ASPEN Self-Study CNSC Exam 2025–2026
Accurate Real Exam Questions and Verified
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A patient in your intensive care unit has severe diarrhea secondary to clostridium difficile toxin.
Which of the following acid-base disorders is likely to occur?
1. metabolic acidosis
2. metabolic alkalosis
3. respiratory acidosis
4. respiratory alkalosis - answer>>>1. metabolic acidosis
What metabolic disturbance does diarrhea lead to and why? - answer>>>Diarrhea induces
gastrointestinal losses of bicarbonate and can cause a metabolic acidosis (normal anion gap)
Metastatic calcification is a complication of
1. hyperkalemia
2. hypokalemia
3. hyperphosphatemia
4. hypophosphatemia - answer>>>3. hyperphosphatemia
What is the most serious complication of hyperphosphatemia? How does this occur? -
answer>>>Metastatic and vascular calcification of non-skeletal tissues. This occurs when the
calcium-phosphorus product exceeds 55 mg2/dL2
At what calcium-phosphorus product does metastatic and vascular calcification of non-skeletal
tissue occur? - answer>>>When the calcium-phosphorus product exceeds 55 mg2/dL2
List 3 consequences of hyperphosphatemia. - answer>>>1. Secondary hyperparathyroidism
,2. Renal osteodystrophy
3. Calcification of non-skeletal tissues
What is the recommended blood glucose level for critically ill patients? - answer>>>For the
critically ill patient, blood glucose levels should be maintained between 140-180 mg/dL. Lower
glucose targets may be appropriate in selected patients. Targets < 110 mg/dL are not
recommended
Under conditions of sepsis and stress, which of the following metabolic alterations are most likely
to occur?
1. increased glucose production and increased glucose uptake
2. increased glucose production and decreased glucose uptake
3. decreased glucose production and decreased glucose uptake
4. decreased glucose production and increased glucose uptake - answer>>>2. increased glucose
production and decreased glucose uptake
Why is the metabolic response to sepsis and stress characterized by an increase in glucose
production and a decrease in glucose uptake? What is recommended? - answer>>>Stress
hormones induce insulin resistance and hyperglycemia is commonly observed with nutrition
support. It is recommended that glucose levels be adequately controlled to avoid polyuria and
electrolyte disturbances
Which of the following immunomodulating nutrients may be harmful in patients with severe
sepsis?
1. Arginine
2. Glutamine
3. Nucleic acids
4. Omega-3 fatty acids - answer>>>1. Arginine
,Why is arginine considered an "immune-enhancing" agent? - answer>>>Arginine is a major
substrate for nitric oxide production. Under normal conditions, small quantities of nitric oxide
have a beneficial effect on immune function and tissue oxygenation. Thus, arginine is considered
an "immune-enhancing" agent
Under what conditions may arginine supplementation be harmful? - answer>>>Nitric oxide can be
detrimental by leading to coagulation abnormalities and altered hemodynamic status. In this case,
arginine could be considered harmful. Because of these effects, there is still much debate over the
value of arginine in nutrition support for critically ill patients
Which of the following best describes enteral glutamine supplementation in the critically ill
patient not in multi organ failure?
1. Enteral glutamine is preferred over parenteral glutamine
2. Glutamine reduces systemic inflammation
3. Preferred glutamine dosage is 20-40 grams/day
4. Glutamine has not been shown to reduce length of stay - answer>>>4. Glutamine has not been
shown to reduce length of stay
What is the purpose of glutamine supplementation? - answer>>>Glutamine supplementation is
supposed to reduce mortality and nosocomial infections in critically ill patients
What has evidence shown about glutamine supplementation? - answer>>>The "reducing deaths
due to oxidative stress" (REDOX) trials did not provide evidence supporting glutamine
supplementations effectiveness to reduce mortality and nosocomial infections in critically ill
patients. A recent meta-analysis investigated the impact of glutamine-supplemented nutrition on
the outcomes of critically ill patients and found that glutamine supplementation conferred no
overall mortality and length of hospital stay benefit in critically ill patients. However, glutamine
supplementation did reduce nosocomial infections among critically ill patients
Which of the following are counter-regulatory hormones responsible for the hypercatabolism
observed in critically ill trauma patients?
