NBNSC Certified Nutrition Support Clinician Practice Test

CNSC Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam 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 exam format. The content of the exam 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: 43
Nutrient needs of infants diagnosed with bronchopulmonary dysplasia:
A. Are linked with linear growth
B. May include a resting energy expenditure 50% higher than that of normal
infants
C. May include use of diuretics to regulate water balance
D. All of the above
Answer: D
Nutrient needs of infants diagnosed with bronchopulmonary disease are linked
with linear growth (a measure of lung development), may include a resting energy
expenditure that is 50% higher than that of normal infants, and may include the
use of diuretics to regulate water balance. Bronchopulmonary disease is a
common lung disorder in premature infants which increases energy needs.
Diuretics are often needed to regulate water balance as a result of respiratory
compromise.
Question: 44
The following nutrition diagnosis is written in what type of format: Poor
glycemic control is related to skipping use of oral hypoglycemic agents as
evidenced by random blood glucose levels greater than 200 mg/dl.
A. SOAP note
B. POMR
C. PES statement
D. Continuity of care record
Answer: C
The nutrition diagnosis Poor glycemic control is related to skipping use of oral
hypoglycemic agents as evidenced by random blood glucose levels greater than
200 mg/dl is written as a PES statement (P is problem, E is etiology, S is signs or
symptoms). Problem = poor glycemic control, Etiology = skipping use of oral
hypoglycemic agents, S = blood glucose levels greater than 200 mg/dl.
Question: 45
Which dietary measures are recommended for treating hypercalcuria that is not
associated with renal stones?
A. Limiting calcium to 1000 mg per day
B. Increasing fluid intake to 2 liters per day
C. 400 IU vitamin D per day
D. Limiting animal protein to less than 1.7 g/kg per day
Answer: D
Limiting animal protein to less than 1.7 g/kg per day is recommended for the
treatment of hypercalcuria because excessive intakes of animal protein cause
calcium loss from the bones. A moderate calcium intake of 600-800 mg of
calcium per day is recommended, since lowering calcium intake results in
increased absorption. Increasing fluid intake does not prevent hypercalcuria.
Question: 46
Which of the following is a common side effect of immunosuppressive drug
therapy used in organ transplantation?
A. Sodium and fluid diuresis
B. Hyperphosphatemia
C. Hyperkalemia
D. Decreased vitamin C requirements
Answer: C
Hyperkalemia (elevated potassium levels) is a common side effect of
immunosuppressive drug therapy used in organ transplantation, as a result of
disturbances in renal hormone activity. Sodium and fluid retention and
hypophosphatemia are also side effects of immunosuppressive drugs.
Question: 47
Brown adipose tissue performs what function in the body:
A. Protects internal organs from injury
B. Storage site for triglycerides
C. Is considered to be essential fat that supports metabolic processes
D. Heat production and regulation of body temperature
Answer: D
Brown adipose tissue is believed to regulate heat production and body
temperature, particularly in infants who are susceptible to hypothermia. White
adipose tissue is the major type of fat in the body. It protects internal organs from
injury, stores triglycerides, and makes up the essential fat that supports many
metabolic processes.
Question: 48
Age-associated bone loss among the elderly:
A. Is always reversed with calcium supplementation
B. Can be prevented by cardiovascular exercise such as swimming
C. Affects both trabecular and cortical bone
D. May be slowed by the use of steroid drugs
Answer: C
Age-associated bone loss among the elderly affects both trabecular (spongy) and
cortical (hard) bone. Age-associated bone loss may be slowed by calcium
supplementation, through may not be reversed. Bone loss is slowed by weight-
bearing exercise, such as walking, aerobics, and weight training, and accelerated
by the use of steroid drugs.
Question: 49
Which of the following vitamins functions as a hormone?
A. Folic acid
B. Vitamin C
C. Vitamin E
D. Vitamin D
Answer: D
Vitamin D functions in the form calcitriol as a hormone in the regulation of body
calcium and phosphorus. It is also responsible for the formation of bone.
Question: 50
50. Which of the following is true for athletic amenorrhea, the loss of menstrual
periods caused by excessive exercise?
A. It results in irreversible bone loss
B. It may be successfully treated by increasing carbohydrate intake
C. It is treated by decreasing the intensity and amount of exercise
D. Both A and C
E. Both A and B
Answer: D
Athletic amenorrhea, the loss of menstrual periods caused by excessive exercise,
results in irreversible bone loss and is treated by decreasing the intensity and
amount of exercise. It is not helped by increasing intake of carbohydrates.

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