NURS 6540 Final Comprehensive Examination
Advanced Practice Care of Frail Elders | Walden University | 2026/2027
Section 1: Physiology of Aging & Frailty (Questions 1–25)
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
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
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
4. An 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
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
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
,7. A 79-year-old female presents with a 9-pound unintentional weight loss over 4 months,
self-reported exhaustion, grip strength of 16 kg (below the cutoff for her BMI/gender), gait
speed of 0.6 m/s, and reports walking fewer than 2 blocks per week. She has no acute
illness. According to the Fried Frailty Phenotype, which of the following is the MOST
accurate classification?
A. Pre-frail (meets 1–2 criteria)
B. Frail (meets 3–5 criteria)
C. Non-frail (meets 0 criteria)
D. Sarcopenic obesity
8. Which of the following BEST explains why serum creatinine is an unreliable marker of
renal function in frail older adults?
A. Creatinine production increases with age due to muscle catabolism
B. Age-related sarcopenia reduces creatinine generation, masking renal impairment
C. Tubular secretion of creatinine increases with age, falsely elevating levels
D. Creatinine is entirely reabsorbed in aging nephrons
9. A frail 82-year-old man is hospitalized with urosepsis. Despite appropriate antibiotics, he
develops delirium, acute kidney injury, and pressure ulcers. The NP recognizes that this
clinical trajectory is BEST explained by:
A. Inadequate antibiotic dosing
B. The patient's diminished physiological reserve and homeostenosis
C. A healthcare-acquired infection
D. Medication non-adherence prior to admission
, 10. Which of the following inflammatory biomarkers is MOST consistently elevated in frail
older adults and is associated with the "inflammaging" phenomenon?
A. C-reactive protein (CRP)
B. Interleukin-6 (IL-6)
C. Tumor necrosis factor-alpha (TNF-α)
D. Interleukin-10 (IL-10)
11. A 77-year-old woman with frailty, osteoporosis, and type 2 diabetes is started on a new
medication. Which pharmacokinetic change associated with aging MOST significantly
affects the volume of distribution of lipid-soluble drugs?
A. Decreased total body water
B. Increased body fat percentage
C. Decreased serum albumin
D. Increased gastric pH
12. A 73-year-old patient with pre-frailty (meets 2 Fried criteria) asks what she can do to
prevent progression to frailty. Which evidence-based intervention has the STRONGEST
evidence for preventing frailty progression?
A. Daily multivitamin with high-dose vitamin E
B. 150 minutes/week of moderate-intensity aerobic activity + resistance training 2x/week
C. Caloric restriction to maintain BMI < 22
D. Daily low-dose aspirin
13. Which of the following molecular mechanisms is MOST implicated in the pathogenesis
of sarcopenia?
Advanced Practice Care of Frail Elders | Walden University | 2026/2027
Section 1: Physiology of Aging & Frailty (Questions 1–25)
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
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
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
4. An 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
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
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
,7. A 79-year-old female presents with a 9-pound unintentional weight loss over 4 months,
self-reported exhaustion, grip strength of 16 kg (below the cutoff for her BMI/gender), gait
speed of 0.6 m/s, and reports walking fewer than 2 blocks per week. She has no acute
illness. According to the Fried Frailty Phenotype, which of the following is the MOST
accurate classification?
A. Pre-frail (meets 1–2 criteria)
B. Frail (meets 3–5 criteria)
C. Non-frail (meets 0 criteria)
D. Sarcopenic obesity
8. Which of the following BEST explains why serum creatinine is an unreliable marker of
renal function in frail older adults?
A. Creatinine production increases with age due to muscle catabolism
B. Age-related sarcopenia reduces creatinine generation, masking renal impairment
C. Tubular secretion of creatinine increases with age, falsely elevating levels
D. Creatinine is entirely reabsorbed in aging nephrons
9. A frail 82-year-old man is hospitalized with urosepsis. Despite appropriate antibiotics, he
develops delirium, acute kidney injury, and pressure ulcers. The NP recognizes that this
clinical trajectory is BEST explained by:
A. Inadequate antibiotic dosing
B. The patient's diminished physiological reserve and homeostenosis
C. A healthcare-acquired infection
D. Medication non-adherence prior to admission
, 10. Which of the following inflammatory biomarkers is MOST consistently elevated in frail
older adults and is associated with the "inflammaging" phenomenon?
A. C-reactive protein (CRP)
B. Interleukin-6 (IL-6)
C. Tumor necrosis factor-alpha (TNF-α)
D. Interleukin-10 (IL-10)
11. A 77-year-old woman with frailty, osteoporosis, and type 2 diabetes is started on a new
medication. Which pharmacokinetic change associated with aging MOST significantly
affects the volume of distribution of lipid-soluble drugs?
A. Decreased total body water
B. Increased body fat percentage
C. Decreased serum albumin
D. Increased gastric pH
12. A 73-year-old patient with pre-frailty (meets 2 Fried criteria) asks what she can do to
prevent progression to frailty. Which evidence-based intervention has the STRONGEST
evidence for preventing frailty progression?
A. Daily multivitamin with high-dose vitamin E
B. 150 minutes/week of moderate-intensity aerobic activity + resistance training 2x/week
C. Caloric restriction to maintain BMI < 22
D. Daily low-dose aspirin
13. Which of the following molecular mechanisms is MOST implicated in the pathogenesis
of sarcopenia?
