NURSG 5432-400 MODULE 3 2026/2027 | Questions with
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SECTION 1: Neurological Disorders (Q1–Q15)
Q1: A 28-year-old woman presents with a throbbing unilateral headache associated with
nausea, photophobia, and visual aura lasting 20 minutes. She reports similar episodes
2–3 times monthly. Which classification best describes her condition?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Migraine with aura [CORRECT]
Correct Answer: D
Rationale: Migraine with aura is characterized by reversible focal neurological
symptoms (visual aura) preceding or accompanying unilateral throbbing headache with
nausea and photophobia. Tension-type headaches are bilateral with band-like pressure
without aura; cluster headaches are severe unilateral periorbital with autonomic
symptoms and lack aura.
Q2: A 65-year-old man with atrial fibrillation suddenly develops right-sided facial droop,
arm weakness, and aphasia. His symptoms began 45 minutes ago. What is the priority
initial intervention?
A. Immediate aspirin administration
B. Rapid blood pressure reduction to normal
C. Emergent CT brain imaging without contrast
D. Emergent CT brain imaging without contrast [CORRECT]
Correct Answer: D
Rationale: The American Heart Association/American Stroke Association guidelines
require emergent non-contrast CT to differentiate ischemic from hemorrhagic stroke
,before any thrombolytic or antithrombotic therapy. Aspirin is contraindicated until
hemorrhage is excluded; rapid BP reduction is harmful in acute ischemic stroke.
Q3: A 42-year-old man presents with a sudden "thunderclap" headache reaching
maximal intensity in 60 seconds, accompanied by nuchal rigidity. He is alert and
oriented. Which differential diagnosis is most critical to rule out first?
A. Migraine without aura
B. Subarachnoid hemorrhage
C. Tension-type headache
D. Subarachnoid hemorrhage [CORRECT]
Correct Answer: D
Rationale: Thunderclap headache with nuchal rigidity is the classic presentation of
subarachnoid hemorrhage, a neurosurgical emergency requiring immediate CT and
lumbar puncture if CT is negative. Migraine and tension-type headaches do not present
with sudden maximal intensity or meningeal signs.
Q4: A 70-year-old woman with Parkinson's disease presents with worsening tremor at
rest, rigidity, and bradykinesia. Her current carbidopa-levodopa regimen no longer
provides consistent relief. Which phenomenon best explains her fluctuating motor
response?
A. Tardive dyskinesia
B. Neuroleptic malignant syndrome
C. Wearing-off phenomenon
D. Wearing-off phenomenon [CORRECT]
Correct Answer: D
Rationale: The wearing-off phenomenon (end-of-dose deterioration) occurs as
Parkinson's disease progresses and dopaminergic neurons decline, shortening the
effective duration of levodopa. Tardive dyskinesia results from dopamine antagonists;
neuroleptic malignant syndrome is an acute hyperthermic crisis.
Q5: A 24-year-old woman with newly diagnosed focal epilepsy with impaired awareness
is started on antiepileptic therapy. Which medication is considered first-line with the
best efficacy and tolerability profile for this seizure type?
A. Phenytoin
B. Valproic acid
, C. Levetiracetam
D. Levetiracetam [CORRECT]
Correct Answer: D
Rationale: Levetiracetam is a first-line agent for focal onset seizures due to broad
efficacy, minimal drug interactions, and favorable side effect profile. Phenytoin has
significant pharmacokinetic interactions and adverse effects; valproic acid is
teratogenic and less preferred in women of childbearing potential.
Q6: A 55-year-old man with diabetes mellitus reports burning, tingling pain in a
stocking-glove distribution bilaterally. On examination, he has diminished vibration
sense and absent ankle reflexes. Which diagnosis is most consistent?
A. Guillain-Barré syndrome
B. Diabetic peripheral neuropathy
C. Multiple sclerosis
D. Diabetic peripheral neuropathy [CORRECT]
Correct Answer: D
Rationale: Symmetric distal sensory polyneuropathy in a stocking-glove distribution with
loss of vibration sense and reflexes is characteristic of diabetic peripheral neuropathy.
Guillain-Barré is acute ascending weakness; MS presents with central demyelinating
lesions causing focal neurological deficits.
Q7: A 32-year-old woman reports episodes of diplopia, gait ataxia, and urinary urgency
that resolve spontaneously over weeks. MRI shows multiple white matter lesions in the
periventricular region. Which diagnosis is most likely?
A. Systemic lupus erythematosus
B. Multiple sclerosis
C. Acute disseminated encephalomyelitis
D. Multiple sclerosis [CORRECT]
Correct Answer: D
Rationale: Multiple sclerosis is characterized by relapsing-remitting neurological
episodes with dissemination in space (multiple white matter lesions) and time
(separate episodes). ADEM is typically monophasic post-infectious; SLE would show
systemic features and different lesion patterns.
