NURS 6540 Advanced Practice Care of Frail Elders
– Comprehensive Assessment Actual Exam –
Complete Questions and Answers with Detailed
Rationales – Pass Guaranteed – A+ Graded
Foundations: Frailty, Geriatric Syndromes & Functional Assessment
Q1: Which of the following best describes the frailty phenotype as defined by Fried and
colleagues?
A. A cumulative index of diseases, disabilities, and social deficits that accumulate over a
lifetime
B. The presence of unintentional weight loss, exhaustion, weakness, slow gait speed,
and low physical activity
C. A state of severe cognitive decline accompanied by functional dependency and
nutritional deficiency
D. The inability to perform three or more instrumental activities of daily living due to
chronic disease burden
Correct Answer: B
Rationale: The best answer is B, because the Fried frailty phenotype specifically
identifies frailty through five physical criteria: unintentional weight loss, self-reported
exhaustion, weakness (grip strength), slow walking speed, and low physical activity,
which distinguishes it from the broader deficit accumulation model.
Q2: When using the Katz Index of Independence in Activities of Daily Living, which of
the following tasks is evaluated?
A. Managing finances and using the telephone
B. Ability to bathe, dress, toilet, transfer, continence, and feed
C. Grocery shopping, cooking, and housekeeping
D. Navigating public transportation and driving
Correct Answer: B
Rationale: This is correct because the Katz ADL tool specifically focuses on the six most
fundamental self-care tasks: bathing, dressing, toileting, transferring, maintaining
continence, and feeding, whereas the more complex tasks like finances and shopping
are reserved for the Lawton IADL scale.
Q3: An 84-year-old patient presents to your clinic with a history of a recent fall. You
observe that she takes several steps before turning around and appears to have a
,wide-based, shuffling gait. Which validated assessment tool is most appropriate to
evaluate her balance and gait dynamics in the clinic setting?
A. The Timed Up and Go (TUG) test
B. The Mini-Mental State Examination (MMSE)
C. The Geriatric Depression Scale (GDS-15)
D. The Braden Scale for pressure injury risk
Correct Answer: A
Rationale: The best answer is the Timed Up and Go test, because it is a quick, validated
clinical tool specifically designed to assess a patient's mobility, balance, gait speed, and
turning ability, all of which are key fall risk factors in older adults.
Q4: During a home visit for a 78-year-old male, you notice he appears withdrawn and
malnourished. When you ask him about his living situation, his adult son answers all the
questions for him and becomes visibly irritated when the patient tries to speak. Which
screening tool is specifically designed for this clinical situation?
A. The Cornell Scale for Depression in Dementia
B. The Elder Abuse Suspicion Index (EASI)
C. The Mini-Cog
D. The Morse Fall Scale
Correct Answer: B
Rationale: This aligns with best practice because the Elder Abuse Suspicion Index
(EASI) is a brief, validated tool specifically meant to be used by clinicians in outpatient
settings to screen for elder mistreatment when risk factors or subtle signs, like caregiver
dominance and patient withdrawal, are present.
Q5: How does the deficit accumulation model of frailty differ from the frailty phenotype
model?
A. The deficit accumulation model focuses exclusively on biological markers of aging
like inflammatory cytokines.
B. The deficit accumulation model uses a simple scoring system based on the number
of age-related health deficits a person has accumulated.
C. The deficit accumulation model requires the presence of sarcopenia and cognitive
decline for a diagnosis.
D. The deficit accumulation model is primarily used to predict acute delirium rather than
long-term mortality.
Correct Answer: B
Rationale: This is correct because unlike the physical phenotype model, the deficit
accumulation approach (often using a Frailty Index) quantifies frailty by counting the
total number of health deficits—including diseases, disabilities, and abnormal lab
values—out of a predefined list, giving a more comprehensive picture of overall
vulnerability.
, Q6: A frail 81-year-old woman reports difficulty rising from a chair without using her
arms and notices her legs look thinner than they used to. You suspect sarcopenia. What
is the primary underlying mechanism of this condition?
