Board Certified Nutrition Support Pharmacist (BCNSP) Practice Exam | Questions and Answers | 2026 Update | 100% Correct

1. A 58-year-old male with short bowel syndrome is on home parenteral nutrition (PN) receiving 2500 mL of a 2-in-1 solution daily. His serum triglycerides are 650 mg/dL. Which change is most appropriate? A. Switch to olive oil-based lipid emulsion B. Add carnitine 500 mg/day C. Reduce dextrose concentration by 20% D. Administer lipid emulsion three times per week Answer: D – Hypertriglyceridemia on PN often responds to reduced lipid frequency. Giving lipids 3 times weekly lowers daily lipid load. Olive oil-based lipids may help but not as first-line without frequency reduction. Carnitine lacks strong evidence. Reducing dextrose may help but lipids are the direct cause. 2. Which laboratory value best reflects short-term protein status in a critically ill patient receiving enteral nutrition? A. Serum albumin B. Prealbumin C. Retinol-binding protein D. C-reactive protein (CRP) Answer: B – Prealbumin has a half-life of 2–3 days, making it a good short-term marker. Albumin half-life is ~21 days, too long. Retinol-binding protein is even shorter (12 hr) but less used clinically. CRP reflects inflammation, not nutrition.3. A patient on continuous PN develops hepatobiliary complications. Which intervention is most likely to prevent or reverse PN-associated liver disease? A. Increase lipid dose to 2.5 g/kg/day B. Use cyclic PN (infuse over 12 hours) C. Add carnitine 1 g daily D. Switch to a high-dextrose, low-lipid formula Answer: B – Cyclic PN reduces continuous hepatic exposure to nutrients, improves bile flow, and lowers risk of steatosis and cholestasis. Increasing lipids worsens steatosis. Carnitine is unproven. High dextrose may increase liver fat. 4. Which electrolyte abnormality is most commonly associated with refeeding syndrome? A. Hyperphosphatemia B. Hypophosphatemia C. Hypermagnesemia D. Hyperkalemia Answer: B – Refeeding syndrome causes severe hypophosphatemia due to intracellular shift during carbohydrate loading. The others are not characteristic; in fact, hypokalemia and hypomagnesemia also occur. 5. A patient requires 1800 kcal/day via enteral tube feeding. You choose a formula with 1.5 kcal/mL. What flow rate is needed for continuous infusion over 24 hours? A. 30 mL/hr B. 40 mL/hrC. 50 mL/hr D. 60 mL/hr Answer: C – 1800 kcal ÷ 1.5 kcal/mL = 1200 mL total. 1200 mL/24 hr = 50 mL/hr. 6. Which trace element deficiency causes a scaly dermatitis, alopecia, and diarrhea that is reversible with supplementation? A. Copper B. Selenium C. Zinc D. Chromium Answer: C – Zinc deficiency classic triad: dermatitis (periorificial), alopecia, diarrhea. Copper deficiency causes anemia and neutropenia. Selenium deficiency causes cardiomyopathy. Chromium deficiency causes glucose intolerance. 7. In central parenteral nutrition, the maximum final concentration of dextrose recommended for peripheral administration is: A. 5% B. 10% C. 12.5% D. 20% Answer: B – Peripheral PN is limited to ≤10% dextrose and ≤5% amino acids due to osmolarity; central PN can go up to 25–35% dextrose. 12.5% or higher requires central line.8. Which of the following is NOT a standard component of a PN admixture stability evaluation? A. Visual inspection for precipitation B. pH measurement C. Zeta potential analysis D. Osmolality testing Answer: C – Zeta potential is used in research for emulsion stability, not routine clinical compounding. Visual inspection, pH, and osmolality are standard. 9. A patient with renal failure on continuous venovenous hemofiltration (CVVH) receiving PN requires protein supplementation. How much protein (g/kg/day) is typically recommended? A. 0.8–1.0 B. 1.0–1.2 C. 1.5–2.5 D. 3.0–3.5 Answer: C – CVVH causes protein losses; guidelines recommend 1.5–2.5 g/kg/day. Lower amounts insufficient. 3.0+ may be excessive except in hypercatabolic states. 10. A patient on warfarin is started on enteral nutrition containing 200 mcg of vitamin K per liter. The patient receives 1.5 L/day. What is the most appropriate action? A. Stop warfarin immediately B. Increase warfarin dose empirically C. Monitor INR and adjust warfarin as neededD. Switch to a vitamin K-free formula Answer: C – 300 mcg vitamin K/day may interfere with warfarin. The best approach is monitoring INR and adjusting dose. Vitamin K-free formulas exist but not always necessary if monitoring is done. 11. Which of the following is the primary energy substrate in most standard parenteral nutrition formulations? A. Lipids B. Amino acids C. Dextrose D. Glycerol Answer: C – Dextrose provides 3.4 kcal/g and is the main caloric source in PN (except in high-lipid formulations). Lipids are 2nd. Amino acids used for protein, not primary energy.