Certified Specialist in Geriatric Nutrition Exam
2026-2027 Questions And Answers Graded A+
Common places for pressure ulcers
Greater Trochanter, coccyx, ischial tuberosities, lateral and medial malleolus, iliac
creasts, sacrum, heels
Risk factors for developing pressure ulcers
Immobility
Malnutrition
Fecal or urinary incontinence
Altered level of consciousness
Advanced age
Poor nursing care
Factors affecting perfusion/oxygenation (vascular disease)
Nutrition-related factors that can contribute to pressure ulcers
Protein deficiency
protein/energy malnutrition
Dehydration (dry, fragile skin)
Obesity (increased weight on pressure points)
Underweight (lack of padding on pressure points)
Anemia (inhibits red blood cell distribution)
,Stage 1 Pressure ulcer description
Skin intact, non-blanchable, local redness
stage 2 pressure ulcer
partial thickness skin loss involving epidermis, dermis, or both
stage 3 pressure ulcer
Full-thickness pressure ulcer extending into the subcutaneous tissue and
resembling a crater. May see subcutaneous fat but not muscle, bone, or tendon.
stage 4 pressure ulcer
Full-thickness tissue loss with exposed bone, muscle, or tendon
Micronutrients in treating pressure ulcers
Zinc- cofactor for protein, collagen synthesis - limit supplementation to 40mg to
prevent copper deficiency
Copper-rebuilding collagen tissues
Vitamin C - increased leukocytes and macrophage
,Screening for pressure ulcers
At admission, with significant change in clinical condition, when progress towards
closure is not being made.
Nutrient needs for pressure ulcers
Kcal: 30-35 per kg (at malnutrition risk)
Protein: 1.25-1.5g/kg (assess renal function)
*Supplement with arginine, micronutrients, high protein supplements for stage 3 or
4 pressure ulcers.
Fluids: 30-35ml/kg (up to 40ml) - higher if drainage, fever, GI losses.
Dosages for vitamin supplementation with pressure ulcers
Vitamins C (stage 1/2): 100-200mg/d
Vitamin C (stage 3/4): 1000-2000ml/d
Vitamin C - renal disease: 60-100mg/dL
Zinc: up to 40ml/d (stop when deficiency resolved to prevent copper deficiency.
Omnibus Reconciliation Act of 1987
Established revisions to Medicare and Medicaid Conditions of Participation
regarding long-term care facilities and pharmacy and established MDS to ID
resident care problem areas
State Operations Manual
, Guidance to surveyors for long-term care facilities
Citations for skilled nursing facilities
Level 1: No actual Harm with potential for minimal harm (A, B, C)
Level 2: No actual harm with potential for more than minimal harm (D,E,F)
Level 3: Actual harm that is not immediate jeopardy (G, H, I)
Level 4: Immediate jeopardy to resident health and safety
Resident Assessment Instrument (RAI)
A comprehensive tool that includes the minimum data set, Care Area Assessment
(CAA), RAI utilization guidelines
RAI (Resident Assessment Instrument) Utilization steps
1. Assessment: Using all available sources for information
2. Decision-making: Including the resident/family, the physician, and the IDT in
the process while putting the resident at the center of care
3. Care planning: Identifying specific resident-directed goals that used the
resident's strengths and IDT's expertise.
4. Identification of outcomes: Determining resident-specific goals and needed
interventions
5. Implementation
6. Evaluation: Critically reviewing above process to determine outcomes and if
revisions are necessary.
2026-2027 Questions And Answers Graded A+
Common places for pressure ulcers
Greater Trochanter, coccyx, ischial tuberosities, lateral and medial malleolus, iliac
creasts, sacrum, heels
Risk factors for developing pressure ulcers
Immobility
Malnutrition
Fecal or urinary incontinence
Altered level of consciousness
Advanced age
Poor nursing care
Factors affecting perfusion/oxygenation (vascular disease)
Nutrition-related factors that can contribute to pressure ulcers
Protein deficiency
protein/energy malnutrition
Dehydration (dry, fragile skin)
Obesity (increased weight on pressure points)
Underweight (lack of padding on pressure points)
Anemia (inhibits red blood cell distribution)
,Stage 1 Pressure ulcer description
Skin intact, non-blanchable, local redness
stage 2 pressure ulcer
partial thickness skin loss involving epidermis, dermis, or both
stage 3 pressure ulcer
Full-thickness pressure ulcer extending into the subcutaneous tissue and
resembling a crater. May see subcutaneous fat but not muscle, bone, or tendon.
stage 4 pressure ulcer
Full-thickness tissue loss with exposed bone, muscle, or tendon
Micronutrients in treating pressure ulcers
Zinc- cofactor for protein, collagen synthesis - limit supplementation to 40mg to
prevent copper deficiency
Copper-rebuilding collagen tissues
Vitamin C - increased leukocytes and macrophage
,Screening for pressure ulcers
At admission, with significant change in clinical condition, when progress towards
closure is not being made.
Nutrient needs for pressure ulcers
Kcal: 30-35 per kg (at malnutrition risk)
Protein: 1.25-1.5g/kg (assess renal function)
*Supplement with arginine, micronutrients, high protein supplements for stage 3 or
4 pressure ulcers.
Fluids: 30-35ml/kg (up to 40ml) - higher if drainage, fever, GI losses.
Dosages for vitamin supplementation with pressure ulcers
Vitamins C (stage 1/2): 100-200mg/d
Vitamin C (stage 3/4): 1000-2000ml/d
Vitamin C - renal disease: 60-100mg/dL
Zinc: up to 40ml/d (stop when deficiency resolved to prevent copper deficiency.
Omnibus Reconciliation Act of 1987
Established revisions to Medicare and Medicaid Conditions of Participation
regarding long-term care facilities and pharmacy and established MDS to ID
resident care problem areas
State Operations Manual
, Guidance to surveyors for long-term care facilities
Citations for skilled nursing facilities
Level 1: No actual Harm with potential for minimal harm (A, B, C)
Level 2: No actual harm with potential for more than minimal harm (D,E,F)
Level 3: Actual harm that is not immediate jeopardy (G, H, I)
Level 4: Immediate jeopardy to resident health and safety
Resident Assessment Instrument (RAI)
A comprehensive tool that includes the minimum data set, Care Area Assessment
(CAA), RAI utilization guidelines
RAI (Resident Assessment Instrument) Utilization steps
1. Assessment: Using all available sources for information
2. Decision-making: Including the resident/family, the physician, and the IDT in
the process while putting the resident at the center of care
3. Care planning: Identifying specific resident-directed goals that used the
resident's strengths and IDT's expertise.
4. Identification of outcomes: Determining resident-specific goals and needed
interventions
5. Implementation
6. Evaluation: Critically reviewing above process to determine outcomes and if
revisions are necessary.
