NURS 6540 EXAM STUDY SET Q&A (LATEST): ADVANCED
PRACTICE CARE OF FRAIL ELDERS – WALDEN
UNIVERSITY – COMPREHENSIVE PRACTICE QUESTIONS &
ANSWERS
NURS 6540
Advanced Practice Care of Frail Elders
Comprehensive Exam Study Set: Questions & Answers
Institution: Walden University
Course Code: NURS 6540
Course Name: Advanced Practice Care of Frail Elders
Document Type: Comprehensive Practice Exam and Study Set
Date: August 9, 2026
Author/Creator: Original study resource
Table of Contents
1. Cardiovascular System — Questions 1–10
2. Respiratory System — Questions 11–20
3. Neurologic and Cognitive System — Questions 21–30
4. Endocrine and Metabolic System — Questions 31–40
5. Renal and Genitourinary System — Questions 41–50
6. Gastrointestinal and Nutritional System — Questions 51–60
7. Musculoskeletal System, Mobility, and Falls — Questions 61–70
8. Sensory and Integumentary Systems — Questions 71–80
9. Hematologic, Infectious Disease, and Immunization — Questions 81–90
10. Geriatric Pharmacology, Syndromes, and Comprehensive Care — Questions 91–100
Section I — Cardiovascular System
,Question 1 — Multiple Choice
An 82-year-old frail adult presents with fatigue, dizziness, and two recent near-falls. Blood
pressure is 108/62 mmHg sitting and 86/50 mmHg after standing. Which finding most strongly
supports orthostatic hypotension?
A. A rise in systolic blood pressure of 10 mmHg
B. A fall in systolic blood pressure of at least 20 mmHg after standing
C. A fall in diastolic pressure of 2 mmHg
D. An increase in heart rate of 5 beats/minute
Correct answer: B
Rationale: Orthostatic hypotension is characterized by a clinically significant fall in blood
pressure after assuming an upright position, classically a systolic decrease of at least 20 mmHg
or a diastolic decrease of at least 10 mmHg. In frail older adults, dehydration, autonomic
dysfunction, cardiovascular disease, and medications can contribute.
Question 2 — Multiple Choice
Which medication class should prompt particular caution when an older adult with recurrent falls
develops dizziness and orthostatic symptoms?
A. Topical emollients
B. Antihypertensive medications
C. Artificial tears
D. Calcium supplements
Correct answer: B
Rationale: Antihypertensive agents can contribute to hypotension and dizziness, increasing fall
risk. Medication review is an important component of fall assessment, particularly when
symptoms began after a medication was initiated or the dose was increased. CDC STEADI
specifically emphasizes medication review as part of fall prevention.
Question 3 — Short Answer
What is the primary clinical concern when treating hypertension in a very frail older adult?
Correct answer: Balancing cardiovascular risk reduction against adverse effects such as
orthostatic hypotension, falls, syncope, renal injury, and functional decline.
Rationale: Frail older adults may have reduced physiologic reserve and greater susceptibility to
treatment-related adverse effects. Blood-pressure management should therefore be individualized
,according to comorbidities, symptoms, functional status, goals of care, and life expectancy rather
than relying exclusively on a single numerical target.
Question 4 — Multiple Choice
An older adult with atrial fibrillation asks why anticoagulation may be recommended. What is
the principal reason?
A. To control ventricular rate
B. To prevent thromboembolic stroke
C. To reduce blood pressure
D. To improve ejection fraction
Correct answer: B
Rationale: Atrial fibrillation promotes blood stasis in the atria and can lead to thrombus
formation and systemic embolization, particularly ischemic stroke. Stroke-prevention decisions
should incorporate validated thromboembolic-risk assessment and individualized bleeding risk.
Question 5 — Multiple Choice
Which symptom in an older adult with heart failure is most concerning for acute
decompensation?
A. Stable mild ankle edema
B. New dyspnea at rest
C. Chronic fatigue
D. Long-standing nocturia
Correct answer: B
Rationale: New or worsening dyspnea at rest can indicate pulmonary congestion and acute
heart-failure exacerbation. Older adults may present atypically, so worsening exercise tolerance,
confusion, weakness, appetite changes, or functional decline can also signal deterioration.
Question 6 — Short Answer
Why can heart failure be difficult to recognize in frail elders?
Correct answer: Older adults may have atypical presentations, multiple comorbidities, limited
activity that masks exertional symptoms, and overlapping symptoms such as fatigue, weakness,
cognitive change, or reduced appetite.
, Rationale: Frailty can obscure classic cardiovascular symptoms. A careful comparison with the
patient's baseline function is often more informative than asking only whether classic symptoms
are present.
Question 7 — Multiple Choice
Which intervention is most appropriate when an older adult develops recurrent dizziness after
intensification of blood-pressure therapy?
A. Automatically increase the medication dose
B. Perform medication and orthostatic assessment
C. Encourage prolonged bed rest
D. Stop all medications immediately
Correct answer: B
Rationale: The clinician should assess orthostatic vital signs, hydration, medication timing,
cardiovascular status, and fall risk. Abruptly stopping all medications is unsafe, while continued
escalation without assessment could worsen hypotension and falls.
Question 8 — Multiple Choice
Which cardiovascular finding is most consistent with left-sided heart failure?
A. Pulmonary crackles
B. Isolated dysuria
C. Hyperactive bowel sounds
D. Unilateral wrist pain
Correct answer: A
Rationale: Left-sided heart failure causes increased pulmonary venous pressure, which can
produce pulmonary congestion and crackles. Other findings can include dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, and reduced exercise tolerance.
Question 9 — Short Answer
What is the significance of pulse pressure in an older adult?
Correct answer: A widened pulse pressure can reflect arterial stiffness and increased vascular
rigidity, common with aging and associated with cardiovascular risk.
