NANP | NATIONAL ASSOCIATION OF NUTRITION PROFESSIONALS
CNT Written Exam
Certified Nutrition Therapist
Official Practice Exam · 2026/2027 Edition
Questions: 100 Time: 90 Minutes Passing Score: 80% Recertification: Biennial
Table of Contents
Nutrition Science & Macronutrient Metabolism (Questions 1-22)
Micronutrients & Nutritional Biochemistry (Questions 23-44)
Medical Nutrition Therapy (Questions 45-66)
Nutrition Assessment & Counseling (Questions 67-84)
Professional Practice & Ethics (Questions 85-102)
Instructions
This practice exam contains 100 multiple-choice questions divided into five sections. You have 90 minutes to
complete the exam. A score of 80% or higher (80 out of 100 correct) is required to pass. Each question has four
answer choices (A through D). Select the single best answer for each question. Read each scenario carefully
before selecting your response. Review the rationale provided after each answer to reinforce your understanding of
nutrition science, medical nutrition therapy, and professional practice.
Exam Content Areas:
Section 1: Nutrition Science & Macronutrient Metabolism - 22 questions (22%)
Section 2: Micronutrients & Nutritional Biochemistry - 22 questions (22%)
Section 3: Medical Nutrition Therapy - 22 questions (22%)
Section 4: Nutrition Assessment & Counseling - 18 questions (18%)
Section 5: Professional Practice & Ethics - 18 questions (18%)
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 1
,Section 1: Nutrition Science & Macronutrient Metabolism | 2026/2027
Q1. Question 1 of 100
Q1. A 35-year-old male athlete consults a nutrition therapist about optimizing his dietary protein intake to support
muscle recovery after intense training sessions. He currently weighs 80 kg and exercises vigorously for 2 hours daily.
The nutrition therapist explains that the Recommended Dietary Allowance for protein does not account for increased
athletic demands. What is the recommended protein intake range for this athlete to support muscle repair and
growth?
A. 0.8 grams per kilogram of body weight per day, which meets the general adult RDA for sedentary individuals
B. 1.2 to 2.0 grams per kilogram of body weight per day, depending on the type and intensity of physical training
C. 2.5 to 3.5 grams per kilogram of body weight per day, which is necessary for all competitive athletes regardless of sport
D. 0.5 to 0.7 grams per kilogram of body weight per day, since exercise improves protein utilization efficiency
Correct Answer: B
Rationale:
Athletes engaged in vigorous training require 1.2-2.0 g/kg/day of protein to support muscle protein synthesis and recovery, which is
significantly higher than the sedentary RDA of 0.8 g/kg/day. Option A reflects the sedentary adult recommendation, and Option C
exceeds evidence-based upper limits for protein intake.
Q2. Question 2 of 100
Q2. A 42-year-old woman with a BMI of 32 is started on a low-carbohydrate diet that restricts carbohydrate intake to
less than 50 grams per day. After one week, she reports fatigue, headache, and irritability. The nutrition therapist
recognizes these as symptoms of the metabolic transition to ketosis. What biochemical process primarily accounts for
the initial rapid weight loss during the first week of a very-low-carbohydrate diet?
A. Depletion of glycogen stores with associated water loss, since each gram of glycogen is stored with
approximately 3 grams of water
B. Rapid breakdown of adipose tissue triglycerides into free fatty acids and glycerol for immediate energy production
C. Increased thermic effect of food from higher protein intake leading to greater caloric expenditure per meal consumed
D. Suppression of insulin secretion causing the kidneys to excrete excess sodium and fluid through the urine
Correct Answer: A
Rationale:
The initial rapid weight loss on a very-low-carbohydrate diet is primarily due to glycogen depletion and its associated water loss, as each
gram of glycogen is stored with approximately 3 grams of water. Option D describes a secondary mechanism, while Option B occurs
later and at a slower rate than the initial glycogen-water loss.
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 2
,Q3. Question 3 of 100
Q3. A 28-year-old female following a strict vegan diet for three years presents with fatigue, pallor, and numbness in
her extremities. Laboratory tests reveal a hemoglobin of 9.2 g/dL and a methylmalonic acid level of 500 nmol/L. The
nutrition therapist suspects a vitamin B12 deficiency. What is the primary reason vitamin B12 deficiency develops in
long-term vegans?
