CNSC COMPREHENSIVE EXAMS LATEST QUESTIONS
AND ANSWERS SURE A+
✔✔In a 100 kg afebrile person with intact skin, insensible fluid loss from lungs and skin
is approximately
1: 500 mL/day.
2: 800 mL/day.
3: 1000 mL/day.
4: 1200 mL/day. - ✔✔3: 1000 mL/day.
✔✔An 87-year-old woman underwent a total abdominal colectomy. Her ileostomy
output is 1.5-2.0 liters per day. Supplementation of which of the following micronutrients
should be considered?
1: Zinc
2: Copper
3: Vitamin E
4: Chromium - ✔✔Older adult patients are at an increased risk of zinc deficiency at
baseline primarily due to decreased intake and absorption. The management of high
output ileostomy (>1 L/d) should include fluid replacement that approximates the
,electrolyte composition of ileal fluid. The insult of recent surgery and the patient's output
losses via her ostomy will increase her risk of zinc deficiency.
✔✔A decrease in food intake in older adults is most likely attributable to
1: decreased taste and flavor sensations.
2: age-related decreases in stomach capacity.
3: fear of stool or flatus incontinence.
4: enhanced olfaction sensation. - ✔✔1: decreased taste and flavor sensations.
✔✔A 68 year old woman with a history of cirrhosis is receiving enteral nutrition due to
recent gastrointestinal surgery. She has worsening hepatic encephalopathy. Which of
the following should be tried first?
1: Decrease in protein provision to 0.6 g/kg/d
2: Formula high in medium chain triglyceride content
3: Formula enriched with branched-chain amino acids
4: Lactulose and rifaximin therapy - ✔✔4: Lactulose and rifaximin therapy
A temporary protein restriction (0.6-0.8 g protein/kg/d) may be indicated if the patient
fails to respond to medical management or until the cause of encephalopathy can be
identified and eliminated.
✔✔An 80 year old man, living alone at home, has experienced a 15 lb unintentional
weight loss over the last year and a half. The clinician assessing his nutrition status
finds that he has inadequate intake. Which of the following is LEAST likely to contribute
to his weight loss?
1: Decreased taste sensation
2: Social isolation
3: Food sensitivities
4: Polypharmacy - ✔✔3: Food sensitivities
✔✔Copper deficiency is associated with
1: leukocytosis.
2: macrocytic anemia.
3: microcytic hypochromic anemia.
4: erythrocytosis. - ✔✔3: microcytic hypochromic anemia.
,Other symptoms of copper deficiency include: sensory ataxia, lower extremity spasticity,
parathesis in extremities, leukopenia, neutropenia, hypercholesterolemia, increased
erythrocyte turnover, decreased ceruloplasmin and erythrocyte copper/zinc superoxide
dismutase (SOD), abnormal EKG patterns, myeloneuropathy.
✔✔A patient receiving PN has high ileostomy output. Which of the following changes to
the PN prescription is most appropriate to recommend?
1: increase sodium and increase fluid volume.
2: decrease water and decrease sodium.
3: increase sodium and decrease protein.
4: decrease sodium and increase fluid volume. - ✔✔1: increase sodium and increase
fluid volume.
✔✔Which of the following is a clinical characteristic of acute disease or injury related
severe malnutrition?
1: Moderate depletion of body fat
2: Mild fluid accumulation
3: Mild depletion of muscle mass
4: 10% weight loss in 6 months - ✔✔1: Moderate depletion of body fat
✔✔Which of the following conditions are most likely to result in malnutrition of mild to
moderate inflammatory response?
1: Anorexia Nervosa
2: Cancer
3: Closed Head Injury
4: Sepsis - ✔✔2: Cancer
✔✔Which of the following is most suggestive of malnutrition?
