NR601 Week 6 Questions With Answers and Explanations
Primary Care of the Maturing and Aged Family Practicum | Gastrointestinal & Genitourinary Disorders | 600 Original Practice
Questions
Question 1. Which approach is most appropriate for identifying malnutrition risk in an older adult during routine
primary care?
A. Order serum albumin alone
B. Wait until BMI is below 18.5
C. Screen only after hospitalization
D. Use a validated nutrition screening tool
Correct Answer: D. Use a validated nutrition screening tool
Explanation: Older adults should be screened for malnutrition risk with a validated instrument rather than waiting for severe physical
signs. Screening is intended to identify risk early enough for assessment and intervention. Management should be individualized to
comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually more effective
than waiting for severe weight or muscle loss.
Question 2. Which tool is specifically designed to screen older adults for malnutrition risk?
A. Glasgow Coma Scale
B. Mini Nutritional Assessment-Short Form (MNA-SF)
C. Wells score
D. CHA2DS2-VASc
Correct Answer: B. Mini Nutritional Assessment-Short Form (MNA-SF)
Explanation: The MNA-SF is a validated screening instrument developed for nutrition risk in older adults. It incorporates factors such as
intake, weight loss, mobility, stress or illness, neuropsychological issues, and anthropometry. The plan should preserve oral intake and
independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are more
informative than one isolated laboratory value.
Question 3. Which finding should most strongly raise concern for clinically important malnutrition in an older adult?
A. Stable weight over 12 months
B. Intentional 2-lb loss after counseling
C. Unintentional progressive weight loss
D. Normal appetite with unchanged intake
Correct Answer: C. Unintentional progressive weight loss
Explanation: Unintentional weight loss is a major phenotypic marker of malnutrition and should trigger a more complete evaluation. The
amount, time course, baseline weight, and accompanying functional decline help determine severity. Polypharmacy, depression, dental
disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves
both nutritional status and daily function.
Question 4. Why should serum albumin not be used as the sole diagnostic test for malnutrition?
A. It measures only vitamin B12
B. It is strongly influenced by inflammation and illness
C. It rises only in dehydration
D. It directly measures skeletal muscle mass
Correct Answer: B. It is strongly influenced by inflammation and illness
Explanation: Albumin is a negative acute-phase reactant and can fall because of inflammation, infection, liver disease, or fluid shifts.
Nutrition diagnosis therefore requires clinical assessment rather than a single laboratory value. Management should be individualized to
comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually more effective
than waiting for severe weight or muscle loss.
Page 1
,NR601 Week 6 - Questions With Answers and Explanations
Question 5. Under the GLIM framework, what combination is required to diagnose malnutrition after risk screening?
A. Two phenotypic criteria only
B. One laboratory abnormality only
C. A low BMI alone in every patient
D. At least one phenotypic criterion and one etiologic criterion
Correct Answer: D. At least one phenotypic criterion and one etiologic criterion
Explanation: GLIM diagnosis combines evidence of the body effect of malnutrition with evidence of a cause. Phenotypic criteria include
weight loss, low BMI, or reduced muscle mass, while etiologic criteria include reduced intake or inflammatory disease. The plan should
preserve oral intake and independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and
tolerance are more informative than one isolated laboratory value.
Question 6. Which finding is a phenotypic GLIM criterion for malnutrition?
A. Reduced muscle mass
B. Reduced food intake
C. Inflammatory disease burden
D. Malabsorption disorder
Correct Answer: A. Reduced muscle mass
Explanation: Reduced muscle mass is one of the phenotypic manifestations used in GLIM assessment. Reduced intake, impaired
assimilation, and inflammation are etiologic rather than phenotypic criteria. Polypharmacy, depression, dental disease, dysphagia, food
access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves both nutritional status and
daily function.
Question 7. Which finding is an etiologic GLIM criterion for malnutrition?
