100+ Free CNSC Practice Questions

Explanation: The Academy of Nutrition and Dietetics (AND)/ASPEN consensus requires at least two of six characteristics to diagnose malnutrition: insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, and diminished functional status (handgrip strength). Requiring two characteristics improves specificity while keeping the framework practical.

Explanation: The AND/ASPEN consensus deliberately excluded serum albumin and prealbumin as diagnostic indicators because they are negative acute-phase reactants that fall with inflammation rather than nutrition status. The six valid characteristics are insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, and reduced handgrip strength.

Explanation: Percent weight loss = (usual weight - current weight) / usual weight x 100 = (80 - 68) / 80 x 100 = 15%. A 15% loss over 3 months represents severe weight loss (more than 7.5% in 3 months), an important malnutrition indicator.

Explanation: Temporal wasting is assessed at the temporalis muscle, located at the temple region above and to the side of the eye/eyebrow. Hollowing or depression there indicates muscle loss. The temporalis is one of the most reliable and accessible sites for detecting muscle wasting in a NFPE.

Explanation: Albumin and prealbumin are negative acute-phase reactants. During inflammation and the systemic stress response, hepatic synthesis is downregulated and capillary permeability increases, lowering serum levels independent of nutrition intake. They better reflect inflammation severity and prognosis than nutritional adequacy.

Explanation: BMI = weight (kg) / height (m) squared = 90 / (1.8 x 1.8) = 90 / 3.24 = 27.8 kg/m2. This places the patient in the overweight category (25 to 29.9 kg/m2).

Explanation: The NUTRIC (Nutrition Risk in the Critically Ill) score was developed and validated specifically for ICU patients, incorporating age, APACHE II, SOFA, comorbidities, days in hospital before ICU, and optionally IL-6. It identifies patients most likely to benefit from aggressive nutrition therapy.

Explanation: A sodium above 145 mEq/L is hypernatremia, and at 165 mEq/L it is severe. In a patient receiving inadequate free water (common with concentrated tube feeds and insufficient water flushes), the deficit concentrates serum sodium. Management includes correcting the free water deficit gradually to avoid cerebral edema.

Explanation: The Hamwi method assigns 100 lb for the first 5 feet of height in women, plus 5 lb for each additional inch. For men, the baseline is 106 lb for the first 5 feet plus 6 lb per additional inch. A plus or minus 10% adjustment accounts for frame size.

Explanation: Fluid accumulation (ascites, edema, anasarca) falsely elevates measured weight and masks underlying muscle and fat loss. Estimating and subtracting the excess fluid weight to approximate dry weight prevents underestimating malnutrition severity and avoids overfeeding based on inflated weight.