ASPEN CNSC ACTUAL EXAM PAPER 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Protein powders, carbohydrate powders, fat emulsion, MCT oil,
fiber and specific amino acids are examples of what? Answer:
Modular products
◍ Are vitamins, minerals and water considered modular products?
Answer: No
◍ Early initiation of enteral feeding has been suggested to benefit
ICU patients by reducing infectious complications, length of hospital
stay and even possibly reducing mortality. Which group of patients
might be at significant risk from early enteral feeding?
1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic
saline
4. Patients admitted to the hospital with acute on chronic pancreatitis
Answer: 2. Patients with increasing vasopressor support
◍ What is the risk of feeding a patient before hemodynamic stability
has been achieved? Answer: May increase the risk of intestinal
ischemia as blood perfusion of the gut may be compromised in a
,patient who is still requiring high doses of vasopressor drugs to
maintain blood pressure
◍ When should EN be initiated in the hemodynamically unstable
patient? Answer: EN should be delayed until fluid resuscitation is
complete
◍ A patient with acute respiratory distress syndrome (ARDS) may
benefit from a feeding formula containing supplemental
1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids Answer: 4. omega-3 fatty acids
◍ Define ARDS. Answer: Acute respiratory distress syndrome -
inflammatory response leading to diffuse alveolar damage and lung
capillary endothelial injury.
◍ Why are formulas containing omega-3 fatty acids recommended in
ALI and ARDS? Answer: Inflammatory mediators, including
prostaglandins and leukotrienes derived from arachidonic acid
metabolism have been implicated in both ALI and ARDS. Formulas
containing omega-3 fatty acids may down regulate the inflammatory
response through the production of less inflammatory prostaglnadins
and leukotrienes
,◍ What is the evidence for use of omega-3 fatty acids in ARDS and
ALI? Answer: Based on 3 level 1 studies the Guidelines for the
Provision and Assessment of Nutrition Support Therapy in the Adult
Critically Ill Patient in 2009 recommended patients with ARDS and
severe ALI be placed on an enteral formulation characterized by an
anti-inflammatory lipid profile. Subsequent to the publication of those
guidelines and recommendations have been studies published in 2011
showing that enteral supplementation of omega-3 fatty acids did not
result in improved biomarkers of inflammation or clinical outcomes
◍ The use of enteral nutrition formulas enriched with BCAAs is best
used for patients with:
1. cirrhosis
2. hepatic failure
3. liver transplantation
4. refractory encephalopathy Answer: 4. refractory encephalopathy
◍ What is the theory behind use of BCAAs in hepatic
encephalopathy? Answer: There is believed to be an increased ratio of
aromatic amino acids to BCAAs in patients experiencing hepatic
encephalopathy. The decrease in BCAA is suspected to be due to an
increased breakdown in BCAA from skeletal muscles and utilization.
The increased levels of AAA generate false neurotransmitters,
resulting in hepatic encephalopathy symptoms.
◍ What is the evidence for BCAA enriched amino acid enteral
formulas? Answer: Published randomized trials have shown mixed
, results in patients with hepatic failure receiving these specialized
formulas. Due to the lack of evidence supporting their use and the
increased cost of such products it has been suggested that the use of
these hepatic fomulas be limited to patients with encephalopathy
refractory to standard medical therapy (lactulose, non-absorbed
antibiotics)
◍ Enteral nutrition may be contraindicated in the early post-transplant
period in adult patients with hematopoietic cell transplants because of:
1. increased incidence of sinusitis with enteral feedings
2. lack of benefit from enteral feedings in allogeneic patients
3. gastrointestinal toxicities related to the conditioning regimen
4. improved survival seen in autologous patients receiving PN
Answer: 3. Gastrointestinal toxicities related to the conditioning
regimen
◍ Why is EN contraindicated in the early post-transplant period in
adult patients with hematopoietic cell transplants? Answer: GI
toxicities such as nausea, vomiting, delayed gastric emptying and
diarrhea seen in the first 2-3 weeks post-stem cell transplant may
preclude EN. GI toxicity is most often related to chemotherapy and
total body irradiatin, however GI toxicity may also result from other
medications or early acute graft-versus-host disease in this patient
population.
