Board Certified Nutrition Support
Pharmacist (BCNSP) Practice Exam
(Questions & Answers) Verified 100%
Correct!!
1. A 58-year-old patient receiving continuous enteral nutrition via a nasogastric tube
develops diarrhea, abdominal distension, and a serum osmolality of 285 mOsm/kg. The
formula is osmolarity 450 mOsm/L. What is the most likely cause?
A) Formula hyperosmolarity
B) Clostridioides difficile infection
C) Sorbitol-containing medications
D) Rapid infusion rate
Answer: C
Explanation: Sorbitol, often in liquid medications, acts as an osmotic laxative and
commonly causes diarrhea in enterally fed patients. Formula osmolarity 450 mOsm/L is
moderate and rarely causes osmotic diarrhea if infused appropriately. C. diff is possible
but less likely without recent antibiotics or specific risk factors. Rapid infusion might
cause dumping but less common with continuous feeds.
2. A patient on home parenteral nutrition (HPN) develops a bloodstream infection with
Candida glabrata. Which antifungal should be avoided due to resistance patterns?
A) Fluconazole
B) Micafungin
C) Caspofungin
D) Amphotericin B
Answer: A
,Explanation: Candida glabrata often has reduced susceptibility or resistance to
fluconazole. Echinocandins (micafungin, caspofungin) are first-line. Amphotericin B is
effective but more toxic.
3. A 45-year-old with short bowel syndrome on long-term PN has elevated serum
triglycerides (650 mg/dL). Which intervention is most effective?
A) Switch to olive oil-based lipid emulsion
B) Reduce IV lipid to 1 g/kg/week
C) Add carnitine supplement
D) Change to a higher dextrose concentration
Answer: B
Explanation: Lipid-induced hypertriglyceridemia responds best to reducing lipid dose
(≤1 g/kg/day or even weekly). Olive oil emulsions may help slightly but dose reduction
is key. Carnitine not proven.
4. Which trace element deficiency is most likely in a patient receiving long-term PN
without routine supplementation presenting with perioral and acral dermatitis, alopecia,
and diarrhea?
A) Selenium
B) Zinc
C) Copper
D) Chromium
Answer: B
Explanation: Severe zinc deficiency causes acrodermatitis enteropathica-like symptoms:
perioral, acral dermatitis, alopecia, diarrhea. Selenium deficiency causes cardiomyopathy;
,copper deficiency causes anemia/neutropenia; chromium deficiency causes glucose
intolerance.
5. A patient with renal failure on continuous venovenous hemofiltration (CVVH) receives
PN. Which electrolyte abnormality is most likely if standard electrolyte concentrations
are used without adjustment?
A) Hyperkalemia
B) Hypokalemia
C) Hyperphosphatemia
D) Hypomagnesemia
Answer: D
Explanation: CVVH removes magnesium, and standard PN typically contains minimal
magnesium (8-10 mEq/L), leading to hypomagnesemia. Hyperkalemia is less likely
because CVVH removes potassium efficiently.
6. Which laboratory finding is most consistent with refeeding syndrome?
A) Hyperphosphatemia, hypokalemia, hypermagnesemia
B) Hypophosphatemia, hypokalemia, hypomagnesemia
C) Hypophosphatemia, hyperkalemia, hypomagnesemia
D) Hyperphosphatemia, hyperkalemia, hypermagnesemia
Answer: B
Explanation: Refeeding syndrome is characterized by intracellular shifts of phosphate,
potassium, and magnesium upon carbohydrate load, causing hypophosphatemia,
hypokalemia, and hypomagnesemia.
, 7. A patient on exclusive PN develops metabolic acidosis with elevated serum chloride
and normal anion gap. What is the most likely cause?
A) Acetate deficiency in PN
B) Sulfur-containing amino acids in PN
C) High chloride content in PN
D) Lactic acidosis from thiamine deficiency
Answer: C
Explanation: High chloride content in PN can cause hyperchloremic non-anion gap
metabolic acidosis. Acetate (which is converted to bicarbonate) deficiency would worsen
acidosis, but high chloride is the direct cause.
8. Which medication is most appropriate for treating PN-associated cholestasis in a
neonate?
A) Ursodeoxycholic acid
B) Metronidazole
C) Rifampin
D) Cholestyramine
Answer: A
Explanation: Ursodeoxycholic acid improves bile flow and is used for PN-associated
cholestasis. Metronidazole may reduce bacterial overgrowth but not first-line.
Cholestyramine for pruritus.
9. A patient with a high-output jejunostomy (output 3 L/day) is on PN. What IV fluid
composition best matches losses?
