Certified Nutrition Support Clinician Practice Test

CNSC test Format | Course Contents | Course Outline | test Syllabus | test Objectives

NBNSC certification provides an avenue to demonstrate that you have attained the skills and knowledge necessary to provide quality nutrition support care. We have determined the body of knowledge needed to have an understanding of nutrition support and developed a fair and valid means to test care providers including physicians, dietitians, pharmacists, physician assistants, and nurses.

Certified professionals are recognized as quality providers of nutrition support by the public, their colleagues, other members of the healthcare team, and administrators. The Certified Nutrition Support Clinician ® (CNSC®) certification can provide job mobility, open up job opportunities, and, in some cases, lead to promotion and monetary gain.

Objectives of Certification
To promote enhanced delivery of safe and effective care through the certification of qualified clinicians in nutrition support by:

Recognizing formally those individuals who meet eligibility requirements of the National Board of Nutrition Support Certification, Inc. and pass the certification examination for nutrition support clinicians.
Encouraging continued professional growth in the practice of nutrition support.
Establishing and measuring the level of knowledge required for certification by a nutrition support clinician.
Providing a standard of minimum knowledge deemed appropriate for clinicians practicing nutrition support; thereby assisting the public, healthcare professionals, and employers in the assessment of nutrition support clinicians.

Nutrition Support is an inter-professional field. After conducting extensive research, NBNSC developed a new credential, the CNSC® that is fair and valid for all professional disciplines involved in nutrition support. The dietitians, nurses, pharmacists, physician assistants, and physicians who provide care share a common body of knowledge and expertise that NBNSC has captured in the new test format. The content of the test reflects the tasks that healthcare professionals provide on a daily basis.

I. Nutrition Assessment (32%)
II. Clinical Management (55%)
III. Process Management (3%)
IV. Professional Practice (10%)

- patient history.
- patient current clinical status.
- diet, medication, and supplements for potential impact on nutritional status.
- Evaluate anthropometric data.
- Identify potential or existing nutrition support access.
- Perform nutrition-focused physical exam.
- Evaluate patient for potential complications of initiating nutrition support therapy.

- Determine fluid, nutrient, and electrolyte intake and output from all sources.
- Determine fluid, electrolyte, macronutrient, and micronutrient requirements for nutrition support therapy.
- Evaluate psychological, socio-economic, developmental, functional, behavioral, and quality of life factors.
- Evaluate indication for timing and route of administration for nutrition support therapy.
- Determine etiology, degree, and type of malnutrition.
- Determine nutritional diagnosis or problem.
- Assess patient and caregiver capabilities and limitations related to nutrition support therapy

- administration route and access for nutrition support therapy.
- formulation, rate, and/or volume of nutrition support therapy.
- use of pharmacologic adjunctive agents.
- cost-effective strategies in the provision of nutrition support therapy.
- short-term nutrition support therapy goals.
- long-term nutrition support therapy goals.
- diagnostic tests, procedures, or consultations that may modify the nutrition support plan.
- laboratory tests that may modify the nutrition support plan.
- regimen for initiation, advancement, maintenance, and discontinuation of nutrition support therapy.

- Verify position, location and functionality of nutrition access device.
- tolerance of nutrition support therapy.
- fluid status.
- adherence with nutrition support therapy plan.
- complications of nutrition support therapy.
- laboratory test results to assess adequacy and tolerance of nutrition support therapy.
- nutritional and metabolic response to nutrition support therapy.
- status of nutrition access device.
- nutrition support therapy for safety concerns, including management of product shortages.
- drug-nutrient interaction.
- enteral or parenteral formula stability.


- Modify nutrition support therapy based on changes in patient clinical status and medical plan of care.
- Manage complications related to nutrition support therapy.
- Reevaluate nutrition support therapy goals.
- Reevaluate adjunctive drug therapy.
- Transition or discontinue nutrition support therapy.
- Transition patient from one care setting to another.
- Educate patient, caregiver, and/or health care professionals on nutrition support therapy management.

