G R A D E A P R E PA R AT I ON
WA LD E N U NIV E R S IT Y NU R S 654 0
Advanced Practice
Care of Frail Elders
Exam Study Set
Comprehensive practice examination covering geriatric
assessment, frailty identification, geriatric syndromes, chronic
disease management, pharmacology, end-of-life care, health
promotion, and integrated clinical reasoning aligned with
2026-2027 AANP/ANCC certification standards.
100 Questions with Answers and Rationales
AANP and ANCC Certification Aligned
Latest Curriculum Update
Q U E S T I O N S A N D A N S W E R S W I T H C O M P R E H E N S I V E R AT I O N A L E S
,Section 1: Comprehensive Geriatric Assessment (CGA) and Frailty Identification
(Q1-Q15)
Q1: An 82-year-old patient presents with unintentional weight loss of 10 pounds over six months,
reports feeling exhausted most days, has a grip strength below the 20th percentile for age and gender,
walks slowly, and has reduced physical activity. Which frailty assessment tool best describes this
presentation, and how many criteria must be met to classify the patient as frail?
A. Rockwood Frailty Index; the patient must score above 0.25 on the cumulative deficit scale
B. Clinical Frailty Scale; the patient must be rated as category 6 or higher
C. Fried Frailty Phenotype; three or more of the five criteria must be present [CORRECT]
D. Timed Up and Go Test; completion time must exceed 20 seconds
Correct Answer: C
Rationale: The Fried Frailty Phenotype identifies frailty through five criteria: unintentional weight loss, exhaustion,
weakness (grip strength), slowness (gait speed), and low physical activity. Meeting three or more criteria classifies a patient
as frail, one to two as pre-frail, and zero as robust. This patient meets all five criteria. The Rockwood Frailty Index uses a
cumulative deficit approach rather than specific physical criteria. The Clinical Frailty Scale is a global clinical judgment
tool. The Timed Up and Go Test assesses mobility but is not a comprehensive frailty diagnostic tool per the Walden NURS
6540 curriculum.
Q2: During a Comprehensive Geriatric Assessment (CGA), the nurse practitioner evaluates a patient
who lives alone, has difficulty managing medications, and cannot prepare balanced meals. Which
domain of the CGA is most directly assessed by evaluating the patient's ability to manage finances,
use transportation, shop, and prepare meals?
A. Physical health assessment including vital signs and laboratory values
B. Instrumental Activities of Daily Living (IADLs) [CORRECT]
C. Basic Activities of Daily Living (ADLs)
D. Psychological well-being and cognitive screening
Correct Answer: B
Rationale: IADLs assess higher-level functional abilities required for independent living, including managing finances,
using transportation, shopping, meal preparation, housework, medication management, and telephone use. Basic ADLs
(bathing, dressing, toileting, transferring, continence, feeding) measure more fundamental self-care abilities. The
distinction between ADLs and IADLs is essential in the CGA framework taught in NURS 6540, as IADL decline typically
precedes ADL decline and signals the need for supportive services before functional dependence worsens.
Q3: A nurse practitioner is conducting a CGA on a 78-year-old patient new to the practice. Which of
the following components is NOT routinely included as a standard domain of a Comprehensive
Geriatric Assessment?
A. Physical health and functional status
B. Psychological well-being including depression screening
C. Genetic predisposition profiling for hereditary diseases [CORRECT]
D. Social support and environmental assessment
Correct Answer: C
Rationale: The standard domains of a CGA include physical health, functional status (ADLs and IADLs), psychological
well-being (depression, cognition), social support, spiritual needs, and environmental assessment. Genetic predisposition
NURS 6540 Advanced Practice Care of Frail Elders | Page 1
,profiling is not a routine component of the CGA, as the assessment focuses on current functional status, medical conditions,
and psychosocial factors that directly impact care planning. The Walden NURS 6540 curriculum emphasizes that CGA is a
multidimensional, interdisciplinary diagnostic process designed to identify the medical, psychological, and functional
capabilities of an elderly person to develop a coordinated and integrated plan for treatment and follow-up.