1. glycogen, insulin, norepinephrine
, 2. glucagon, epinephrine, cortisol
3. glycerol, serotonin, thymoglobulin
4. glycerin, leptin, adenosine - answer>>>2. glucagon, epinephrine, cortisol
Describe the inflammatory response following a traumatic injury. - answer>>>The inflammation
following a traumatic injury provokes a release of systemic catabolic hormones like epinephrine,
glucagon and cortisol from the hypothalamus. These hormones are responsible for glycogenolysis,
gluconeogenesis, proteolysis and free fatty acid release. The goal of the metabolic response by
the patient is to maintain survival, homeostasis and promote recovery
What is the purpose of therapeutic intervention during the inflammatory response following a
traumatic injury? - answer>>>Therapeutic intervention is geared toward blunting the
inflammatory response without making the patient susceptible to immunosuppression
What is top priority for intervention following a traumatic injury? - answer>>>Timely
resuscitation, including restoration of perfusion, oxygenation and hemodynamic stability
In patients with burns, providing caloric support above energy expenditure has been found to
1. decrease mortality
2. improve wound healing
3. decrease fat mass accumulation
4. have no effect on lean body mass preservation - answer>>>4. have no effect on lean body mass
preservation
How do burns impact metabolism? - answer>>>The metabolic stress that occurs in burn injury
generates a hypercatabolic state that increases energy expenditure
Why is feeding in excess of energy expenditure in burn patients not recommended? -
answer>>>Although patients with burns have increased needs, feeding in excess of energy
expenditure may cause hyperglycemia, hepatic steatosis and prolonged ventilator dependence.
One study of critically ill burn patients showed that caloric delivery beyond 1.2 x measured resting
Accurate Real Exam Questions and Verified
Correct Answers JUST RELEASED
A patient in your intensive care unit has severe diarrhea secondary to clostridium difficile toxin.
Which of the following acid-base disorders is likely to occur?
1. metabolic acidosis
2. metabolic alkalosis
3. respiratory acidosis
4. respiratory alkalosis - answer>>>1. metabolic acidosis
What metabolic disturbance does diarrhea lead to and why? - answer>>>Diarrhea induces
gastrointestinal losses of bicarbonate and can cause a metabolic acidosis (normal anion gap)
Metastatic calcification is a complication of
1. hyperkalemia
2. hypokalemia
3. hyperphosphatemia
4. hypophosphatemia - answer>>>3. hyperphosphatemia
What is the most serious complication of hyperphosphatemia? How does this occur? -
answer>>>Metastatic and vascular calcification of non-skeletal tissues. This occurs when the
calcium-phosphorus product exceeds 55 mg2/dL2
At what calcium-phosphorus product does metastatic and vascular calcification of non-skeletal
tissue occur? - answer>>>When the calcium-phosphorus product exceeds 55 mg2/dL2
List 3 consequences of hyperphosphatemia. - answer>>>1. Secondary hyperparathyroidism
,2. Renal osteodystrophy
3. Calcification of non-skeletal tissues
What is the recommended blood glucose level for critically ill patients? - answer>>>For the
critically ill patient, blood glucose levels should be maintained between 140-180 mg/dL. Lower
glucose targets may be appropriate in selected patients. Targets < 110 mg/dL are not
recommended
Under conditions of sepsis and stress, which of the following metabolic alterations are most likely
to occur?
