NURS6540 Exam 3 | NURS 6540 / NRNP 6540
Advanced Practice Care of Frail Elders | Actual Q&A
with Rationale | Walden University
1. An 84-year-old woman with moderate Alzheimer's disease is hospitalized for a hip fracture
repair. On postoperative day 2, she becomes acutely confused, restless, and tries to pull out her
IV line. Her vital signs are stable. Which is the most appropriate initial intervention?
A. Apply soft wrist restraints
B. Administer haloperidol 0.5 mg IM
C. Reorient the patient and ensure presence of familiar objects
D. Start a scheduled dose of lorazepam
[Answer] C
Rationale: Nonpharmacologic interventions (reorientation, family presence, familiar objects,
minimizing disruptions) are first-line for delirium. Restraints and antipsychotics should only be
used if the patient is at immediate risk of harm to self or others and nonpharmacologic
measures fail. Lorazepam can worsen delirium.
2. A 79-year-old man with vascular dementia and a history of falls is brought to the clinic by his
wife, who reports he has become increasingly withdrawn, refuses to eat, and has lost 10 lb over
2 months. He scores 8/15 on the Geriatric Depression Scale. Which is the most likely diagnosis?
A. Dementia progression
B. Major depressive disorder
C. Delirium
D. Failure to thrive
[Answer] B
Rationale: Withdrawal, anorexia, weight loss, and a GDS score >5 are highly suggestive of
depression in dementia. The GDS-15 is validated for older adults. Dementia progression alone
does not typically cause such acute mood changes. Delirium has acute onset and fluctuating
course. Failure to thrive is a descriptive term, not a specific diagnosis.
3. A frail 88-year-old woman with advanced dementia and dysphagia is admitted with
dehydration and a urinary tract infection. Her serum sodium is 152 mEq/L. Which is the most
appropriate rehydration strategy?
A. 0.9% normal saline at 125 mL/hour
B. 0.45% normal saline at 100 mL/hour
C. 5% dextrose in water at 75 mL/hour
D. Enteral free water via nasogastric tube
[Answer] A
, Rationale: Hypernatremia indicates free water deficit. Isotonic saline (0.9% NS) is the
appropriate initial fluid for rehydration in older adults, as rapid correction with hypotonic fluids
can cause cerebral edema. Enteral water is an option but less reliable in acute setting. D5W is
hypotonic and not first-line.
4. A 76-year-old woman with Parkinson's disease and mild cognitive impairment reports
frequent falls. She has a shuffling gait and uses a cane. Which is the most appropriate
intervention to reduce fall risk?
A. Prescribe a walker with wheels
B. Refer for physical therapy for gait and balance training
C. Increase carbidopa-levodopa dose
D. Recommend a hip protector
[Answer] B
Rationale: Physical therapy with gait and balance training is the most effective intervention for
reducing falls in Parkinson's disease. A walker may help but should be fitted by a therapist.
Medication adjustment may be needed but is not the first step. Hip protectors reduce fracture
risk, not falls.
5. An 82-year-old man with a history of stroke and urinary incontinence is found to have a post-
void residual of 50 mL. He reports leaking urine when he coughs or sneezes. Which type of
incontinence is most likely?
A. Urge incontinence
B. Stress incontinence
C. Overflow incontinence
D. Functional incontinence
[Answer] B
Rationale: Stress incontinence is characterized by leakage with increased intra-abdominal
pressure (cough, sneeze, laugh). A normal post-void residual rules out overflow incontinence.
Urge incontinence involves a sudden urge to void. Functional incontinence is due to mobility or
cognitive barriers.
6. A frail 90-year-old woman with advanced dementia is found to have a stage 3 pressure injury
on her sacrum with necrotic tissue. Which is the most appropriate initial wound care
intervention?