A. Vitamin B12 is exclusively found in animal-derived foods, and plant sources do not provide bioavailable
cobalamin without fortification
B. Vegan diets contain high levels of folate that mask the hematologic symptoms of vitamin B12 deficiency indefinitely
C. Plant-based diets increase intestinal bacterial overgrowth that competes for and consumes dietary vitamin B12 before
absorption
D. Vegans have impaired intrinsic factor production due to the absence of animal protein stimulation in the stomach
Correct Answer: A
Rationale:
Vitamin B12 (cobalamin) is exclusively found in animal-derived foods; plants do not produce bioavailable B12, making supplementation
or fortified foods essential for vegans. Option B is incorrect because while folate can mask hematologic symptoms, it does not prevent
the neurologic damage from B12 deficiency.
Q4. Question 4 of 100
Q4. A 55-year-old man with type 2 diabetes asks the nutrition therapist about the glycemic index of various foods. He
wants to understand how different carbohydrates affect his blood glucose levels. The nutrition therapist explains that
the glycemic index ranks carbohydrate-containing foods based on their effect on blood glucose. What food has the
highest glycemic index among the common dietary staples?
A. White bread made from refined wheat flour with a glycemic index of approximately 70 to 75
B. White rice with a glycemic index of approximately 73, which causes rapid glucose absorption
C. Baked potato with a glycemic index of approximately 85, causing the most rapid rise in blood glucose
D. Lentils and legumes with a glycemic index of approximately 30, providing slow and sustained glucose release
Correct Answer: C
Rationale:
Among common dietary staples, baked potatoes have one of the highest glycemic indices at approximately 85, causing a rapid rise in
blood glucose compared to white bread (70-75) and white rice (73). Option D describes low-glycemic foods that would be recommended
for glycemic control, not the highest GI food.
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 3
, Q5. Question 5 of 100
Q5. A 30-year-old pregnant woman in her second trimester asks the nutrition therapist about essential fatty acid
requirements during pregnancy. She is concerned about getting enough DHA for fetal brain development. The
nutrition therapist explains the role of omega-3 fatty acids. What is the recommended daily intake of DHA during
pregnancy?
A. At least 200 milligrams of DHA per day to support fetal brain and retinal development throughout pregnancy
B. At least 1000 milligrams of DHA per day to ensure maximum neurodevelopmental benefits for the growing fetus
C. No specific DHA requirement exists because the mother can synthesize sufficient amounts from alpha-linolenic acid
D. At least 50 milligrams of DHA per day, which is sufficient given the enhanced conversion efficiency during pregnancy
Correct Answer: A
Rationale:
The recommended DHA intake during pregnancy is at least 200 mg per day to support fetal brain and retinal development, as the
conversion of ALA to DHA is limited in humans. Option C is incorrect because the conversion rate of ALA to DHA is only about 1-5
percent, insufficient to meet pregnancy demands.
Q6. Question 6 of 100
Q6. A 45-year-old patient with chronic pancreatitis is being counseled about dietary fat modification. The nutrition
therapist recommends medium-chain triglycerides as an alternative fat source. What is the primary advantage of
MCTs over long-chain triglycerides for patients with pancreatic insufficiency?
A. MCTs are absorbed directly into the portal circulation without requiring bile salts or pancreatic lipase for
digestion
B. MCTs are transported through the lymphatic system more efficiently than long-chain triglycerides after micelle formation
C. MCTs require pancreatic lipase but bypass the need for bile salt emulsification in the small intestine lumen
D. MCTs are broken down into short-chain fatty acids that are absorbed through passive diffusion in the stomach
Correct Answer: A
Rationale:
MCTs are absorbed directly into the portal circulation without requiring bile salts, pancreatic lipase, or chylomicron formation, making
them ideal for patients with pancreatic insufficiency. Option B is incorrect because MCTs bypass the lymphatic system entirely, and
Option D incorrectly describes the site and mechanism of absorption.
