CNSC PRACTICE TEST QUESTIONS WITH CORRRECT
MARKING SCHEME
/.In an intensive care setting, which of the following complications associated with
malnutrition is most likely to occur as a result of the failure to begin nutrition support
early in the treatment regimen? - Answer-✅Increased serum levels of protein-bound
drugs
/.Which of the following is the inpatient glycemic target for critically ill patients?
1: 80-110 mg/dL
2: 140-180 mg/dL
3: 181-210 mg/dL
4: 211-240 mg/dL - Answer-✅2: 140-180 mg/dL
Targets <110mg/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
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: Selenium
3: Nucleic acids
4: Omega-3 fatty acids - Answer-✅1: Arginine
,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 decreases mortality
2: Enteral glutamine decreases ventilator days
3: Enteral glutamine decreases hospital length of stay
4: Enteral glutamine decreases nosocomial infections - Answer-✅4: Enteral glutamine
decreases nosocomial infections
/.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
/.In patients with burns, providing caloric support above energy expenditure has been
found to
1: significantly decrease hospital length of stay.
2: improve wound healing and graft success.
3: decrease fat accumulation and steatosis.
4: have no effect on preservation of lean body mass. - Answer-✅4: have no effect on
preservation of lean body mass.
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 energy expenditure did not conserve lean body mass but was
associated with increased fat mass accumulation.
/.In pulmonary insufficiency, excessive calorie administration may cause increased
blood pCO2 resulting in
1: metabolic acidosis.
2: metabolic alkalosis.
3: respiratory acidosis.
4: respiratory alkalosis. - Answer-✅3: respiratory acidosis.
,/.Which of the following is true of essential fatty acid deficiency (EFAD) in patients with
cystic fibrosis (CF)?
1: Routine supplementation of omega-3 fatty acids is essential in the management of
CF
2: EFAD usually does not manifest in CF patients until the second decade.
3: CF patients without pancreatic insufficiency rarely develop EFAD
4: EFA profiles have been shown to improve in CF patients after lung transplantation -
Answer-✅4: EFA profiles have been shown to improve in CF patients after lung
transplantation
EFA status is usually evaluated by measuring the triene: tetraene ratio. Although
supplementation with omega 3 fatty acids are sometimes used in the management of
CF, results from clinical trials have shown mixed results and further trials are needed to
determine the efficacy of routine EFA supplementation in the management of CF.
/.Which of the following is the best choice for feeding a pancreatic insufficient infant with
cystic fibrosis?
1: Protein hydrolysate formula with medium chain triglyceride (MCT)
2: Free amino acid formula with MCT
3: Human milk
4: Standard infant formula - Answer-✅Human milk is the optimal choice over standard
formula for any infant due to multiple beneficial components including immunologic
properties, growth factors, and both pre- and probiotics. Human milk or standard infant
formula with appropriate enzyme dosing is recommended. Protein hydrolysate or free
amino acid formulas containing MCT are not indicated for infants with cystic fibrosis
(CF) unless there is another medical reason such as bowel resection resulting in
malabsorption or liver abnormalities.
/.Which of the following blood chemistries will most effectively indicate the response to
the protein component of nutrition support in a patient on hemodialysis?
1: Albumin
2: Prealbumin
3: Urea nitrogen appearance
4: Normalized protein equivalent of total nitrogen - Answer-✅4: Normalized protein
equivalent of total nitrogen
/.For a patient requiring nutrition support therapy, which of the following may be
necessary for a patient with acute kidney injury (AKI) receiving continuous renal
replacement therapy (CRRT)?
1: Low potassium
2: Increased phosphorus
, 3: Low protein
4: Increased fluid - Answer-✅4: Increased fluid
A nutrition support regimen need not be restricted in fluid for patients receiving CRRT.
However, increased fluid provision from nutrition support is not necessary.
/.For acute renal failure patients requiring parenteral nutrition support, recommendations
include
1: balanced mixture of essential (EAA) and non-essential amino acids (NEAA).
2: essential amino acids (EAA) plus dextrose.
3: non-essential amino acids (NEAA).
4: dextrose alone, no amino acids. - Answer-✅1: balanced mixture of essential (EAA)
and non-essential amino acids (NEAA).
/.What is the glomerular filtration rate (GFR) of a patient with end-stage renal disease?
1: >90 mL/min/1.73 M2
2: 30-59 mL/min/1.73 M2
3: 15-29 mL/min/1.73 M2
4: <15 mL/min/1.73 M2 - Answer-✅4: <15 mL/min/1.73 M2
/.Increased mortality in maintenance hemodialysis patients has been associated with
1: low baseline body fat percentage and low muscle mass.
2: elevated albumin and decreased CRP values.
3: increased body mass index.
4: decreased serum cholesterol. - Answer-✅1: low baseline body fat percentage and
low muscle mass.
A BMI between 30 Kg/m^2 and 34.9 Kg/m^2 as demonstrated by Dialysis Outcomes
and Practice Patterns Study is considered protective in dialysis patients. A BMI of less
than 25 Kg/m^2 is not considered beneficial for patients on HD.
/.Which of the following has NOT been shown to delay weaning from mechanical
ventilation in patients with chronic obstructive pulmonary disease who are receiving
enteral nutrition?
1: Refeeding syndrome
2: Tube feeding syndrome
3: Underfeeding
4: Overfeeding - Answer-✅2: Tube feeding syndrome
Tube feeding syndrome is the development of azotemia, hypernatremia and
dehydration related to the use of high protein tube feedings and inadequate fluid
provision.
