NURS6540 / NURS 6540 Exam Study Guide:
Advanced Practice Care of Frail Elders
Latest Update 2026/2027 | Walden University
Questions and Verified Answers
Section 1: Frailty Syndrome and Comprehensive Geriatric Assessment
Q1: An 82-year-old patient presents to the clinic for a routine physical. The advanced practice
registered nurse (APRN) is screening for the frailty phenotype. Which of the following clinical
manifestations are components of Fried’s Frailty Phenotype? (Select all that apply)
A. Unintentional weight loss of 10 lbs in the past year
B. Self-reported exhaustion
C. Slow walking speed (time to walk 15 feet)
D. Lowest quartile of grip strength adjusted for gender and BMI
E. Macrocytic anemia on laboratory evaluation
Correct Answer: A, B, C, D
Rationale: Fried’s frailty phenotype is a validated physical measure requiring the presence of
three or more of the following criteria: unintentional weight loss, self-reported exhaustion, low
physical activity, slow gait speed, and weak grip strength. Macrocytic anemia is a laboratory
finding that may contribute to fatigue or frailty but is not a diagnostic criterion for the frailty
phenotype itself. Recognizing these five criteria is essential for the APRN to accurately identify
frailty and implement targeted interventions to prevent adverse outcomes.
Q2: An 84-year-old patient is being evaluated using the Frailty Index (FI) based on a cumulative
deficit model. The patient has 25 out of 50 possible health deficits. The APRN calculates an FI
score of 0.50. How should the APRN interpret this score in the context of the patient's care plan?
A. The patient is robust and requires standard preventive care.
B. The patient is pre-frail and requires minimal intervention.
C. The patient is severely frail with a significantly increased risk of mortality and adverse
health outcomes. [CORRECT]
,D. The patient's score indicates an acute, reversible delirium.
Correct Answer: C
Rationale: The Frailty Index calculates the proportion of potential health deficits present in an
individual; a score of 0.50 (50% of deficits present) indicates severe frailty. According to deficit
accumulation models, an FI of ≥0.25 indicates frailty, and scores approaching 0.50 or higher are
strongly associated with an exponential increase in the risk of mortality, institutionalization, and
adverse surgical outcomes. A score of 0 represents robustness, and <0.25 indicates pre-frailty.
The FI measures chronic vulnerability, not an acute state like delirium.
Q3: The APRN is conducting a Comprehensive Geriatric Assessment (CGA) for a newly
admitted patient to a subacute rehabilitation facility. Which of the following domains must be
included in a standardized CGA? (Select all that apply)
A. Medical (comorbidities, medications, nutrition)
B. Functional (ADLs, IADLs, mobility)
C. Cognitive and psychological (delirium, dementia, depression)
D. Social and environmental (caregiver support, financial status, home safety)
E. Spiritual (meaning, purpose, existential distress)
Correct Answer: A, B, C, D, E
Rationale: A true CGA is a multidimensional, interdisciplinary diagnostic process designed to
determine a frail older person's medical, psychological, and functional capabilities to develop a
coordinated and integrated plan for treatment and long-term follow-up. It explicitly includes
physical, functional, cognitive, social/environmental, and spiritual domains. Omitting the
spiritual or social domain limits the APRN's ability to address the whole person, which is critical
in managing frail elders who often face existential distress and lack of social support.
Q4: A 79-year-old frail woman with multiple comorbidities is diagnosed with early-stage breast
cancer. The surgical oncologist recommends a radical mastectomy with lymph node dissection.
The APRN, using principles of frailty assessment, anticipates which of the following outcomes?
