CNSCP Prep Course (CNSCP): free quiz

1. Question 1 of 10

   A pharmacist on the nutrition support team reviews a 76-year-old inpatient with pneumonia receiving ceftriaxone 1 g IV every 24 hours and azithromycin 500 mg IV every 24 hours. The record shows unintentional weight loss and intake under 50% for 5 days. Which pharmacist-scope recommendation best applies nutrition risk screening principles?

   Choose one answer

   A

   Use an adult nutrition risk screen such as the MST or NRS-2002 and request timely nutrition evaluation if positive.

   B

   Use a pediatric tool such as STRONGkids because infection increases nutrition risk in all ages.

   C

   Complete a full malnutrition-focused nutrition assessment before any screening result is documented.

   D

   Delay nutrition screening until antibiotic therapy is completed to avoid confusing medication adverse effects with malnutrition risk.

2. Question 2 of 10

   A pharmacist on the nutrition support team reviews an adult receiving furosemide 40 mg IV every 12 hours and pantoprazole 40 mg IV daily. Weight history: usual dry weight 72 kg 1 month ago, admission weight 68 kg, current weight 77 kg with new ascites and 3+ edema. Which anthropometric interpretation best supports the nutrition assessment?

   Choose one answer

   ADefer nutrition assessment until diuresis is complete because furosemide therapy prevents meaningful anthropometric interpretation.BUse the current 77 kg weight because it is the most recent measured value and indicates weight gain.CUse ideal body weight only because edema makes all actual weight history invalid.DUse the usual dry weight and admission trend to identify clinically significant recent weight loss masked by fluid accumulation.
3. Question 3 of 10

   A 72-year-old fictional patient had an ischemic stroke with severe dysphagia. Oral intake has been negligible for 5 days and no safe oral intake is expected for another week. The abdomen is soft, bowel sounds are present, and there is no ileus or shock. Current medications include thiamine 100 mg IV daily and phenytoin 100 mg IV every 8 hours. As the nutrition support pharmacist on rounds, which recommendation best matches guideline-concordant indications and route selection?

   Choose one answer

   A

   Avoid enteral nutrition and use parenteral nutrition because phenytoin may interact with tube feeding once administered enterally.

   B

   Continue maintenance IV dextrose only and reassess nutrition support after 14 days because aspiration risk makes feeding unsafe.

   C

   Start central parenteral nutrition at full estimated calorie goal today because oral intake has been inadequate for 5 days.

   D

   Recommend enteral nutrition access and cautious initiation with electrolyte monitoring because the GI tract is functional and intake is inadequate.

4. Question 4 of 10

   A pharmacist on the ICU nutrition support team reviews a 52-year-old adult with BMI 38 kg/m² receiving propofol 30 mcg/kg/min IV continuous infusion and norepinephrine 0.04 mcg/kg/min IV continuous infusion. Enteral nutrition is being planned, indirect calorimetry is available, and the team wants to avoid overfeeding during critical illness. Which energy-requirement approach is most appropriate?

   Choose one answer

   AUse indirect calorimetry to set the energy target, then account for propofol lipid calories within the total daily energy provision.BUse 30–35 kcal/kg actual body weight per day because obesity increases stress-related energy needs in critical illness.CUse a stress-factor predictive equation with actual body weight and add propofol lipid calories to the calculated feeding goal.DUse 25 kcal/kg actual body weight per day and ignore propofol calories because they are medication-related.
5. Question 5 of 10

   A pharmacist on the pediatric nutrition support team reviews PN containing dextrose 12.5% infusing IV at 14 mL/hr continuously for a fictional 3.5-kg infant. The infant also receives methylprednisolone 1 mg/kg IV every 12 hours. Which GIR should the pharmacist verify and communicate during PN monitoring?

   Choose one answer

   A14.0 mg/kg/min, using the mL/hr rate as if it were already mg/kg/min.B2.1 mg/kg/min, from treating 12.5% dextrose as 12.5 mg/mL.C8.3 mg/kg/min, using dextrose concentration, infusion rate, weight, and minutes.D12.5 mg/kg/min, selecting the dextrose percentage as the GIR because steroids increase glucose exposure.
6. Question 6 of 10

   A nutrition support pharmacist reviews an adult PN order: amino acids 40 g, dextrose 100 g, sodium chloride 35 mEq, potassium acetate 20 mEq, calcium gluconate 4.5 mEq, and magnesium sulfate 8 mEq in 1,000 mL IV over 24 hours daily. Ceftriaxone 2 g IV every 24 hours is also active. Using \(10\) mOsm/g amino acids, \(5\) mOsm/g dextrose, and \(2\) mOsm/mEq cations, what is the best recommendation?

