NURS 6540 / NRNP 6540: ADVANCED
PRACTICE CARE OF FRAIL ELDERS
COMPREHENSIVE EXAM
1. According to the Fried Phenotype of Frailty, which of the following criteria is necessary to
categorize an older adult as ‘frail’?
A. Meeting at least one of the five specific criteria: weight loss, exhaustion, low activity,
slowness, or weakness.
B. Meeting at least three of the five specific criteria: weight loss, exhaustion, low activity,
slowness, or weakness.
C. Presence of at least two geriatric syndromes such as falls or incontinence.
D. A deficit accumulation index score of greater than 0.25.
Answer: B
Conceptual Explanation: The Fried Phenotype defines frailty as meeting three or more of
the following: unintentional weight loss, self-reported exhaustion, low energy expenditure,
slow gait speed, and weak grip strength.
,2. When evaluating an 82-year-old for delirium using the Confusion Assessment Method
(CAM), which two features must be present along with either inattention or disorganized
thinking?
A. Sleep-wake cycle disturbance and altered level of consciousness.
B. Memory impairment and disorientation.
C. Psychomotor agitation and perceptual disturbances.
D. Acute onset and fluctuating course.
Answer: D
Conceptual Explanation: The CAM diagnosis requires: (1) acute onset and fluctuating
course, AND (2) inattention, AND EITHER (3) disorganized thinking OR (4) altered level of
consciousness.
3. An NP is reviewing medications for a frail elder. According to the AGS Beers Criteria, why
should tertiary amine Tricyclic Antidepressants (TCAs) like Amitriptyline be avoided?
A. They significantly increase the risk of hyperkalemia when used with ACE inhibitors.
B. They are ineffective in the elderly population compared to SSRIs.
C. They cause paradoxical hypertension in patients over age 75.
D. They are highly anticholinergic, increasing risks of orthostatic hypotension, sedation,
and falls.
Answer: D
, Conceptual Explanation: TCAs are highly anticholinergic and are associated with a high
risk of adverse effects in elders, including blurred vision, urinary retention, sedation, and
syncope.
4. Which of the following is considered an Instrumental Activity of Daily Living (IADL) rather
than a Basic Activity of Daily Living (ADL)?
A. Transferring from bed to chair.
B. Personal hygiene and grooming.
C. Feeding oneself.
D. Managing finances and medications.
Answer: D
Conceptual Explanation: ADLs are basic self-care tasks (bathing, dressing, toileting, etc.),
while IADLs are more complex tasks necessary for independent living in the community,
like shopping, cooking, and managing money.
5. A 78-year-old patient presents with a ‘stuck’ feeling, visual hallucinations, and significant
fluctuations in alertness. Which type of dementia is most likely?
A. Dementia with Lewy Bodies (DLB)
B. Vascular Dementia
C. Frontotemporal Dementia
D. Alzheimer’s Disease
PRACTICE CARE OF FRAIL ELDERS
COMPREHENSIVE EXAM
1. According to the Fried Phenotype of Frailty, which of the following criteria is necessary to
categorize an older adult as ‘frail’?
A. Meeting at least one of the five specific criteria: weight loss, exhaustion, low activity,
slowness, or weakness.
B. Meeting at least three of the five specific criteria: weight loss, exhaustion, low activity,
slowness, or weakness.
C. Presence of at least two geriatric syndromes such as falls or incontinence.
D. A deficit accumulation index score of greater than 0.25.
Answer: B
Conceptual Explanation: The Fried Phenotype defines frailty as meeting three or more of
the following: unintentional weight loss, self-reported exhaustion, low energy expenditure,
slow gait speed, and weak grip strength.
,2. When evaluating an 82-year-old for delirium using the Confusion Assessment Method
(CAM), which two features must be present along with either inattention or disorganized
thinking?
A. Sleep-wake cycle disturbance and altered level of consciousness.
B. Memory impairment and disorientation.
C. Psychomotor agitation and perceptual disturbances.
D. Acute onset and fluctuating course.
Answer: D
Conceptual Explanation: The CAM diagnosis requires: (1) acute onset and fluctuating
course, AND (2) inattention, AND EITHER (3) disorganized thinking OR (4) altered level of
consciousness.
3. An NP is reviewing medications for a frail elder. According to the AGS Beers Criteria, why
should tertiary amine Tricyclic Antidepressants (TCAs) like Amitriptyline be avoided?
A. They significantly increase the risk of hyperkalemia when used with ACE inhibitors.
B. They are ineffective in the elderly population compared to SSRIs.
C. They cause paradoxical hypertension in patients over age 75.
D. They are highly anticholinergic, increasing risks of orthostatic hypotension, sedation,
and falls.
Answer: D
, Conceptual Explanation: TCAs are highly anticholinergic and are associated with a high
risk of adverse effects in elders, including blurred vision, urinary retention, sedation, and
syncope.
4. Which of the following is considered an Instrumental Activity of Daily Living (IADL) rather
than a Basic Activity of Daily Living (ADL)?
A. Transferring from bed to chair.
B. Personal hygiene and grooming.
C. Feeding oneself.
D. Managing finances and medications.
Answer: D
Conceptual Explanation: ADLs are basic self-care tasks (bathing, dressing, toileting, etc.),
while IADLs are more complex tasks necessary for independent living in the community,
like shopping, cooking, and managing money.
5. A 78-year-old patient presents with a ‘stuck’ feeling, visual hallucinations, and significant
fluctuations in alertness. Which type of dementia is most likely?
A. Dementia with Lewy Bodies (DLB)
B. Vascular Dementia
C. Frontotemporal Dementia
D. Alzheimer’s Disease
