Certified Specialist in Gerontological Nutrition (CSG) Exam — Questions and Answers

Question 1: A resident with mid-stage dementia paces all day and leaves meals unfinished. Which intervention is most appropriate?

Restrict them to bed during meals
Start a clear liquid diet
Cut meals to twice daily
Offer energy-dense finger foods they can eat while moving (Correct answer)

Correct answer: Offer energy-dense finger foods they can eat while moving

Portable, nutrient-dense finger foods help residents who wander meet higher energy needs without needing to stay seated.

Question 2: What is the PRIMARY objective of infection control & prevention within the Certified Specialist in Gerontological Nutrition profession?

To create additional requirements for practitioners
To maintain the status quo without change
To ensure quality outcomes through standardized practices and continuous improvement (Correct answer)
To limit the scope of professional activities

Correct answer: To ensure quality outcomes through standardized practices and continuous improvement

The primary objective is ensuring quality outcomes through established standards while continuously improving practices and processes.

Question 3: A resident chooses to keep eating regular-texture food despite a speech-language pathologist's recommendation for minced and moist. What should the dietitian's documentation include?

Nothing, since the diet order is unchanged
A note that the resident is noncompliant
Only the SLP's recommendation
The informed refusal: risks explained, the resident's understanding and choice, and the care plan update (Correct answer)

Correct answer: The informed refusal: risks explained, the resident's understanding and choice, and the care plan update

Documenting informed choice and risk education protects the resident's autonomy and the facility.

Question 4: What is the first step in creating a care plan for older adults?

Focusing on medication management
Starting with treatment planning
Providing a list of available services
Assessing the health and functional status (Correct answer)

Correct answer: Assessing the health and functional status

The first step in creating a care plan for older adults is to conduct a comprehensive assessment of their health and functional status. This initial evaluation helps identify their unique needs, strengths, limitations, and preferences, forming the foundation for a personalized and effective care plan. Without this thorough understanding, subsequent planning steps would be less targeted and potentially ineffective.

Question 5: Which educational adaptation best supports an older adult with low vision?

Glossy handouts with pastel text
Light gray 10-point font to fit more content
Italicized script fonts for emphasis
High-contrast, large-print (at least 14-point) sans-serif text on matte paper (Correct answer)

Correct answer: High-contrast, large-print (at least 14-point) sans-serif text on matte paper

Large, high-contrast, non-glossy print reduces glare and improves legibility for low vision.

Question 6: How do nutrient absorption rates change as we age?

Absorption increases for all nutrients
Absorption of carbohydrates increases
Absorption of most nutrients declines (Correct answer)
Absorption stays the same for vitamins

Correct answer: Absorption of most nutrients declines

As we age, physiological changes in the digestive system, such as reduced stomach acid production and decreased enzyme activity, can impair the absorption of many essential nutrients. This decline in absorption can lead to deficiencies, even with adequate dietary intake, highlighting the importance of nutrient-dense foods and sometimes supplementation for older adults.

Question 7: Which Care Area Assessment (CAA) is triggered specifically for residents at risk of fluid deficit?

Nutritional Status
Feeding Tube
Dehydration/Fluid Maintenance (Correct answer)
Pressure Ulcer/Injury

Correct answer: Dehydration/Fluid Maintenance

The Dehydration/Fluid Maintenance CAA addresses risk of inadequate fluid intake or excess losses.

Question 8: Which EWGSOP2 physical performance result indicates severe sarcopenia when low muscle strength and mass are present?

Gait speed of 1.2 m/s
Five chair stands in 10 seconds
Gait speed of 0.8 m/s or less (Correct answer)
Timed Up and Go of 8 seconds

Correct answer: Gait speed of 0.8 m/s or less

Gait speed ≤0.8 m/s shows low physical performance, which together with low strength and muscle mass defines severe sarcopenia.

Question 9: A resident is receiving a total of 1,000 mL fluid daily and shows rising BUN:creatinine ratio. Which care plan intervention is most appropriate?

Discontinue all diuretics without physician input
Switch to honey-thick liquids
Schedule fluid rounds and offer preferred beverages between meals (Correct answer)
Implement a fluid restriction

Correct answer: Schedule fluid rounds and offer preferred beverages between meals

Structured fluid offerings with preferred drinks are effective in correcting inadequate intake in long-term care.

Question 10: Which CMS F-tag requires LTC facilities to keep acceptable parameters of nutrition and hydration status unless the resident's condition makes this impossible?

F758
F689
F880
F692 (Correct answer)

Correct answer: F692

F692 covers keeping body weight, protein levels, and hydration status within acceptable parameters.

Question 11: Why does the iron RDA for women fall after age 50?

Menstrual iron losses stop after menopause (Correct answer)
Hemoglobin production stops
Iron absorption increases after menopause
Dietary iron becomes toxic

Correct answer: Menstrual iron losses stop after menopause

After menopause the RDA drops from 18 mg to 8 mg because menstrual blood loss ends.

Question 12: Which ICD-10-CM code represents severe protein-calorie malnutrition?

E46
E43 (Correct answer)
E44.1
E44.0

Correct answer: E43

E43 is unspecified severe protein-calorie malnutrition; E44.0 is moderate and E44.1 is mild.

Question 13: A useful baseline fluid estimate for many older adults without fluid restrictions is:

1 L/day regardless of weight
30 mL/kg/day (Correct answer)
50 mL/kg/day
15 mL/kg/day

Correct answer: 30 mL/kg/day

About 30 mL/kg/day, or 1 mL/kcal, is a common baseline fluid estimate adjusted for clinical conditions.

Question 14: A client says, "I know my salt intake is a problem, and I might cut back sometime in the next few months." Which Transtheoretical Model stage fits?

Precontemplation
Contemplation (Correct answer)
Preparation
Action

Correct answer: Contemplation

Contemplation involves recognizing a problem and intending to change within about six months without a firm plan.

Question 15: When documenting a telehealth nutrition visit with an older adult, which element is essential?

The visit modality (audio-video or audio-only), patient location, consent, and participants (Correct answer)
A handwritten patient signature
A photo of the patient's meals
A weight measured by the dietitian

Correct answer: The visit modality (audio-video or audio-only), patient location, consent, and participants

Telehealth notes must record modality, locations, consent, and who took part to support compliance and billing.

Question 16: An older Greek Orthodox client tells you she observes Lent. Which dietary change is most likely?

