10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The BCNSP exam has 150 questions and runs 3 hours 45 minutes.
These 10 free BCNSP questions are organized by exam domain, so you can see how each part of the Board-Certified Nutrition Support Pharmacist blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Nutrition Support 21% of exam
Question 1
A neonatal pharmacy must replace one pediatric amino-acid product with another because of a shortage. Both stock solutions contain 10% amino acids, and the infant's final amino-acid concentration, calcium gluconate dose, phosphate dose, and PN volume will remain unchanged. The replacement's amino-acid profile and inherent electrolytes have been reviewed. What additional evidence is needed before approving the existing calcium-phosphate prescription with the replacement product?
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Correct answer: D - Calcium-phosphate compatibility data for the replacement product and the final admixture.
Question 2
A home-infusion pharmacy aseptically compounds a Category 2 PN preparation from only sterile starting components, without sterility testing. All applicable Category 2 requirements are met. Chemical and physical stability of this exact formulation and container have been demonstrated for 14 days at 2-8°C. Ingredient labeling and other applicable requirements impose no shorter limit. What is the longest refrigerated beyond-use date that may be assigned under USP <797>?
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Correct answer: B - 10 days
Domain 2: Therapeutics and Patient Management 53% of exam
Question 3
Nutrition screening is positive for a 74-year-old receiving chemoradiation for head and neck cancer. The patient has unintentionally lost 12% of body weight over 4 months and has consumed approximately 40% of estimated energy requirements for 3 weeks. Current BMI is 31.4 kg/m², and serum albumin is 3.8 g/dL (reference 3.5-5.0). Using the Global Leadership Initiative on Malnutrition (GLIM) criteria, which conclusion is justified?
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Correct answer: B - Stage 2 (severe) malnutrition is present despite the current obesity.
Question 4
During morning rounds, a nurse reports a single gastric residual volume of 240 mL in a mechanically ventilated adult receiving enteral nutrition at the prescribed goal rate. The patient has been off vasopressors for 24 hours, has no vomiting or abdominal distension, and has a soft abdomen. Tube position is confirmed, and the head of the bed is elevated to 35 degrees. Which feeding order should the pharmacist support?
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Correct answer: A - Continue gastric feeding at goal while monitoring clinical tolerance.
Question 5
A 1.5-kg preterm infant receives central PN containing dextrose 12% at 5 mL/hour. A separate medication carrier supplies dextrose 10% at 1.5 mL/hour continuously. After recent hyperglycemia, the neonatal team prescribes a maximum total glucose infusion rate of 7.0 mg/kg/min. The carrier rate must remain unchanged. Which assessment of the current dextrose exposure supports the appropriate PN adjustment?
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Correct answer: C - Total GIR is 8.3 mg/kg/min; reduce the PN dextrose concentration.
Question 6
At a home-PN follow-up visit, a 58-year-old with progressive cholestasis reports a slowing gait. Examination shows rigidity and a resting tremor. Brain MRI demonstrates symmetric T1 hyperintensity in the globus pallidus. The daily multitrace-element preparation has not been modified as the cholestasis progressed. Which nutrient-related complication should be investigated first?
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Correct answer: A - Manganese accumulation
Question 7
A stable surgical-ward patient admitted yesterday has complete bowel obstruction and established severe malnutrition after several weeks of minimal intake. The surgeon expects oral and enteral nutrition to remain impossible for at least 10 days. The patient is pursuing restorative treatment. Volume deficits have been corrected; potassium, magnesium, and phosphorus are now within their reference ranges. Which initiation strategy best fits this patient's nutritional status?
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Correct answer: D - Begin PN promptly, with thiamine supplementation and cautious calorie advancement.
Question 8
A request to increase phenytoin reaches the nutrition-support pharmacist for an adult receiving continuous gastric feeding. Administration timing and the dose have been consistent, and the patient has no breakthrough seizures or signs of toxicity. At steady state, total phenytoin is 7.8 mcg/mL, measured free phenytoin is 1.6 mcg/mL, and albumin is 1.9 g/dL. The laboratory's reference ranges are 10-20 mcg/mL for total and 1-2 mcg/mL for free phenytoin. What recommendation follows from these findings?
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Correct answer: A - Maintain the present dose and monitor the measured free phenytoin concentration.
Domain 3: Professional Practice 26% of exam
Question 9
A randomized superiority trial compares a new catheter-care program with usual care in adults receiving home PN. The primary outcome is catheter-related bloodstream infection over 6 months. The reported relative risk is 0.76, with a 95% confidence interval of 0.49-1.18; the prespecified significance level is 0.05. Which statement accurately summarizes the result for the nutrition-support committee?
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Correct answer: C - The estimate favors the program, but the interval also permits increased infection risk.
Question 10
During testing of a new electronic PN-order interface, the pharmacist finds that potassium totals are correct in the prescribing system but higher in the automated compounder's instructions. Investigation shows that potassium supplied by potassium phosphate is being added a second time during data transfer. Which corrective action most directly prevents this error from recurring when the interface enters clinical use?
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Correct answer: D - Correct the ingredient mapping and validate end-to-end electrolyte totals before clinical use.
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