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 4
CNT Written Exam
Certified Nutrition Therapist
Official Practice Exam · 2026/2027 Edition
Questions: 100 Time: 90 Minutes Passing Score: 80% Recertification: Biennial
Table of Contents
Nutrition Science & Macronutrient Metabolism (Questions 1-22)
Micronutrients & Nutritional Biochemistry (Questions 23-44)
Medical Nutrition Therapy (Questions 45-66)
Nutrition Assessment & Counseling (Questions 67-84)
Professional Practice & Ethics (Questions 85-102)
Instructions
This practice exam contains 100 multiple-choice questions divided into five sections. You have 90 minutes to
complete the exam. A score of 80% or higher (80 out of 100 correct) is required to pass. Each question has four
answer choices (A through D). Select the single best answer for each question. Read each scenario carefully
before selecting your response. Review the rationale provided after each answer to reinforce your understanding of
nutrition science, medical nutrition therapy, and professional practice.
Exam Content Areas:
Section 1: Nutrition Science & Macronutrient Metabolism - 22 questions (22%)
Section 2: Micronutrients & Nutritional Biochemistry - 22 questions (22%)
Section 3: Medical Nutrition Therapy - 22 questions (22%)
Section 4: Nutrition Assessment & Counseling - 18 questions (18%)
Section 5: Professional Practice & Ethics - 18 questions (18%)
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 1
,Section 1: Nutrition Science & Macronutrient Metabolism | 2026/2027
Q1. Question 1 of 100
Q1. A 35-year-old male athlete consults a nutrition therapist about optimizing his dietary protein intake to support
muscle recovery after intense training sessions. He currently weighs 80 kg and exercises vigorously for 2 hours daily.
The nutrition therapist explains that the Recommended Dietary Allowance for protein does not account for increased
athletic demands. What is the recommended protein intake range for this athlete to support muscle repair and
growth?
A. 0.8 grams per kilogram of body weight per day, which meets the general adult RDA for sedentary individuals
B. 1.2 to 2.0 grams per kilogram of body weight per day, depending on the type and intensity of physical training
C. 2.5 to 3.5 grams per kilogram of body weight per day, which is necessary for all competitive athletes regardless of sport
D. 0.5 to 0.7 grams per kilogram of body weight per day, since exercise improves protein utilization efficiency
Correct Answer: B
Rationale:
Athletes engaged in vigorous training require 1.2-2.0 g/kg/day of protein to support muscle protein synthesis and recovery, which is
significantly higher than the sedentary RDA of 0.8 g/kg/day. Option A reflects the sedentary adult recommendation, and Option C
exceeds evidence-based upper limits for protein intake.
Q2. Question 2 of 100
Q2. A 42-year-old woman with a BMI of 32 is started on a low-carbohydrate diet that restricts carbohydrate intake to
less than 50 grams per day. After one week, she reports fatigue, headache, and irritability. The nutrition therapist
recognizes these as symptoms of the metabolic transition to ketosis. What biochemical process primarily accounts for
the initial rapid weight loss during the first week of a very-low-carbohydrate diet?
A. Depletion of glycogen stores with associated water loss, since each gram of glycogen is stored with
approximately 3 grams of water
B. Rapid breakdown of adipose tissue triglycerides into free fatty acids and glycerol for immediate energy production
C. Increased thermic effect of food from higher protein intake leading to greater caloric expenditure per meal consumed
D. Suppression of insulin secretion causing the kidneys to excrete excess sodium and fluid through the urine
Correct Answer: A
Rationale:
The initial rapid weight loss on a very-low-carbohydrate diet is primarily due to glycogen depletion and its associated water loss, as each
gram of glycogen is stored with approximately 3 grams of water. Option D describes a secondary mechanism, while Option B occurs
later and at a slower rate than the initial glycogen-water loss.
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 2
,Q3. Question 3 of 100
Q3. A 28-year-old female following a strict vegan diet for three years presents with fatigue, pallor, and numbness in
her extremities. Laboratory tests reveal a hemoglobin of 9.2 g/dL and a methylmalonic acid level of 500 nmol/L. The
nutrition therapist suspects a vitamin B12 deficiency. What is the primary reason vitamin B12 deficiency develops in
long-term vegans?