Avoiding meat, dairy, and often eggs and fish, with a more plant-based diet (Correct answer)
Eating only meat
Fasting from water
Avoiding all plant foods

Correct answer: Avoiding meat, dairy, and often eggs and fish, with a more plant-based diet

Greek Orthodox fasting periods restrict animal products, which can affect protein, calcium, and B12 intake in frail elders.

Question 17: Why is cultural competence important in gerontological practice?

To reduce the risk of bias in treatment plans (Correct answer)
To avoid legal ramifications
To provide more culturally aligned treatments
To increase medication prescriptions

Correct answer: To reduce the risk of bias in treatment plans

Cultural competence is crucial in gerontological practice because it enables healthcare providers to understand and respect the diverse beliefs, values, and practices of older adults from various backgrounds. This understanding helps to minimize assumptions and stereotypes, thereby reducing the risk of bias in assessment, diagnosis, and treatment planning. Ultimately, it leads to more person-centered, effective, and equitable care that aligns with the individual's cultural context.

Question 18: Under the HIPAA Breach Notification Rule, affected individuals must be notified of a breach of unsecured PHI no later than:

1 year after discovery
60 calendar days after discovery (Correct answer)
Only if the breach affects 500+ people
10 days after discovery

Correct answer: 60 calendar days after discovery

Covered entities must notify affected individuals without unreasonable delay and no later than 60 days after discovery.

Question 19: Within the Nutrition Care Process, which step involves tracking indicators to determine whether goals are being met?

Nutrition Assessment
Nutrition Diagnosis
Nutrition Monitoring and Evaluation (Correct answer)
Nutrition Intervention

Correct answer: Nutrition Monitoring and Evaluation

Monitoring and Evaluation measures progress toward expected outcomes and prompts care plan revision.

Question 20: Under the Elder Justice Act, a covered LTC staff member who suspects a crime that caused serious bodily injury must report it within how long?

24 hours
2 hours (Correct answer)
48 hours
5 business days

Correct answer: 2 hours

Suspected crimes involving serious bodily injury must be reported within 2 hours, and all others within 24 hours.

Question 21: Which goal is written in the most measurable, person-centered format for a care plan?

Staff will encourage meals
Resident will eat better
Resident will improve nutrition status
Resident will maintain weight within 3% of 132 lb over the next 90 days (Correct answer)

Correct answer: Resident will maintain weight within 3% of 132 lb over the next 90 days

A SMART goal specifies a measurable target and timeframe focused on the resident.

Question 22: Which IDDSI level describes 'minced and moist' food texture?

Level 4
Level 5 (Correct answer)
Level 6
Level 7

Correct answer: Level 5

IDDSI Level 5 is minced and moist, between Level 4 pureed and Level 6 soft and bite-sized.

Question 23: An older adult stage 3 pressure injury patient admitted after a disaster needs which protein target per NPIAP guidelines?

0.6 g/kg per day
0.8 g/kg per day
1.25-1.5 g/kg per day (Correct answer)
3.0 g/kg per day

Correct answer: 1.25-1.5 g/kg per day

NPIAP recommends 1.25-1.5 g/kg/day protein for adults with pressure injuries who are malnourished or at risk.

Question 24: Which statement best distinguishes capacity from competence?

Capacity is permanent once lost
Capacity is a clinical judgment; competence is a legal determination made by a court (Correct answer)
Competence is determined by the RDN during assessment
Capacity and competence are both determined only by courts

Correct answer: Capacity is a clinical judgment; competence is a legal determination made by a court

Clinicians assess decision-making capacity, while competence is a legal finding.

Question 25: Which HIPAA principle limits the protected health information a dietitian shares with a meal-delivery vendor to only what's needed for the task?

Accounting of disclosures
Minimum necessary standard (Correct answer)
Breach notification
Right of access

Correct answer: Minimum necessary standard

The minimum necessary standard limits uses and disclosures of PHI to what the purpose requires.

Question 26: Which pathogen is a particular concern for older adults because it can grow at refrigeration temperatures in deli meats and soft cheeses?

Staphylococcus aureus
Clostridium perfringens
Listeria monocytogenes (Correct answer)
Bacillus cereus

Correct answer: Listeria monocytogenes

Listeria grows at refrigerator temperatures and causes severe invasive illness in older adults.

Question 27: The RDA for vitamin D for adults over 70 years is:

600 IU/day
400 IU/day
1,000 IU/day
800 IU/day (Correct answer)

Correct answer: 800 IU/day

The IOM set the RDA at 800 IU (20 mcg) per day for adults older than 70.

Question 28: The PROT-AGE study group recommends what daily protein intake for healthy older adults?

2.0-2.5 g/kg
0.8 g/kg
1.0-1.2 g/kg (Correct answer)
0.6-0.8 g/kg

Correct answer: 1.0-1.2 g/kg

PROT-AGE recommends 1.0-1.2 g/kg/day for healthy older adults, and 1.2-1.5 g/kg/day for those with acute or chronic disease.

Question 29: Which finding should prompt the clinician to suspect early refeeding syndrome after starting EN in a frail older adult?

Improved grip strength
Rising serum albumin
Increased stool frequency only
New-onset hypokalemia, hypomagnesemia, and fluid retention within 72 hours (Correct answer)

Correct answer: New-onset hypokalemia, hypomagnesemia, and fluid retention within 72 hours

Drops in potassium, phosphorus, and magnesium plus fluid overload within the first days of feeding signal refeeding syndrome.

Question 30: During a norovirus outbreak in an assisted living facility, which foodservice change is most appropriate?

Switch all residents to disposable dishes and utensils
Remove all fresh fruit from the menu
Serve only cold foods to limit kitchen handling
Suspend self-service buffets and family-style dining (Correct answer)

Correct answer: Suspend self-service buffets and family-style dining

Stopping self-service and shared serving utensils cuts down on hand-to-food transmission during norovirus outbreaks.

Question 31: The calcium RDA for men aged 51–70 is:

1,000 mg/day (Correct answer)
800 mg/day
1,200 mg/day
1,500 mg/day

Correct answer: 1,000 mg/day

Men 51–70 need 1,000 mg/day, rising to 1,200 mg/day after 70, while women need 1,200 mg/day after 50.

Question 32: What is the PRIMARY objective of emergency response & critical care within the Certified Specialist in Gerontological Nutrition profession?

To maintain the status quo without change
To limit the scope of professional activities
To ensure quality outcomes through standardized practices and continuous improvement (Correct answer)
To create additional requirements for practitioners

Correct answer: To ensure quality outcomes through standardized practices and continuous improvement

The primary objective is ensuring quality outcomes through established standards while continuously improving practices and processes.

Question 33: Under Medicare Part B, which condition qualifies a beneficiary for medical nutrition therapy (MNT) benefits?