1: 10th percentile of tricep skinfold thickness
2: Voluntary body mass index change from 30 to 25 over 6 months
3: Involuntary weight loss of 10% usual body weight over six months
4: Albumin decrease from 4.0 to 3.5 - ✔✔3: Involuntary weight loss of 10% usual body
weight over six months
✔✔When conducting a nutrition focused physical exam (NFPE), which of the following
is an indicator of severe muscle loss?
, 1: Hollowing depression of the temporalis muscle
2: Rounded curves at the arm and shoulder
3: Slightly depressed interosseous muscle
4: Somewhat prominent iliac crest - ✔✔1: Hollowing depression of the temporalis
muscle
✔✔Which of the following is common in both acute illness or injury-related and social or
environmental related malnutrition?
1: Ketosis
2: Hypoglycemia
3: Lipolysis
4: Hypermetabolism - ✔✔Catabolism of endogenous substrate including fat stored in
adipose tissue (lipolysis) is common in both forms of malnutrition. Hypoglycemia and
ketosis are characteristic of starvation. Hypermetabolism and hyperglycemia are
characteristic of stress-related malnutrition.
✔✔Which of the following nutrition assessment tools includes evaluating subcutaneous
fat and muscle wasting at multiple body sites to determine nutritional status?
1: Nutritional risk index (NRI)
2: Prognostic nutrition index (PNI)
3: Subjective Global Assessment (SGA)
4: Prognostic inflammatory and nutritional index (PINI) - ✔✔3: Subjective Global
Assessment (SGA)
✔✔The subjective global assessment uses which of the following to evaluate the
nutritional status of patients?
1: Dietary intake, delayed hypersensitivity skin testing, and weight history
2: Weight history, dietary intake, and gastrointestinal symptoms
3: Laboratory indices, weight history, and gastrointestinal symptoms
4: Arm anthropometry, dietary intake, and laboratory indices - ✔✔2: Weight history,
dietary intake, and gastrointestinal symptoms
✔✔Which of the following has been reported to be a significant independent predictor of
morbidity and mortality in critically ill patients?
1: Albumin
2: Prealbumin
AND ANSWERS SURE A+
✔✔In a 100 kg afebrile person with intact skin, insensible fluid loss from lungs and skin
is approximately
1: 500 mL/day.
2: 800 mL/day.
3: 1000 mL/day.
4: 1200 mL/day. - ✔✔3: 1000 mL/day.
✔✔An 87-year-old woman underwent a total abdominal colectomy. Her ileostomy
output is 1.5-2.0 liters per day. Supplementation of which of the following micronutrients
should be considered?
1: Zinc
2: Copper
3: Vitamin E
4: Chromium - ✔✔Older adult patients are at an increased risk of zinc deficiency at
baseline primarily due to decreased intake and absorption. The management of high
output ileostomy (>1 L/d) should include fluid replacement that approximates the
,electrolyte composition of ileal fluid. The insult of recent surgery and the patient's output
losses via her ostomy will increase her risk of zinc deficiency.
✔✔A decrease in food intake in older adults is most likely attributable to
1: decreased taste and flavor sensations.
2: age-related decreases in stomach capacity.
3: fear of stool or flatus incontinence.
4: enhanced olfaction sensation. - ✔✔1: decreased taste and flavor sensations.
✔✔A 68 year old woman with a history of cirrhosis is receiving enteral nutrition due to
recent gastrointestinal surgery. She has worsening hepatic encephalopathy. Which of
the following should be tried first?
1: Decrease in protein provision to 0.6 g/kg/d
2: Formula high in medium chain triglyceride content
3: Formula enriched with branched-chain amino acids
4: Lactulose and rifaximin therapy - ✔✔4: Lactulose and rifaximin therapy
A temporary protein restriction (0.6-0.8 g protein/kg/d) may be indicated if the patient
fails to respond to medical management or until the cause of encephalopathy can be
identified and eliminated.