A. Rapid return to baseline functional status due to curative intent.
B. High likelihood of postoperative delirium, prolonged institutionalization, and failure to
return to baseline. [CORRECT]
C. No increased surgical risk compared to a robust 79-year-old.
D. Increased risk of metastasis due to the suppression of the immune system.
, Correct Answer: B
Rationale: Frailty is a well-established independent predictor of poor postoperative outcomes,
including increased risk of delirium, surgical complications, prolonged length of stay, and failure
to return to baseline functional status or living situation. This knowledge is crucial for the APRN
to advocate for less invasive options or focused geriatric prehabilitation. Age alone is not the
determinant of surgical risk; frailty is. While cancer can suppress immunity, frailty does not
directly cause increased metastasis in this manner.
Q5: During the CGA, the APRN uses the FICA tool (Faith, Importance, Community, Address) to
assess the spiritual domain. The patient states, "I don't go to church anymore, but I find peace in
my garden and believe everything happens for a reason." What is the APRN's most appropriate
response?
A. "Since you don't attend formal services, I will mark 'None' for your spiritual assessment."
B. "Finding peace in nature is a valid spiritual practice. How can we support this during
your hospital stay?" [CORRECT]
C. "You should consider joining a local church to improve your mental health outcomes."
D. "It is against medical protocol to include gardening in your medical care plan."
Correct Answer: B
Rationale: Spirituality in older adults extends far beyond formal religious attendance and often
involves finding meaning, peace, and connection through nature, art, or personal philosophy.
Acknowledging and supporting these individualized spiritual practices is a core component of
patient-centered geriatric care. Marking "None" dismisses the patient's stated coping mechanism.
Suggesting they join a church imposes personal biases. Excluding non-traditional practices from
the care plan violates holistic geriatric principles.
Q6: A frail 86-year-old living alone is brought to the clinic by a neighbor due to weight loss and
poor hygiene. The APRN assesses social determinants of health (SDOH). Which finding poses
the greatest immediate risk to this patient's ability to age in place?
A. Lack of high-speed internet access.
B. Inability to afford medications and food due to the "donut hole" in Medicare Part D.
C. Expressing a preference for alternative medicine over pharmaceuticals.
D. Living more than 10 miles from the primary care clinic.
Correct Answer: B
Advanced Practice Care of Frail Elders
Latest Update 2026/2027 | Walden University
Questions and Verified Answers
Section 1: Frailty Syndrome and Comprehensive Geriatric Assessment
Q1: An 82-year-old patient presents to the clinic for a routine physical. The advanced practice
registered nurse (APRN) is screening for the frailty phenotype. Which of the following clinical
manifestations are components of Fried’s Frailty Phenotype? (Select all that apply)
A. Unintentional weight loss of 10 lbs in the past year
B. Self-reported exhaustion
C. Slow walking speed (time to walk 15 feet)
D. Lowest quartile of grip strength adjusted for gender and BMI
E. Macrocytic anemia on laboratory evaluation
Correct Answer: A, B, C, D
Rationale: Fried’s frailty phenotype is a validated physical measure requiring the presence of
three or more of the following criteria: unintentional weight loss, self-reported exhaustion, low
physical activity, slow gait speed, and weak grip strength. Macrocytic anemia is a laboratory
finding that may contribute to fatigue or frailty but is not a diagnostic criterion for the frailty
phenotype itself. Recognizing these five criteria is essential for the APRN to accurately identify
frailty and implement targeted interventions to prevent adverse outcomes.
Q2: An 84-year-old patient is being evaluated using the Frailty Index (FI) based on a cumulative
deficit model. The patient has 25 out of 50 possible health deficits. The APRN calculates an FI
score of 0.50. How should the APRN interpret this score in the context of the patient's care plan?
A. The patient is robust and requires standard preventive care.
B. The patient is pre-frail and requires minimal intervention.
C. The patient is severely frail with a significantly increased risk of mortality and adverse
health outcomes. [CORRECT]
,D. The patient's score indicates an acute, reversible delirium.
