A man with a sudden severe headache has a normal non-contrast CT done 14 hours after onset. Subarachnoid haemorrhage is still suspected. The next investigation is usually:

Lumbar puncture to look for xanthochromia

Plain X-ray of the skull and cervical spine

Electroencephalography during sleep

Repeat CT after one week of observation

In the overnight dexamethasone suppression test for suspected Cushing syndrome, which morning result supports the diagnosis?

Serum cortisol stays high after dexamethasone

Serum ACTH rises sharply after dexamethasone

Urine glucose disappears after dexamethasone

Serum cortisol falls to a very low level

To find out whether a drowsy patient localises to pain on the GCS motor scale, the painful stimulus should be applied:

Centrally, such as a trapezius pinch

To the nail bed of a finger on the weaker side

To the sole of the foot to test plantar response

By pricking the forearm with a sterile needle

In head injury, a Glasgow Coma Scale score of 8 or less usually means the patient:

Needs a definitive airway such as intubation

Has only a mild concussion needing rest

Is ready for oral feeding and mobilisation

Can safely be managed on a general ward

Neurological, renal and endocrine nursing

60 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Neurological, renal and endocrine nursing, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A man with a sudden severe headache has a normal non-contrast CT done 14 hours after onset. Subarachnoid haemorrhage is still suspected. The next investigation is usually:
1. APlain X-ray of the skull and cervical spine
2. BLumbar puncture to look for xanthochromia
3. CElectroencephalography during sleep
4. DRepeat CT after one week of observation
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Answer: B · Lumbar puncture to look for xanthochromia
CT is very sensitive for subarachnoid blood in the first hours, but sensitivity falls as blood disperses. When CT is normal and suspicion remains, a lumbar puncture done at least 12 hours after onset looks for xanthochromia, the yellow colour of bilirubin from broken-down red cells. This separates a true bleed from a traumatic tap. A positive result leads to angiography to find the aneurysm.
- A: Plain films do not show intracranial bleeding.
- C: EEG shows electrical activity and cannot detect subarachnoid blood.
- D: Waiting a week risks a fatal rebleed in the meantime.
Question 2 · Medium
In the overnight dexamethasone suppression test for suspected Cushing syndrome, which morning result supports the diagnosis?
1. ASerum ACTH rises sharply after dexamethasone
2. BSerum cortisol stays high after dexamethasone
3. CUrine glucose disappears after dexamethasone
4. DSerum cortisol falls to a very low level
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Answer: B · Serum cortisol stays high after dexamethasone
Dexamethasone is a potent glucocorticoid that normally suppresses pituitary ACTH, so the next morning's cortisol falls to a very low level. In Cushing syndrome cortisol production is autonomous or driven by excess ACTH and does not suppress. Failure to suppress is therefore an abnormal, positive screening result. Dexamethasone does not interfere with the cortisol assay.
- A: Dexamethasone suppresses ACTH; a rise is not the measured endpoint.
- C: Urine glucose is not part of this test.
- D: Suppression to a low level is the normal response that excludes Cushing syndrome.
Question 3 · Medium
To find out whether a drowsy patient localises to pain on the GCS motor scale, the painful stimulus should be applied:
1. ATo the nail bed of a finger on the weaker side
2. BTo the sole of the foot to test plantar response
3. CCentrally, such as a trapezius pinch
4. DBy pricking the forearm with a sterile needle
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Answer: C · Centrally, such as a trapezius pinch
Localising means the patient brings a hand up above the clavicle toward the source of pain. That can only be judged with a stimulus applied centrally, at the trapezius or supraorbital notch. Nail-bed pressure can provoke a spinal reflex flexion and does not show whether the hand moves toward the stimulus. Needle pricks break the skin and are not used.
- A: Peripheral nail-bed pressure cannot show a hand moving toward the stimulus.
- B: Plantar stimulation tests the Babinski response, not localisation.
- D: Pricking skin causes injury and is not an accepted stimulus.
Question 4 · Easy