✔✔An 80 year old man, living alone at home, has experienced a 15 lb unintentional
weight loss over the last year and a half. The clinician assessing his nutrition status
finds that he has inadequate intake. Which of the following is LEAST likely to contribute
to his weight loss?
1: Decreased taste sensation
2: Social isolation
3: Food sensitivities
4: Polypharmacy - ✔✔3: Food sensitivities
✔✔Copper deficiency is associated with
1: leukocytosis.
2: macrocytic anemia.
3: microcytic hypochromic anemia.
4: erythrocytosis. - ✔✔3: microcytic hypochromic anemia.
,Other symptoms of copper deficiency include: sensory ataxia, lower extremity spasticity,
parathesis in extremities, leukopenia, neutropenia, hypercholesterolemia, increased
erythrocyte turnover, decreased ceruloplasmin and erythrocyte copper/zinc superoxide
dismutase (SOD), abnormal EKG patterns, myeloneuropathy.
✔✔A patient receiving PN has high ileostomy output. Which of the following changes to
the PN prescription is most appropriate to recommend?
1: increase sodium and increase fluid volume.
2: decrease water and decrease sodium.
3: increase sodium and decrease protein.
4: decrease sodium and increase fluid volume. - ✔✔1: increase sodium and increase
fluid volume.
✔✔Which of the following is a clinical characteristic of acute disease or injury related
severe malnutrition?
1: Moderate depletion of body fat
2: Mild fluid accumulation
3: Mild depletion of muscle mass
4: 10% weight loss in 6 months - ✔✔1: Moderate depletion of body fat
✔✔Which of the following conditions are most likely to result in malnutrition of mild to
moderate inflammatory response?
1: Anorexia Nervosa
2: Cancer
3: Closed Head Injury
4: Sepsis - ✔✔2: Cancer
✔✔Which of the following is most suggestive of malnutrition?
1: 10th percentile of tricep skinfold thickness
2: Voluntary body mass index change from 30 to 25 over 6 months
3: Involuntary weight loss of 10% usual body weight over six months
4: Albumin decrease from 4.0 to 3.5 - ✔✔3: Involuntary weight loss of 10% usual body
weight over six months
✔✔When conducting a nutrition focused physical exam (NFPE), which of the following
is an indicator of severe muscle loss?
, 1: Hollowing depression of the temporalis muscle
2: Rounded curves at the arm and shoulder
3: Slightly depressed interosseous muscle
4: Somewhat prominent iliac crest - ✔✔1: Hollowing depression of the temporalis
muscle
✔✔Which of the following is common in both acute illness or injury-related and social or
environmental related malnutrition?
1: Ketosis
2: Hypoglycemia
3: Lipolysis
4: Hypermetabolism - ✔✔Catabolism of endogenous substrate including fat stored in
adipose tissue (lipolysis) is common in both forms of malnutrition. Hypoglycemia and
ketosis are characteristic of starvation. Hypermetabolism and hyperglycemia are
characteristic of stress-related malnutrition.
✔✔Which of the following nutrition assessment tools includes evaluating subcutaneous
fat and muscle wasting at multiple body sites to determine nutritional status?
1: Nutritional risk index (NRI)
2: Prognostic nutrition index (PNI)
3: Subjective Global Assessment (SGA)
4: Prognostic inflammatory and nutritional index (PINI) - ✔✔3: Subjective Global
Assessment (SGA)
✔✔The subjective global assessment uses which of the following to evaluate the
nutritional status of patients?
1: Dietary intake, delayed hypersensitivity skin testing, and weight history
2: Weight history, dietary intake, and gastrointestinal symptoms
3: Laboratory indices, weight history, and gastrointestinal symptoms
4: Arm anthropometry, dietary intake, and laboratory indices - ✔✔2: Weight history,
dietary intake, and gastrointestinal symptoms
✔✔Which of the following has been reported to be a significant independent predictor of
morbidity and mortality in critically ill patients?
1: Albumin
2: Prealbumin