Non-dialysis chronic kidney disease (Correct answer)
Hypertension
Osteoporosis
Unintentional weight loss

Correct answer: Non-dialysis chronic kidney disease

Medicare Part B MNT covers diabetes, non-dialysis kidney disease, and kidney transplant within 36 months.

Question 34: Why are older adults more susceptible to foodborne illness?

They need fewer calories, so they eat smaller portions
They have higher stomach acid production
Their gut transit time is faster
Immunosenescence and lower gastric acid let pathogens survive and invade (Correct answer)

Correct answer: Immunosenescence and lower gastric acid let pathogens survive and invade

Age-related immune decline and less stomach acid make older adults less able to neutralize and fight foodborne pathogens.

Question 35: In advanced dementia, what does the American Geriatrics Society recommend about feeding tubes?

Offer careful hand feeding instead of feeding tubes (Correct answer)
Start tube feeding to prevent aspiration
Place a PEG tube when intake falls
Use nasogastric feeding for comfort

Correct answer: Offer careful hand feeding instead of feeding tubes

AGS advises against feeding tubes in advanced dementia because they do not improve survival, aspiration, or comfort, and recommends careful hand feeding.

Question 36: Using EWGSOP2 cut points, which handgrip strength result indicates probable sarcopenia in an older woman?

Less than 16 kg (Correct answer)
Less than 20 kg
Less than 27 kg
Less than 30 kg

Correct answer: Less than 16 kg

EWGSOP2 sets low grip strength at <16 kg for women and <27 kg for men.

Question 37: A dietitian discovers an error in a signed paper progress note. What is the correct way to fix it?

Black out the error completely so it can't be misread
Draw a single line through the error, write the correction, and initial and date it (Correct answer)
Remove the page and rewrite the whole note
Use correction fluid and rewrite the entry

Correct answer: Draw a single line through the error, write the correction, and initial and date it

A single line keeps the original entry readable and preserves the legal integrity of the record.

Question 38: A high gastric residual volume (GRV) during tube feeding typically indicates:

Need for increased caloric density
Adequate formula absorption
Dehydration requiring additional free water
Delayed gastric emptying requiring feeding rate adjustment (Correct answer)

Correct answer: Delayed gastric emptying requiring feeding rate adjustment

Elevated GRV suggests delayed gastric emptying, which increases aspiration risk and warrants holding or reducing the feeding rate and assessing for prokinetic therapy.

Question 39: Sarcopenic dysphagia refers to swallowing difficulty caused by:

Radiation-induced fibrosis of the pharynx
Age-related loss of swallowing muscle mass and strength (Correct answer)
Esophageal stricture from long-term GERD
Neurological damage from Parkinson's disease

Correct answer: Age-related loss of swallowing muscle mass and strength

Sarcopenic dysphagia results from whole-body sarcopenia extending to the swallowing musculature, causing reduced muscle mass and force generation in the tongue, pharynx, and larynx.

Question 40: What is the importance of social support in managing chronic diseases for older adults?

It has no impact on chronic disease management
It enhances adherence to treatment and improves quality of life (Correct answer)
It reduces the need for medication
It makes physical activity unnecessary

Correct answer: It enhances adherence to treatment and improves quality of life

Social support is vital in managing chronic diseases for older adults as it enhances adherence to treatment and significantly improves their quality of life. Emotional encouragement, practical assistance, and a sense of belonging can reduce stress, combat isolation, and motivate individuals to follow their care plans, leading to better health outcomes and overall well-being.

Question 41: Which factor BEST indicates mastery of pharmacology & treatment protocols in Certified Specialist in Gerontological Nutrition?

Speed of task completion
Years of experience in a single setting
Number of certifications held
The ability to adapt knowledge and skills to varying contexts while maintaining standards (Correct answer)

Correct answer: The ability to adapt knowledge and skills to varying contexts while maintaining standards

True mastery is demonstrated by the ability to apply knowledge flexibly across different contexts while consistently maintaining quality standards.

Question 42: What is the PRIMARY purpose of documentation & health records in Certified Specialist in Gerontological Nutrition?

To create paperwork for filing purposes
To satisfy audit requirements only
To provide accurate, accessible information for decision-making and compliance (Correct answer)
To limit access to information

Correct answer: To provide accurate, accessible information for decision-making and compliance

Data and documentation exist primarily to provide accurate, accessible information that supports both decision-making and regulatory compliance.

Question 43: Which element is ESSENTIAL for an effective professional ethics & legal standards program in Certified Specialist in Gerontological Nutrition?

Regular audits and continuous monitoring processes (Correct answer)
Compliance responsibility assigned to one individual only
Annual review without interim checks
Documentation stored without regular updates

Correct answer: Regular audits and continuous monitoring processes

Regular audits and continuous monitoring enable early detection of compliance gaps and ensure ongoing adherence to standards.

Question 44: A competent 88-year-old nursing home resident with diabetes refuses the prescribed consistent-carbohydrate diet and wants regular desserts. What is the most appropriate RDN action?

Discharge the resident from nutrition services
Continue serving the therapeutic diet because it was ordered by the physician
Honor the choice, educate on risks, document the informed refusal, and update the care plan (Correct answer)
Ask the family to override the resident's decision

Correct answer: Honor the choice, educate on risks, document the informed refusal, and update the care plan

A resident with decision-making capacity has the right to refuse treatment, and the RDN must educate, document, and care-plan around that choice.

Question 45: Where should a formal complaint about an RDN's alleged violation of the Code of Ethics be filed?

The U.S. Department of Labor
The FDA
The Centers for Disease Control and Prevention
The Academy/CDR Ethics Committee (Correct answer)

Correct answer: The Academy/CDR Ethics Committee

The Academy/CDR Ethics Committee reviews complaints of Code of Ethics violations by credentialed practitioners.

Question 46: Hepatic changes with aging that affect nutrition and medications include:

Increased albumin synthesis
Reduced liver blood flow and mass, slowing some drug metabolism (Correct answer)
Enhanced first-pass metabolism
Increased liver size

Correct answer: Reduced liver blood flow and mass, slowing some drug metabolism

Lower hepatic blood flow and mass can slow clearance of drugs that depend on first-pass metabolism.

Question 47: An older adult on warfarin wants to start eating more leafy greens. What is the best guidance?

Eat greens only on weekends
Take a vitamin K supplement to balance it out
Keep vitamin K intake consistent from day to day (Correct answer)
Avoid all vitamin K foods completely

Correct answer: Keep vitamin K intake consistent from day to day

Consistent vitamin K intake keeps the INR stable, and warfarin doses can then be adjusted to that intake.