In head injury, a Glasgow Coma Scale score of 8 or less usually means the patient:
1. AHas only a mild concussion needing rest
2. BIs ready for oral feeding and mobilisation
3. CCan safely be managed on a general ward
4. DNeeds a definitive airway such as intubation
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Answer: D · Needs a definitive airway such as intubation
A GCS of 8 or less defines severe head injury, and such patients cannot reliably protect their airway. The rule of thumb is to secure a definitive airway to prevent aspiration and hypoxia, both of which worsen secondary brain injury. They need ICU care and urgent CT. Mild head injury is GCS 13-15 and moderate 9-12.
- A: Mild head injury is GCS 13-15.
- B: Oral feeding is unsafe without airway protection.
- C: A GCS of 8 needs intensive care, not a general ward.
Question 5 · Easy
A complete spinal cord injury at which level is most likely to leave a patient dependent on long-term mechanical ventilation?
1. AC2
2. BL1
3. CT4
4. DC6
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Answer: A · C2
The phrenic nerve to the diaphragm arises from C3, C4 and C5. A complete lesion at C2 cuts off the diaphragm's nerve supply, so the patient cannot breathe without a ventilator or phrenic pacing. Injuries at C5 and below usually keep diaphragmatic breathing, though cough and vital capacity are reduced. Lower lesions affect the intercostal and abdominal muscles progressively less.
- B: L1 injury does not affect breathing muscles.
- C: T4 injury spares the diaphragm and most intercostals above it.
- D: A C6 lesion spares the phrenic nerve, so the diaphragm still works.
Question 6 · Medium
In the first days after an acute spinal cord injury, spinal shock is best described as:
1. APsychological shock from learning of the paralysis
2. BSpastic paralysis with brisk reflexes below the injury
3. CTemporary flaccid areflexia below the injury
4. DLow blood pressure from blood loss at the fracture site
Answer and explanation in LearnFree account
Question 7 · Easy
Of all strokes seen in adults, the largest share, about four in five, are caused by:
1. ASubarachnoid haemorrhage
2. BIntracerebral haemorrhage
3. CIschaemia from arterial occlusion
4. DCerebral venous thrombosis
Answer and explanation in LearnFree account
Question 8 · Easy
Graves disease, the commonest cause of hyperthyroidism, is caused by:
1. AAntibodies that stimulate the TSH receptor
2. BA TSH-secreting tumour of the pituitary
3. CExcess dietary iodine in the diet
4. DAntibodies that destroy thyroid peroxidase
Answer and explanation in LearnFree account
Question 9 · Medium
During the oliguric phase of acute kidney injury, which complication is the most immediately life-threatening?
1. AHypernatraemia from salt retention
2. BHypercalcaemia causing kidney stones
3. CHypokalaemia from excess urinary loss
4. DHyperkalaemia causing cardiac arrhythmias
Answer and explanation in LearnFree account
Question 10 · Hard
A 48-year-old woman has a routine health check-up. She has no symptoms. Results: TSH 9.2 mIU/L (0.4-4.0), free T4 1.1 ng/dL (0.8-1.8), anti-TPO antibodies positive. Which interpretation fits?
1. ASubclinical hyperthyroidism due to Graves disease
2. BSecondary hypothyroidism from pituitary failure
3. COvert primary hypothyroidism needing urgent treatment
4. DSubclinical hypothyroidism due to autoimmune thyroiditis
Answer and explanation in LearnFree account
Question 11 · Hard
A 70 kg man in the surgical ICU has a stable creatinine but has passed 25 mL of urine per hour for the last 12 hours. By the KDIGO urine output criteria (stage 1: below 0.5 mL/kg/h for 6-12 h; stage 2: below 0.5 mL/kg/h for 12 h or more; stage 3: below 0.3 mL/kg/h for 24 h or anuria for 12 h), what is his AKI stage?
1. AStage 3
2. BNo AKI yet
3. CStage 1
4. DStage 2
Answer and explanation in LearnFree account
Question 12 · Medium
In a patient with an expanding right-sided extradural haematoma, a newly dilated, sluggish right pupil is caused by compression of the:
1. ARight oculomotor nerve by uncal herniation
2. BLeft optic nerve by the expanding clot
3. CRight facial nerve within the temporal bone
4. DSympathetic chain in the right side of the neck
Answer and explanation in LearnFree account
Question 13 · Medium
A urine ketone strip may underestimate ketosis early in DKA, so measuring blood beta-hydroxybutyrate is preferred, because the strip:
1. ADetects ketones only in patients with type 2 diabetes