A. Low body weight alone
B. Reduced nutrient intake or assimilation
C. Reduced calf circumference alone
D. Unintentional weight loss alone
Correct Answer: B. Reduced nutrient intake or assimilation
Explanation: Reduced intake or impaired nutrient assimilation is an etiologic criterion because it helps explain why malnutrition is
developing. Weight loss, low BMI, and reduced muscle mass describe phenotypic consequences instead. Management should be
individualized to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually
more effective than waiting for severe weight or muscle loss.
Question 8. An older adult is losing weight despite having food available. Which additional assessment is especially
important?
A. Assume aging alone explains the weight loss
B. Prescribe an appetite stimulant before evaluation
C. Evaluate chewing, dentition, swallowing, medications, mood, cognition, and social factors
D. Restrict dietary variety immediately
Correct Answer: C. Evaluate chewing, dentition, swallowing, medications, mood, cognition, and social factors
Explanation: Malnutrition in later life is often multifactorial and may reflect oral, swallowing, medication, cognitive, mood, or social
problems. Identifying reversible contributors is essential before relying on supplements or medications. The plan should preserve oral
intake and independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are
more informative than one isolated laboratory value.
Page 2
,NR601 Week 6 - Questions With Answers and Explanations
Question 9. What daily protein intake is a reasonable general minimum target for many older adults unless
disease-specific restrictions require adjustment?
A. About 1.0 g/kg/day or more
B. About 0.2 g/kg/day
C. Exactly 0.4 g/kg/day for everyone
D. No protein after age 70
Correct Answer: A. About 1.0 g/kg/day or more
Explanation: Geriatric nutrition guidance generally recommends at least about 1.0 g/kg/day of protein, with higher needs in many
illnesses. Kidney function, acute illness, wounds, activity level, and overall goals can modify the target. Polypharmacy, depression, dental
disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves
both nutritional status and daily function.
Question 10. A malnourished older adult can safely eat and swallow but cannot meet needs with meals alone. What
is the preferred next strategy?
A. Food enrichment and oral nutritional supplements
B. Immediate parenteral nutrition
C. Routine feeding tube placement
D. Stop regular meals and give only water
Correct Answer: A. Food enrichment and oral nutritional supplements
Explanation: When oral intake is possible, dietary counseling, food fortification, and oral supplements are preferred before invasive
nutrition support. This approach preserves normal eating while increasing energy and protein delivery. Management should be
individualized to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually
more effective than waiting for severe weight or muscle loss.
Question 11. For an older adult who is malnourished or at high risk, what should a prescribed oral nutritional
supplement generally provide each day according to ESPEN guidance?
A. 50 kcal and 2 g of protein
B. At least about 400 kcal and 30 g of protein
C. Only electrolytes without calories
D. Unlimited free water with no protein
Correct Answer: B. At least about 400 kcal and 30 g of protein
Explanation: ESPEN recommends substantial oral supplementation rather than very small calorie or protein amounts when treating
malnutrition risk. A commonly cited target is at least 400 kcal daily with 30 g or more of protein. The plan should preserve oral intake and
independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are more
informative than one isolated laboratory value.
Question 12. When is the best time to give oral nutritional supplements if they are reducing a patient's appetite for
regular meals?
A. Between meals
B. Only immediately before meals
C. Instead of every meal
D. Only during the night while asleep
Correct Answer: A. Between meals
Explanation: Giving supplements between meals can raise total energy and protein intake without displacing as much normal food.
Timing should be individualized to appetite, medication schedules, glycemic needs, and patient preference. Polypharmacy, depression,
dental disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often
improves both nutritional status and daily function.
Page 3
, NR601 Week 6 - Questions With Answers and Explanations
Question 13. Which intervention can increase calorie and protein density without substantially increasing meal
volume?
A. Dilute meals with extra water
B. Remove protein-containing foods
C. Fortify foods with energy- and protein-dense ingredients
D. Use only clear liquids indefinitely
Correct Answer: C. Fortify foods with energy- and protein-dense ingredients
Explanation: Food fortification is useful when appetite is poor because a smaller volume can deliver more energy and protein. Examples
include adding powdered milk, nut butters, oils, cheese, or other nutrient-dense ingredients when appropriate. Management should be
individualized to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually
more effective than waiting for severe weight or muscle loss.