Question 48: Aspiration risk during enteral feeding can be reduced by:

Elevating the head of the bed to 30–45 degrees during and after feeding (Correct answer)
Administering feeding rapidly to minimize time at risk
Feeding the patient in a supine (flat) position
Using higher-viscosity formula

Correct answer: Elevating the head of the bed to 30–45 degrees during and after feeding

Elevating the head of the bed to 30–45 degrees uses gravity to keep gastric contents from refluxing into the esophagus and airways during enteral feeding.

Question 49: In the IDDSI framework, which level describes 'thin' liquids such as water, coffee, and juice in their standard unmodified form?

Level 2 (Mildly Thick)
Level 3 (Moderately Thick)
Level 0 (Thin) (Correct answer)
Level 1 (Slightly Thick)

Correct answer: Level 0 (Thin)

IDDSI Level 0 (Thin) describes liquids in their natural unmodified state including water, juice, coffee, and broth, which flow rapidly and require the most intact swallowing function.

Question 50: Which statement about lactose intolerance in older adults is most accurate?

All older adults must avoid dairy
It is rare in people of African, Asian, and Native American descent
Lactase persistence is most common among people of Northern European descent (Correct answer)
Lactose intolerance always means calcium needs cannot be met

Correct answer: Lactase persistence is most common among people of Northern European descent

Lactase nonpersistence is the global norm and is highly common among African, Asian, Hispanic, and Native American groups.

Question 51: In long-term care, the Academy of Nutrition and Dietetics position on therapeutic diets for older adults favors:

Removing dessert for residents with diabetes
Liberalized diets when they improve intake and quality of life (Correct answer)
Pureed diets for everyone over 85
Strict sodium and sugar limits for all residents

Correct answer: Liberalized diets when they improve intake and quality of life

The Academy supports individualized, liberalized diets because restrictive diets can reduce intake and raise malnutrition risk.

Question 52: Why is cultural competence important in gerontological practice?

To reduce the risk of bias in treatment plans (Correct answer)
To avoid legal ramifications
To increase medication prescriptions
To provide more culturally aligned treatments

Correct answer: To reduce the risk of bias in treatment plans

Question 53: An older adult on simvastatin drinks large amounts of grapefruit juice daily. What is the main risk?

Decreased statin effect
Increased statin levels and risk of myopathy (Correct answer)
Hypoglycemia
Vitamin C toxicity

Correct answer: Increased statin levels and risk of myopathy

Grapefruit inhibits intestinal CYP3A4, raising simvastatin levels and the risk of myopathy and rhabdomyolysis.

Question 54: A score of 4 or more on the SARC-F questionnaire suggests:

Normal muscle function
Sarcopenia risk that needs further assessment (Correct answer)
Dysphagia risk
Confirmed severe sarcopenia

Correct answer: Sarcopenia risk that needs further assessment

SARC-F ≥4 is a screening result for sarcopenia, which is then confirmed with strength and muscle mass measures.

Question 55: A resident's usual weight is 150 lb and current weight is 138 lb. What is the percent weight change?

12%
10%
5%
8% (Correct answer)

Correct answer: 8%

(150 − 138) ÷ 150 × 100 = 8% weight loss.

Question 56: For an older adult with limited numeracy, which way of presenting sodium guidance is BEST?

Reduce sodium by 35% from baseline
Keep sodium-to-potassium ratio under 1.0
Keep sodium below 100% of the Daily Value across meals
Limit sodium to less than 2,300 mg, about 1 teaspoon of salt per day (Correct answer)

Correct answer: Limit sodium to less than 2,300 mg, about 1 teaspoon of salt per day

Pairing a whole number with a familiar household measure is easier than percentages or ratios.

Question 57: Under the RAI process, the comprehensive care plan must be completed within how many days after the admission MDS assessment is completed?

21 days
7 days (Correct answer)
14 days
3 days

Correct answer: 7 days

CMS requires the comprehensive care plan within 7 days after the comprehensive assessment is completed.

Question 58: An older Japanese American client with hypertension eats miso soup and pickled vegetables daily. What is the main nutrition concern?

Excess saturated fat
Too much fiber
Too little protein
High sodium (Correct answer)

Correct answer: High sodium

Miso, soy sauce, and pickled foods are major sodium sources in traditional Japanese diets.

Question 59: In Certified Specialist in Gerontological Nutrition, how should clinical assessment & patient care results be communicated to stakeholders?

Verbally without written documentation
Only when specifically requested
Through clear, structured reports with actionable recommendations (Correct answer)
Using technical jargon without explanation

Correct answer: Through clear, structured reports with actionable recommendations

Clear, structured reports with actionable recommendations ensure stakeholders understand findings and can take appropriate action.

Question 60: Which electrolyte abnormality is the hallmark of refeeding syndrome?

Hypophosphatemia (Correct answer)
Hypernatremia
Hypercalcemia
Hyperkalemia

Correct answer: Hypophosphatemia

Insulin release with refeeding drives phosphorus intracellularly, making hypophosphatemia the defining feature.

Question 61: Which change in renal function is typical with aging?

Increased renal activation of vitamin D
Increased renal mass
Enhanced ability to excrete a sodium load
Gradual decline in glomerular filtration rate (Correct answer)

Correct answer: Gradual decline in glomerular filtration rate

GFR typically declines with age, affecting drug clearance and electrolyte handling.

Question 62: When determining nutritional support for an older adult with severe dysphagia and high aspiration risk, which principle should guide the clinical decision between enteral tube feeding and continued modified oral diet?

Enteral feeding is always preferred over any oral intake once aspiration is confirmed
Modified textures should always be attempted before discussing tube feeding regardless of aspiration severity
The patient's goals of care, quality of life preferences, and degree of aspiration risk must be weighed collaboratively (Correct answer)
Percutaneous endoscopic gastrostomy (PEG) tubes eliminate all nutritional deficiency risk

Correct answer: The patient's goals of care, quality of life preferences, and degree of aspiration risk must be weighed collaboratively

Dysphagia management is ethically complex; decisions about enteral vs. oral intake require balancing aspiration risk, nutritional adequacy, patient autonomy, quality of life, and goals-of-care discussions with the patient and family.

Question 63: Calcium citrate is preferred over calcium carbonate for older adults primarily because:

It is less expensive
It contains more elemental calcium per tablet
It has fewer drug interactions
It is better absorbed in low-stomach-acid environments (Correct answer)

Correct answer: It is better absorbed in low-stomach-acid environments

Calcium citrate does not require stomach acid for absorption, making it superior for older adults who commonly have hypochlorhydria or take proton pump inhibitors.

