NURS6540 / NURS 6540 Exam Study
Guide (Latest 2025/2026): Advanced
Practice Care of Frail Elders - Walden
Section 1: Physiology of Aging & Frailty
Key Topics: Fried Frailty Criteria, Sarcopenia, Immunosenescence,
Normal vs. Pathological Aging Changes
Question 1: A 78-year-old patient reports feeling weak, has
unintentional weight loss of 8% over the past 6 months, reports
exhaustion most days, walks slowly, and has low physical activity.
This presentation is most consistent with:
A. Normal aging
B. Sarcopenia
C. Frailty syndrome
D. Major depressive disorder
Correct ,,,answer,,,,: C) Frailty syndrome
Rationale: This patient meets three or more of the Fried frailty
criteria: unintentional weight loss (>5% in 6 months), exhaustion
(self-reported), weakness (low grip strength implied), slow walking
speed, and low physical activity. Frailty is a distinct clinical
,syndrome associated with increased vulnerability to stressors and
adverse outcomes. Normal aging does not include progressive
weight loss or functional decline; sarcopenia is a component but not
the full syndrome; depression may cause some symptoms but not
the full physical phenotype.
Question 2: Which physiological change of aging increases the risk
of hypothermia in older adults?
A. Increased metabolic rate
B. Decreased subcutaneous fat and impaired thermoregulation
C. Increased sweat gland activity
D. Enhanced peripheral vasodilation
Correct ,,,answer,,,,: B) Decreased subcutaneous fat and impaired
thermoregulation
Rationale: Aging is associated with decreased subcutaneous fat
(reduced insulation), impaired vasoconstriction response,
decreased shivering response, and blunted perception of cold — all
of which increase the risk of hypothermia. These normal age-related
changes make older adults vulnerable to temperature extremes
even in mild environmental conditions.
Question 3: A 72-year-old patient has a serum creatinine of 1.4
mg/dL. The nurse practitioner understands that:
A. This indicates normal renal function for age
B. Creatinine may overestimate GFR due to decreased muscle mass
,C. Creatinine is the most accurate measure of renal function in older
adults
D. This value indicates acute kidney injury
Correct ,,,answer,,,,: B) Creatinine may overestimate GFR due to
decreased muscle mass
Rationale: Age-related loss of muscle mass (sarcopenia) reduces
creatinine production. Therefore, a serum creatinine in the normal
range can mask significantly reduced glomerular filtration rate
(GFR) in older adults. A calculated eGFR or measured creatinine
clearance provides a more accurate assessment of renal function.
Question 4: A 85-year-old patient has an eGFR of 45
mL/min/1.73m². Which statement about medication dosing is most
accurate?
A. All medications should be avoided due to renal impairment
B. Doses should be adjusted based on creatinine clearance for
renally-cleared medications
C. Serum creatinine is the only value needed for safe prescribing
D. Renal function testing is unnecessary in stable older adults
Correct ,,,answer,,,,: B) Doses should be adjusted based on creatinine
clearance for renally-cleared medications
Rationale: The Cockcroft-Gault equation using actual body weight
(or ideal/adjacent weight in obesity) is preferred for medication
dosing in older adults. Many medications require dose reduction
based on estimated GFR or creatinine clearance to prevent toxicity
from reduced renal elimination.
, Question 5: Which statement about immunosenescence is accurate?
A. Immune function remains unchanged with aging
B. Older adults have enhanced response to vaccinations
C. Decreased T-cell function increases susceptibility to infections
and reactivation of latent viruses
D. Immunosenescence only affects humoral immunity
Correct ,,,answer,,,,: C) Decreased T-cell function increases
susceptibility to infections and reactivation of latent viruses
Rationale: Immunosenescence includes thymic involution, reduced
naive T-cell production, and impaired antigen presentation. This
leads to increased susceptibility to new infections, reactivation of
latent viruses (e.g., herpes zoster), and decreased vaccine responses.
Humoral immunity is also affected, but T-cell changes are
prominent.
Question 6: Which of the following is NOT a normal physiological
change of aging?
