None MOTOR RESPONSE (M) 6 – Obeys commands 5 – Localizes pain 4 – Withdraws from pain 3 – Flexion (decorticate) 2 – Extension (decerebrate) 1 – None Total Score: E + V + M (max = 15, min = 3) Interpretation: - 13–15 = Mild injury - 9–12 = Moderate - ≤ 8 = Severe (often intubate) Tips: - For intubated patients: document as “VT” or “T” (e.g., GCS = 7T) - Always document components (E, V, M) separately - Reassess frequently for trends, especially in neuro patients

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