Question 64: When transitioning an older adult from tube feeding to oral intake, the BEST approach is to:

Gradually decrease tube feeding volume while encouraging oral intake and monitoring tolerance (Correct answer)
Stop tube feeding abruptly and offer full oral meals immediately
Switch directly to parenteral nutrition during the transition
Continue full tube feeding simultaneously with unrestricted oral diet

Correct answer: Gradually decrease tube feeding volume while encouraging oral intake and monitoring tolerance

A gradual transition allows the patient to increase oral intake while tube feeding supplements remaining needs, preventing undernutrition while rebuilding oral feeding capacity.

Question 65: Under the FDA Food Code, a dietary aide in a nursing home has a sore throat with fever. What action is required?

No action unless vomiting or diarrhea is present
Restrict the aide from handling food but allow other kitchen duties
Allow work if the aide wears gloves
Exclude the aide from the establishment because residents are a highly susceptible population (Correct answer)

Correct answer: Exclude the aide from the establishment because residents are a highly susceptible population

In facilities serving a highly susceptible population, the Food Code requires excluding food employees who have a sore throat with fever.

Question 66: Which MDS item records nutritional approaches such as a mechanically altered diet, therapeutic diet, or feeding tube, both during and before the stay?

K0310
K0520 (Correct answer)
K0200
M0300

Correct answer: K0520

K0520 captures nutritional approaches in the look-back periods before and during the stay.

Question 67: For an older resident with a stage 3 pressure injury and no renal disease, which nutrition goal fits current NPIAP guidance?

Protein 2.5 g/kg and 40 kcal/kg
Protein 0.8 g/kg and 25 kcal/kg
Protein 1.25-1.5 g/kg and 30-35 kcal/kg (Correct answer)
Protein 1.0 g/kg and 20 kcal/kg

Correct answer: Protein 1.25-1.5 g/kg and 30-35 kcal/kg

NPIAP guidelines recommend 30-35 kcal/kg and 1.25-1.5 g protein/kg for adults with pressure injuries who are malnourished or at risk.

Question 68: Hot TCS food is being cooled for later use. According to the FDA Food Code, it must cool from 135°F to 70°F within how long?

2 hours (Correct answer)
4 hours
6 hours
1 hour

Correct answer: 2 hours

Food must cool from 135°F to 70°F within 2 hours and from 70°F to 41°F within the next 4 hours.

Question 69: The Hunger Vital Sign screening tool used with older adults consists of how many questions?

Two (Correct answer)
One
Six
Eighteen

Correct answer: Two

The Hunger Vital Sign uses two validated questions about the past 12 months to identify food insecurity risk.

Question 70: Silent aspiration is particularly dangerous in older adults because:

It triggers an immediate gag reflex that alerts clinicians
It only occurs with thin liquids and is easily prevented
It occurs without cough reflex activation, making it undetected until pneumonia develops (Correct answer)
It causes immediate laryngospasm detectable by caregivers

Correct answer: It occurs without cough reflex activation, making it undetected until pneumonia develops

Silent aspiration occurs when food or liquid enters the airway below the vocal folds without triggering a cough response, commonly due to reduced laryngeal sensitivity in older adults, leading to undetected aspiration pneumonia.

Question 71: A resident with dysphagia insists on thin liquids despite aspiration risk. What is the best practice approach?

Withhold all liquids until the resident agrees
Thicken liquids secretly without telling the resident
Hold an interdisciplinary discussion, document informed refusal of the risks, and care-plan for safer strategies (Correct answer)
Transfer the resident to another facility

Correct answer: Hold an interdisciplinary discussion, document informed refusal of the risks, and care-plan for safer strategies

Respecting an informed choice while reducing harm through the care plan balances autonomy and nonmaleficence.

Question 72: During an extended power outage, how should insulin that has been at room temperature be handled?

Most insulins can be used for up to 28 days unrefrigerated if kept below about 86°F and out of direct heat (Correct answer)
Store it in a hot car to prevent freezing
Freeze it to preserve potency
Discard immediately once refrigeration fails

Correct answer: Most insulins can be used for up to 28 days unrefrigerated if kept below about 86°F and out of direct heat

FDA guidance notes most insulins remain usable for about 28 days at room temperature, but extreme heat or freezing degrades them.

Question 73: A severely malnourished ICU patient (NUTRIC score high) cannot tolerate any EN. When should PN be started per ASPEN/SCCM?

After 7 days
After 14 days
As soon as possible after ICU admission (Correct answer)
Only after trying a second feeding tube

Correct answer: As soon as possible after ICU admission

High-risk or severely malnourished patients should start PN as soon as possible when EN is not feasible.

Question 74: During a care transition from hospital to skilled nursing facility, which nutrition information is most critical to communicate?

Favorite restaurant
Past diet history from childhood
Grocery budget
Current diet order, texture/liquid consistency, and recent weight trend (Correct answer)

Correct answer: Current diet order, texture/liquid consistency, and recent weight trend

Accurate transfer of diet orders, IDDSI levels, and weight data prevents errors and supports continuity.

Question 75: On the MNA-Short Form (MNA-SF), what score range indicates an older adult is 'at risk of malnutrition'?

8-11 points (Correct answer)
15-17 points
12-14 points
0-7 points

Correct answer: 8-11 points

MNA-SF scores of 8-11 mean at risk, 0-7 mean malnourished, and 12-14 mean normal nutritional status.

Question 76: How should documentation & health records retention policies be determined in Certified Specialist in Gerontological Nutrition?

Keeping everything indefinitely
Based on available storage space
Destroying records as soon as they are no longer immediately needed
Based on legal requirements, operational needs, and industry best practices (Correct answer)

Correct answer: Based on legal requirements, operational needs, and industry best practices

Retention policies should balance legal requirements, operational needs, and best practices to ensure appropriate preservation and disposal.

Question 77: An older adult on long-term proton pump inhibitor therapy is at higher risk of which deficiencies?

Vitamin B12, magnesium, and calcium (Correct answer)
Vitamin A and vitamin K
Sodium and chloride
Folate and vitamin C only

Correct answer: Vitamin B12, magnesium, and calcium

Lower gastric acid impairs absorption of B12, calcium, and magnesium, which raises fracture and hypomagnesemia risk.

Question 78: Which ethical principle is MOST directly at stake when an RDN advocates for fair distribution of limited home-delivered meal slots?

