CCRN Multisystem Practice Questions
Updated October 30, 2026
Multisystem questions cover the problems that hit several organs at once: shock and sepsis, burns, toxic ingestions, temperature emergencies, acid-base problems and the care of dying patients. The 2025 Adult test plan raised this area from 14% to 16% of the scored questions.
The 12 questions below are original, written for this page in the style of the real exam. They are independent practice and are not official AACN material.
Multisystem on the CCRN at a glance
| Item | Details |
|---|---|
| Share of the exam | 16% of the scored questions, about 20 of 125 |
| Test plan | Adult CCRN test plan for exams on or after November 12, 2025 |
| Question style | Bedside vignettes with vitals, labs and ABGs, four choices, one best answer |
| Previous share | 14% under the 2020 plan |
What the multisystem questions cover
The test plan lists acid-base imbalance, anoxic injury, burns, transplant comorbidity, palliative and end-of-life care, failure to thrive, fluid and electrolyte imbalances, healthcare-associated and other infections, life-threatening maternal and fetal complications such as eclampsia and HELLP, multiple organ dysfunction, obesity-related complications, pain, rhabdomyolysis, sepsis, shock states, sleep disruption, submersion injuries, SIRS, thermoregulation, and toxic ingestions, inhalations and exposures.
The nursing actions include early sepsis identification, preventing hospital-acquired infections, recognizing and managing toxin and drug exposure, malignant hyperthermia, ECMO, intra-abdominal pressure monitoring, organ donation and targeted temperature management.
Tips for multisystem questions
- Know the first-line drug. Norepinephrine in septic shock, dantrolene in malignant hyperthermia and IM epinephrine in anaphylaxis are tested again and again.
- Match the antidote to the toxin. Several overdose questions are a matter of recognizing the toxidrome from the vitals and ECG.
- Calculate when it helps. An anion gap or a MAP from the numbers in the stem often decides the answer. There is no calculator, so the math is simple.
- Comfort is the goal at the end of life. Opioids for dyspnea in a dying patient are appropriate care, not a risk to avoid.
For the hemodynamic patterns of each shock state, see hemodynamics for the CCRN.
CCRN multisystem practice questions
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A patient with pneumonia remains hypotensive after 2 L of balanced crystalloid, with a MAP of 58 mm Hg, lactate 4.6 mmol/L and cool, mottled knees. Which medication should the nurse anticipate?Answer: DNorepinephrine is the first-line vasopressor in septic shock, started to reach a MAP of about 65 mm Hg when fluids alone have not restored perfusion. Dopamine causes more dysrhythmias, phenylephrine is not first-line, and dobutamine is an inotrope rather than a vasopressor.
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A patient pulled from a house fire has a headache, confusion and cherry-red lips. Pulse oximetry reads 99% on room air, but the carboxyhemoglobin level is 28%. Which statement BEST explains the pulse oximetry reading?Answer: AA standard two-wavelength pulse oximeter reads carboxyhemoglobin as if it were oxyhemoglobin, so SpO2 can look normal while oxygen delivery is badly impaired. The patient needs 100% oxygen, and a co-oximetry level guides treatment.
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Six hours after an intentional ingestion of a large amount of acetaminophen, a patient's drug level is above the treatment line on the nomogram. Liver enzymes are still normal. Which medication should the nurse anticipate?Answer: BAcetylcysteine restores glutathione and prevents liver injury from acetaminophen, and it works best when started within 8 to 10 hours of ingestion. Normal liver enzymes early on do not rule out later liver failure. Fomepizole is for toxic alcohols, and naloxone and flumazenil reverse opioids and benzodiazepines.
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A patient who took an unknown amount of amitriptyline has BP 78/44 mm Hg, HR 128 and a QRS duration of 0.14 seconds, and has just had a brief seizure. Which medication should the nurse anticipate?Answer: CTricyclic antidepressants block cardiac sodium channels and widen the QRS. Sodium bicarbonate supplies sodium and raises the pH, narrowing the QRS and treating hypotension. Physostigmine and flumazenil can provoke seizures and dysrhythmias in this overdose, and procainamide also blocks sodium channels.