A. Apply a hydrocolloid dressing
B. Debride the necrotic tissue
C. Start negative pressure wound therapy
D. Apply a moisture barrier cream
[Answer] B
Rationale: Necrotic tissue must be removed for wound healing to occur. Debridement (sharp,
enzymatic, or autolytic) is the priority. Hydrocolloid dressings are not appropriate for wounds
Advanced Practice Care of Frail Elders | Actual Q&A
with Rationale | Walden University
1. An 84-year-old woman with moderate Alzheimer's disease is hospitalized for a hip fracture
repair. On postoperative day 2, she becomes acutely confused, restless, and tries to pull out her
IV line. Her vital signs are stable. Which is the most appropriate initial intervention?
A. Apply soft wrist restraints
B. Administer haloperidol 0.5 mg IM
C. Reorient the patient and ensure presence of familiar objects
D. Start a scheduled dose of lorazepam
[Answer] C
Rationale: Nonpharmacologic interventions (reorientation, family presence, familiar objects,
minimizing disruptions) are first-line for delirium. Restraints and antipsychotics should only be
used if the patient is at immediate risk of harm to self or others and nonpharmacologic
measures fail. Lorazepam can worsen delirium.
2. A 79-year-old man with vascular dementia and a history of falls is brought to the clinic by his
wife, who reports he has become increasingly withdrawn, refuses to eat, and has lost 10 lb over
2 months. He scores 8/15 on the Geriatric Depression Scale. Which is the most likely diagnosis?
A. Dementia progression
B. Major depressive disorder
C. Delirium
D. Failure to thrive
[Answer] B
Rationale: Withdrawal, anorexia, weight loss, and a GDS score >5 are highly suggestive of
depression in dementia. The GDS-15 is validated for older adults. Dementia progression alone
does not typically cause such acute mood changes. Delirium has acute onset and fluctuating
course. Failure to thrive is a descriptive term, not a specific diagnosis.
3. A frail 88-year-old woman with advanced dementia and dysphagia is admitted with
dehydration and a urinary tract infection. Her serum sodium is 152 mEq/L. Which is the most
appropriate rehydration strategy?
A. 0.9% normal saline at 125 mL/hour
B. 0.45% normal saline at 100 mL/hour
C. 5% dextrose in water at 75 mL/hour
D. Enteral free water via nasogastric tube
[Answer] A
, Rationale: Hypernatremia indicates free water deficit. Isotonic saline (0.9% NS) is the
appropriate initial fluid for rehydration in older adults, as rapid correction with hypotonic fluids
can cause cerebral edema. Enteral water is an option but less reliable in acute setting. D5W is
hypotonic and not first-line.
4. A 76-year-old woman with Parkinson's disease and mild cognitive impairment reports
frequent falls. She has a shuffling gait and uses a cane. Which is the most appropriate
intervention to reduce fall risk?
A. Prescribe a walker with wheels
B. Refer for physical therapy for gait and balance training
C. Increase carbidopa-levodopa dose
D. Recommend a hip protector
[Answer] B
Rationale: Physical therapy with gait and balance training is the most effective intervention for
reducing falls in Parkinson's disease. A walker may help but should be fitted by a therapist.
Medication adjustment may be needed but is not the first step. Hip protectors reduce fracture
risk, not falls.
5. An 82-year-old man with a history of stroke and urinary incontinence is found to have a post-
void residual of 50 mL. He reports leaking urine when he coughs or sneezes. Which type of
incontinence is most likely?
A. Urge incontinence
B. Stress incontinence
C. Overflow incontinence
D. Functional incontinence
[Answer] B
Rationale: Stress incontinence is characterized by leakage with increased intra-abdominal
pressure (cough, sneeze, laugh). A normal post-void residual rules out overflow incontinence.
Urge incontinence involves a sudden urge to void. Functional incontinence is due to mobility or
cognitive barriers.
6. A frail 90-year-old woman with advanced dementia is found to have a stage 3 pressure injury
on her sacrum with necrotic tissue. Which is the most appropriate initial wound care
intervention?
A. Apply a hydrocolloid dressing
B. Debride the necrotic tissue
C. Start negative pressure wound therapy
D. Apply a moisture barrier cream
[Answer] B
Rationale: Necrotic tissue must be removed for wound healing to occur. Debridement (sharp,
enzymatic, or autolytic) is the priority. Hydrocolloid dressings are not appropriate for wounds