A. Vitamin B12 is exclusively found in animal-derived foods, and plant sources do not provide bioavailable
cobalamin without fortification
B. Vegan diets contain high levels of folate that mask the hematologic symptoms of vitamin B12 deficiency indefinitely
C. Plant-based diets increase intestinal bacterial overgrowth that competes for and consumes dietary vitamin B12 before
absorption
D. Vegans have impaired intrinsic factor production due to the absence of animal protein stimulation in the stomach
Correct Answer: A
Rationale:
Vitamin B12 (cobalamin) is exclusively found in animal-derived foods; plants do not produce bioavailable B12, making supplementation
or fortified foods essential for vegans. Option B is incorrect because while folate can mask hematologic symptoms, it does not prevent
the neurologic damage from B12 deficiency.
Q4. Question 4 of 100
Q4. A 55-year-old man with type 2 diabetes asks the nutrition therapist about the glycemic index of various foods. He
wants to understand how different carbohydrates affect his blood glucose levels. The nutrition therapist explains that
the glycemic index ranks carbohydrate-containing foods based on their effect on blood glucose. What food has the
highest glycemic index among the common dietary staples?
A. White bread made from refined wheat flour with a glycemic index of approximately 70 to 75
B. White rice with a glycemic index of approximately 73, which causes rapid glucose absorption
C. Baked potato with a glycemic index of approximately 85, causing the most rapid rise in blood glucose
D. Lentils and legumes with a glycemic index of approximately 30, providing slow and sustained glucose release
Correct Answer: C
Rationale:
Among common dietary staples, baked potatoes have one of the highest glycemic indices at approximately 85, causing a rapid rise in
blood glucose compared to white bread (70-75) and white rice (73). Option D describes low-glycemic foods that would be recommended
for glycemic control, not the highest GI food.
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 3
, Q5. Question 5 of 100
Q5. A 30-year-old pregnant woman in her second trimester asks the nutrition therapist about essential fatty acid
requirements during pregnancy. She is concerned about getting enough DHA for fetal brain development. The
nutrition therapist explains the role of omega-3 fatty acids. What is the recommended daily intake of DHA during
pregnancy?
A. At least 200 milligrams of DHA per day to support fetal brain and retinal development throughout pregnancy
B. At least 1000 milligrams of DHA per day to ensure maximum neurodevelopmental benefits for the growing fetus
C. No specific DHA requirement exists because the mother can synthesize sufficient amounts from alpha-linolenic acid
D. At least 50 milligrams of DHA per day, which is sufficient given the enhanced conversion efficiency during pregnancy
Correct Answer: A
Rationale:
The recommended DHA intake during pregnancy is at least 200 mg per day to support fetal brain and retinal development, as the
conversion of ALA to DHA is limited in humans. Option C is incorrect because the conversion rate of ALA to DHA is only about 1-5
percent, insufficient to meet pregnancy demands.
Q6. Question 6 of 100
Q6. A 45-year-old patient with chronic pancreatitis is being counseled about dietary fat modification. The nutrition
therapist recommends medium-chain triglycerides as an alternative fat source. What is the primary advantage of
MCTs over long-chain triglycerides for patients with pancreatic insufficiency?
A. MCTs are absorbed directly into the portal circulation without requiring bile salts or pancreatic lipase for
digestion
B. MCTs are transported through the lymphatic system more efficiently than long-chain triglycerides after micelle formation
C. MCTs require pancreatic lipase but bypass the need for bile salt emulsification in the small intestine lumen
D. MCTs are broken down into short-chain fatty acids that are absorbed through passive diffusion in the stomach
Correct Answer: A
Rationale:
MCTs are absorbed directly into the portal circulation without requiring bile salts, pancreatic lipase, or chylomicron formation, making
them ideal for patients with pancreatic insufficiency. Option B is incorrect because MCTs bypass the lymphatic system entirely, and
Option D incorrectly describes the site and mechanism of absorption.
CNT Written Exam -- 2026/2027 | Passing Score: 80% | Page 4