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In the post-anesthesia unit, a patient who received a volatile anesthetic and succinylcholine develops jaw rigidity, HR 142 and an end-tidal CO2 that keeps rising despite increased ventilation. The temperature is climbing quickly. Which medication should the nurse anticipate FIRST?Answer: ARising end-tidal CO2 despite more ventilation, muscle rigidity, tachycardia and fever after a triggering agent are signs of malignant hyperthermia. Dantrolene stops the uncontrolled calcium release in skeletal muscle and is the specific treatment. Cyproheptadine is used for serotonin syndrome.
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A 70 kg patient with 40% total body surface area burns is in the first 24 hours of fluid resuscitation. Which parameter is the BEST guide for adjusting the fluid rate?Answer: CHourly urine output is the standard target for titrating burn resuscitation, with the rate adjusted up or down to avoid both under-resuscitation and the harms of excess fluid. CVP, hemoglobin and blood pressure alone are less reliable guides in burn shock.
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A ventilated patient with circumferential full-thickness burns of the chest has peak airway pressures that keep rising and delivered tidal volumes that are falling. Breath sounds are present and equal, and the tube is patent. Which intervention should the nurse anticipate?Answer: BRigid circumferential eschar on the chest restricts chest wall movement, raising airway pressures and limiting ventilation. Escharotomy releases the constriction. With equal breath sounds and a patent tube, airway causes are less likely, and more volume would only raise pressures further.
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A patient found on the floor after an unknown time has tea-colored urine, a creatine kinase of 48,000 units/L and a potassium of 5.9 mEq/L. Which intervention is the PRIORITY?Answer: AIn rhabdomyolysis, myoglobin can injure the kidneys, and early aggressive fluids dilute it and keep urine flowing, along with watching potassium closely. Diuretics before volume is restored can worsen kidney injury, and fluid restriction is the opposite of what is needed.
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An ICU patient has an ABG of pH 7.24, PaCO2 28 mm Hg and HCO3 12 mEq/L. Sodium is 138 mEq/L and chloride is 100 mEq/L. Which interpretation is correct?Answer: DThe low pH and low bicarbonate show metabolic acidosis, and the low PaCO2 is the expected respiratory compensation. The anion gap is 138 minus (100 plus 12), or 26, which is clearly high, pointing to causes such as lactic acidosis, ketoacidosis or toxic ingestion.
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A patient with end-stage lung cancer is receiving comfort-focused care. The patient has severe air hunger with a respiratory rate of 36 and is anxious. Which intervention is MOST appropriate?Answer: COpioids are the most effective drugs for dyspnea at the end of life and, titrated to symptom relief, are appropriate care. Intubation and lab tests do not fit comfort-focused goals, and withholding opioids leaves the patient suffering.
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A postpartum patient with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse finds the patellar reflexes absent and a respiratory rate of 10. Which action should the nurse take FIRST?Answer: DLost deep tendon reflexes and slowed breathing are signs of magnesium toxicity. The infusion must stop right away, and calcium gluconate is the antidote if breathing or cardiac function is compromised. Waiting for a level or only slowing the rate lets the toxicity progress.
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Minutes after an IV antibiotic is started, a patient develops hives, stridor and a BP of 74/40 mm Hg. The infusion has been stopped. Which medication should the nurse give FIRST?Answer: BEpinephrine is the first-line treatment for anaphylaxis; it reverses airway swelling, bronchospasm and vasodilation. Antihistamines and steroids are adjuncts that act too slowly and do not treat the airway or shock.
Keep practicing
Our Multisystem practice exam has 20 questions, the same share as the real exam, and the full practice exams mix all six areas into 125 scored questions with 83 to pass. Start from the home page.
Next, try the cardiovascular questions or the respiratory questions, or see the CCRN exam guide.
Pass the CCRN exam on your first try
- All 338 questions across every area of the 2025 Adult CCRN test plan
- A rationale for every answer, including why the tempting choice is wrong
- Unlimited full 125-question practice exams, scored like the real one (83 to pass)