MARKING SCHEME
/.In an intensive care setting, which of the following complications associated with
malnutrition is most likely to occur as a result of the failure to begin nutrition support
early in the treatment regimen? - Answer-✅Increased serum levels of protein-bound
drugs
/.Which of the following is the inpatient glycemic target for critically ill patients?
1: 80-110 mg/dL
2: 140-180 mg/dL
3: 181-210 mg/dL
4: 211-240 mg/dL - Answer-✅2: 140-180 mg/dL
Targets <110mg/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
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: Selenium
3: Nucleic acids
4: Omega-3 fatty acids - Answer-✅1: Arginine
,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 decreases mortality
2: Enteral glutamine decreases ventilator days
3: Enteral glutamine decreases hospital length of stay
4: Enteral glutamine decreases nosocomial infections - Answer-✅4: Enteral glutamine
decreases nosocomial infections
/.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
/.In patients with burns, providing caloric support above energy expenditure has been
found to
1: significantly decrease hospital length of stay.
2: improve wound healing and graft success.
3: decrease fat accumulation and steatosis.
4: have no effect on preservation of lean body mass. - Answer-✅4: have no effect on
preservation of lean body mass.
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 energy expenditure did not conserve lean body mass but was
associated with increased fat mass accumulation.
/.In pulmonary insufficiency, excessive calorie administration may cause increased
blood pCO2 resulting in
1: metabolic acidosis.
2: metabolic alkalosis.
3: respiratory acidosis.
4: respiratory alkalosis. - Answer-✅3: respiratory acidosis.
,/.Which of the following is true of essential fatty acid deficiency (EFAD) in patients with
cystic fibrosis (CF)?
1: Routine supplementation of omega-3 fatty acids is essential in the management of
CF
2: EFAD usually does not manifest in CF patients until the second decade.
3: CF patients without pancreatic insufficiency rarely develop EFAD
4: EFA profiles have been shown to improve in CF patients after lung transplantation -
Answer-✅4: EFA profiles have been shown to improve in CF patients after lung
transplantation
EFA status is usually evaluated by measuring the triene: tetraene ratio. Although
supplementation with omega 3 fatty acids are sometimes used in the management of
CF, results from clinical trials have shown mixed results and further trials are needed to
determine the efficacy of routine EFA supplementation in the management of CF.
/.Which of the following is the best choice for feeding a pancreatic insufficient infant with
cystic fibrosis?
1: Protein hydrolysate formula with medium chain triglyceride (MCT)
2: Free amino acid formula with MCT
3: Human milk
4: Standard infant formula - Answer-✅Human milk is the optimal choice over standard
formula for any infant due to multiple beneficial components including immunologic
properties, growth factors, and both pre- and probiotics. Human milk or standard infant
formula with appropriate enzyme dosing is recommended. Protein hydrolysate or free
amino acid formulas containing MCT are not indicated for infants with cystic fibrosis
(CF) unless there is another medical reason such as bowel resection resulting in
malabsorption or liver abnormalities.
/.Which of the following blood chemistries will most effectively indicate the response to
the protein component of nutrition support in a patient on hemodialysis?
1: Albumin
2: Prealbumin
3: Urea nitrogen appearance
4: Normalized protein equivalent of total nitrogen - Answer-✅4: Normalized protein
equivalent of total nitrogen
/.For a patient requiring nutrition support therapy, which of the following may be
necessary for a patient with acute kidney injury (AKI) receiving continuous renal
replacement therapy (CRRT)?
1: Low potassium
2: Increased phosphorus
, 3: Low protein
4: Increased fluid - Answer-✅4: Increased fluid
A nutrition support regimen need not be restricted in fluid for patients receiving CRRT.
However, increased fluid provision from nutrition support is not necessary.
/.For acute renal failure patients requiring parenteral nutrition support, recommendations
include
1: balanced mixture of essential (EAA) and non-essential amino acids (NEAA).
2: essential amino acids (EAA) plus dextrose.
3: non-essential amino acids (NEAA).
4: dextrose alone, no amino acids. - Answer-✅1: balanced mixture of essential (EAA)
and non-essential amino acids (NEAA).
/.What is the glomerular filtration rate (GFR) of a patient with end-stage renal disease?
1: >90 mL/min/1.73 M2
2: 30-59 mL/min/1.73 M2
3: 15-29 mL/min/1.73 M2
4: <15 mL/min/1.73 M2 - Answer-✅4: <15 mL/min/1.73 M2
/.Increased mortality in maintenance hemodialysis patients has been associated with
1: low baseline body fat percentage and low muscle mass.
2: elevated albumin and decreased CRP values.
3: increased body mass index.
4: decreased serum cholesterol. - Answer-✅1: low baseline body fat percentage and
low muscle mass.
A BMI between 30 Kg/m^2 and 34.9 Kg/m^2 as demonstrated by Dialysis Outcomes
and Practice Patterns Study is considered protective in dialysis patients. A BMI of less
than 25 Kg/m^2 is not considered beneficial for patients on HD.
/.Which of the following has NOT been shown to delay weaning from mechanical
ventilation in patients with chronic obstructive pulmonary disease who are receiving
enteral nutrition?
1: Refeeding syndrome
2: Tube feeding syndrome
3: Underfeeding
4: Overfeeding - Answer-✅2: Tube feeding syndrome
Tube feeding syndrome is the development of azotemia, hypernatremia and
dehydration related to the use of high protein tube feedings and inadequate fluid
provision.