Question 14. For many older women without a fluid-restricting condition, what daily amount of beverages is a
reasonable ESPEN hydration target?
A. 250 mL per day
B. 500 mL per week
C. No fluids between meals
D. At least about 1.6 liters per day
Correct Answer: D. At least about 1.6 liters per day
Explanation: ESPEN geriatric hydration guidance commonly uses about 1.6 liters of drinks daily for older women as a general minimum.
Heart failure, kidney disease, fever, climate, losses, and other factors can require individualized fluid goals. The plan should preserve oral
intake and independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are
more informative than one isolated laboratory value.
Question 15. For many older men without a fluid-restricting condition, what daily amount of beverages is a
reasonable ESPEN hydration target?
A. 400 mL per day
B. 750 mL per week
C. At least about 2.0 liters per day
D. Only fluids contained in medications
Correct Answer: C. At least about 2.0 liters per day
Explanation: A general geriatric hydration target is about 2.0 liters of drinks daily for older men when no clinical reason for restriction
exists. Actual needs vary with illness, environment, renal and cardiac status, and ongoing losses. Polypharmacy, depression, dental
disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves
both nutritional status and daily function.
Question 16. A severely malnourished patient begins nutrition support and develops weakness, edema, and
arrhythmia. Which electrolyte abnormality is most characteristic of refeeding syndrome?
A. Hypercalcemia
B. Hypernatremia as the defining abnormality
C. Hypophosphatemia
D. Isolated hypermagnesemia
Correct Answer: C. Hypophosphatemia
Explanation: Refeeding increases insulin activity and drives phosphate into cells, making hypophosphatemia a hallmark abnormality.
Potassium and magnesium can also fall, and thiamine deficiency may become clinically important. Management should be individualized
to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually more effective
than waiting for severe weight or muscle loss.
Page 4
Primary Care of the Maturing and Aged Family Practicum | Gastrointestinal & Genitourinary Disorders | 600 Original Practice
Questions
Question 1. Which approach is most appropriate for identifying malnutrition risk in an older adult during routine
primary care?
A. Order serum albumin alone
B. Wait until BMI is below 18.5
C. Screen only after hospitalization
D. Use a validated nutrition screening tool
Correct Answer: D. Use a validated nutrition screening tool
Explanation: Older adults should be screened for malnutrition risk with a validated instrument rather than waiting for severe physical
signs. Screening is intended to identify risk early enough for assessment and intervention. Management should be individualized to
comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually more effective
than waiting for severe weight or muscle loss.
Question 2. Which tool is specifically designed to screen older adults for malnutrition risk?
A. Glasgow Coma Scale
B. Mini Nutritional Assessment-Short Form (MNA-SF)
C. Wells score
D. CHA2DS2-VASc
Correct Answer: B. Mini Nutritional Assessment-Short Form (MNA-SF)
Explanation: The MNA-SF is a validated screening instrument developed for nutrition risk in older adults. It incorporates factors such as
intake, weight loss, mobility, stress or illness, neuropsychological issues, and anthropometry. The plan should preserve oral intake and
independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are more
informative than one isolated laboratory value.
Question 3. Which finding should most strongly raise concern for clinically important malnutrition in an older adult?
A. Stable weight over 12 months
B. Intentional 2-lb loss after counseling
C. Unintentional progressive weight loss
D. Normal appetite with unchanged intake
Correct Answer: C. Unintentional progressive weight loss
Explanation: Unintentional weight loss is a major phenotypic marker of malnutrition and should trigger a more complete evaluation. The
amount, time course, baseline weight, and accompanying functional decline help determine severity. Polypharmacy, depression, dental
disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves
both nutritional status and daily function.
Question 4. Why should serum albumin not be used as the sole diagnostic test for malnutrition?
