CCRN Plan

Multisystem: practice questions

3 original questions · 3 editor-approved · every choice explained.

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Blueprint-mapped questions with full rationales for every choice.

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MultisystemDifficulty 3/5

A patient has warm extremities, a wide pulse pressure, systemic vascular resistance of 480 dynes/sec/cm-5, a cardiac index of 4.8 L/min/m2 and a rising lactate. Which intervention is most appropriate?

  1. AStart an inotrope to improve a failing cardiac output
  2. BFluid resuscitation and a vasopressor to restore perfusion pressure
  3. CGive a diuretic to relieve vasodilation and reduce preload
  4. DStart a beta blocker to control the compensatory tachycardia
Show answer and rationale

Correct: B. This is distributive shock: low systemic vascular resistance with a high cardiac index and tissue hypoperfusion. Treatment restores intravascular volume and vascular tone; the pump is not the problem.

  • A — Cardiac index is already high, so inotropy is not the deficit.
  • C — Diuresis worsens hypoperfusion in a vasodilated patient.
  • D — Beta blockade removes a compensatory mechanism and worsens shock.
MultisystemDifficulty 2/5

A patient with suspected sepsis has a normal blood pressure but a lactate of 4.2 mmol/L. How should this be interpreted?

  1. AThe patient requires immediate intubation regardless of respiratory status
  2. BPerfusion is adequate because the blood pressure remains within normal limits
  3. CTissue hypoperfusion is present despite the normal blood pressure
  4. DThe lactate is unrelated to perfusion and should be repeated in 24 hours
Show answer and rationale

Correct: C. An elevated lactate indicates tissue hypoperfusion or metabolic stress even when the blood pressure is preserved — so-called cryptic shock. Normal pressure does not exclude inadequate perfusion.

  • B — Blood pressure is a late and insensitive marker of perfusion.
  • D — Delaying 24 hours ignores a marker of active hypoperfusion.
  • A — Nothing in the scenario indicates airway failure.
MultisystemDifficulty 3/5

During rewarming of a severely hypothermic patient, why is a slow, controlled rate preferred?

  1. ARapid rewarming denatures circulating clotting factors and causes uncontrolled haemorrhage
  2. BSlow rewarming is required by policy but has no physiological rationale
  3. CSlow rewarming allows kidneys to excrete accumulated potassium before circulation improves
  4. DRapid rewarming causes vasodilation and core afterdrop with dysrhythmia risk
Show answer and rationale

Correct: D. Rapid external rewarming dilates peripheral vessels and returns cold, acidotic blood to the core, producing core temperature afterdrop, hypotension and a risk of ventricular dysrhythmia in an irritable myocardium.

  • A — Coagulopathy in hypothermia relates to enzyme kinetics, not thermal denaturation during rewarming.
  • B — There is a clear physiological rationale.
  • C — Potassium handling is not the basis of the rewarming rate.

Primary references

  1. CCRN Exam Handbook — Direct Care (July 2026) — AACN Certification Corporation · primary · retrieved 2026-09-22, verified 2026-09-22