UNIVERSITY OF ALABAMA
NUR 521 Exam 4 Blueprint
Practice Questions and Answers
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% Annual
TABLE OF CONTENTS
Section 1: Neurological Disorders ........ Q1-Q15
Section 2: Endocrine Disorders ........ Q16-Q30
Section 3: Renal and Urinary Disorders ........ Q31-Q45
Section 4: Reproductive Disorders ........ Q46-Q60
Section 5: Musculoskeletal and Integumentary Disorders ........ Q61-Q75
INSTRUCTIONS
Read each question carefully. Select the best answer from the four options provided. A rationale explaining the correct
answer and addressing a common misconception follows each question. You have 90 minutes to complete all 75
questions. A score of 80% or higher is required to pass. Review the answer key at the end of the document for quick
reference.
NUR 521 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of {TOTAL}
,Section 1: Neurological Disorders -- 2026/2027
Q1 Question 1 of 75
Q1. A 62-year-old male presents with sudden-onset right-sided weakness, facial droop, and slurred
speech that began 45 minutes ago. His blood pressure is 178/98 mmHg. This presentation is most
consistent with which type of cerebrovascular event?
A. Ischemic stroke involving the left middle cerebral artery territory
B. Hemorrhagic stroke in the basal ganglia from ruptured microaneurysm
C. Transient ischemic attack with complete resolution within 24 hours
D. Subarachnoid hemorrhage from a ruptured berry aneurysm
Correct Answer: A
Rationale:
Sudden unilateral weakness with facial droop and dysarthria is the hallmark of an ischemic stroke, most
commonly affecting the middle cerebral artery territory. Hemorrhagic stroke typically presents with severe
headache and altered consciousness, not focal motor deficits alone.
Q2 Question 2 of 75
Q2. A 55-year-old female with a history of migraines reports a new headache pattern that is worse in
the morning and accompanied by nausea and vomiting that worsens with position changes. These
findings should prompt the clinician to suspect which condition?
A. Cluster headache with autonomic features and lacrimation
B. Increased intracranial pressure from a space-occupying lesion
C. Chronic migraine with typical aura and photophobia
D. Tension-type headache from cervical muscle spasms
Correct Answer: B
Rationale:
Morning headaches with nausea and vomiting that worsen with position changes are classic signs of increased
intracranial pressure from a mass lesion, as recumbency overnight raises ICP further. Chronic migraines
typically have photophobia rather than positional vomiting.
,Q3 Question 3 of 75
Q3. A 48-year-old male presents with progressive muscle weakness that began in his distal
extremities and has advanced proximally over the past three months. He reports muscle cramps and
fasciculations. Electromyography reveals both upper and lower motor neuron signs. These findings
are most consistent with which diagnosis?
A. Multiple sclerosis with relapsing-remitting demyelination
B. Myasthenia gravis with autoimmune postsynaptic receptor destruction
C. Amyotrophic lateral sclerosis with combined UMN and LMN involvement
D. Guillain-Barre syndrome with ascending demyelinating polyneuropathy
Correct Answer: C
Rationale:
Progressive weakness with both upper and lower motor neuron signs on EMG is the defining presentation of
ALS, which selectively destroys both corticospinal tracts and anterior horn cells. Guillain-Barre involves only
peripheral nerves and presents as ascending weakness without UMN signs.
Q4 Question 4 of 75
Q4. A 30-year-old female reports episodes of bilateral visual loss, paresthesias in her extremities, and
bladder dysfunction that occur and then partially resolve over weeks. MRI of the brain shows multiple
periventricular white matter lesions of varying ages. This presentation is most consistent with which
disorder?
A. Neuromyelitis optica with selective opticospinal demyelination
B. Acute disseminated encephalomyelitis following viral infection
C. Vitamin B12 deficiency causing subacute combined degeneration
D. Multiple sclerosis with relapsing-remitting disease course
Correct Answer: D
Rationale:
Relapsing and remitting neurological deficits with periventricular white matter lesions of varying ages on MRI are
diagnostic for multiple sclerosis. Neuromyelitis optica primarily affects the optic nerves and spinal cord rather
than producing periventricular brain lesions.