◍ Which nutrition therapy is preferred in early post-transplant
hematopoietic cell transplant patients (adult)? Answer: Currently there
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Protein powders, carbohydrate powders, fat emulsion, MCT oil,
fiber and specific amino acids are examples of what? Answer:
Modular products
◍ Are vitamins, minerals and water considered modular products?
Answer: No
◍ Early initiation of enteral feeding has been suggested to benefit
ICU patients by reducing infectious complications, length of hospital
stay and even possibly reducing mortality. Which group of patients
might be at significant risk from early enteral feeding?
1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic
saline
4. Patients admitted to the hospital with acute on chronic pancreatitis
Answer: 2. Patients with increasing vasopressor support
◍ What is the risk of feeding a patient before hemodynamic stability
has been achieved? Answer: May increase the risk of intestinal
ischemia as blood perfusion of the gut may be compromised in a
,patient who is still requiring high doses of vasopressor drugs to
maintain blood pressure
◍ When should EN be initiated in the hemodynamically unstable
patient? Answer: EN should be delayed until fluid resuscitation is
complete
◍ A patient with acute respiratory distress syndrome (ARDS) may
benefit from a feeding formula containing supplemental
1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids Answer: 4. omega-3 fatty acids
◍ Define ARDS. Answer: Acute respiratory distress syndrome -
inflammatory response leading to diffuse alveolar damage and lung
capillary endothelial injury.
◍ Why are formulas containing omega-3 fatty acids recommended in
ALI and ARDS? Answer: Inflammatory mediators, including
prostaglandins and leukotrienes derived from arachidonic acid
metabolism have been implicated in both ALI and ARDS. Formulas
containing omega-3 fatty acids may down regulate the inflammatory
response through the production of less inflammatory prostaglnadins
and leukotrienes
,◍ What is the evidence for use of omega-3 fatty acids in ARDS and
ALI? Answer: Based on 3 level 1 studies the Guidelines for the
Provision and Assessment of Nutrition Support Therapy in the Adult
Critically Ill Patient in 2009 recommended patients with ARDS and
severe ALI be placed on an enteral formulation characterized by an
anti-inflammatory lipid profile. Subsequent to the publication of those
guidelines and recommendations have been studies published in 2011
showing that enteral supplementation of omega-3 fatty acids did not
result in improved biomarkers of inflammation or clinical outcomes
◍ The use of enteral nutrition formulas enriched with BCAAs is best
used for patients with:
1. cirrhosis
2. hepatic failure
3. liver transplantation
4. refractory encephalopathy Answer: 4. refractory encephalopathy
◍ What is the theory behind use of BCAAs in hepatic
encephalopathy? Answer: There is believed to be an increased ratio of
aromatic amino acids to BCAAs in patients experiencing hepatic
encephalopathy. The decrease in BCAA is suspected to be due to an
increased breakdown in BCAA from skeletal muscles and utilization.
The increased levels of AAA generate false neurotransmitters,
resulting in hepatic encephalopathy symptoms.
◍ What is the evidence for BCAA enriched amino acid enteral
formulas? Answer: Published randomized trials have shown mixed
, results in patients with hepatic failure receiving these specialized
formulas. Due to the lack of evidence supporting their use and the
increased cost of such products it has been suggested that the use of
these hepatic fomulas be limited to patients with encephalopathy
refractory to standard medical therapy (lactulose, non-absorbed
antibiotics)
◍ Enteral nutrition may be contraindicated in the early post-transplant
period in adult patients with hematopoietic cell transplants because of:
1. increased incidence of sinusitis with enteral feedings
2. lack of benefit from enteral feedings in allogeneic patients
3. gastrointestinal toxicities related to the conditioning regimen
4. improved survival seen in autologous patients receiving PN
Answer: 3. Gastrointestinal toxicities related to the conditioning
regimen
◍ Why is EN contraindicated in the early post-transplant period in
adult patients with hematopoietic cell transplants? Answer: GI
toxicities such as nausea, vomiting, delayed gastric emptying and
diarrhea seen in the first 2-3 weeks post-stem cell transplant may
preclude EN. GI toxicity is most often related to chemotherapy and
total body irradiatin, however GI toxicity may also result from other
medications or early acute graft-versus-host disease in this patient
population.
◍ Which nutrition therapy is preferred in early post-transplant
hematopoietic cell transplant patients (adult)? Answer: Currently there
