I have convinced myself in a computation-heavy, ad-hoc way that a quadratic extension $K$ of $\mathbb{Q}$ occurs as the unique quadratic subfield of a $\mathbb{Z}/4$-extension of $\mathbb{Q}$ if and only if $N_{K/\mathbb{Q}}(x)=-1$ for some $x\in K$. (See below for proof sketch.) There must be a more conceptually illuminating proof?
Morally / conceptually, why is it that a quadratic field occurs inside a cyclic degree 4 field if and only if -1 occurs in it as a norm?
What's the story here? An optimum answer would be a proof that doesn't ask the reader to follow, trust, or replicate any calculations. (As opposed to the following, where I have written "computation shows" about 5 times.)
Computation-heavy, ad-hoc proof sketch: $\Rightarrow$ If $K=\mathbb{Q}(\alpha)$ with $\alpha^2\in \mathbb{Q}, \alpha\notin\mathbb{Q}$, and $\exists x\in K$ with $N_{K/\mathbb{Q}}(x)=-1$, we have $x=a+b\alpha$, $a,b\in\mathbb{Q}$, with $N(x)=a^2-\alpha^2b^2 = -1$. Let $\beta = \sqrt{\alpha^2b-a\alpha}$ and let $L=K(\beta)$. Then, by computation, $\beta$ satisfies the polynomial $$f=x^4-2\alpha^2bx^2+\alpha^2\in\mathbb{Q}[x]$$ which is irreducible by Eisenstein, thus $\beta^2$ is not a square in $K$, so $\mathbb{Q}(\beta)=L$ is degree $4$. Let $$\beta'=(a+b\alpha)\beta\in L$$ Computation shows $\beta'$ also satisfies $f$, so $\beta\mapsto\beta'$ induces an automorphism of $L$; call it $g$. More computation shows $g(\beta')=-\beta$, so $g$ has order $4$, and $\beta$ has 4 conjugates in $L$, thus $L/\mathbb{Q}$ is Galois, with $\operatorname{Gal}(L/\mathbb{Q})$ generated by $g$. This proves the "if" direction.
$\Leftarrow$ If $L$ is a $\mathbb{Z}/4$ extension of $\mathbb{Q}$, let $g$ be a generator of its Galois group and let $K$ be the unique quadratic subfield. We can take $K=\mathbb{Q}(\alpha)$ with $\alpha^2\in\mathbb{Q}$ and $L=K(\beta)$ with $\beta^2\in K$. $1,\alpha,\beta,\alpha\beta$ is a basis for $L/\mathbb{Q}$; we can write a matrix for $g$, seen as a $\mathbb{Q}$-linear transformation, with respect to this basis. We must have $g(1)=1$, and $g(\alpha)=-\alpha$ because $g$ cannot act trivially on $K$. Let $g(\beta)=c+d\alpha+a\beta+b\alpha\beta$ with $a,b,c,d\in\mathbb{Q}$. Then, using the fact that $g(\alpha\beta)=g(\alpha)g(\beta)$, the matrix of $g$ is
$$\begin{pmatrix}1& &c&-\alpha^2d\\ &-1&d&-c\\ & &a&-\alpha^2b\\ & &b&-a\end{pmatrix}$$
Also, $g^2(\alpha)=\alpha$ because $K$ is fixed by $g^2$, and $g^2(\beta)=-\beta$ because $-\beta$ is $\beta$'s only conjugate over $K$ and $L$ is not fixed by $g^2$. Thus the matrix of $g^2$ is
$$\begin{pmatrix}1& & & \\ &1& & \\ & &-1& \\ & & &-1\end{pmatrix}$$
It follows by computation that $a^2-\alpha^2b^2=-1$. (It also follows that $c=d=0$, but this isn't needed.) Thus $a+b\alpha\in K$ has norm $-1$. This proves the "only if" direction.