2. BReacts with acetoacetate but not beta-hydroxybutyrate
3. CGives a positive result only after 24 hours
4. DReacts only with glucose, not with any ketone
Answer and explanation in LearnFree account
Question 14 · Hard
A 38-year-old woman with paroxysms of headache, sweating and palpitations has raised plasma metanephrines and a 4 cm adrenal mass. She is listed for adrenalectomy. The admission chart starts oral propranolol today, with no other antihypertensive. What should the nurse do?
1. AGive the propranolol and restrict her fluid intake before surgery
2. BHold all antihypertensives until the tumour has been removed
3. CGive the propranolol and add an alpha-blocker after surgery
4. DQuestion it: alpha blockade must come first
Answer and explanation in LearnFree account
Question 15 · Medium
In chronic kidney disease, serum calcium tends to fall mainly because the failing kidneys:
1. ARetain phosphate and make less active vitamin D
2. BExcrete large amounts of calcium in urine
3. CLose the ability to secrete erythropoietin
4. DProduce too much parathyroid hormone directly
Answer and explanation in LearnFree account
Question 16 · Easy
The most common cause of Cushing syndrome seen in clinical practice is:
1. AAn ACTH-secreting pituitary adenoma
2. BA cortisol-secreting adrenal adenoma
3. CEctopic ACTH from lung cancer
4. DLong-term glucocorticoid therapy
Answer and explanation in LearnFree account
Question 17 · Hard
A patient with a severe head injury opens his eyes to no stimulus, makes incomprehensible sounds and shows abnormal (decorticate) flexion to pain. One pupil reacts to light and the other does not. Using the GCS-Pupils score (GCS minus the number of non-reacting pupils), what is his GCS-P?
1. A5
2. B7
3. C4
4. D6
Answer and explanation in LearnFree account
Question 18 · Medium
In a patient being observed after a head injury, the earliest sign that intracranial pressure is rising is usually:
1. AA change in level of consciousness
2. BWidening pulse pressure with bradycardia
3. CA fixed and dilated pupil
4. DDecerebrate posturing to pain
Answer and explanation in LearnFree account
Question 19 · Easy
To screen the feet of a diabetic patient for loss of protective sensation, the standard bedside tool is the:
1. ASterile needle pressed into the sole
2. B10 g Semmes-Weinstein monofilament
3. CReflex hammer applied to the ankle
4. DDoppler probe over the dorsalis pedis
Answer and explanation in LearnFree account
Question 20 · Easy
A 42-year-old woman collapses after a sudden, explosive headache she calls the worst of her life, with vomiting and neck stiffness. Which condition must be excluded first?
1. ATension-type headache
2. BSubarachnoid haemorrhage
3. CAcute bacterial sinusitis
4. DMigraine with aura
Answer and explanation in LearnFree account
Question 21 · Medium
A patient's serum potassium stays low at 2.9 mmol/L despite two days of oral and IV potassium replacement. Which test should be checked next?
1. ASerum uric acid
2. BSerum sodium
3. CSerum amylase
4. DSerum magnesium
Answer and explanation in LearnFree account
Question 22 · Medium
IV phenytoin is loaded in an adult at no faster than 50 mg per minute, with ECG and BP monitoring, because faster infusion can cause:
1. AAcute gum overgrowth and hirsutism
2. BSevere hypoglycaemia and seizures
3. CImmediate liver failure and jaundice
4. DHypotension and cardiac arrhythmias
Answer and explanation in LearnFree account
Question 23 · Hard
A patient with malnutrition and cirrhosis has a total serum calcium of 7.6 mg/dL (8.5-10.5) and serum albumin of 2.0 g/dL (3.5-5.0). She has no tingling or tetany. Using corrected calcium = measured Ca + 0.8 x (4.0 - albumin), what does this mean?
1. A9.2 mg/dL, so the true calcium is normal
2. B11.2 mg/dL, so she has hypercalcaemia
3. C6.0 mg/dL, so she has severe hypocalcaemia
4. D7.6 mg/dL, so IV calcium gluconate is needed
Answer and explanation in LearnFree account
Question 24 · Easy
For a generalised convulsive seizure, the operational definition used to start emergency treatment for status epilepticus is continuous seizure activity, or repeated seizures without recovery between them, lasting at least:
1. A60 minutes
2. B5 minutes
3. C30 seconds
4. D15 minutes
Answer and explanation in LearnFree account
Question 25 · Easy
The normal resting intracranial pressure in an adult, as commonly quoted in nursing texts, is about:
1. A30-45 mmHg
2. B20-30 mmHg
3. C5-15 mmHg
4. D40-60 mmHg
Answer and explanation in LearnFree account