Q4: A 75-year-old woman is being evaluated for frailty. Her gait speed is 0.6 m/s, and she reports no
weight loss, normal energy levels, and regular physical activity. According to the Fried Frailty
Phenotype, how should this patient be classified?
A. Robust, because she meets zero of the five criteria
B. Pre-frail, because she meets one of the five criteria [CORRECT]
C. Frail, because gait speed alone is sufficient for diagnosis
D. Pre-frail, because gait speed and age together constitute two criteria
Correct Answer: B
Rationale: The Fried Frailty Phenotype classifies patients based on the number of criteria met: robust (zero criteria),
pre-frail (one or two criteria), or frail (three or more criteria). This patient meets only one criterion (slowness, defined as
gait speed below established cutoffs), placing her in the pre-frail category. Gait speed alone is not sufficient for a frailty
diagnosis; the tool requires three or more of the five criteria. Age alone is not a Fried criterion. Pre-frailty is clinically
significant because it identifies patients at risk for progression to frailty, allowing for early intervention as emphasized in
the Walden NURS 6540 gerontological curriculum.
Q5: An advanced practice nurse is caring for an 85-year-old patient and wants to use a quick clinical
tool to categorize the patient's overall level of fitness and frailty. Which tool uses a 9-point scale
ranging from very fit (1) to terminally ill (9) based on clinical judgment?
A. Fried Frailty Phenotype
B. Rockwood Frailty Index
C. Clinical Frailty Scale (CFS) [CORRECT]
D. Timed Up and Go (TUG) Test
Correct Answer: C
Rationale: The Clinical Frailty Scale (CFS) developed by Rockwood and colleagues is a 9-point global clinical judgment
scale ranging from 1 (very fit) to 9 (terminally ill). It allows clinicians to quickly categorize a patient's level of frailty based
on clinical descriptors and functional status. The Fried Frailty Phenotype uses five specific physical criteria rather than a
global judgment. The Rockwood Frailty Index is a cumulative deficit model counting individual health deficits. The TUG
Test is a physical performance measure of mobility, not a comprehensive frailty classification tool.
Q6: Which of the following best distinguishes frailty from normal aging?
A. Frailty involves a predictable, linear decline in all organ systems, while normal aging is variable
B. Frailty is a distinct clinical syndrome characterized by increased vulnerability to stressors
and decreased functional reserve, whereas normal aging does not inevitably lead to frailty
[CORRECT]
C. Normal aging always results in frailty by age 85, making the distinction clinically irrelevant
D. Frailty is defined solely by chronological age, while normal aging refers to biological changes
Correct Answer: B
Rationale: Frailty is recognized as a distinct clinical syndrome characterized by decreased physiological reserve and
increased vulnerability to stressors that may result in disproportionate health decline. It is NOT an inevitable consequence of
normal aging; many older adults age without becoming frail. This distinction is critical in the Walden NURS 6540
curriculum because it guides clinical decision-making regarding interventions, care intensity, and prognosis. Frailty is
multidimensional and dynamic, meaning it can potentially be reversed or mitigated with appropriate interventions, unlike
, the gradual biological changes of normal aging.
Q7: During a home visit for a CGA, the nurse practitioner assesses the patient's spiritual needs and
cultural background. Why is the inclusion of spirituality and cultural considerations important in the
care planning process for frail elders?
A. It is only relevant when the patient requests spiritual care or chaplain services
B. Spirituality and culture influence health beliefs, treatment adherence, coping mechanisms,
and end-of-life decisions, making them integral to holistic care planning [CORRECT]
C. Cultural assessment is required only for patients from minority ethnic backgrounds
D. Spiritual needs are addressed exclusively during end-of-life care and not during routine CGA
Correct Answer: B
Rationale: The Walden NURS 6540 curriculum emphasizes that holistic geriatric assessment includes spiritual and cultural
dimensions because these factors profoundly influence health beliefs, treatment preferences, medication adherence, coping
strategies, and goals of care. Cultural background affects how patients perceive illness, accept interventions, and engage
with healthcare providers. Spiritual well-being can impact mental health, resilience, and quality of life. Excluding these
domains from the CGA would result in an incomplete assessment and a care plan that may not align with the patient's
values and preferences.