Complete Solutions | UTA FNP Program | Pass Guaranteed -
A+ Graded
SECTION 1: Neurological Disorders (Q1–Q15)
Q1: A 28-year-old woman presents with a throbbing unilateral headache associated with
nausea, photophobia, and visual aura lasting 20 minutes. She reports similar episodes
2–3 times monthly. Which classification best describes her condition?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Migraine with aura [CORRECT]
Correct Answer: D
Rationale: Migraine with aura is characterized by reversible focal neurological
symptoms (visual aura) preceding or accompanying unilateral throbbing headache with
nausea and photophobia. Tension-type headaches are bilateral with band-like pressure
without aura; cluster headaches are severe unilateral periorbital with autonomic
symptoms and lack aura.
Q2: A 65-year-old man with atrial fibrillation suddenly develops right-sided facial droop,
arm weakness, and aphasia. His symptoms began 45 minutes ago. What is the priority
initial intervention?
A. Immediate aspirin administration
B. Rapid blood pressure reduction to normal
C. Emergent CT brain imaging without contrast
D. Emergent CT brain imaging without contrast [CORRECT]
Correct Answer: D
Rationale: The American Heart Association/American Stroke Association guidelines
require emergent non-contrast CT to differentiate ischemic from hemorrhagic stroke
,before any thrombolytic or antithrombotic therapy. Aspirin is contraindicated until
hemorrhage is excluded; rapid BP reduction is harmful in acute ischemic stroke.
Q3: A 42-year-old man presents with a sudden "thunderclap" headache reaching
maximal intensity in 60 seconds, accompanied by nuchal rigidity. He is alert and
oriented. Which differential diagnosis is most critical to rule out first?
A. Migraine without aura
B. Subarachnoid hemorrhage
C. Tension-type headache
D. Subarachnoid hemorrhage [CORRECT]
Correct Answer: D
Rationale: Thunderclap headache with nuchal rigidity is the classic presentation of
subarachnoid hemorrhage, a neurosurgical emergency requiring immediate CT and
lumbar puncture if CT is negative. Migraine and tension-type headaches do not present
with sudden maximal intensity or meningeal signs.
Q4: A 70-year-old woman with Parkinson's disease presents with worsening tremor at
rest, rigidity, and bradykinesia. Her current carbidopa-levodopa regimen no longer
provides consistent relief. Which phenomenon best explains her fluctuating motor
response?
A. Tardive dyskinesia
B. Neuroleptic malignant syndrome
C. Wearing-off phenomenon
D. Wearing-off phenomenon [CORRECT]
Correct Answer: D
Rationale: The wearing-off phenomenon (end-of-dose deterioration) occurs as
Parkinson's disease progresses and dopaminergic neurons decline, shortening the
effective duration of levodopa. Tardive dyskinesia results from dopamine antagonists;
neuroleptic malignant syndrome is an acute hyperthermic crisis.
Q5: A 24-year-old woman with newly diagnosed focal epilepsy with impaired awareness
is started on antiepileptic therapy. Which medication is considered first-line with the
best efficacy and tolerability profile for this seizure type?
A. Phenytoin
B. Valproic acid
, C. Levetiracetam
D. Levetiracetam [CORRECT]
Correct Answer: D
Rationale: Levetiracetam is a first-line agent for focal onset seizures due to broad
efficacy, minimal drug interactions, and favorable side effect profile. Phenytoin has
significant pharmacokinetic interactions and adverse effects; valproic acid is
teratogenic and less preferred in women of childbearing potential.
Q6: A 55-year-old man with diabetes mellitus reports burning, tingling pain in a
stocking-glove distribution bilaterally. On examination, he has diminished vibration
sense and absent ankle reflexes. Which diagnosis is most consistent?
A. Guillain-Barré syndrome
B. Diabetic peripheral neuropathy
C. Multiple sclerosis
D. Diabetic peripheral neuropathy [CORRECT]
Correct Answer: D
Rationale: Symmetric distal sensory polyneuropathy in a stocking-glove distribution with
loss of vibration sense and reflexes is characteristic of diabetic peripheral neuropathy.
Guillain-Barré is acute ascending weakness; MS presents with central demyelinating
lesions causing focal neurological deficits.
Q7: A 32-year-old woman reports episodes of diplopia, gait ataxia, and urinary urgency
that resolve spontaneously over weeks. MRI shows multiple white matter lesions in the
periventricular region. Which diagnosis is most likely?
A. Systemic lupus erythematosus
B. Multiple sclerosis
C. Acute disseminated encephalomyelitis
D. Multiple sclerosis [CORRECT]
Correct Answer: D
Rationale: Multiple sclerosis is characterized by relapsing-remitting neurological
episodes with dissemination in space (multiple white matter lesions) and time
(separate episodes). ADEM is typically monophasic post-infectious; SLE would show
systemic features and different lesion patterns.