Autonomy
Justice (Correct answer)
Beneficence
Fidelity

Correct answer: Justice

Justice concerns fair and equitable distribution of resources.

Question 79: Which statement about calf circumference in older adult nutrition assessment is correct?

It is not affected by edema
It is the gold standard for body composition
Values above 40 cm indicate malnutrition
A value below 31 cm on the full MNA suggests reduced muscle mass (Correct answer)

Correct answer: A value below 31 cm on the full MNA suggests reduced muscle mass

On the MNA, calf circumference <31 cm scores as low, reflecting possible muscle loss, though edema can skew it.

Question 80: On the Braden Scale, which total score generally indicates pressure injury risk in older adults?

23 or higher
Exactly 20
18 or lower (Correct answer)
Any score above 19

Correct answer: 18 or lower

Braden totals of 18 or below show risk, and lower scores mean higher risk, with nutrition as one of six subscales.

Question 81: Which quality is MOST important for professionals conducting diagnostic procedures & interpretation in Certified Specialist in Gerontological Nutrition?

Personal relationships with those being assessed
Speed and efficiency above all else
Objectivity and attention to detail (Correct answer)
Experience in unrelated fields

Correct answer: Objectivity and attention to detail

Objectivity ensures unbiased results while attention to detail captures all relevant information for accurate assessment.

Question 82: Which tube feeding route is MOST appropriate for an older adult who requires long-term enteral nutrition (greater than 4 weeks)?

Orogastric tube
Percutaneous endoscopic gastrostomy (PEG) tube (Correct answer)
Nasogastric tube
Nasojejunal tube

Correct answer: Percutaneous endoscopic gastrostomy (PEG) tube

PEG tubes are indicated for long-term enteral nutrition beyond 4 weeks as they are more comfortable, lower aspiration risk, and allow patients greater mobility than nasogastric tubes.

Question 83: In the Social Cognitive Theory, older adults gaining confidence by watching peers successfully prepare low-sodium meals in a group class demonstrates:

Decisional balance
Observational learning (modeling) (Correct answer)
Perceived severity
Cue to action

Correct answer: Observational learning (modeling)

Observational learning occurs when people adopt behaviors after watching similar others succeed.

Question 84: An older adult has Na 150 mEq/L, glucose 180 mg/dL, and BUN 42 mg/dL. The calculated serum osmolality is about:

340 mOsm/kg
310 mOsm/kg
325 mOsm/kg (Correct answer)
295 mOsm/kg

Correct answer: 325 mOsm/kg

2(150) + 180/18 + 42/2.8 = 300 + 10 + 15 = 325 mOsm/kg, indicating hyperosmolar dehydration.

Question 85: Which of these is the best-written nutrition PES statement?

Inadequate oral intake related to dysphagia as evidenced by intake of less than 50% of meals for 7 days (Correct answer)
Malnutrition due to low albumin
Patient needs supplements as evidenced by weight
Weight loss related to weight loss

Correct answer: Inadequate oral intake related to dysphagia as evidenced by intake of less than 50% of meals for 7 days

A good PES statement names a nutrition problem, a specific cause, and measurable signs or symptoms.

Question 86: A bedbound resident with kyphosis cannot stand for height measurement. Which measurement is most appropriate for estimating stature?

Self-reported height
Knee height with Chumlea equation (Correct answer)
Length of the recumbent spine
Arm span with Chumlea equation

Correct answer: Knee height with Chumlea equation

Knee height changes little with age and is used in Chumlea equations to estimate height in nonambulatory older adults.

Question 87: An 82-year-old resident rarely asks for water and has rising serum sodium. Which physiologic change best explains this?

Blunted thirst sensation (Correct answer)
Excess antidiuretic hormone secretion
Increased renal concentrating ability
Increased total body water

Correct answer: Blunted thirst sensation

Older adults have diminished thirst perception, raising risk of hypernatremic dehydration.

Question 88: Which electronic health information exchange standard supports interoperable sharing of nutrition data, such as diet orders, between EHR systems?

HTML5
SQL
HL7 FHIR (Correct answer)
PDF/A

Correct answer: HL7 FHIR

HL7 FHIR defines resources, including NutritionOrder, for exchanging clinical data between systems.

Question 89: During Passover, an observant Jewish nursing home resident will avoid which foods?

All dairy foods
Eggs
Leavened grain products (chametz) such as regular bread (Correct answer)
All fruits

Correct answer: Leavened grain products (chametz) such as regular bread

Passover observance prohibits chametz, so matzah and certified kosher-for-Passover foods replace leavened products.

Question 90: An 82-year-old with diabetes, moderate cognitive impairment, and three chronic illnesses would most appropriately have which A1C goal?

<10.0%
<6.5%
<7.0%
<8.0% (Correct answer)

Correct answer: <8.0%

Older adults with complex or intermediate health status warrant a less stringent goal of <8.0% to reduce hypoglycemia risk.

Question 91: Which trace mineral supplementation is most appropriate for an older adult recovering from a pressure injury to support wound healing?

Zinc (Correct answer)
Iodine
Chromium
Selenium

Correct answer: Zinc

Zinc plays a critical role in collagen synthesis, immune function, and cell proliferation, making it important for wound healing in older adults with pressure injuries.

Question 92: Under the GLIM criteria, diagnosing malnutrition requires which combination?

Two phenotypic criteria only
Low serum albumin plus weight loss
At least one phenotypic and one etiologic criterion (Correct answer)
Two etiologic criteria plus a positive screen

Correct answer: At least one phenotypic and one etiologic criterion

GLIM needs at least one phenotypic criterion (weight loss, low BMI, low muscle mass) and one etiologic criterion (reduced intake/absorption or inflammation/disease burden).

Question 93: What is the primary goal in chronic disease management for older adults?

Optimizing health outcomes and improving quality of life (Correct answer)
Preventing any form of treatment
Restricting all physical activity
Focusing only on medication

Correct answer: Optimizing health outcomes and improving quality of life

The primary goal in chronic disease management for older adults is to optimize health outcomes and improve their quality of life. This involves not only managing symptoms and preventing complications but also enhancing functional independence, promoting well-being, and supporting their ability to engage in meaningful activities. The focus is on holistic care that empowers older adults to live as fully as possible despite their conditions.

Question 94: Why are serum albumin and prealbumin poor markers of nutritional status in acutely ill older adults?

They are negative acute-phase proteins that drop with inflammation (Correct answer)
They depend only on vitamin intake
They cannot be measured in older adults
They rise during infection

Correct answer: They are negative acute-phase proteins that drop with inflammation

Inflammation lowers hepatic synthesis of albumin and prealbumin whatever the nutrient intake, so they reflect illness severity more than nutrition.