Q8: A 70-year-old patient is brought to the clinic by her daughter, who reports that her mother has
been gradually losing the ability to manage her checkbook, no longer drives, and has stopped cooking
meals. However, the patient can still bathe, dress, and toilet independently. What does this pattern of
functional decline indicate?
A. The patient has lost basic ADL function and requires skilled nursing facility placement
B. The patient has preserved basic ADLs but has declining IADLs, suggesting early functional
decline that may benefit from supportive interventions [CORRECT]
C. The patient is demonstrating normal age-related changes that do not require clinical intervention
D. The patient has developed delirium and needs immediate emergency evaluation
Correct Answer: B
Rationale: This pattern demonstrates preserved basic ADLs (bathing, dressing, toileting) with declining IADLs (finances,
transportation, meal preparation). In the gerontological framework taught in NURS 6540, IADL decline typically precedes
ADL decline and signals the need for supportive services such as home health aides, financial management assistance, and
meal delivery programs. Early recognition of IADL decline allows for proactive interventions to maintain independence
and prevent further functional deterioration. This is not delirium, which presents acutely with fluctuating attention and
awareness.
Q9: The Rockwood Frailty Index differs from the Fried Frailty Phenotype in which fundamental
way?
A. The Rockwood Index uses five specific physical criteria, while the Fried Phenotype counts
accumulated health deficits
B. The Rockwood Index counts the number of health deficits accumulated by a patient out of a
standardized list, while the Fried Phenotype uses five specific physical criteria [CORRECT]
C. The Rockwood Index is used exclusively in research settings, while the Fried Phenotype is used only
in clinical practice
D. The Rockwood Index measures cognitive function, while the Fried Phenotype measures physical
function only
Correct Answer: B
WA LD E N U NIV E R S IT Y NU R S 654 0
Advanced Practice
Care of Frail Elders
Exam Study Set
Comprehensive practice examination covering geriatric
assessment, frailty identification, geriatric syndromes, chronic
disease management, pharmacology, end-of-life care, health
promotion, and integrated clinical reasoning aligned with
2026-2027 AANP/ANCC certification standards.
100 Questions with Answers and Rationales
AANP and ANCC Certification Aligned
Latest Curriculum Update
Q U E S T I O N S A N D A N S W E R S W I T H C O M P R E H E N S I V E R AT I O N A L E S
,Section 1: Comprehensive Geriatric Assessment (CGA) and Frailty Identification
(Q1-Q15)
Q1: An 82-year-old patient presents with unintentional weight loss of 10 pounds over six months,
reports feeling exhausted most days, has a grip strength below the 20th percentile for age and gender,
walks slowly, and has reduced physical activity. Which frailty assessment tool best describes this
presentation, and how many criteria must be met to classify the patient as frail?
A. Rockwood Frailty Index; the patient must score above 0.25 on the cumulative deficit scale
B. Clinical Frailty Scale; the patient must be rated as category 6 or higher
C. Fried Frailty Phenotype; three or more of the five criteria must be present [CORRECT]
D. Timed Up and Go Test; completion time must exceed 20 seconds
Correct Answer: C
Rationale: The Fried Frailty Phenotype identifies frailty through five criteria: unintentional weight loss, exhaustion,
weakness (grip strength), slowness (gait speed), and low physical activity. Meeting three or more criteria classifies a patient
as frail, one to two as pre-frail, and zero as robust. This patient meets all five criteria. The Rockwood Frailty Index uses a
cumulative deficit approach rather than specific physical criteria. The Clinical Frailty Scale is a global clinical judgment
tool. The Timed Up and Go Test assesses mobility but is not a comprehensive frailty diagnostic tool per the Walden NURS
6540 curriculum.