A. Accelerated bone resorption due to osteoclast overactivity
B. Progressive loss of skeletal muscle mass and strength due to aging
C. Accumulation of amyloid plaques in the motor cortex
D. Chronic vitamin B12 deficiency leading to peripheral neuropathy
Correct Answer: B
Rationale: The best answer is B, because sarcopenia is defined as the age-related,
progressive loss of skeletal muscle mass and function that leads to weakness and
reduced mobility, which directly explains her difficulty rising from a chair and the
observed muscle wasting.
Q7: A 76-year-old patient complains that he wakes up at 4:00 AM every morning and
cannot get back to sleep, even though he goes to bed at 8:00 PM. He denies snoring or
daytime sleepiness. What is the most appropriate initial response regarding his sleep
complaint?
A. Prescribe a low-dose trazodone to extend his sleep duration
B. Reassure him that a decrease in total sleep time and early morning awakenings are
normal age-related changes in sleep architecture
C. Order an overnight polysomnography to rule out obstructive sleep apnea
D. Recommend over-the-counter diphenhydramine to induce drowsiness
Correct Answer: B
Rationale: This is correct because older adults naturally experience changes in sleep
architecture, including a reduction in slow-wave sleep and more frequent early morning
awakenings, so patient education and sleep hygiene should always precede prescribing
medications that carry high risks for this population.
Q8: A 72-year-old patient lives independently but recently stopped paying her bills and
burned a pot on the stove. However, she is still fully able to bathe, dress, and toilet
herself without assistance. How should you interpret this clinical presentation?
A. She has preserved basic ADLs but is demonstrating declines in instrumental
activities of daily living (IADLs), which often signal early cognitive or functional decline
B. She is functionally independent and her errors are likely isolated incidents related to
normal aging
C. She requires immediate skilled nursing facility placement due to failure of basic
self-care
D. She has advanced dementia and requires 24-hour supervised care
Correct Answer: A
Rationale: The best answer is A, because the ability to perform basic ADLs like bathing
and dressing typically persists until later stages of decline, whereas losing the ability to
– Comprehensive Assessment Actual Exam –
Complete Questions and Answers with Detailed
Rationales – Pass Guaranteed – A+ Graded
Foundations: Frailty, Geriatric Syndromes & Functional Assessment
Q1: Which of the following best describes the frailty phenotype as defined by Fried and
colleagues?
A. A cumulative index of diseases, disabilities, and social deficits that accumulate over a
lifetime
B. The presence of unintentional weight loss, exhaustion, weakness, slow gait speed,
and low physical activity
C. A state of severe cognitive decline accompanied by functional dependency and
nutritional deficiency
D. The inability to perform three or more instrumental activities of daily living due to
chronic disease burden
Correct Answer: B
Rationale: The best answer is B, because the Fried frailty phenotype specifically
identifies frailty through five physical criteria: unintentional weight loss, self-reported
exhaustion, weakness (grip strength), slow walking speed, and low physical activity,
which distinguishes it from the broader deficit accumulation model.
Q2: When using the Katz Index of Independence in Activities of Daily Living, which of
the following tasks is evaluated?
A. Managing finances and using the telephone
B. Ability to bathe, dress, toilet, transfer, continence, and feed
C. Grocery shopping, cooking, and housekeeping
D. Navigating public transportation and driving
Correct Answer: B
Rationale: This is correct because the Katz ADL tool specifically focuses on the six most
fundamental self-care tasks: bathing, dressing, toileting, transferring, maintaining
continence, and feeding, whereas the more complex tasks like finances and shopping
are reserved for the Lawton IADL scale.
Q3: An 84-year-old patient presents to your clinic with a history of a recent fall. You
observe that she takes several steps before turning around and appears to have a
,wide-based, shuffling gait. Which validated assessment tool is most appropriate to
evaluate her balance and gait dynamics in the clinic setting?