   Choose one answer

   A

   Administer peripherally if dextrose is reduced to 70 g/L, without reassessing electrolytes or total nutrient goals.

   B

   Administer peripherally as written because calcium and magnesium are compatibility concerns but do not contribute meaningfully to osmolarity.

   C

   Administer peripherally as written because the estimated osmolarity is about 765 mOsm/L.

   D

   Recommend central administration or reformulation/dilution before peripheral use because the estimated osmolarity is about 1,035 mOsm/L.

7. Question 7 of 10

   A nutrition support pharmacist reviews an ICU adult receiving metoclopramide 10 mg IV every 6 hours and pantoprazole 40 mg IV daily. Current nutrition order is polymeric enteral nutrition 60 mL/hour by nasogastric tube. The patient has a functional GI tract but recurrent witnessed regurgitation and suspected aspiration despite head-of-bed elevation and prokinetic therapy; expected nutrition support duration is about 10 days. Which route/access recommendation is most appropriate?

   Choose one answer

   ARecommend central parenteral nutrition because recurrent regurgitation is a contraindication to using the GI tract.BContinue gastric nasogastric feeding but reduce the enteral nutrition rate to 30 mL/hour while checking gastric residual volumes more frequently.CRecommend postpyloric nasoenteric feeding access placed by the appropriate service, with enteral nutrition resumed after tube position is confirmed.DRecommend immediate percutaneous endoscopic gastrostomy because aspiration risk makes nasogastric feeding inappropriate.
8. Question 8 of 10

   As the nutrition support pharmacist, you evaluate a 68-kg adult receiving phenytoin suspension 100 mg via nasogastric tube every 8 hours. The patient has an intact GI tract, estimated need 1800 kcal/day, and a fluid goal near 1500 mL/day. Which enteral nutrition recommendation best applies standard polymeric formula principles?

   Choose one answer

   A

   Use a standard polymeric 1.0 kcal/mL formula at 75 mL/hour continuously because intact digestion is present.

   B

   Use a standard polymeric 1.5 kcal/mL formula at 50 mL/hour or an equivalent schedule, coordinating phenytoin administration and monitoring levels.

   C

   Use a peptide-based 1.0 kcal/mL formula at 75 mL/hour continuously; no feeding adjustment around phenytoin is needed.

   D

   Use a disease-specific 2.0 kcal/mL formula at 37.5 mL/hour and avoid fiber or protein adjustments initially.

9. Question 9 of 10

   A nutrition support pharmacist reviews a fictional 68-year-old ICU step-down patient receiving phenytoin suspension 100 mg via gastric tube every 8 hours and pantoprazole 40 mg IV daily. The patient has tolerated gastric continuous enteral nutrition at 60 mL/hour for 72 hours, is now hemodynamically stable, and is preparing for inpatient rehabilitation with daytime therapy. The team asks how to transition feeding delivery without exceeding the patient’s known tolerance. Which recommendation is most appropriate?

   Choose one answer

   A

   Convert immediately to 360 mL gastric bolus feedings four times daily and mix each phenytoin dose into the formula.

   B

   Transition to cyclic gastric feeding, such as 90 mL/hour for 16 hours, with planned phenytoin separation when feasible and serum level monitoring.

   C

   Continue 24-hour continuous gastric feeding at 60 mL/hour and give phenytoin through the tube without feed interruption.

   D

   Use a 12-hour nocturnal cycle at 120 mL/hour and empirically increase phenytoin to 150 mg every 8 hours to offset reduced absorption.

10. Question 10 of 10

    A 62-year-old fictional ICU patient receives enteral nutrition at 60 mL/hr via nasogastric tube and metoclopramide 10 mg enterally every 6 hours. The bedside nurse reports a gastric residual volume of 250 mL. The patient has no vomiting, abdominal distension, pain, or new oxygen requirement; bowel sounds are present and the head of bed is elevated. As the nutrition support pharmacist on rounds, which recommendation is most appropriate?

    Choose one answer

    AContinue enteral nutrition, reassess clinical tolerance and residuals per institutional policy, and avoid interruption for an isolated 250 mL residual.BAdd erythromycin 250 mg enterally every 6 hours for motility while continuing the patient’s scheduled amiodarone.CIncrease metoclopramide to 20 mg every 6 hours to lower residuals, even though the estimated creatinine clearance is 32 mL/min.DHold enteral nutrition for 6 hours and convert metoclopramide to 10 mg IV every 6 hours solely because the residual is 250 mL.

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