1. increased glucose production and increased glucose uptake
2. increased glucose production and decreased glucose uptake
3. decreased glucose production and decreased glucose uptake
4. decreased glucose production and increased glucose uptake - answer>>>2. increased glucose
production and decreased glucose uptake
Why is the metabolic response to sepsis and stress characterized by an increase in glucose
production and a decrease in glucose uptake? What is recommended? - answer>>>Stress
hormones induce insulin resistance and hyperglycemia is commonly observed with nutrition
support. It is recommended that glucose levels be adequately controlled to avoid polyuria and
electrolyte disturbances
Which of the following immunomodulating nutrients may be harmful in patients with severe
sepsis?
1. Arginine
2. Glutamine
3. Nucleic acids
4. Omega-3 fatty acids - answer>>>1. Arginine
,Why is arginine considered an "immune-enhancing" agent? - answer>>>Arginine is a major
substrate for nitric oxide production. Under normal conditions, small quantities of nitric oxide
have a beneficial effect on immune function and tissue oxygenation. Thus, arginine is considered
an "immune-enhancing" agent
Under what conditions may arginine supplementation be harmful? - answer>>>Nitric oxide can be
detrimental by leading to coagulation abnormalities and altered hemodynamic status. In this case,
arginine could be considered harmful. Because of these effects, there is still much debate over the
value of arginine in nutrition support for critically ill patients
Which of the following best describes enteral glutamine supplementation in the critically ill
patient not in multi organ failure?
1. Enteral glutamine is preferred over parenteral glutamine
2. Glutamine reduces systemic inflammation
3. Preferred glutamine dosage is 20-40 grams/day
4. Glutamine has not been shown to reduce length of stay - answer>>>4. Glutamine has not been
shown to reduce length of stay
What is the purpose of glutamine supplementation? - answer>>>Glutamine supplementation is
supposed to reduce mortality and nosocomial infections in critically ill patients
What has evidence shown about glutamine supplementation? - answer>>>The "reducing deaths
due to oxidative stress" (REDOX) trials did not provide evidence supporting glutamine
supplementations effectiveness to reduce mortality and nosocomial infections in critically ill
patients. A recent meta-analysis investigated the impact of glutamine-supplemented nutrition on
the outcomes of critically ill patients and found that glutamine supplementation conferred no
overall mortality and length of hospital stay benefit in critically ill patients. However, glutamine
supplementation did reduce nosocomial infections among critically ill patients
Which of the following are counter-regulatory hormones responsible for the hypercatabolism
observed in critically ill trauma patients?
1. glycogen, insulin, norepinephrine
, 2. glucagon, epinephrine, cortisol
3. glycerol, serotonin, thymoglobulin
4. glycerin, leptin, adenosine - answer>>>2. glucagon, epinephrine, cortisol
Describe the inflammatory response following a traumatic injury. - answer>>>The inflammation
following a traumatic injury provokes a release of systemic catabolic hormones like epinephrine,
glucagon and cortisol from the hypothalamus. These hormones are responsible for glycogenolysis,
gluconeogenesis, proteolysis and free fatty acid release. The goal of the metabolic response by
the patient is to maintain survival, homeostasis and promote recovery
What is the purpose of therapeutic intervention during the inflammatory response following a
traumatic injury? - answer>>>Therapeutic intervention is geared toward blunting the
inflammatory response without making the patient susceptible to immunosuppression
What is top priority for intervention following a traumatic injury? - answer>>>Timely
resuscitation, including restoration of perfusion, oxygenation and hemodynamic stability
In patients with burns, providing caloric support above energy expenditure has been found to
1. decrease mortality
2. improve wound healing
3. decrease fat mass accumulation
4. have no effect on lean body mass preservation - answer>>>4. have no effect on lean body mass
preservation
How do burns impact metabolism? - answer>>>The metabolic stress that occurs in burn injury
generates a hypercatabolic state that increases energy expenditure
Why is feeding in excess of energy expenditure in burn patients not recommended? -
answer>>>Although patients with burns have increased needs, feeding in excess of energy
expenditure may cause hyperglycemia, hepatic steatosis and prolonged ventilator dependence.
One study of critically ill burn patients showed that caloric delivery beyond 1.2 x measured resting