A. It measures only vitamin B12
B. It is strongly influenced by inflammation and illness
C. It rises only in dehydration
D. It directly measures skeletal muscle mass
Correct Answer: B. It is strongly influenced by inflammation and illness
Explanation: Albumin is a negative acute-phase reactant and can fall because of inflammation, infection, liver disease, or fluid shifts.
Nutrition diagnosis therefore requires clinical assessment rather than a single laboratory value. Management should be individualized to
comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually more effective
than waiting for severe weight or muscle loss.
Page 1
,NR601 Week 6 - Questions With Answers and Explanations
Question 5. Under the GLIM framework, what combination is required to diagnose malnutrition after risk screening?
A. Two phenotypic criteria only
B. One laboratory abnormality only
C. A low BMI alone in every patient
D. At least one phenotypic criterion and one etiologic criterion
Correct Answer: D. At least one phenotypic criterion and one etiologic criterion
Explanation: GLIM diagnosis combines evidence of the body effect of malnutrition with evidence of a cause. Phenotypic criteria include
weight loss, low BMI, or reduced muscle mass, while etiologic criteria include reduced intake or inflammatory disease. The plan should
preserve oral intake and independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and
tolerance are more informative than one isolated laboratory value.
Question 6. Which finding is a phenotypic GLIM criterion for malnutrition?
A. Reduced muscle mass
B. Reduced food intake
C. Inflammatory disease burden
D. Malabsorption disorder
Correct Answer: A. Reduced muscle mass
Explanation: Reduced muscle mass is one of the phenotypic manifestations used in GLIM assessment. Reduced intake, impaired
assimilation, and inflammation are etiologic rather than phenotypic criteria. Polypharmacy, depression, dental disease, dysphagia, food
access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves both nutritional status and
daily function.
Question 7. Which finding is an etiologic GLIM criterion for malnutrition?
A. Low body weight alone
B. Reduced nutrient intake or assimilation
C. Reduced calf circumference alone
D. Unintentional weight loss alone
Correct Answer: B. Reduced nutrient intake or assimilation
Explanation: Reduced intake or impaired nutrient assimilation is an etiologic criterion because it helps explain why malnutrition is
developing. Weight loss, low BMI, and reduced muscle mass describe phenotypic consequences instead. Management should be
individualized to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually
more effective than waiting for severe weight or muscle loss.
Question 8. An older adult is losing weight despite having food available. Which additional assessment is especially
important?
A. Assume aging alone explains the weight loss
B. Prescribe an appetite stimulant before evaluation
C. Evaluate chewing, dentition, swallowing, medications, mood, cognition, and social factors
D. Restrict dietary variety immediately
Correct Answer: C. Evaluate chewing, dentition, swallowing, medications, mood, cognition, and social factors
Explanation: Malnutrition in later life is often multifactorial and may reflect oral, swallowing, medication, cognitive, mood, or social
problems. Identifying reversible contributors is essential before relying on supplements or medications. The plan should preserve oral
intake and independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are
more informative than one isolated laboratory value.
Page 2
,NR601 Week 6 - Questions With Answers and Explanations
Question 9. What daily protein intake is a reasonable general minimum target for many older adults unless
disease-specific restrictions require adjustment?
A. About 1.0 g/kg/day or more
B. About 0.2 g/kg/day
C. Exactly 0.4 g/kg/day for everyone
D. No protein after age 70
Correct Answer: A. About 1.0 g/kg/day or more
Explanation: Geriatric nutrition guidance generally recommends at least about 1.0 g/kg/day of protein, with higher needs in many
illnesses. Kidney function, acute illness, wounds, activity level, and overall goals can modify the target. Polypharmacy, depression, dental
disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves
both nutritional status and daily function.
Question 10. A malnourished older adult can safely eat and swallow but cannot meet needs with meals alone. What
is the preferred next strategy?
A. Food enrichment and oral nutritional supplements
B. Immediate parenteral nutrition
C. Routine feeding tube placement
D. Stop regular meals and give only water
Correct Answer: A. Food enrichment and oral nutritional supplements
Explanation: When oral intake is possible, dietary counseling, food fortification, and oral supplements are preferred before invasive
nutrition support. This approach preserves normal eating while increasing energy and protein delivery. Management should be
individualized to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually
more effective than waiting for severe weight or muscle loss.