Correct Answer: C
Rationale: The Frailty Index calculates the proportion of potential health deficits present in an
individual; a score of 0.50 (50% of deficits present) indicates severe frailty. According to deficit
accumulation models, an FI of ≥0.25 indicates frailty, and scores approaching 0.50 or higher are
strongly associated with an exponential increase in the risk of mortality, institutionalization, and
adverse surgical outcomes. A score of 0 represents robustness, and <0.25 indicates pre-frailty.
The FI measures chronic vulnerability, not an acute state like delirium.
Q3: The APRN is conducting a Comprehensive Geriatric Assessment (CGA) for a newly
admitted patient to a subacute rehabilitation facility. Which of the following domains must be
included in a standardized CGA? (Select all that apply)
A. Medical (comorbidities, medications, nutrition)
B. Functional (ADLs, IADLs, mobility)
C. Cognitive and psychological (delirium, dementia, depression)
D. Social and environmental (caregiver support, financial status, home safety)
E. Spiritual (meaning, purpose, existential distress)
Correct Answer: A, B, C, D, E
Rationale: A true CGA is a multidimensional, interdisciplinary diagnostic process designed to
determine a frail older person's medical, psychological, and functional capabilities to develop a
coordinated and integrated plan for treatment and long-term follow-up. It explicitly includes
physical, functional, cognitive, social/environmental, and spiritual domains. Omitting the
spiritual or social domain limits the APRN's ability to address the whole person, which is critical
in managing frail elders who often face existential distress and lack of social support.
Q4: A 79-year-old frail woman with multiple comorbidities is diagnosed with early-stage breast
cancer. The surgical oncologist recommends a radical mastectomy with lymph node dissection.
The APRN, using principles of frailty assessment, anticipates which of the following outcomes?
A. Rapid return to baseline functional status due to curative intent.
B. High likelihood of postoperative delirium, prolonged institutionalization, and failure to
return to baseline. [CORRECT]
C. No increased surgical risk compared to a robust 79-year-old.
D. Increased risk of metastasis due to the suppression of the immune system.
, Correct Answer: B
Rationale: Frailty is a well-established independent predictor of poor postoperative outcomes,
including increased risk of delirium, surgical complications, prolonged length of stay, and failure
to return to baseline functional status or living situation. This knowledge is crucial for the APRN
to advocate for less invasive options or focused geriatric prehabilitation. Age alone is not the
determinant of surgical risk; frailty is. While cancer can suppress immunity, frailty does not
directly cause increased metastasis in this manner.
Q5: During the CGA, the APRN uses the FICA tool (Faith, Importance, Community, Address) to
assess the spiritual domain. The patient states, "I don't go to church anymore, but I find peace in
my garden and believe everything happens for a reason." What is the APRN's most appropriate
response?
A. "Since you don't attend formal services, I will mark 'None' for your spiritual assessment."
B. "Finding peace in nature is a valid spiritual practice. How can we support this during
your hospital stay?" [CORRECT]
C. "You should consider joining a local church to improve your mental health outcomes."
D. "It is against medical protocol to include gardening in your medical care plan."
Correct Answer: B
Rationale: Spirituality in older adults extends far beyond formal religious attendance and often
involves finding meaning, peace, and connection through nature, art, or personal philosophy.
Acknowledging and supporting these individualized spiritual practices is a core component of
patient-centered geriatric care. Marking "None" dismisses the patient's stated coping mechanism.
Suggesting they join a church imposes personal biases. Excluding non-traditional practices from
the care plan violates holistic geriatric principles.
Q6: A frail 86-year-old living alone is brought to the clinic by a neighbor due to weight loss and
poor hygiene. The APRN assesses social determinants of health (SDOH). Which finding poses
the greatest immediate risk to this patient's ability to age in place?
A. Lack of high-speed internet access.
B. Inability to afford medications and food due to the "donut hole" in Medicare Part D.
C. Expressing a preference for alternative medicine over pharmaceuticals.
D. Living more than 10 miles from the primary care clinic.
Correct Answer: B