Q2: During a Comprehensive Geriatric Assessment (CGA), the nurse practitioner evaluates a patient
who lives alone, has difficulty managing medications, and cannot prepare balanced meals. Which
domain of the CGA is most directly assessed by evaluating the patient's ability to manage finances,
use transportation, shop, and prepare meals?
A. Physical health assessment including vital signs and laboratory values
B. Instrumental Activities of Daily Living (IADLs) [CORRECT]
C. Basic Activities of Daily Living (ADLs)
D. Psychological well-being and cognitive screening
Correct Answer: B
Rationale: IADLs assess higher-level functional abilities required for independent living, including managing finances,
using transportation, shopping, meal preparation, housework, medication management, and telephone use. Basic ADLs
(bathing, dressing, toileting, transferring, continence, feeding) measure more fundamental self-care abilities. The
distinction between ADLs and IADLs is essential in the CGA framework taught in NURS 6540, as IADL decline typically
precedes ADL decline and signals the need for supportive services before functional dependence worsens.
Q3: A nurse practitioner is conducting a CGA on a 78-year-old patient new to the practice. Which of
the following components is NOT routinely included as a standard domain of a Comprehensive
Geriatric Assessment?
A. Physical health and functional status
B. Psychological well-being including depression screening
C. Genetic predisposition profiling for hereditary diseases [CORRECT]
D. Social support and environmental assessment
Correct Answer: C
Rationale: The standard domains of a CGA include physical health, functional status (ADLs and IADLs), psychological
well-being (depression, cognition), social support, spiritual needs, and environmental assessment. Genetic predisposition
NURS 6540 Advanced Practice Care of Frail Elders | Page 1
,profiling is not a routine component of the CGA, as the assessment focuses on current functional status, medical conditions,
and psychosocial factors that directly impact care planning. The Walden NURS 6540 curriculum emphasizes that CGA is a
multidimensional, interdisciplinary diagnostic process designed to identify the medical, psychological, and functional
capabilities of an elderly person to develop a coordinated and integrated plan for treatment and follow-up.
Q4: A 75-year-old woman is being evaluated for frailty. Her gait speed is 0.6 m/s, and she reports no
weight loss, normal energy levels, and regular physical activity. According to the Fried Frailty
Phenotype, how should this patient be classified?
A. Robust, because she meets zero of the five criteria
B. Pre-frail, because she meets one of the five criteria [CORRECT]
C. Frail, because gait speed alone is sufficient for diagnosis
D. Pre-frail, because gait speed and age together constitute two criteria
Correct Answer: B
Rationale: The Fried Frailty Phenotype classifies patients based on the number of criteria met: robust (zero criteria),
pre-frail (one or two criteria), or frail (three or more criteria). This patient meets only one criterion (slowness, defined as
gait speed below established cutoffs), placing her in the pre-frail category. Gait speed alone is not sufficient for a frailty
diagnosis; the tool requires three or more of the five criteria. Age alone is not a Fried criterion. Pre-frailty is clinically
significant because it identifies patients at risk for progression to frailty, allowing for early intervention as emphasized in
the Walden NURS 6540 gerontological curriculum.
Q5: An advanced practice nurse is caring for an 85-year-old patient and wants to use a quick clinical
tool to categorize the patient's overall level of fitness and frailty. Which tool uses a 9-point scale
ranging from very fit (1) to terminally ill (9) based on clinical judgment?
A. Fried Frailty Phenotype
B. Rockwood Frailty Index
C. Clinical Frailty Scale (CFS) [CORRECT]
D. Timed Up and Go (TUG) Test
Correct Answer: C
Rationale: The Clinical Frailty Scale (CFS) developed by Rockwood and colleagues is a 9-point global clinical judgment
scale ranging from 1 (very fit) to 9 (terminally ill). It allows clinicians to quickly categorize a patient's level of frailty based
on clinical descriptors and functional status. The Fried Frailty Phenotype uses five specific physical criteria rather than a
global judgment. The Rockwood Frailty Index is a cumulative deficit model counting individual health deficits. The TUG
Test is a physical performance measure of mobility, not a comprehensive frailty classification tool.
