CCRN Multisystem Practice Questions
Multisystem makes up 8 of every 50 questions on a Tigertest CCRN practice test. Here are 10 of the 32 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Based on the AACN Adult CCRN test plan. Original questions; 50 per test, weighted like the real exam. Not affiliated with AACN or AACN Certification Corporation.
1. An ABG shows pH 7.30, PaCO2 55 mm Hg and HCO3 26 mmol/L. What is the interpretation?
- A.Metabolic acidosis
- B.Respiratory acidosis
- C.Metabolic alkalosis
- D.Respiratory alkalosis
Answer: B. The pH is low and the PaCO2 is high, so the acidosis is respiratory; a normal bicarbonate means the kidneys have not compensated yet, so it is acute.
2. An ABG shows pH 7.50, PaCO2 48 mm Hg and HCO3 36 mmol/L. What is the interpretation?
- A.Uncompensated metabolic acidosis
- B.Respiratory acidosis, fully compensated
- C.Acute respiratory alkalosis
- D.Metabolic alkalosis, partly compensated
Answer: D. A high pH with a high bicarbonate is a metabolic alkalosis; the raised PaCO2 is the lungs compensating by retaining CO2, and the pH is still abnormal, so the compensation is only partial. Vomiting and gastric suction are common causes.
3. A patient has Na 140, Cl 100 and HCO3 12 mmol/L. What is the anion gap?
- A.28 mmol/L
- B.16 mmol/L
- C.52 mmol/L
- D.40 mmol/L
Answer: A. Anion gap = Na - (Cl + HCO3) = 140 - 112 = 28, which is high and points to an unmeasured acid such as lactate, ketones or a toxin. Adding the bicarbonate instead of subtracting it gives 52.
4. An 80 kg patient has sepsis-induced hypoperfusion. Under the 2021 Surviving Sepsis guideline, how much IV crystalloid is suggested in the first 3 hours?
- A.At least 1,200 mL
- B.At least 4,000 mL
- C.At least 2,400 mL
- D.At least 800 mL
Answer: C. The guideline suggests at least 30 mL/kg of IV crystalloid within the first 3 hours: 30 x 80 = 2,400 mL, with further fluid guided by reassessment of perfusion and fluid responsiveness.
5. What initial mean arterial pressure target does the 2021 Surviving Sepsis guideline recommend for septic shock on vasopressors?
- A.100 mm Hg
- B.85 mm Hg
- C.65 mm Hg
- D.55 mm Hg
Answer: C. An initial MAP target of 65 mm Hg is a strong recommendation over higher targets, which added no benefit and more vasopressor exposure in trials.
6. Which vasopressor is recommended first-line for adults with septic shock?
- A.Norepinephrine
- B.Dopamine infusion
- C.Phenylephrine
- D.Vasopressin alone
Answer: A. Norepinephrine is the first-line vasopressor. Vasopressin is added rather than escalating norepinephrine further, usually once norepinephrine reaches 0.25 to 0.5 mcg/kg/min, and dopamine causes more dysrhythmias.
7. When does the 2021 Surviving Sepsis guideline suggest adding IV corticosteroids in septic shock?
- A.Before the first fluid bolus is given
- B.At the very first vasopressor dose
- C.Only if a cortisol level is low
- D.Norepinephrine 0.25 mcg/kg/min for 4 h
Answer: D. IV hydrocortisone, typically 200 mg a day, is suggested for patients with an ongoing need for vasopressors, defined as norepinephrine or epinephrine at 0.25 mcg/kg/min or more for at least 4 hours after starting.
8. A patient has possible septic shock. How soon should antimicrobials be given?
- A.Within 24 hours
- B.Within 1 hour
- C.Within 6 hours
- D.After culture results
Answer: B. For possible septic shock or a high likelihood of sepsis, antimicrobials are given immediately, ideally within 1 hour of recognition, after cultures are drawn if that causes no delay. Possible sepsis without shock allows up to 3 hours of rapid workup.
9. What does the 2021 Surviving Sepsis guideline say about qSOFA as a screening tool?
- A.Use it as the only screen
- B.Do not use it alone
- C.Use it only after lactate
- D.Use it in place of SIRS
Answer: B. The guideline recommends against using qSOFA alone, compared with SIRS, NEWS or MEWS, because it is specific but misses many patients early. It predicts poor outcome better than it screens.
10. A patient develops wheezing, hives, lip swelling and a BP of 70/40 minutes after an IV antibiotic starts. What is given first?
- A.Nebulized albuterol
- B.IV methylprednisolone
- C.IV diphenhydramine
- D.IM epinephrine
Answer: D. Anaphylaxis is treated first with IM epinephrine into the thigh after stopping the drug; antihistamines, steroids and bronchodilators are adjuncts that do not reverse shock or airway swelling.
Practice all 32 multisystem questions, and the rest of the 200-question bank, in the free CCRN training sets. Questions you miss come back until you have mastered them.
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