NUR 521 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 3 of {TOTAL}
, Q5 Question 5 of 75
Q5. A 70-year-old male with a history of hypertension and diabetes presents with a severe headache,
neck stiffness, and a declining level of consciousness. A non-contrast CT of the head shows diffuse
blood in the subarachnoid space. The most likely cause of this finding is which of the following?
A. Ruptured saccular aneurysm at the circle of Willis
B. Arteriovenous malformation with venous hemorrhage
C. Hypertensive bleed in the putamen region
D. Cerebral amyloid angiopathy with lobar hemorrhage
Correct Answer: A
Rationale:
Sudden severe headache with neck stiffness and subarachnoid blood on CT is the classic presentation of a
ruptured saccular aneurysm, most commonly at the circle of Willis. Hypertensive bleeds typically occur in the
basal ganglia, thalamus, or pons rather than the subarachnoid space.
Q6 Question 6 of 75
Q6. A 65-year-old male presents with a resting tremor in his right hand, cogwheel rigidity in his upper
extremities, and bradykinesia that has progressed over 18 months. These motor symptoms result
primarily from degeneration of dopaminergic neurons in which brain structure?
A. Motor cortex pyramidal cells producing upper motor neuron signs
B. Substantia nigra pars compacta reducing dopamine in the basal ganglia
C. Caudate nucleus leading to cholinergic excess in the striatum
D. Cerebellar Purkinje cells causing dysmetria and ataxia
Correct Answer: B
Rationale:
The classic triad of resting tremor, rigidity, and bradykinesia results from degeneration of dopaminergic neurons
in the substantia nigra pars compacta, disrupting basal ganglia circuitry. Caudate degeneration is associated
with Huntington disease, not Parkinson disease.
NUR 521 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 4 of {TOTAL}
NUR 521 Exam 4 Blueprint
Practice Questions and Answers
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% Annual
TABLE OF CONTENTS
Section 1: Neurological Disorders ........ Q1-Q15
Section 2: Endocrine Disorders ........ Q16-Q30
Section 3: Renal and Urinary Disorders ........ Q31-Q45
Section 4: Reproductive Disorders ........ Q46-Q60
Section 5: Musculoskeletal and Integumentary Disorders ........ Q61-Q75
INSTRUCTIONS
Read each question carefully. Select the best answer from the four options provided. A rationale explaining the correct
answer and addressing a common misconception follows each question. You have 90 minutes to complete all 75
questions. A score of 80% or higher is required to pass. Review the answer key at the end of the document for quick
reference.
NUR 521 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of {TOTAL}
,Section 1: Neurological Disorders -- 2026/2027
Q1 Question 1 of 75
Q1. A 62-year-old male presents with sudden-onset right-sided weakness, facial droop, and slurred
speech that began 45 minutes ago. His blood pressure is 178/98 mmHg. This presentation is most
consistent with which type of cerebrovascular event?
A. Ischemic stroke involving the left middle cerebral artery territory
B. Hemorrhagic stroke in the basal ganglia from ruptured microaneurysm
C. Transient ischemic attack with complete resolution within 24 hours
D. Subarachnoid hemorrhage from a ruptured berry aneurysm
Correct Answer: A
Rationale:
Sudden unilateral weakness with facial droop and dysarthria is the hallmark of an ischemic stroke, most
commonly affecting the middle cerebral artery territory. Hemorrhagic stroke typically presents with severe
headache and altered consciousness, not focal motor deficits alone.
Q2 Question 2 of 75
Q2. A 55-year-old female with a history of migraines reports a new headache pattern that is worse in
the morning and accompanied by nausea and vomiting that worsens with position changes. These
findings should prompt the clinician to suspect which condition?