- Develop or update policies and procedures to guide patient care.
- Implement current guidelines and standards of practice in the provision of nutrition support therapy.
- Develop or update patient education materials.
- Utilize a continuous process improvement model to evaluate nutrition care.
- Apply ethical principles in the application of nutrition support therapy.
- Provide nutrition support therapy in compliance with legal and regulatory standards.
- Evaluate scientific literature and interpret study design, methodology, statistical analysis and results to practice evidence-based nutrition support therapy.
- Apply principles of evidence-based practice in provision of nutrition support therapy.

- Identify patients with malnutrition.
- Identify patients with risk factors for developing malnutrition.
- Review patient history.
- Review patient current clinical status.
- Review diet, medication, and supplements for potential impact on nutritional status.
- Evaluate anthropometric data.
- Identify potential or existing nutrition support access.
- Perform nutrition-focused physical exam.

- Evaluate patient for potential complications of initiating nutrition support therapy.
- Determine fluid, nutrient, and electrolyte intake and output from all sources.
- Determine fluid, electrolyte, macronutrient, and micronutrient requirements for nutrition support therapy.
- Evaluate psychological, socio-economic, developmental, functional, behavioral, and quality of life factors.
- Evaluate indication for timing and route of administration for nutrition support therapy.
- Determine etiology, degree, and type of malnutrition.
- Determine nutritional diagnosis or problem.
- Assess patient and caregiver capabilities and limitations related to nutrition support therapy.


- administration route and access for nutrition support therapy.
- formulation, rate, and/or volume of nutrition support therapy.
- use of pharmacologic adjunctive agents.
- cost-effective strategies in the provision of nutrition support therapy.
- short-term nutrition support therapy goals.
- long-term nutrition support therapy goals.
- diagnostic tests, procedures, or consultations that may modify the nutrition support plan.
- laboratory tests that may modify the nutrition support plan.
- regimen for initiation, advancement, maintenance, and discontinuation of nutrition support therapy.

- Verify position, location and functionality of nutrition access device.
- Evaluate tolerance of nutrition support therapy.
- Evaluate fluid status.
- Monitor adherence with nutrition support therapy plan.
- Monitor for complications of nutrition support therapy.
- Evaluate laboratory test results to assess adequacy and tolerance of nutrition support therapy.
- Monitor nutritional and metabolic response to nutrition support therapy.
- Evaluate status of nutrition access device.
- Assess nutrition support therapy for safety concerns, including management of product shortages.
- Monitor for drug-nutrient interaction.
- Monitor for enteral or parenteral formula stability.

- Modify nutrition support therapy based on changes in patient clinical status and medical plan of care.
- Manage complications related to nutrition support therapy.
- Reevaluate nutrition support therapy goals.
- Reevaluate adjunctive drug therapy.
- Transition or discontinue nutrition support therapy.
- Transition patient from one care setting to another.
- Educate patient, caregiver, and/or health care professionals on nutrition support therapy management.

- Develop or update policies and procedures to guide patient care.
- Implement current guidelines and standards of practice in the provision of nutrition support therapy.
- Develop or update patient education materials.
- Utilize a continuous process improvement model to evaluate nutrition care.
- Apply ethical principles in the application of nutrition support therapy.
- Provide nutrition support therapy in compliance with legal and regulatory standards.
- Evaluate scientific literature and interpret study design, methodology, statistical analysis and results to practice evidence-based nutrition support therapy.
- Apply principles of evidence-based practice in provision of nutrition support therapy.

