BCNSP Prep Course (BCNSP): free quiz

1. Question 1 of 10

   A PN order for dextrose 250 g, amino acids 90 g, and potassium phosphate 40 mmol IV over 24 hours is entered for a postoperative adult with a newly placed PICC. During pharmacist verification, the latest potassium is 6.1 mEq/L and the hemolysis comment is absent. What is the most appropriate pharmacist action?

   Choose one answer

   ARemove potassium phosphate from the formula and release the PN, then document the change afterward.BHold PN compounding and clarify the order and current potassium result with the prescriber before release.CDispense the PN as ordered because the infusion is continuous over 24 hours.DAdminister a one-time saline flush through the PICC to confirm line patency, then proceed with compounding.
2. Question 2 of 10

   A pharmacist is checking a home PN prescription containing amino acids 75 g/day, dextrose 240 g/day, multivitamins 10 mL/day, and trace elements 1 mL/day IV cyclic over 12 hours. The order omits the final total volume. What is the safest next step?

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   AClarify the final volume before compounding because concentration, rate, and stability depend on it.BSet the volume based on the vitamin volume and release the bag for overnight delivery.CUse the previous admission’s PN volume because the macronutrients are similar.DAssume a standard 2-liter volume and process the order to avoid delaying discharge.
3. Question 3 of 10

   The pharmacist checks a PN order written as sodium acetate 30 mEq/day IV and potassium acetate 20 mEq/day IV in the same final bag. What is the combined acetate salt amount from these two additives in mEq per day?

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   A60 mEq/day combinedB20 mEq/day combinedC30 mEq/day combinedD50 mEq/day combined
4. Question 4 of 10

   A pharmacist reviews chronic medication and nutrition therapy for a patient taking colesevelam 625 mg, 3 tablets by mouth twice daily, and an oral supplement providing 15 g fat per serving twice daily. Which absorption consequence is most expected from bile acid sequestration?

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   AImproved micelle formation and increased long-chain fat absorption in the proximal jejunum.BReduced absorption of fat and fat-soluble vitamins because bile acid binding impairs micelle-mediated uptake.CSelective loss of glucose absorption because bile acids are required for sodium-glucose cotransport.DIncreased vitamin B12 absorption because bile acid binding frees intrinsic factor receptors in the ileum.
5. Question 5 of 10

   A pharmacist reviews a protein goal for an adult with open fractures receiving PN with amino acids 85 g/day IV continuously, dextrose 190 g/day, and lipid 40 g/day. Serum creatinine is stable, and urine output is adequate. Which statement best reflects the effect of critical illness on protein metabolism?

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   AProtein needs usually fall in trauma because endogenous amino acid release fully meets healing demands.BCritical illness often increases protein turnover and breakdown, so standard unstressed protein doses may be inadequate.CIf renal function is stable, protein metabolism is unaffected by inflammatory stress.DDextrose delivery alone determines whether protein catabolism occurs during fracture recovery.
6. Question 6 of 10

   A pharmacist verifies potassium phosphate 15 mmol IV once in 250 mL and reviews a patient whose serum sodium increased after inadequate tube-water flushes. Which additional finding would best support a free-water deficit rather than sodium-rich extracellular loss?

   Choose one answer

   ALarge-volume ileostomy output with orthostasis and low urine output.BContinuous nasogastric suction with hypochloremic alkalosis.CHigh-fever insensible losses with concentrated urine and minimal GI sodium loss history.DRecent loop diuretic use with substantial natriuresis and postural symptoms.
7. Question 7 of 10

   A pharmacist reviews an adult home PN formula containing sodium chloride 120 mEq IV daily, potassium chloride 50 mEq IV daily, and no free-water adjustment. The patient reports high ostomy output. Labs show sodium 150 mEq/L, potassium 3.3 mEq/L, magnesium 1.7 mg/dL, bicarbonate 19 mEq/L, serum creatinine 1.0 mg/dL. Which interpretation best fits the pattern?

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   AThe hypernatremia proves sodium chloride content is the only cause, so ostomy losses are not relevant.BHigh ostomy output can cause water and bicarbonate loss, contributing to hypernatremia, hypokalemia, and metabolic acidosis.CPotassium is low because chloride salts always reduce serum potassium in PN.DLow bicarbonate with high ostomy output indicates vomiting-type alkalosis rather than intestinal loss.
8. Question 8 of 10

   A pharmacist assesses lipid dosing in a 900-g premature infant receiving amino acids 3 g/kg/day, dextrose 8 mg/kg/min, and intravenous lipid emulsion 3 g/kg/day. Which monitoring priority is most age-specific?

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   AWeekly INR because lipid emulsion directly predicts coagulation changes in all neonates.BMonthly albumin because it is the primary marker of short-term lipid tolerance.CNo lipid monitoring is needed if the dose is under 4 g/kg/day.DDaily triglyceride assessment early in therapy because very low birth weight infants may clear lipid less efficiently.
9. Question 9 of 10

   A pharmacist reviews a PN trace element order for a 62-year-old adult with bilirubin elevation and persistent cholestasis. The order continues standard multi-trace elements plus copper 2 mg IV daily from a separate additive. Which toxicity concern is most appropriate to raise during verification?

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   AChromium accumulation is a concern because cholestasis primarily reduces chromium elimination, especially with separate copper additives.BZinc accumulation is a concern because cholestasis usually decreases renal zinc elimination and causes acute neurologic toxicity.CThiamine accumulation is a concern because biliary obstruction markedly reduces thiamine clearance during PN therapy.DCopper accumulation is a concern because biliary excretion is impaired in cholestasis, increasing toxicity risk with continued supplementation.
10. Question 10 of 10

    A pharmacist is verifying a nutrition plan for a 52-year-old adult with Promote with Fiber 75 mL/hour via gastrostomy tube. Medication profile includes prednisone 40 mg by mouth daily and trimethoprim-sulfamethoxazole DS 1 tablet by mouth three times weekly. Which assessment element is most important to review because it can substantially affect interpretation of current weight and body composition?

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    AWhether the patient prefers room-temperature formula, because preference changes body composition estimates.BWhether prednisone was given in the morning, because dose timing determines anthropometric correction factors.CWhether the formula contains fiber, because fiber content determines the accuracy of ideal body weight.DWhether the patient has a major amputation, because standard anthropometric interpretation may require adjustment when body parts are absent.

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