Q6: Which of the following best distinguishes frailty from normal aging?
A. Frailty involves a predictable, linear decline in all organ systems, while normal aging is variable
B. Frailty is a distinct clinical syndrome characterized by increased vulnerability to stressors
and decreased functional reserve, whereas normal aging does not inevitably lead to frailty
[CORRECT]
C. Normal aging always results in frailty by age 85, making the distinction clinically irrelevant
D. Frailty is defined solely by chronological age, while normal aging refers to biological changes
Correct Answer: B
Rationale: Frailty is recognized as a distinct clinical syndrome characterized by decreased physiological reserve and
increased vulnerability to stressors that may result in disproportionate health decline. It is NOT an inevitable consequence of
normal aging; many older adults age without becoming frail. This distinction is critical in the Walden NURS 6540
curriculum because it guides clinical decision-making regarding interventions, care intensity, and prognosis. Frailty is
multidimensional and dynamic, meaning it can potentially be reversed or mitigated with appropriate interventions, unlike
, the gradual biological changes of normal aging.
Q7: During a home visit for a CGA, the nurse practitioner assesses the patient's spiritual needs and
cultural background. Why is the inclusion of spirituality and cultural considerations important in the
care planning process for frail elders?
A. It is only relevant when the patient requests spiritual care or chaplain services
B. Spirituality and culture influence health beliefs, treatment adherence, coping mechanisms,
and end-of-life decisions, making them integral to holistic care planning [CORRECT]
C. Cultural assessment is required only for patients from minority ethnic backgrounds
D. Spiritual needs are addressed exclusively during end-of-life care and not during routine CGA
Correct Answer: B
Rationale: The Walden NURS 6540 curriculum emphasizes that holistic geriatric assessment includes spiritual and cultural
dimensions because these factors profoundly influence health beliefs, treatment preferences, medication adherence, coping
strategies, and goals of care. Cultural background affects how patients perceive illness, accept interventions, and engage
with healthcare providers. Spiritual well-being can impact mental health, resilience, and quality of life. Excluding these
domains from the CGA would result in an incomplete assessment and a care plan that may not align with the patient's
values and preferences.
Q8: A 70-year-old patient is brought to the clinic by her daughter, who reports that her mother has
been gradually losing the ability to manage her checkbook, no longer drives, and has stopped cooking
meals. However, the patient can still bathe, dress, and toilet independently. What does this pattern of
functional decline indicate?
A. The patient has lost basic ADL function and requires skilled nursing facility placement
B. The patient has preserved basic ADLs but has declining IADLs, suggesting early functional
decline that may benefit from supportive interventions [CORRECT]
C. The patient is demonstrating normal age-related changes that do not require clinical intervention
D. The patient has developed delirium and needs immediate emergency evaluation
Correct Answer: B
Rationale: This pattern demonstrates preserved basic ADLs (bathing, dressing, toileting) with declining IADLs (finances,
transportation, meal preparation). In the gerontological framework taught in NURS 6540, IADL decline typically precedes
ADL decline and signals the need for supportive services such as home health aides, financial management assistance, and
meal delivery programs. Early recognition of IADL decline allows for proactive interventions to maintain independence
and prevent further functional deterioration. This is not delirium, which presents acutely with fluctuating attention and
awareness.
Q9: The Rockwood Frailty Index differs from the Fried Frailty Phenotype in which fundamental
way?
A. The Rockwood Index uses five specific physical criteria, while the Fried Phenotype counts
accumulated health deficits
B. The Rockwood Index counts the number of health deficits accumulated by a patient out of a
standardized list, while the Fried Phenotype uses five specific physical criteria [CORRECT]
C. The Rockwood Index is used exclusively in research settings, while the Fried Phenotype is used only
in clinical practice
D. The Rockwood Index measures cognitive function, while the Fried Phenotype measures physical
function only
Correct Answer: B
