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NURS 6540: Advanced Practice Care of Frail Elders
Comprehensive Exam Study Guide | Latest 2026/2027
Edition
Walden University | 100+ Practice Questions with
Verified Answers & Detailed Rationales
Section 1: Physiology of Aging & Frailty (Questions 1-15)
Question 1: A 78-year-old patient reports feeling weak, has
unintentional weight loss of 8% over the past 6 months, and reports
feeling exhausted most days. The patient walks slowly and has low
physical activity. This presentation is most consistent with:
A) Normal aging
B) Sarcopenia
C) Frailty syndrome
D) Depression
Answer: C) Frailty syndrome
Rationale: This patient meets three or more of the Fried frailty criteria:
unintentional weight loss (>5% in 6 months), exhaustion, weakness (low
grip strength), slow walking speed, and low physical activity. Frailty is a
distinct clinical syndrome associated with increased vulnerability to
stressors and adverse outcomes.
,2|Page
Question 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
Answer: B) Decreased subcutaneous fat and impaired
thermoregulation
Rationale: Aging is associated with decreased subcutaneous fat
(reduced insulation), impaired vasoconstriction response, and decreased
shivering response, all contributing to increased risk of hypothermia in
older adults.
Question 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
Answer: B) Creatinine may overestimate GFR due to decreased
muscle mass
Rationale: Age-related loss of muscle mass (sarcopenia) reduces
creatinine production. A normal or slightly elevated creatinine may mask
significant reduction in GFR. Estimated GFR (eGFR) should be
calculated using cystatin C or creatinine with age adjustment for more
accurate assessment.
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Question 4: Which cardiovascular change is considered a normal part of
aging?
A) Increased left ventricular ejection fraction
B) Decreased arterial compliance and increased afterload
C) Decreased systolic blood pressure
D) Increased heart rate at rest
Answer: B) Decreased arterial compliance and increased afterload
Rationale: Aging causes arterial stiffening, increased pulse wave
velocity, and increased afterload. These changes contribute to increased
systolic blood pressure and left ventricular hypertrophy, even in the
absence of disease.
Question 5: A 75-year-old patient is concerned about memory lapses.
Which finding suggests normal age-related cognitive change rather than
dementia?
A) Forgetting the names of close family members
B) Getting lost in familiar neighborhoods
C) Occasionally misplacing keys but retracing steps to find them
D) Inability to manage finances independently
Answer: C) Occasionally misplacing keys but retracing steps to find
them
Rationale: Normal age-related cognitive changes include occasional
word-finding difficulty, misplacing objects with ability to retrace steps,
and mild slowing of processing speed. Inability to manage finances,
getting lost in familiar areas, and forgetting close family members
suggest cognitive impairment.
, 4|Page
Question 6: The nurse practitioner understands that sarcopenia is
characterized by:
A) Increased muscle mass with aging
B) Age-related loss of muscle mass, strength, and function
C) Benign muscle weakness that does not affect function
D) Reversible condition with high protein diet alone
Answer: B) Age-related loss of muscle mass, strength, and function
Rationale: Sarcopenia is the age-related progressive loss of skeletal
muscle mass, strength, and function. It contributes to frailty, falls, and
functional decline. While nutrition and exercise can help, it is not fully
reversible.
Question 7: Which immunologic change in aging contributes to
increased infection risk and decreased vaccine response?
A) Increased T-cell production
B) Immunosenescence with decreased naive T-cells and impaired
antibody response
C) Enhanced B-cell function
D) Increased inflammatory response to vaccines
Answer: B) Immunosenescence with decreased naive T-cells and
impaired antibody response
Rationale: Immunosenescence involves decreased production of naive
T-cells, reduced T-cell diversity, and impaired antibody response to
novel antigens. This explains increased susceptibility to infections and
reduced vaccine efficacy in older adults.
NURS 6540: Advanced Practice Care of Frail Elders
Comprehensive Exam Study Guide | Latest 2026/2027
Edition
Walden University | 100+ Practice Questions with
Verified Answers & Detailed Rationales
Section 1: Physiology of Aging & Frailty (Questions 1-15)
Question 1: A 78-year-old patient reports feeling weak, has
unintentional weight loss of 8% over the past 6 months, and reports
feeling exhausted most days. The patient walks slowly and has low
physical activity. This presentation is most consistent with:
A) Normal aging
B) Sarcopenia
C) Frailty syndrome
D) Depression
Answer: C) Frailty syndrome
Rationale: This patient meets three or more of the Fried frailty criteria:
unintentional weight loss (>5% in 6 months), exhaustion, weakness (low
grip strength), slow walking speed, and low physical activity. Frailty is a
distinct clinical syndrome associated with increased vulnerability to
stressors and adverse outcomes.
,2|Page
Question 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
Answer: B) Decreased subcutaneous fat and impaired
thermoregulation
Rationale: Aging is associated with decreased subcutaneous fat
(reduced insulation), impaired vasoconstriction response, and decreased
shivering response, all contributing to increased risk of hypothermia in
older adults.
Question 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
Answer: B) Creatinine may overestimate GFR due to decreased
muscle mass
Rationale: Age-related loss of muscle mass (sarcopenia) reduces
creatinine production. A normal or slightly elevated creatinine may mask
significant reduction in GFR. Estimated GFR (eGFR) should be
calculated using cystatin C or creatinine with age adjustment for more
accurate assessment.
,3|Page
Question 4: Which cardiovascular change is considered a normal part of
aging?
A) Increased left ventricular ejection fraction
B) Decreased arterial compliance and increased afterload
C) Decreased systolic blood pressure
D) Increased heart rate at rest
Answer: B) Decreased arterial compliance and increased afterload
Rationale: Aging causes arterial stiffening, increased pulse wave
velocity, and increased afterload. These changes contribute to increased
systolic blood pressure and left ventricular hypertrophy, even in the
absence of disease.
Question 5: A 75-year-old patient is concerned about memory lapses.
Which finding suggests normal age-related cognitive change rather than
dementia?
A) Forgetting the names of close family members
B) Getting lost in familiar neighborhoods
C) Occasionally misplacing keys but retracing steps to find them
D) Inability to manage finances independently
Answer: C) Occasionally misplacing keys but retracing steps to find
them
Rationale: Normal age-related cognitive changes include occasional
word-finding difficulty, misplacing objects with ability to retrace steps,
and mild slowing of processing speed. Inability to manage finances,
getting lost in familiar areas, and forgetting close family members
suggest cognitive impairment.
, 4|Page
Question 6: The nurse practitioner understands that sarcopenia is
characterized by:
A) Increased muscle mass with aging
B) Age-related loss of muscle mass, strength, and function
C) Benign muscle weakness that does not affect function
D) Reversible condition with high protein diet alone
Answer: B) Age-related loss of muscle mass, strength, and function
Rationale: Sarcopenia is the age-related progressive loss of skeletal
muscle mass, strength, and function. It contributes to frailty, falls, and
functional decline. While nutrition and exercise can help, it is not fully
reversible.
Question 7: Which immunologic change in aging contributes to
increased infection risk and decreased vaccine response?
A) Increased T-cell production
B) Immunosenescence with decreased naive T-cells and impaired
antibody response
C) Enhanced B-cell function
D) Increased inflammatory response to vaccines
Answer: B) Immunosenescence with decreased naive T-cells and
impaired antibody response
Rationale: Immunosenescence involves decreased production of naive
T-cells, reduced T-cell diversity, and impaired antibody response to
novel antigens. This explains increased susceptibility to infections and
reduced vaccine efficacy in older adults.