A. Cluster headache with autonomic features and lacrimation
B. Increased intracranial pressure from a space-occupying lesion
C. Chronic migraine with typical aura and photophobia
D. Tension-type headache from cervical muscle spasms
Correct Answer: B
Rationale:
Morning headaches with nausea and vomiting that worsen with position changes are classic signs of increased
intracranial pressure from a mass lesion, as recumbency overnight raises ICP further. Chronic migraines
typically have photophobia rather than positional vomiting.
,Q3 Question 3 of 75
Q3. A 48-year-old male presents with progressive muscle weakness that began in his distal
extremities and has advanced proximally over the past three months. He reports muscle cramps and
fasciculations. Electromyography reveals both upper and lower motor neuron signs. These findings
are most consistent with which diagnosis?
A. Multiple sclerosis with relapsing-remitting demyelination
B. Myasthenia gravis with autoimmune postsynaptic receptor destruction
C. Amyotrophic lateral sclerosis with combined UMN and LMN involvement
D. Guillain-Barre syndrome with ascending demyelinating polyneuropathy
Correct Answer: C
Rationale:
Progressive weakness with both upper and lower motor neuron signs on EMG is the defining presentation of
ALS, which selectively destroys both corticospinal tracts and anterior horn cells. Guillain-Barre involves only
peripheral nerves and presents as ascending weakness without UMN signs.
Q4 Question 4 of 75
Q4. A 30-year-old female reports episodes of bilateral visual loss, paresthesias in her extremities, and
bladder dysfunction that occur and then partially resolve over weeks. MRI of the brain shows multiple
periventricular white matter lesions of varying ages. This presentation is most consistent with which
disorder?
A. Neuromyelitis optica with selective opticospinal demyelination
B. Acute disseminated encephalomyelitis following viral infection
C. Vitamin B12 deficiency causing subacute combined degeneration
D. Multiple sclerosis with relapsing-remitting disease course
Correct Answer: D
Rationale:
Relapsing and remitting neurological deficits with periventricular white matter lesions of varying ages on MRI are
diagnostic for multiple sclerosis. Neuromyelitis optica primarily affects the optic nerves and spinal cord rather
than producing periventricular brain lesions.
NUR 521 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 3 of {TOTAL}
, Q5 Question 5 of 75
Q5. A 70-year-old male with a history of hypertension and diabetes presents with a severe headache,
neck stiffness, and a declining level of consciousness. A non-contrast CT of the head shows diffuse
blood in the subarachnoid space. The most likely cause of this finding is which of the following?
A. Ruptured saccular aneurysm at the circle of Willis
B. Arteriovenous malformation with venous hemorrhage
C. Hypertensive bleed in the putamen region
D. Cerebral amyloid angiopathy with lobar hemorrhage
Correct Answer: A
Rationale:
Sudden severe headache with neck stiffness and subarachnoid blood on CT is the classic presentation of a
ruptured saccular aneurysm, most commonly at the circle of Willis. Hypertensive bleeds typically occur in the
basal ganglia, thalamus, or pons rather than the subarachnoid space.
Q6 Question 6 of 75
Q6. A 65-year-old male presents with a resting tremor in his right hand, cogwheel rigidity in his upper
extremities, and bradykinesia that has progressed over 18 months. These motor symptoms result
primarily from degeneration of dopaminergic neurons in which brain structure?
A. Motor cortex pyramidal cells producing upper motor neuron signs
B. Substantia nigra pars compacta reducing dopamine in the basal ganglia
C. Caudate nucleus leading to cholinergic excess in the striatum
D. Cerebellar Purkinje cells causing dysmetria and ataxia
Correct Answer: B
Rationale:
The classic triad of resting tremor, rigidity, and bradykinesia results from degeneration of dopaminergic neurons
in the substantia nigra pars compacta, disrupting basal ganglia circuitry. Caudate degeneration is associated
with Huntington disease, not Parkinson disease.
NUR 521 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 4 of {TOTAL}