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Question: 1053
Which of the following is a fat-soluble vitamin that acts as an antioxidant, protecting cells from damage caused by free radicals?
1. Vitamin A
amin C amin K
er: B
nation: Vitamin E is a fat-soluble vitamin that acts as an antioxidant, protecting cells from da by free radicals. It helps maintain the integrity of cell membranes and is involved in immun
on, DNA repair, and other vital processes.
ion: 1054
ent with celiac disease is advised to follow a gluten-free diet. Which of the following grains nsumption?
eat ley
inoa er: D
nation: Quinoa is safe for consumption in a gluten-free diet for individuals with celiac diseas n-free grain that can be used as a substitute for wheat, barley, and rye, which contain gluten.
ion: 1055
Vitamin E
2. Vit
3. Vit Answ
Expla mage
caused e
functi
Quest
A pati is safe
for co
1. Wh
2. Bar
3. Rye
4. Qu
Answ
Expla e. It is
a glute
Quest
When examining the ethical considerations in nutrition support therapy, which scenario best illustrates a conflict between beneficence and autonomy?
1. A patient declines enteral nutrition despite a recommendation from the healthcare team.
2. A patient receives parenteral nutrition without informed consent.
3. A healthcare provider prescribes a nutrition regimen based on personal bias.
4. A family insists on aggressive nutrition support for a terminally ill patient. Answer: D
Explanation: This scenario illustrates a conflict between beneficence (acting in the patient's best interest) and autonomy (respecting the patient's wishes), especially when the patient's quality of life is at stake.
Question: 1056
During discharge planning, a nutrition support clinician is preparing a patient for home enteral nutrition. What is the most crucial aspect of education to ensure the patient can manage their therapy safely?
1. Recognizing signs of potential complications
hniques for administering feeds
derstanding the nutritional content of their formula er: A
nation: Educating the patient on recognizing signs of potential complications ensures they ca intervention and manage their home enteral nutrition safely.
ion: 1057
luating a patient�s dietary intake, which assessment tool is most effective for identifying nutrient deficiencies over a long-term period?
hour dietary recall
od frequency questionnaire history
ect observation er: B
nation: A food frequency questionnaire provides a broader view of long-term dietary patterns ial micronutrient deficiencies compared to short-term recalls.
ion: 1058
Importance of maintaining proper hydration
2. Tec
3. Un
Answ
Expla n seek
timely
Quest
In eva micro
1. 24-
2. Fo
3. Diet
4. Dir Answ
Expla and
potent
Quest
Which of the following best describes the role of ethics in the provision of nutrition support therapy?
1. Ethics is irrelevant in clinical practice as all decisions are based on science
2. Ethical considerations guide the decision-making process to balance patient needs and clinical judgment
3. Ethics only applies to end-of-life decisions in nutrition support
4. Ethical principles can be ignored if they conflict with clinical protocols Answer: B
Explanation: Ethical considerations are integral to guiding decision-making in nutrition support therapy, ensuring that patient needs are balanced with clinical judgment.
Question: 1059
You are tasked with updating the nutrition support guidelines for patients with liver disease. What should be the primary focus when revising these guidelines based on emerging evidence?
1. Ensuring that the guidelines are strictly followed without exception
miting the guidelines to only the most severe cases of liver disease egrating new research findings while considering individual patient needs
er: D
nation: Integrating new research while considering individual patient needs allows for a more alized and effective approach to nutrition support.
ion: 1060
of the following is a potential complication of excessive protein intake in patients with omised kidney function?
potension pernatremia
rsening of renal function percalcemia
er: C
nation: Worsening of renal function is a potential complication of excessive protein intake in
with compromised kidney function. High protein intake can increase the workload on the kidneys tentially worsen renal function in individuals with existing kidney disease. Protein intake ne
efully monitored and tailored to the individual's renal function to prevent further kidney dam
Avoiding changes to prevent confusion among staff
2. Li
3. Int Answ
Expla person
Quest
Which compr
1. Hy
2. Hy
3. Wo
4. Hy
Answ Expla
patients
