NURS6540 Exam 1 | NURS 6540 / NRNP 6540
Advanced Practice Care of Frail Elders | Actual Q&A
with Rationale | Walden University
1. An 82-year-old woman with hypertension, osteoarthritis, and mild cognitive impairment
reports feeling “slowed down” and unintentionally lost 8 lb over three months. Her gait speed
is 0.6 m/s. Which finding best defines her as frail according to the Fried phenotype?
A. Weight loss and low gait speed only
B. Weight loss, low gait speed, and exhaustion
C. Weight loss, low gait speed, and low physical activity
D. Weight loss, low gait speed, and weakness
[Answer] D
Rationale: The Fried frailty phenotype requires at least three of five criteria: unintentional
weight loss, exhaustion, weakness (grip strength), slow gait speed, and low physical activity.
This patient has weight loss and slow gait speed; weakness (measured by grip strength) would
be the third. Exhaustion and low physical activity are not yet documented.
2. A frail 88-year-old male with heart failure, COPD, and chronic kidney disease stage 3 is
admitted after a fall. He takes 12 medications. Which is the priority initial assessment?
A. Comprehensive medication reconciliation
B. Orthostatic vital signs
C. Timed Up and Go test
D. Mini-Mental State Examination
[Answer] B
Rationale: Orthostatic hypotension is a common contributor to falls in frail elders, especially
with polypharmacy (e.g., diuretics, beta-blockers). Assessing orthostatic vital signs is the priority
to identify immediate fall risk and guide management.
3. A 79-year-old woman with diabetes and peripheral neuropathy reports difficulty preparing
meals and managing finances. This indicates impairment in:
A. Activities of daily living (ADLs)
B. Instrumental activities of daily living (IADLs)
C. Mobility
D. Cognitive function
[Answer] B
, Rationale: IADLs include meal preparation, financial management, shopping, telephone use,
and medication management. ADLs are basic self-care tasks (bathing, dressing, toileting,
transferring, continence, feeding).
4. An 85-year-old man with mild dementia lives alone. His daughter is concerned about safety.
Which screening tool is most appropriate to assess his ability to live independently?
A. Montreal Cognitive Assessment (MoCA)
B. Barthel Index
C. Lawton IADL scale
D. Geriatric Depression Scale (GDS)
[Answer] C
Rationale: The Lawton Instrumental Activities of Daily Living scale directly assesses the skills
needed for independent living (e.g., cooking, shopping, managing medications). The MoCA
screens cognition but does not directly assess functional capacity.
5. A frail 90-year-old woman with a history of falls and osteoporosis is prescribed a new
antihypertensive. Which principle of medication prescribing is most important?
A. Start low, go slow
B. Use the lowest number of medications possible
C. Avoid all central nervous system-active drugs
D. Titrate to maximum tolerated dose quickly
[Answer] A
Rationale: In frail elders, pharmacodynamics and pharmacokinetics are altered. “Start low, go
slow” minimizes adverse effects and orthostatic hypotension. While minimizing number of
drugs is important, the principle of slow titration is key when initiating any new agent.
6. Which of the following is a hallmark of pathological aging rather than normal aging?
A. Presbycusis (high-frequency hearing loss)
B. Decreased renal function by 1% per year after age 40
C. Delirium superimposed on dementia
D. Slower gait speed by 0.1 m/s per decade
[Answer] C
Rationale: Delirium is an acute, reversible disturbance of consciousness and cognition, often
due to an underlying medical cause—it is not part of normal aging. Presbycusis, gradual renal
decline, and slight slowing of gait are typical age-related changes.
7. A 78-year-old man with atrial fibrillation on warfarin, hypertension, and benign prostatic
hyperplasia complains of dizziness. His blood pressure is 142/88 supine and 108/64 standing.
What is the most likely cause?
A. Dehydration
B. Autonomic neuropathy
Advanced Practice Care of Frail Elders | Actual Q&A
with Rationale | Walden University
1. An 82-year-old woman with hypertension, osteoarthritis, and mild cognitive impairment
reports feeling “slowed down” and unintentionally lost 8 lb over three months. Her gait speed
is 0.6 m/s. Which finding best defines her as frail according to the Fried phenotype?
A. Weight loss and low gait speed only
B. Weight loss, low gait speed, and exhaustion
C. Weight loss, low gait speed, and low physical activity
D. Weight loss, low gait speed, and weakness
[Answer] D
Rationale: The Fried frailty phenotype requires at least three of five criteria: unintentional
weight loss, exhaustion, weakness (grip strength), slow gait speed, and low physical activity.
This patient has weight loss and slow gait speed; weakness (measured by grip strength) would
be the third. Exhaustion and low physical activity are not yet documented.
2. A frail 88-year-old male with heart failure, COPD, and chronic kidney disease stage 3 is
admitted after a fall. He takes 12 medications. Which is the priority initial assessment?
A. Comprehensive medication reconciliation
B. Orthostatic vital signs
C. Timed Up and Go test
D. Mini-Mental State Examination
[Answer] B
Rationale: Orthostatic hypotension is a common contributor to falls in frail elders, especially
with polypharmacy (e.g., diuretics, beta-blockers). Assessing orthostatic vital signs is the priority
to identify immediate fall risk and guide management.
3. A 79-year-old woman with diabetes and peripheral neuropathy reports difficulty preparing
meals and managing finances. This indicates impairment in:
A. Activities of daily living (ADLs)
B. Instrumental activities of daily living (IADLs)
C. Mobility
D. Cognitive function
[Answer] B
, Rationale: IADLs include meal preparation, financial management, shopping, telephone use,
and medication management. ADLs are basic self-care tasks (bathing, dressing, toileting,
transferring, continence, feeding).
4. An 85-year-old man with mild dementia lives alone. His daughter is concerned about safety.
Which screening tool is most appropriate to assess his ability to live independently?
A. Montreal Cognitive Assessment (MoCA)
B. Barthel Index
C. Lawton IADL scale
D. Geriatric Depression Scale (GDS)
[Answer] C
Rationale: The Lawton Instrumental Activities of Daily Living scale directly assesses the skills
needed for independent living (e.g., cooking, shopping, managing medications). The MoCA
screens cognition but does not directly assess functional capacity.
5. A frail 90-year-old woman with a history of falls and osteoporosis is prescribed a new
antihypertensive. Which principle of medication prescribing is most important?
A. Start low, go slow
B. Use the lowest number of medications possible
C. Avoid all central nervous system-active drugs
D. Titrate to maximum tolerated dose quickly
[Answer] A
Rationale: In frail elders, pharmacodynamics and pharmacokinetics are altered. “Start low, go
slow” minimizes adverse effects and orthostatic hypotension. While minimizing number of
drugs is important, the principle of slow titration is key when initiating any new agent.
6. Which of the following is a hallmark of pathological aging rather than normal aging?
A. Presbycusis (high-frequency hearing loss)
B. Decreased renal function by 1% per year after age 40
C. Delirium superimposed on dementia
D. Slower gait speed by 0.1 m/s per decade
[Answer] C
Rationale: Delirium is an acute, reversible disturbance of consciousness and cognition, often
due to an underlying medical cause—it is not part of normal aging. Presbycusis, gradual renal
decline, and slight slowing of gait are typical age-related changes.
7. A 78-year-old man with atrial fibrillation on warfarin, hypertension, and benign prostatic
hyperplasia complains of dizziness. His blood pressure is 142/88 supine and 108/64 standing.
What is the most likely cause?
A. Dehydration
B. Autonomic neuropathy