PRACTICE CARE OF FRAIL ELDERS – WALDEN
UNIVERSITY – COMPREHENSIVE PRACTICE QUESTIONS &
ANSWERS
NURS 6540
Advanced Practice Care of Frail Elders
Comprehensive Exam Study Set: Questions & Answers
Institution: Walden University
Course Code: NURS 6540
Course Name: Advanced Practice Care of Frail Elders
Document Type: Comprehensive Practice Exam and Study Set
Date: August 9, 2026
Author/Creator: Original study resource
Table of Contents
1. Cardiovascular System — Questions 1–10
2. Respiratory System — Questions 11–20
3. Neurologic and Cognitive System — Questions 21–30
4. Endocrine and Metabolic System — Questions 31–40
5. Renal and Genitourinary System — Questions 41–50
6. Gastrointestinal and Nutritional System — Questions 51–60
7. Musculoskeletal System, Mobility, and Falls — Questions 61–70
8. Sensory and Integumentary Systems — Questions 71–80
9. Hematologic, Infectious Disease, and Immunization — Questions 81–90
10. Geriatric Pharmacology, Syndromes, and Comprehensive Care — Questions 91–100
Section I — Cardiovascular System
,Question 1 — Multiple Choice
An 82-year-old frail adult presents with fatigue, dizziness, and two recent near-falls. Blood
pressure is 108/62 mmHg sitting and 86/50 mmHg after standing. Which finding most strongly
supports orthostatic hypotension?
A. A rise in systolic blood pressure of 10 mmHg
B. A fall in systolic blood pressure of at least 20 mmHg after standing
C. A fall in diastolic pressure of 2 mmHg
D. An increase in heart rate of 5 beats/minute
Correct answer: B
Rationale: Orthostatic hypotension is characterized by a clinically significant fall in blood
pressure after assuming an upright position, classically a systolic decrease of at least 20 mmHg
or a diastolic decrease of at least 10 mmHg. In frail older adults, dehydration, autonomic
dysfunction, cardiovascular disease, and medications can contribute.
Question 2 — Multiple Choice
Which medication class should prompt particular caution when an older adult with recurrent falls
develops dizziness and orthostatic symptoms?
A. Topical emollients
B. Antihypertensive medications
C. Artificial tears
D. Calcium supplements
Correct answer: B
Rationale: Antihypertensive agents can contribute to hypotension and dizziness, increasing fall
risk. Medication review is an important component of fall assessment, particularly when
symptoms began after a medication was initiated or the dose was increased. CDC STEADI
specifically emphasizes medication review as part of fall prevention.
Question 3 — Short Answer
What is the primary clinical concern when treating hypertension in a very frail older adult?
Correct answer: Balancing cardiovascular risk reduction against adverse effects such as
orthostatic hypotension, falls, syncope, renal injury, and functional decline.
Rationale: Frail older adults may have reduced physiologic reserve and greater susceptibility to
treatment-related adverse effects. Blood-pressure management should therefore be individualized
,according to comorbidities, symptoms, functional status, goals of care, and life expectancy rather
than relying exclusively on a single numerical target.
Question 4 — Multiple Choice
An older adult with atrial fibrillation asks why anticoagulation may be recommended. What is
the principal reason?
A. To control ventricular rate
B. To prevent thromboembolic stroke
C. To reduce blood pressure
D. To improve ejection fraction
Correct answer: B
Rationale: Atrial fibrillation promotes blood stasis in the atria and can lead to thrombus
formation and systemic embolization, particularly ischemic stroke. Stroke-prevention decisions
should incorporate validated thromboembolic-risk assessment and individualized bleeding risk.
Question 5 — Multiple Choice
Which symptom in an older adult with heart failure is most concerning for acute
decompensation?
A. Stable mild ankle edema
B. New dyspnea at rest
C. Chronic fatigue
D. Long-standing nocturia
Correct answer: B
Rationale: New or worsening dyspnea at rest can indicate pulmonary congestion and acute
heart-failure exacerbation. Older adults may present atypically, so worsening exercise tolerance,
confusion, weakness, appetite changes, or functional decline can also signal deterioration.
Question 6 — Short Answer
Why can heart failure be difficult to recognize in frail elders?
Correct answer: Older adults may have atypical presentations, multiple comorbidities, limited
activity that masks exertional symptoms, and overlapping symptoms such as fatigue, weakness,
cognitive change, or reduced appetite.
, Rationale: Frailty can obscure classic cardiovascular symptoms. A careful comparison with the
patient's baseline function is often more informative than asking only whether classic symptoms
are present.
Question 7 — Multiple Choice
Which intervention is most appropriate when an older adult develops recurrent dizziness after
intensification of blood-pressure therapy?
A. Automatically increase the medication dose
B. Perform medication and orthostatic assessment
C. Encourage prolonged bed rest
D. Stop all medications immediately
Correct answer: B
Rationale: The clinician should assess orthostatic vital signs, hydration, medication timing,
cardiovascular status, and fall risk. Abruptly stopping all medications is unsafe, while continued
escalation without assessment could worsen hypotension and falls.
Question 8 — Multiple Choice
Which cardiovascular finding is most consistent with left-sided heart failure?
A. Pulmonary crackles
B. Isolated dysuria
C. Hyperactive bowel sounds
D. Unilateral wrist pain
Correct answer: A
Rationale: Left-sided heart failure causes increased pulmonary venous pressure, which can
produce pulmonary congestion and crackles. Other findings can include dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, and reduced exercise tolerance.
Question 9 — Short Answer
What is the significance of pulse pressure in an older adult?
Correct answer: A widened pulse pressure can reflect arterial stiffness and increased vascular
rigidity, common with aging and associated with cardiovascular risk.