and po eds to
be car age.
Question: 1061
In a scenario where a patient on parenteral nutrition presents with elevated liver enzymes, what adjustment in the nutritional support plan might be necessary to Improve liver function and tolerance?
1. Increase lipid infusion rate
2. Decrease carbohydrate concentration
3. Change to a higher-protein formula
4. Add supplemental vitamins
Answer: B
Explanation: Decreasing carbohydrate concentration may help reduce the risk of hepatic steatosis and Improve liver function in patients receiving long-term parenteral nutrition.
Question: 1062
Which of the following is an appropriate indication for the use of a peripherally inserted central catheter (PICC) for nutrition support?
ients with severe malabsorption
ients with a history of central line-associated bloodstream infections (CLABSIs) ients with adequate peripheral venous access
er: B
nation: A peripherally inserted central catheter (PICC) is commonly used for long-term nutrit in patients with severe malabsorption. It provides a more secure and stable access point for
ring parenteral nutrition compared to peripheral venous access. Short-term nutrition support ed through peripheral venous access, and patients with a history of central line-associated tream infections (CLABSIs) may require alternative access options.
ion: 1063
ent with a history of diabetes and renal failure is receiving nutritional support. Which electro nce should be monitored closely in this scenario?
pocalcemia perkalemia ponatremia pomagnesemia
er: B
nation: Patients with renal failure are at high risk for hyperkalemia due to impaired potassiu
Short-term nutrition support (<2 weeks)
Pat
Pat
Pat Answ
Expla ion
support
delive can be
achiev bloods
Quest
A pati lyte
imbala
1. Hy
2. Hy
3. Hy
4. Hy
Answ
Expla m
excretion, particularly when receiving nutrition support that may include potassium.
Question: 1064
Which of the following conditions is associated with increased protein needs?
1. Hypothyroidism
2. Type 2 diabetes mellitus
3. Chronic kidney disease
4. Iron deficiency anemia
Answer: C
Explanation: Chronic kidney disease is associated with increased protein needs due to the loss of protein through urine and increased protein breakdown. Adequate protein intake is essential to prevent malnutrition and maintain muscle mass in individuals with kidney disease.
Question: 1065
trition. What is the recommended protein intake for this patient to meet his nutritional needs ting complications?
g protein/kg/day. g protein/kg/day. g protein/kg/day. g protein/kg/day.
er: D
nation: For patients with end-stage renal disease on hemodialysis, a protein intake of 1.2 g n/kg/day is recommended to compensate for protein losses during dialysis while maintaining onal status.
ion: 1066
a nutritional assessment, a patient reports significant financial difficulties affecting their acc nd healthcare. Which of the following factors should be prioritized in the nutrition support p ve the patient's overall well-being?
iating oral nutritional supplements plementing a high-protein diet
using solely on macronutrient intake erring the patient to a social worker
A 75-year-old male with end-stage renal disease is on hemodialysis and presents with symptoms of malnu while
preven
1. 0.6
2. 2.0
3. 1.5
4. 1.2
Answ Expla
protei nutriti
Quest
During ess to
food a lan to
impro
1. Init
2. Im
3. Foc
4. Ref Answer: D
Explanation: Addressing socio-economic factors is essential for improving access to food and healthcare. A referral to a social worker can help the patient navigate resources available to them.
Question: 1067
Which of the following is a potential complication of untreated hypothyroidism?
1. Depression
2. Weight loss
3. Hyperactivity
4. Heat intolerance Answer: A
weight gain is a common symptom. Heat intolerance (option D) is associated with hyroidism. Therefore, option C is the correct answer.
ion: 1068
ent on parenteral nutrition develops new-onset hypertriglyceridemia. Which of the following es would be most appropriate to manage this complication while continuing nutritional supp
rease the rate of dextrose infusion duce the lipid infusion rate
itch to a higher-calorie formula iate insulin therapy
er: B
nation: Reducing the lipid infusion rate directly addresses hypertriglyceridemia while allowin uation of nutritional support through other macronutrients.
ion: 1069
itically ill patient requiring nutrition support therapy, what is the most appropriate initial app ermining the feeding route?
iate parenteral nutrition to ensure nutrient delivery
enteral nutrition exclusively, regardless of the patient's condition