Question 11. For an older adult who is malnourished or at high risk, what should a prescribed oral nutritional
supplement generally provide each day according to ESPEN guidance?
A. 50 kcal and 2 g of protein
B. At least about 400 kcal and 30 g of protein
C. Only electrolytes without calories
D. Unlimited free water with no protein
Correct Answer: B. At least about 400 kcal and 30 g of protein
Explanation: ESPEN recommends substantial oral supplementation rather than very small calorie or protein amounts when treating
malnutrition risk. A commonly cited target is at least 400 kcal daily with 30 g or more of protein. The plan should preserve oral intake and
independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are more
informative than one isolated laboratory value.
Question 12. When is the best time to give oral nutritional supplements if they are reducing a patient's appetite for
regular meals?
A. Between meals
B. Only immediately before meals
C. Instead of every meal
D. Only during the night while asleep
Correct Answer: A. Between meals
Explanation: Giving supplements between meals can raise total energy and protein intake without displacing as much normal food.
Timing should be individualized to appetite, medication schedules, glycemic needs, and patient preference. Polypharmacy, depression,
dental disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often
improves both nutritional status and daily function.
Page 3
, NR601 Week 6 - Questions With Answers and Explanations
Question 13. Which intervention can increase calorie and protein density without substantially increasing meal
volume?
A. Dilute meals with extra water
B. Remove protein-containing foods
C. Fortify foods with energy- and protein-dense ingredients
D. Use only clear liquids indefinitely
Correct Answer: C. Fortify foods with energy- and protein-dense ingredients
Explanation: Food fortification is useful when appetite is poor because a smaller volume can deliver more energy and protein. Examples
include adding powdered milk, nut butters, oils, cheese, or other nutrient-dense ingredients when appropriate. Management should be
individualized to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually
more effective than waiting for severe weight or muscle loss.
Question 14. For many older women without a fluid-restricting condition, what daily amount of beverages is a
reasonable ESPEN hydration target?
A. 250 mL per day
B. 500 mL per week
C. No fluids between meals
D. At least about 1.6 liters per day
Correct Answer: D. At least about 1.6 liters per day
Explanation: ESPEN geriatric hydration guidance commonly uses about 1.6 liters of drinks daily for older women as a general minimum.
Heart failure, kidney disease, fever, climate, losses, and other factors can require individualized fluid goals. The plan should preserve oral
intake and independence whenever possible while escalating support only when needed. Serial weight, intake, strength, and tolerance are
more informative than one isolated laboratory value.
Question 15. For many older men without a fluid-restricting condition, what daily amount of beverages is a
reasonable ESPEN hydration target?
A. 400 mL per day
B. 750 mL per week
C. At least about 2.0 liters per day
D. Only fluids contained in medications
Correct Answer: C. At least about 2.0 liters per day
Explanation: A general geriatric hydration target is about 2.0 liters of drinks daily for older men when no clinical reason for restriction
exists. Actual needs vary with illness, environment, renal and cardiac status, and ongoing losses. Polypharmacy, depression, dental
disease, dysphagia, food access, and functional limitations are common reversible contributors. A multidisciplinary plan often improves
both nutritional status and daily function.
Question 16. A severely malnourished patient begins nutrition support and develops weakness, edema, and
arrhythmia. Which electrolyte abnormality is most characteristic of refeeding syndrome?
A. Hypercalcemia
B. Hypernatremia as the defining abnormality
C. Hypophosphatemia
D. Isolated hypermagnesemia
Correct Answer: C. Hypophosphatemia
Explanation: Refeeding increases insulin activity and drives phosphate into cells, making hypophosphatemia a hallmark abnormality.
Potassium and magnesium can also fall, and thiamine deficiency may become clinically important. Management should be individualized
to comorbidities, swallowing safety, cognition, function, and the patient's goals. In older adults, early intervention is usually more effective
than waiting for severe weight or muscle loss.
Page 4