Question 95: An older adult with CKD has a serum potassium of 5.8 mEq/L; which fruit is the best lower-potassium choice?

Banana
Apple (Correct answer)
Cantaloupe
Orange juice

Correct answer: Apple

Apples are low in potassium, whereas bananas, orange juice, and cantaloupe are high-potassium foods.

Question 96: According to ASPEN, how should a feeding tube be managed when giving medications?

Mix all medications together in the formula
Flush only once daily
Flush with about 15 mL of water before and after each medication (Correct answer)
Flush with carbonated beverages after each dose

Correct answer: Flush with about 15 mL of water before and after each medication

ASPEN recommends flushing with at least 15 mL of water before and after each medication to prevent clogging and interactions.

Question 97: What is the recommended approach to managing weight in older adults?

Focus on nutrient-dense, low-calorie foods (Correct answer)
Skip meals to reduce calorie intake
Increase calorie intake significantly
Avoid physical activity

Correct answer: Focus on nutrient-dense, low-calorie foods

For older adults, the recommended approach to weight management is to focus on nutrient-dense, low-calorie foods. While calorie needs decrease with age, nutrient requirements remain high, making it crucial to choose foods that provide essential vitamins, minerals, and protein without excessive calories. This strategy supports healthy weight, preserves muscle mass, and prevents nutritional deficiencies.

Question 98: Why is fiber important in the diet of aging adults?

It aids in digestion and prevents constipation (Correct answer)
It promotes dehydration
It inhibits nutrient absorption
It increases appetite

Correct answer: It aids in digestion and prevents constipation

Fiber is important in the diet of aging adults because it promotes healthy bowel function and helps prevent constipation, a common issue due to slower gut motility and reduced fluid intake. Additionally, fiber contributes to satiety, helps regulate blood sugar levels, and supports a healthy gut microbiome, all beneficial for overall health in older age.

Question 99: Which tool helps clinicians draw out a client's own beliefs about illness?

Harris-Benedict equation
Braden Scale
Mini Nutritional Assessment
Kleinman's explanatory model questions (Correct answer)

Correct answer: Kleinman's explanatory model questions

Kleinman's questions ask what the patient thinks caused the illness, what they fear, and what treatment they expect.

Question 100: What consequence can result from failing to maintain proper professional ethics & legal standards standards in Certified Specialist in Gerontological Nutrition?

Lower training requirements
Loss of certification, legal penalties, and reputational damage (Correct answer)
Increased customer satisfaction
Reduced workload for staff

Correct answer: Loss of certification, legal penalties, and reputational damage

Non-compliance can result in serious consequences including certification revocation, legal penalties, fines, and significant reputational damage.

Question 101: Which document is a set of actionable medical orders on life-sustaining treatment, including artificial nutrition, that follows the patient across care settings?

HIPAA authorization
Living will
Health care proxy
POLST/MOLST form (Correct answer)

Correct answer: POLST/MOLST form

POLST forms are signed medical orders that cover preferences such as tube feeding and transfer between settings.

Question 102: An RDN provides telehealth counseling to an older adult living in another state. Which licensure rule generally applies?

Only the RDN's home-state license matters
CDR registration replaces all state licensure
Telehealth is exempt from licensure laws
The RDN must comply with licensure laws of the state where the patient is located (Correct answer)

Correct answer: The RDN must comply with licensure laws of the state where the patient is located

Practice is generally considered to take place where the patient is located, so that state's laws apply.

Question 103: Which federally required assessment tool in U.S. nursing homes includes a section documenting swallowing and nutritional status?

Braden Scale
Katz ADL Index
Minimum Data Set (MDS) (Correct answer)
OASIS

Correct answer: Minimum Data Set (MDS)

The MDS Section K records swallowing problems, weight changes, and nutritional approaches for long-term care residents.

Question 104: Using the Fried frailty phenotype, an older adult with three of the five criteria is classified as:

Robust
Pre-frail
Sarcopenic obese
Frail (Correct answer)

Correct answer: Frail

Three or more Fried criteria indicate frailty, and one or two indicate pre-frailty.

Question 105: A dietitian copies and pastes last week's assessment into today's note without changes. What is the main documentation risk?

Notes get shorter
It meets the requirements perfectly
Outdated or wrong information is carried forward, weakening the record's accuracy and legal defensibility (Correct answer)
It improves interoperability

Correct answer: Outdated or wrong information is carried forward, weakening the record's accuracy and legal defensibility

Cloned documentation can spread errors and may not reflect the resident's current status.

Question 106: Medicare Part B covers medical nutrition therapy by a registered dietitian for which diagnoses?

Obesity and hypertension
Heart failure and COPD
Dysphagia and dementia
Diabetes and non-dialysis chronic kidney disease, including post-kidney transplant (Correct answer)

Correct answer: Diabetes and non-dialysis chronic kidney disease, including post-kidney transplant

The Medicare MNT benefit is limited to diabetes, non-dialysis renal disease, and the post-kidney-transplant period.

Question 107: How often must the MDS be completed at minimum for a long-term nursing facility resident without significant changes?

Every 6 months only
Quarterly, with a comprehensive assessment annually (Correct answer)
Monthly
Only on admission

Correct answer: Quarterly, with a comprehensive assessment annually

Quarterly assessments are required no less than every 92 days, with a comprehensive annual assessment.

Question 108: Before giving oral food or fluids to an older adult admitted with acute stroke, what must be completed?

A swallow screen (Correct answer)
A 24-hour dietary recall
Indirect calorimetry
A lipid panel

Correct answer: A swallow screen

A dysphagia screen should precede any oral intake after stroke to reduce aspiration pneumonia risk.

Question 109: Which HIPAA principle requires an RDN to share only the patient information needed to accomplish a specific purpose?

Right of access
Accounting of disclosures
Minimum necessary standard (Correct answer)
Breach notification rule

Correct answer: Minimum necessary standard

The minimum necessary standard limits uses and disclosures of PHI to what is needed for the task.

Question 110: Which component of an ADIME note holds the PES statement?

Monitoring and Evaluation
Assessment
Intervention
Diagnosis (Correct answer)

Correct answer: Diagnosis

The nutrition diagnosis step is documented as a Problem, Etiology, Signs/Symptoms statement.

Question 111: Which folate measure best reflects long-term folate status in an older adult with irregular intake?

Red blood cell folate (Correct answer)
Serum folate
Serum homocysteine alone
Urinary folate

Correct answer: Red blood cell folate

RBC folate reflects stores over the RBC lifespan, whereas serum folate reflects recent intake.