Explanation: Depression is a potential complication of untreated hypothyroidism. Hypothyroidism is a condition characterized by an underactive thyroid gland, which leads to a decrease in the production of thyroid hormones. Thyroid hormones play a role in regulating mood, and low levels of these hormones can contribute to symptoms of depression. Hyperactivity (option A) is more commonly associated with hyperthyroidism (overactive thyroid). Weight loss (option B) is not typically seen in hypothyroidism; instead,
hypert
Quest
A pati
chang ort?
1. Inc
2. Re
3. Sw
4. Init Answ
Expla g the
contin
Quest
In a cr roach
to det
1. Init
2. Use
3. Begin with oral nutrition to maintain normalcy
4. Assess the patient's gastrointestinal function before deciding the route Answer: D
Explanation: Assessing gastrointestinal function is critical in determining the most appropriate feeding route, ensuring that the chosen method is safe and effective for the patient's condition.
Question: 1070
When reviewing a patient�s current clinical status, which laboratory value would provide the most direct
insight into their protein status, particularly in the context of malnutrition?
1. Blood urea nitrogen (BUN)
2. Hemoglobin
3. Serum albumin
4. Serum electrolytes Answer: C
mation.
ion: 1071
ent on long-term TPN suddenly presents with chills and fever. What is the most appropriate diate course of action?
rease the TPN infusion rate itch to enteral nutrition
minister antipyretics and continue TPN tain blood cultures and discontinue TPN
er: D
nation: Obtaining blood cultures and discontinuing TPN is critical to rule out catheter-related ons, which are a common risk associated with long-term TPN use.
ion: 1072
of the following is a common symptom of vitamin B12 deficiency? igue
ht blindness kets
urvy
Explanation: Serum albumin is a key marker for protein status and nutritional adequacy. Low levels can indicate malnutrition and are often seen in patients with chronic diseases and those undergoing
inflam
Quest
A pati imme
1. Inc
2. Sw
3. Ad
4. Ob
Answ Expla
infecti Quest Which
1. Fat
2. Nig
3. Ric
4. Sc
Answer: A
Explanation: A common symptom of vitamin B12 deficiency is fatigue. Vitamin B12 plays a crucial role in the production of red blood cells and the maintenance of nerve cells. When levels of vitamin B12 are low, it can lead to a condition called pernicious anemia, which is characterized by fatigue, weakness, and shortness of breath. Night blindness is associated with vitamin A deficiency, rickets is associated with vitamin D deficiency, and scurvy is associated with vitamin C deficiency. Therefore, option A is the correct answer.
Question: 1073
A patient in the ICU has been on enteral nutrition for three days but is not meeting their caloric goals due to gastrointestinal intolerance. Their current prescription is 1500 kcal/day. What would be the most effective strategy to optimize their nutrition support therapy?
1. Switch to total parenteral nutrition (TPN)
2. Increase the caloric density of the enteral formula
3. Administer medications to enhance gastric motility
er: B
nation: Increasing the caloric density allows the patient to meet nutritional requirements with sing the volume, which can help reduce gastrointestinal intolerance.
ion: 1074
ent on long-term parenteral nutrition has developed metabolic bone disease. Which modificat be made to their nutrition support therapy to address this complication?
mit phosphorus intake to prevent further bone loss
rease the calcium and vitamin D content in their parenteral solution itch to a higher-calorie parenteral formula
duce the rate of infusion to enhance tolerance er: B
nation: Increasing calcium and vitamin D in the parenteral solution is essential to help mitiga of metabolic bone disease and promote bone health.
ion: 1075
ontext of nutrition support therapy, which of the following represents a violation of ethical ples when making decisions about patient care?
Reduce the enteral feeding rate Answ
Expla out
increa
Quest
A pati ion
should
1. Li
2. Inc
3. Sw
4. Re
Answ
Expla te the
effects
Quest
In the c princi
1. Utilizing a standardized protocol for all patients
2. Failing to consider the patient's cultural beliefs in treatment decisions
3. Collaborating with the healthcare team to develop a care plan
4. Educating patients about their nutrition options Answer: B
Explanation: Failing to consider a patient's cultural beliefs violates ethical principles of respect for autonomy and beneficence, as it disregards the patient's values and preferences in care decisions.

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