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Multisystem CCRN Practice Questions

10 free CCRN-style multisystem practice questions with full rationales. Perfect for last-minute review or rapid drilling on high-yield concepts.

Question Index

  1. Q1: According to Sepsis-3 criteria, septic shock is defined as sepsis requiring vaso…
  2. Q2: The first-line vasopressor for septic shock is:
  3. Q3: The qSOFA (Quick SOFA) score includes all of the following EXCEPT:
  4. Q4: Which infection prevention bundle component is specific to VAP prevention?
  5. Q5: The antidote for opioid overdose is:
  6. Q6: MODS (Multiple Organ Dysfunction Syndrome) is most commonly triggered by:
  7. Q7: Contact precautions are indicated for all of the following EXCEPT:
  8. Q8: The Hour-1 Sepsis Bundle includes all EXCEPT:
  9. Q9: A patient presents with "hot as a hare, blind as a bat, dry as a bone, red as a …
  10. Q10: Antivirals for influenza are MOST effective when given:
Question 1

According to Sepsis-3 criteria, septic shock is defined as sepsis requiring vasopressors PLUS:

  1. Temperature >38.5°C
  2. WBC >12,000
  3. Lactate >2 mmol/L despite adequate fluid resuscitation
  4. Heart rate >100 bpm

Correct Answer: C. Lactate >2 mmol/L despite adequate fluid resuscitation

Rationale: Septic shock (Sepsis-3) is defined as sepsis with persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg AND serum lactate >2 mmol/L despite adequate fluid resuscitation. Elevated lactate indicates tissue hypoperfusion and carries significant mortality risk.
Question 2

The first-line vasopressor for septic shock is:

  1. Dopamine
  2. Epinephrine
  3. Norepinephrine
  4. Phenylephrine

Correct Answer: C. Norepinephrine

Rationale: Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Guidelines. It provides potent alpha-adrenergic vasoconstriction with some beta-1 effect. Vasopressin may be added as a second agent (not titrated). Epinephrine can be used if additional agents are needed. Dopamine is no longer preferred due to increased arrhythmia risk.
Question 3

The qSOFA (Quick SOFA) score includes all of the following EXCEPT:

  1. Respiratory rate ≥22
  2. Altered mental status
  3. Systolic BP ≤100 mmHg
  4. Temperature ≥38°C

Correct Answer: D. Temperature ≥38°C

Rationale: qSOFA includes: RR ≥22, altered mental status (GCS <15), and SBP ≤100 mmHg. Temperature is NOT part of qSOFA. A score of ≥2 suggests higher risk of poor outcomes and prompts further evaluation for organ dysfunction. qSOFA is a bedside screening tool, not diagnostic criteria.
Question 4

Which infection prevention bundle component is specific to VAP prevention?

  1. Chlorhexidine skin prep
  2. Daily line necessity review
  3. Head of bed elevation
  4. Aseptic catheter insertion technique

Correct Answer: C. Head of bed elevation

Rationale: Head of bed elevation (30-45 degrees) is specific to VAP prevention bundles. It reduces aspiration of oropharyngeal secretions. Other VAP bundle elements include oral care with chlorhexidine, sedation vacation, and spontaneous breathing trials. Chlorhexidine prep and line reviews are for CLABSI prevention; aseptic technique applies to CAUTI.
Question 5

The antidote for opioid overdose is:

  1. Flumazenil
  2. Naloxone
  3. N-acetylcysteine
  4. Atropine

Correct Answer: B. Naloxone

Rationale: Naloxone (Narcan) is the antidote for opioid overdose. It competitively antagonizes opioid receptors, rapidly reversing respiratory depression, sedation, and miosis. Duration of action is shorter than most opioids, so repeat doses or infusion may be needed. Flumazenil reverses benzodiazepines (use cautiously). NAC is for acetaminophen toxicity.
Question 6

MODS (Multiple Organ Dysfunction Syndrome) is most commonly triggered by:

  1. Medication overdose
  2. Sepsis
  3. Cardiac arrhythmia
  4. Pulmonary embolism

Correct Answer: B. Sepsis

Rationale: Sepsis is the most common trigger for MODS. The systemic inflammatory response leads to endothelial dysfunction and progressive organ failure. Other causes include severe trauma, burns, pancreatitis, and massive transfusion. Mortality increases with each additional organ system involved.
Question 7

Contact precautions are indicated for all of the following EXCEPT:

  1. MRSA
  2. VRE
  3. C. difficile
  4. Influenza

Correct Answer: D. Influenza

Rationale: Influenza requires DROPLET precautions (surgical mask within 3-6 feet), not contact precautions. MRSA, VRE, and C. difficile all require contact precautions (gown and gloves). C. difficile also requires hand washing with soap and water since alcohol-based sanitizers do not kill spores.
Question 8

The Hour-1 Sepsis Bundle includes all EXCEPT:

  1. Measure lactate
  2. Obtain blood cultures before antibiotics
  3. Administer broad-spectrum antibiotics
  4. Insert central venous catheter

Correct Answer: D. Insert central venous catheter

Rationale: The Hour-1 Bundle includes: measure lactate, obtain blood cultures, administer broad-spectrum antibiotics, begin 30 mL/kg crystalloid for hypotension or lactate ≥4, and apply vasopressors if hypotensive after fluids. Central line insertion is NOT part of the Hour-1 bundle, though it may be needed for vasopressor administration.
Question 9

A patient presents with "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter." This describes which toxidrome?

  1. Sympathomimetic
  2. Opioid
  3. Anticholinergic
  4. Cholinergic

Correct Answer: C. Anticholinergic

Rationale: The classic description fits anticholinergic toxidrome: hyperthermia (hot), mydriasis with blurred vision (blind), anhidrosis and dry mucous membranes (dry), flushed skin (red), and altered mental status/hallucinations (mad). Causes include antihistamines, tricyclics, and atropine. Treatment is supportive; physostigmine for severe cases.
Question 10

Antivirals for influenza are MOST effective when given:

  1. Within 48 hours of symptom onset
  2. Within 72 hours of symptom onset
  3. Within 5 days of symptom onset
  4. Any time during illness

Correct Answer: A. Within 48 hours of symptom onset

Rationale: Antivirals (oseltamivir, zanamivir, baloxavir) are most effective within 48 hours of symptom onset. However, they may still be considered for hospitalized patients or high-risk individuals even after 48 hours. Early treatment reduces duration and severity of illness and may reduce complications.

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