A. Decreased lung elasticity
B. Increased vagal tone leading to bradycardia
C. Decreased gastrointestinal motility
D. Cortical neuronal loss in the thalamus and striatum
Correct ,,,answer,,,,: B) Increased vagal tone leading to bradycardia
Rationale: While resting heart rate may remain stable, heart rate
response to stress (exercise, illness) may be blunted due to
decreased beta-adrenergic responsiveness. However, "increased
Guide (Latest 2025/2026): Advanced
Practice Care of Frail Elders - Walden
Section 1: Physiology of Aging & Frailty
Key Topics: Fried Frailty Criteria, Sarcopenia, Immunosenescence,
Normal vs. Pathological Aging Changes
Question 1: A 78-year-old patient reports feeling weak, has
unintentional weight loss of 8% over the past 6 months, reports
exhaustion most days, walks slowly, and has low physical activity.
This presentation is most consistent with:
A. Normal aging
B. Sarcopenia
C. Frailty syndrome
D. Major depressive disorder
Correct ,,,answer,,,,: C) Frailty syndrome
Rationale: This patient meets three or more of the Fried frailty
criteria: unintentional weight loss (>5% in 6 months), exhaustion
(self-reported), weakness (low grip strength implied), slow walking
speed, and low physical activity. Frailty is a distinct clinical
,syndrome associated with increased vulnerability to stressors and
adverse outcomes. Normal aging does not include progressive
weight loss or functional decline; sarcopenia is a component but not
the full syndrome; depression may cause some symptoms but not
the full physical phenotype.
Question 2: Which physiological change of aging increases the risk
of hypothermia in older adults?
A. Increased metabolic rate
B. Decreased subcutaneous fat and impaired thermoregulation
C. Increased sweat gland activity
D. Enhanced peripheral vasodilation
Correct ,,,answer,,,,: B) Decreased subcutaneous fat and impaired
thermoregulation
Rationale: Aging is associated with decreased subcutaneous fat
(reduced insulation), impaired vasoconstriction response,
decreased shivering response, and blunted perception of cold — all
of which increase the risk of hypothermia. These normal age-related
changes make older adults vulnerable to temperature extremes
even in mild environmental conditions.
Question 3: A 72-year-old patient has a serum creatinine of 1.4
mg/dL. The nurse practitioner understands that:
A. This indicates normal renal function for age
B. Creatinine may overestimate GFR due to decreased muscle mass
,C. Creatinine is the most accurate measure of renal function in older
adults
D. This value indicates acute kidney injury
Correct ,,,answer,,,,: B) Creatinine may overestimate GFR due to
decreased muscle mass
Rationale: Age-related loss of muscle mass (sarcopenia) reduces
creatinine production. Therefore, a serum creatinine in the normal
range can mask significantly reduced glomerular filtration rate
(GFR) in older adults. A calculated eGFR or measured creatinine
clearance provides a more accurate assessment of renal function.
Question 4: A 85-year-old patient has an eGFR of 45
mL/min/1.73m². Which statement about medication dosing is most
accurate?
A. All medications should be avoided due to renal impairment
B. Doses should be adjusted based on creatinine clearance for
renally-cleared medications
C. Serum creatinine is the only value needed for safe prescribing
D. Renal function testing is unnecessary in stable older adults
Correct ,,,answer,,,,: B) Doses should be adjusted based on creatinine
clearance for renally-cleared medications
Rationale: The Cockcroft-Gault equation using actual body weight
(or ideal/adjacent weight in obesity) is preferred for medication
dosing in older adults. Many medications require dose reduction
based on estimated GFR or creatinine clearance to prevent toxicity
from reduced renal elimination.
, Question 5: Which statement about immunosenescence is accurate?
A. Immune function remains unchanged with aging
B. Older adults have enhanced response to vaccinations
C. Decreased T-cell function increases susceptibility to infections
and reactivation of latent viruses
D. Immunosenescence only affects humoral immunity
Correct ,,,answer,,,,: C) Decreased T-cell function increases
susceptibility to infections and reactivation of latent viruses
Rationale: Immunosenescence includes thymic involution, reduced
naive T-cell production, and impaired antigen presentation. This
leads to increased susceptibility to new infections, reactivation of
latent viruses (e.g., herpes zoster), and decreased vaccine responses.
Humoral immunity is also affected, but T-cell changes are
prominent.
Question 6: Which of the following is NOT a normal physiological
change of aging?
A. Decreased lung elasticity
B. Increased vagal tone leading to bradycardia
C. Decreased gastrointestinal motility
D. Cortical neuronal loss in the thalamus and striatum
Correct ,,,answer,,,,: B) Increased vagal tone leading to bradycardia
Rationale: While resting heart rate may remain stable, heart rate
response to stress (exercise, illness) may be blunted due to
decreased beta-adrenergic responsiveness. However, "increased