Question 112: An alert older adult with diabetes has a fingerstick glucose of 62 mg/dL; what is the recommended first step?

Administer the next scheduled insulin dose early
Wait 30 minutes and recheck
Give a high-protein snack such as peanut butter
Give 15-20 g of fast-acting glucose and recheck in 15 minutes (Correct answer)

Correct answer: Give 15-20 g of fast-acting glucose and recheck in 15 minutes

Hypoglycemia (<70 mg/dL) in a conscious person is treated with 15-20 g of glucose, rechecking after 15 minutes.

Question 113: For a non-dialysis older adult with stage 4 CKD and no diabetes who is metabolically stable, KDOQI 2020 suggests what protein intake under close supervision?

0.55-0.6 g/kg/day (Correct answer)
1.2-1.5 g/kg/day
0.3 g/kg/day with no supplements
1.0-1.2 g/kg/day

Correct answer: 0.55-0.6 g/kg/day

KDOQI 2020 suggests a low-protein diet of 0.55-0.6 g/kg/day for stable non-diabetic CKD stages 3-5 not on dialysis.

Question 114: Which clinical assessment & patient care method provides the MOST reliable results in Certified Specialist in Gerontological Nutrition?

Single-point assessments without follow-up
Informal observation without documentation
Assessments based solely on self-reporting
Standardized protocols with validated measurement tools (Correct answer)

Correct answer: Standardized protocols with validated measurement tools

Standardized protocols and validated tools ensure consistency, reliability, and comparability of assessment results.

Question 115: Why is cultural competence important in gerontological practice?

To avoid legal ramifications
To provide more culturally aligned treatments
To reduce the risk of bias in treatment plans (Correct answer)
To increase medication prescriptions

Correct answer: To reduce the risk of bias in treatment plans

Question 116: For a critically ill older adult with a BMI of 42, what protein provision is recommended by ASPEN/SCCM?

2.0 g/kg actual body weight per day
0.8 g/kg ideal body weight per day
Up to 2.5 g/kg ideal body weight per day (Correct answer)
1.0 g/kg actual body weight per day

Correct answer: Up to 2.5 g/kg ideal body weight per day

ASPEN/SCCM recommends 2.0 g/kg IBW for BMI 30-40 and up to 2.5 g/kg IBW for BMI ≥40.

Question 117: When should clinical assessment & patient care be conducted in Certified Specialist in Gerontological Nutrition?

Only when required by external auditors
Only when problems are identified
At regular intervals and whenever significant changes occur (Correct answer)
Once during initial setup only

Correct answer: At regular intervals and whenever significant changes occur

Regular assessments combined with trigger-based reviews ensure ongoing monitoring while capturing the impact of significant changes.

Question 118: Which serum finding best supports hypertonic dehydration in an older adult?

Serum osmolality above 300 mOsm/kg (Correct answer)
Serum sodium of 132 mEq/L
BUN:creatinine ratio of 8:1
Serum albumin of 4.2 g/dL

Correct answer: Serum osmolality above 300 mOsm/kg

Measured serum osmolality above 300 mOsm/kg is the reference-standard marker of low-intake (hypertonic) dehydration in older adults.

Question 119: For a frail older resident with type 2 diabetes, several chronic conditions, and moderate cognitive impairment, which A1C goal is generally appropriate per ADA guidance?

Less than 6.5%
Less than 6.0%
Less than 8.0% (Correct answer)
Less than 10.5%

Correct answer: Less than 8.0%

ADA suggests a less strict A1C goal of about <8.0% for older adults with complex or intermediate health to limit hypoglycemia risk.

Question 120: Which documentation & health records practice is MOST critical for maintaining data integrity in Certified Specialist in Gerontological Nutrition?

Manual data entry without verification
Storing data in multiple disconnected systems
Allowing unrestricted access to modify records
Standardized input procedures with validation checks and regular audits (Correct answer)

Correct answer: Standardized input procedures with validation checks and regular audits

Standardized procedures with validation and audits ensure data remains accurate, consistent, and trustworthy.

Question 121: Many Chinese older adults follow hot-cold food beliefs. How should an RDN respond?

Avoid talking about food beliefs
Include the beliefs in the plan by choosing balanced foods that fit both the belief system and nutrition goals (Correct answer)
Correct the beliefs as unscientific
Refer to a traditional healer and stop nutrition care

Correct answer: Include the beliefs in the plan by choosing balanced foods that fit both the belief system and nutrition goals

Working within health beliefs builds trust and adherence without giving up nutrition goals.

Question 122: Which communication practice is most appropriate when counseling many older Asian clients?

Making constant direct eye contact as a sign of trust
Speaking for the client
Using first names immediately
Showing respect through formal address and checking understanding, since nodding may not mean agreement (Correct answer)

Correct answer: Showing respect through formal address and checking understanding, since nodding may not mean agreement

In many Asian cultures a nod or 'yes' can signal politeness rather than understanding, so teach-back is important.

Question 123: An older Somali Muslim resident in long-term care refuses the meat entrée. What is the most likely reason, and the right fix?

Low appetite; offer a supplement only
The meat is not halal; offer halal-certified meat or vegetarian protein (Correct answer)
Chewing difficulty; puree it
Food dislike; serve a dessert

Correct answer: The meat is not halal; offer halal-certified meat or vegetarian protein

Observant Muslims eat only halal meat and avoid pork and alcohol, so halal or vegetarian options respect this.

Question 124: Long-term metformin use in an older adult with diabetes calls for monitoring of which nutrient?

Vitamin E
Vitamin A
Vitamin B12 (Correct answer)
Iron

Correct answer: Vitamin B12

Metformin impairs B12 absorption, and deficiency can worsen neuropathy and cognitive decline in older adults.

Question 125: Which leftover-reheating instruction is correct to teach an older adult client?

Reheat to 135°F and hold
Reheat leftovers to 145°F
Reheat leftovers to 165°F (Correct answer)
Warm until hot to the touch on the outside

Correct answer: Reheat leftovers to 165°F

USDA advises reheating leftovers to an internal temperature of 165°F.

Certified Specialist in Gerontological Nutrition (CSG) Exam

This exam certifies registered dietitian nutritionists (RDNs) who possess advanced knowledge and skills in providing nutrition care to older adults.

125

Questions

180 min

Time Limit

65%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

cdrnet.org — Renewal, eligibility, fees, test delivery, exam format, passing score, registration deadline, retake policy, score release, time limit · verified Oct 2026