A. The Timed Up and Go (TUG) test
B. The Mini-Mental State Examination (MMSE)
C. The Geriatric Depression Scale (GDS-15)
D. The Braden Scale for pressure injury risk
Correct Answer: A
Rationale: The best answer is the Timed Up and Go test, because it is a quick, validated
clinical tool specifically designed to assess a patient's mobility, balance, gait speed, and
turning ability, all of which are key fall risk factors in older adults.
Q4: During a home visit for a 78-year-old male, you notice he appears withdrawn and
malnourished. When you ask him about his living situation, his adult son answers all the
questions for him and becomes visibly irritated when the patient tries to speak. Which
screening tool is specifically designed for this clinical situation?
A. The Cornell Scale for Depression in Dementia
B. The Elder Abuse Suspicion Index (EASI)
C. The Mini-Cog
D. The Morse Fall Scale
Correct Answer: B
Rationale: This aligns with best practice because the Elder Abuse Suspicion Index
(EASI) is a brief, validated tool specifically meant to be used by clinicians in outpatient
settings to screen for elder mistreatment when risk factors or subtle signs, like caregiver
dominance and patient withdrawal, are present.
Q5: How does the deficit accumulation model of frailty differ from the frailty phenotype
model?
A. The deficit accumulation model focuses exclusively on biological markers of aging
like inflammatory cytokines.
B. The deficit accumulation model uses a simple scoring system based on the number
of age-related health deficits a person has accumulated.
C. The deficit accumulation model requires the presence of sarcopenia and cognitive
decline for a diagnosis.
D. The deficit accumulation model is primarily used to predict acute delirium rather than
long-term mortality.
Correct Answer: B
Rationale: This is correct because unlike the physical phenotype model, the deficit
accumulation approach (often using a Frailty Index) quantifies frailty by counting the
total number of health deficits—including diseases, disabilities, and abnormal lab
values—out of a predefined list, giving a more comprehensive picture of overall
vulnerability.
, Q6: A frail 81-year-old woman reports difficulty rising from a chair without using her
arms and notices her legs look thinner than they used to. You suspect sarcopenia. What
is the primary underlying mechanism of this condition?
A. Accelerated bone resorption due to osteoclast overactivity
B. Progressive loss of skeletal muscle mass and strength due to aging
C. Accumulation of amyloid plaques in the motor cortex
D. Chronic vitamin B12 deficiency leading to peripheral neuropathy
Correct Answer: B
Rationale: The best answer is B, because sarcopenia is defined as the age-related,
progressive loss of skeletal muscle mass and function that leads to weakness and
reduced mobility, which directly explains her difficulty rising from a chair and the
observed muscle wasting.
Q7: A 76-year-old patient complains that he wakes up at 4:00 AM every morning and
cannot get back to sleep, even though he goes to bed at 8:00 PM. He denies snoring or
daytime sleepiness. What is the most appropriate initial response regarding his sleep
complaint?
A. Prescribe a low-dose trazodone to extend his sleep duration
B. Reassure him that a decrease in total sleep time and early morning awakenings are
normal age-related changes in sleep architecture
C. Order an overnight polysomnography to rule out obstructive sleep apnea
D. Recommend over-the-counter diphenhydramine to induce drowsiness
Correct Answer: B
Rationale: This is correct because older adults naturally experience changes in sleep
architecture, including a reduction in slow-wave sleep and more frequent early morning
awakenings, so patient education and sleep hygiene should always precede prescribing
medications that carry high risks for this population.
Q8: A 72-year-old patient lives independently but recently stopped paying her bills and
burned a pot on the stove. However, she is still fully able to bathe, dress, and toilet
herself without assistance. How should you interpret this clinical presentation?
A. She has preserved basic ADLs but is demonstrating declines in instrumental
activities of daily living (IADLs), which often signal early cognitive or functional decline
B. She is functionally independent and her errors are likely isolated incidents related to
normal aging
C. She requires immediate skilled nursing facility placement due to failure of basic
self-care
D. She has advanced dementia and requires 24-hour supervised care
Correct Answer: A
Rationale: The best answer is A, because the ability to perform basic ADLs like bathing
and dressing typically persists until later stages of decline, whereas losing the ability to