A) 0.9% sodium chloride with 20 mEq/L potassium
B) Lactated Ringer’s solution
Pharmacist (BCNSP) Practice Exam
(Questions & Answers) Verified 100%
Correct!!
1. A 58-year-old patient receiving continuous enteral nutrition via a nasogastric tube
develops diarrhea, abdominal distension, and a serum osmolality of 285 mOsm/kg. The
formula is osmolarity 450 mOsm/L. What is the most likely cause?
A) Formula hyperosmolarity
B) Clostridioides difficile infection
C) Sorbitol-containing medications
D) Rapid infusion rate
Answer: C
Explanation: Sorbitol, often in liquid medications, acts as an osmotic laxative and
commonly causes diarrhea in enterally fed patients. Formula osmolarity 450 mOsm/L is
moderate and rarely causes osmotic diarrhea if infused appropriately. C. diff is possible
but less likely without recent antibiotics or specific risk factors. Rapid infusion might
cause dumping but less common with continuous feeds.
2. A patient on home parenteral nutrition (HPN) develops a bloodstream infection with
Candida glabrata. Which antifungal should be avoided due to resistance patterns?
A) Fluconazole
B) Micafungin
C) Caspofungin
D) Amphotericin B
Answer: A
,Explanation: Candida glabrata often has reduced susceptibility or resistance to
fluconazole. Echinocandins (micafungin, caspofungin) are first-line. Amphotericin B is
effective but more toxic.
3. A 45-year-old with short bowel syndrome on long-term PN has elevated serum
triglycerides (650 mg/dL). Which intervention is most effective?
A) Switch to olive oil-based lipid emulsion
B) Reduce IV lipid to 1 g/kg/week
C) Add carnitine supplement
D) Change to a higher dextrose concentration
Answer: B
Explanation: Lipid-induced hypertriglyceridemia responds best to reducing lipid dose
(≤1 g/kg/day or even weekly). Olive oil emulsions may help slightly but dose reduction
is key. Carnitine not proven.
4. Which trace element deficiency is most likely in a patient receiving long-term PN
without routine supplementation presenting with perioral and acral dermatitis, alopecia,
and diarrhea?
A) Selenium
B) Zinc
C) Copper
D) Chromium
Answer: B
Explanation: Severe zinc deficiency causes acrodermatitis enteropathica-like symptoms:
perioral, acral dermatitis, alopecia, diarrhea. Selenium deficiency causes cardiomyopathy;
,copper deficiency causes anemia/neutropenia; chromium deficiency causes glucose
intolerance.
5. A patient with renal failure on continuous venovenous hemofiltration (CVVH) receives
PN. Which electrolyte abnormality is most likely if standard electrolyte concentrations
are used without adjustment?
A) Hyperkalemia
B) Hypokalemia
C) Hyperphosphatemia
D) Hypomagnesemia
Answer: D
Explanation: CVVH removes magnesium, and standard PN typically contains minimal
magnesium (8-10 mEq/L), leading to hypomagnesemia. Hyperkalemia is less likely
because CVVH removes potassium efficiently.
6. Which laboratory finding is most consistent with refeeding syndrome?
A) Hyperphosphatemia, hypokalemia, hypermagnesemia
B) Hypophosphatemia, hypokalemia, hypomagnesemia
C) Hypophosphatemia, hyperkalemia, hypomagnesemia
D) Hyperphosphatemia, hyperkalemia, hypermagnesemia
Answer: B
Explanation: Refeeding syndrome is characterized by intracellular shifts of phosphate,
potassium, and magnesium upon carbohydrate load, causing hypophosphatemia,
hypokalemia, and hypomagnesemia.
, 7. A patient on exclusive PN develops metabolic acidosis with elevated serum chloride
and normal anion gap. What is the most likely cause?
A) Acetate deficiency in PN
B) Sulfur-containing amino acids in PN
C) High chloride content in PN
D) Lactic acidosis from thiamine deficiency
Answer: C
Explanation: High chloride content in PN can cause hyperchloremic non-anion gap
metabolic acidosis. Acetate (which is converted to bicarbonate) deficiency would worsen
acidosis, but high chloride is the direct cause.
8. Which medication is most appropriate for treating PN-associated cholestasis in a
neonate?
A) Ursodeoxycholic acid
B) Metronidazole
C) Rifampin
D) Cholestyramine
Answer: A
Explanation: Ursodeoxycholic acid improves bile flow and is used for PN-associated
cholestasis. Metronidazole may reduce bacterial overgrowth but not first-line.
Cholestyramine for pruritus.
9. A patient with a high-output jejunostomy (output 3 L/day) is on PN. What IV fluid
composition best matches losses?
A) 0.9% sodium chloride with 20 mEq/L potassium
B) Lactated Ringer’s solution