35 more Neurological, renal and endocrine nursing questions

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Neurological, renal and endocrine nursing

A man with a sudden severe headache has a normal non-contrast CT done 14 hours after onset. Subarachnoid haemorrhage is still suspected. The next investigation is usually:

In the overnight dexamethasone suppression test for suspected Cushing syndrome, which morning result supports the diagnosis?

To find out whether a drowsy patient localises to pain on the GCS motor scale, the painful stimulus should be applied:

In head injury, a Glasgow Coma Scale score of 8 or less usually means the patient:

A complete spinal cord injury at which level is most likely to leave a patient dependent on long-term mechanical ventilation?

In the first days after an acute spinal cord injury, spinal shock is best described as:

Of all strokes seen in adults, the largest share, about four in five, are caused by:

Graves disease, the commonest cause of hyperthyroidism, is caused by:

During the oliguric phase of acute kidney injury, which complication is the most immediately life-threatening?

A 48-year-old woman has a routine health check-up. She has no symptoms. Results: TSH 9.2 mIU/L (0.4-4.0), free T4 1.1 ng/dL (0.8-1.8), anti-TPO antibodies positive. Which interpretation fits?

In a patient with an expanding right-sided extradural haematoma, a newly dilated, sluggish right pupil is caused by compression of the:

A urine ketone strip may underestimate ketosis early in DKA, so measuring blood beta-hydroxybutyrate is preferred, because the strip:

A 38-year-old woman with paroxysms of headache, sweating and palpitations has raised plasma metanephrines and a 4 cm adrenal mass. She is listed for adrenalectomy. The admission chart starts oral propranolol today, with no other antihypertensive. What should the nurse do?

In chronic kidney disease, serum calcium tends to fall mainly because the failing kidneys:

The most common cause of Cushing syndrome seen in clinical practice is:

A patient with a severe head injury opens his eyes to no stimulus, makes incomprehensible sounds and shows abnormal (decorticate) flexion to pain. One pupil reacts to light and the other does not. Using the GCS-Pupils score (GCS minus the number of non-reacting pupils), what is his GCS-P?

In a patient being observed after a head injury, the earliest sign that intracranial pressure is rising is usually:

To screen the feet of a diabetic patient for loss of protective sensation, the standard bedside tool is the:

A 42-year-old woman collapses after a sudden, explosive headache she calls the worst of her life, with vomiting and neck stiffness. Which condition must be excluded first?

A patient's serum potassium stays low at 2.9 mmol/L despite two days of oral and IV potassium replacement. Which test should be checked next?

IV phenytoin is loaded in an adult at no faster than 50 mg per minute, with ECG and BP monitoring, because faster infusion can cause:

A patient with malnutrition and cirrhosis has a total serum calcium of 7.6 mg/dL (8.5-10.5) and serum albumin of 2.0 g/dL (3.5-5.0). She has no tingling or tetany. Using corrected calcium = measured Ca + 0.8 x (4.0 - albumin), what does this mean?

For a generalised convulsive seizure, the operational definition used to start emergency treatment for status epilepticus is continuous seizure activity, or repeated seizures without recovery between them, lasting at least:

The normal resting intracranial pressure in an adult, as commonly quoted in nursing texts, is about: