ELITE TEST BANK: HAM’S
PRIMARY CARE GERIATRICS
(7TH EDITION) & 2026
CLINICAL STANDARDS
PART 0: THE NAVIGATOR
Section Phase Question Block Cognitive Focus Core Competencies
Assessed
Foundational Questions 1–15 Syntax & Application PREVENT 2026,
penKid KDIGO, MPFS
G2211, OBBBA,
WISeR Model, LACE,
Beers 2026, ADA 2026,
GOLD COPD.
Simulation Questions 16–40 Professional Execution Atypical presentations,
pharmacokinetics,
immediate regulatory
compliance, geriatric
syndromes, ethical
autonomy.
Synthesis Questions 41–55 Grandmaster Scenarios High-acuity
multi-system failures,
advanced
deprescribing
cascades, and
aggressive legislative
matrix integration.
PART I: THE PRIMER
Mastering geriatric advanced practice in the 2026 landscape demands the absolute synthesis of
atypical physiological presentation with aggressive legislative and pharmacological realities.
Excellence requires moving beyond academic memorization into the realm of professional
intuition, where every subtle cue is analyzed against the backdrop of an aging, fragile
phenotype.
The "Panic Button" Cheat Sheet:
● The LACE Boundary: Certification defines legal scope; primary care practitioners cannot
legally manage unstable acute care patients.
● PREVENT 2026: Replaces Pooled Cohort Equations; removes race, integrates eGFR
, and Social Deprivation Index (SDI), with a ≥7.5% intervention threshold.
● Public Law 119-21 (OBBBA): Imposes a 10-year moratorium on CMS facility staffing
mandates and enacts strict Medicaid work requirements, exempting the "medically frail".
● MPFS 2026: Expands the G2211 longitudinal complexity add-on code to home/residence
E/M visits.
● Beers Criteria (2025/2026): Apixaban replaces Warfarin; Z-drugs are contraindicated;
Tramadol mandates SIADH monitoring.
PART II: THE ELITE TEST BANK
Q1: Under the 2025/2026 AHA guidelines, which fundamental change to cardiovascular
risk assessment must a practitioner utilize when evaluating an older adult without
established cardiovascular disease? A) Utilizing the Pooled Cohort Equations (PCE) to
assess a 10-year risk threshold of >10%. B) Utilizing the PREVENT equation, which removes
race and integrates the Social Deprivation Index (SDI) and eGFR, targeting a ≥7.5%
intervention threshold. C) Utilizing the PREVENT equation, which strictly incorporates race to
adjust for socioeconomic disparities in statin prescribing. D) Utilizing the PCE to identify heart
failure risk exclusively in patients over 80 years of age.
● The Answer: B (Utilizing the PREVENT equation, which removes race and integrates the
Social Deprivation Index (SDI) and eGFR, targeting a ≥7.5% intervention threshold).
● Distractor Analysis: Options A and D rely on the deprecated PCE, which overestimates
risk and ignores heart failure. Option C is false; PREVENT explicitly removed race as a
biological variable to promote health equity, replacing it with objective renal and social
metrics.
● The Mentor's Analysis: The 2026 protocol fundamentally shifts from isolated metrics to a
Cardio-Kidney-Metabolic (CKM) trajectory. The PREVENT tool acknowledges that zip
code and kidney function drive vascular disease far more accurately than socio-political
constructs like race. Hitting the 7.5% threshold indicates the physiological momentum
toward target organ damage is too severe for lifestyle changes alone, mandating chemical
intervention.
Risk Calculator Key Variables Included Application Scope
PREVENT (2026) BMI, eGFR, SDI, statin use, 10- and 30-year total CVD and
optional UACR/HbA1c Heart Failure risk
PCE (Deprecated) Race, age, total cholesterol 10-year ASCVD risk only
Q2: A 78-year-old presents to the emergency department with suspected sepsis. To
evaluate for subclinical Acute Kidney Injury (AKI) before serum creatinine rises, which
biomarker and corresponding threshold is the 2026 standard? A) Serum Creatinine > 1.5
mg/dL. B) Proenkephalin A 119-159 (penKid) > 89 pmol/L. C) Blood Urea Nitrogen (BUN) > 20
mg/dL. D) Interleukin-18 (IL-18) > 500 pg/mg.
● The Answer: B (Proenkephalin A 119-159 (penKid) > 89 pmol/L).
● Distractor Analysis: Options A and C are lagging indicators; creatinine requires 48-72
hours of accumulated metabolic waste to flag an injury. Option D is a biomarker for tubular
damage but lacks the immediate real-time filtration precision of penKid in a critical setting.
● The Mentor's Analysis: PenKid is exclusively filtered by the glomerulus and is not
influenced by the patient's muscle mass or inflammation. In frail geriatrics, cachexia
masks creatinine elevations. A penKid level above 89 pmol/L confirms acute filtration
failure in real-time, allowing the practitioner to halt nephrotoxic drugs instantly before
, irreversible necrosis occurs.
Q3: According to the expansion of the Medicare Physician Fee Schedule (MPFS) in 2026,
how should a practitioner correctly utilize the G2211 complexity add-on code? A) Billed
exclusively with acute care inpatient codes to reflect high-acuity deterioration. B) Appended to
surgical procedural codes to capture the extra time required for older adults. C) Appended to
home and residence E/M codes (99341–99350) when the practitioner serves as the continuing
focal point for the patient's longitudinal care. D) Billed independently without a base E/M code
for asynchronous telehealth check-ins.
● The Answer: C (Appended to home and residence E/M codes (99341–99350) when the
practitioner serves as the continuing focal point for the patient's longitudinal care).
● Distractor Analysis: Options A, B, and D violate statutory billing laws. G2211 is strictly
an add-on code for E/M visits, and it cannot be appended to procedural codes with a
modifier 25 in most routine scenarios.
● The Mentor's Analysis: Managing a complex, multimorbid elder in their home requires
profound cognitive overhead—coordinating caregivers, reconciling polypharmacy, and
adapting to environmental deficits. CMS recognized this "invisible work" in 2026. Failing to
append G2211 to a qualifying home visit represents a critical failure of operational practice
management.
Q4: Under the One Big Beautiful Bill Act (OBBBA) of 2025 (Public Law 119-21), what is the
legal status of the CMS minimum staffing rule (3.48 HPRD and 24/7 RN) for long-term care
facilities? A) Facilities must strictly adhere to the mandate or face immediate federal closure. B)
Facilities are subject to a 10-year federal moratorium on the mandate until 2034. C) Facilities
must replace all RNs with LPNs to meet the new rural budget constraints. D) Facilities are
exempt only if they maintain a daily census of fewer than 50 patients.
● The Answer: B (Facilities are subject to a 10-year federal moratorium on the mandate
until 2034).
● Distractor Analysis: Option A applies to the defunct 2024 CMS rule. Options C and D
are fabricated administrative policies that endanger patients and violate state nursing
practice acts.
● The Mentor's Analysis: Public Law 119-21 legally halted the enforcement of arbitrary
numeric staffing minimums to prevent mass facility closures in rural zones. However, the
professional practitioner understands this shifts liability directly back to the unit level. Safe
staffing must now be justified through dynamic, localized patient acuity assessments
rather than relying on suspended federal quotas.
Q5: The 2026 Wasteful and Inappropriate Service Reduction (WISeR) Model imposes
strict technology-enabled prior authorization for 13 specific outpatient services. Which of
the following is targeted under this model? A) Routine cataract extraction. B) Application of
bioengineered skin substitutes for chronic lower-extremity wounds. C) Placement of a
Percutaneous Endoscopic Gastrostomy (PEG) tube. D) Administration of intravenous antibiotics
in the emergency department.
● The Answer: B (Application of bioengineered skin substitutes for chronic lower-extremity
wounds).
● Distractor Analysis: Options A, C, and D are not included in the WISeR 13-procedure
target list. Option D is an emergency service, which is explicitly exempt from WISeR
delays.
● The Mentor's Analysis: WISeR leverages AI to block payment for high-cost, high-abuse
outpatient procedures in traditional Medicare. Skin substitutes for diabetic or venous
ulcers are a primary target. The professional must secure AI-affirmed prior authorization
PRIMARY CARE GERIATRICS
(7TH EDITION) & 2026
CLINICAL STANDARDS
PART 0: THE NAVIGATOR
Section Phase Question Block Cognitive Focus Core Competencies
Assessed
Foundational Questions 1–15 Syntax & Application PREVENT 2026,
penKid KDIGO, MPFS
G2211, OBBBA,
WISeR Model, LACE,
Beers 2026, ADA 2026,
GOLD COPD.
Simulation Questions 16–40 Professional Execution Atypical presentations,
pharmacokinetics,
immediate regulatory
compliance, geriatric
syndromes, ethical
autonomy.
Synthesis Questions 41–55 Grandmaster Scenarios High-acuity
multi-system failures,
advanced
deprescribing
cascades, and
aggressive legislative
matrix integration.
PART I: THE PRIMER
Mastering geriatric advanced practice in the 2026 landscape demands the absolute synthesis of
atypical physiological presentation with aggressive legislative and pharmacological realities.
Excellence requires moving beyond academic memorization into the realm of professional
intuition, where every subtle cue is analyzed against the backdrop of an aging, fragile
phenotype.
The "Panic Button" Cheat Sheet:
● The LACE Boundary: Certification defines legal scope; primary care practitioners cannot
legally manage unstable acute care patients.
● PREVENT 2026: Replaces Pooled Cohort Equations; removes race, integrates eGFR
, and Social Deprivation Index (SDI), with a ≥7.5% intervention threshold.
● Public Law 119-21 (OBBBA): Imposes a 10-year moratorium on CMS facility staffing
mandates and enacts strict Medicaid work requirements, exempting the "medically frail".
● MPFS 2026: Expands the G2211 longitudinal complexity add-on code to home/residence
E/M visits.
● Beers Criteria (2025/2026): Apixaban replaces Warfarin; Z-drugs are contraindicated;
Tramadol mandates SIADH monitoring.
PART II: THE ELITE TEST BANK
Q1: Under the 2025/2026 AHA guidelines, which fundamental change to cardiovascular
risk assessment must a practitioner utilize when evaluating an older adult without
established cardiovascular disease? A) Utilizing the Pooled Cohort Equations (PCE) to
assess a 10-year risk threshold of >10%. B) Utilizing the PREVENT equation, which removes
race and integrates the Social Deprivation Index (SDI) and eGFR, targeting a ≥7.5%
intervention threshold. C) Utilizing the PREVENT equation, which strictly incorporates race to
adjust for socioeconomic disparities in statin prescribing. D) Utilizing the PCE to identify heart
failure risk exclusively in patients over 80 years of age.
● The Answer: B (Utilizing the PREVENT equation, which removes race and integrates the
Social Deprivation Index (SDI) and eGFR, targeting a ≥7.5% intervention threshold).
● Distractor Analysis: Options A and D rely on the deprecated PCE, which overestimates
risk and ignores heart failure. Option C is false; PREVENT explicitly removed race as a
biological variable to promote health equity, replacing it with objective renal and social
metrics.
● The Mentor's Analysis: The 2026 protocol fundamentally shifts from isolated metrics to a
Cardio-Kidney-Metabolic (CKM) trajectory. The PREVENT tool acknowledges that zip
code and kidney function drive vascular disease far more accurately than socio-political
constructs like race. Hitting the 7.5% threshold indicates the physiological momentum
toward target organ damage is too severe for lifestyle changes alone, mandating chemical
intervention.
Risk Calculator Key Variables Included Application Scope
PREVENT (2026) BMI, eGFR, SDI, statin use, 10- and 30-year total CVD and
optional UACR/HbA1c Heart Failure risk
PCE (Deprecated) Race, age, total cholesterol 10-year ASCVD risk only
Q2: A 78-year-old presents to the emergency department with suspected sepsis. To
evaluate for subclinical Acute Kidney Injury (AKI) before serum creatinine rises, which
biomarker and corresponding threshold is the 2026 standard? A) Serum Creatinine > 1.5
mg/dL. B) Proenkephalin A 119-159 (penKid) > 89 pmol/L. C) Blood Urea Nitrogen (BUN) > 20
mg/dL. D) Interleukin-18 (IL-18) > 500 pg/mg.
● The Answer: B (Proenkephalin A 119-159 (penKid) > 89 pmol/L).
● Distractor Analysis: Options A and C are lagging indicators; creatinine requires 48-72
hours of accumulated metabolic waste to flag an injury. Option D is a biomarker for tubular
damage but lacks the immediate real-time filtration precision of penKid in a critical setting.
● The Mentor's Analysis: PenKid is exclusively filtered by the glomerulus and is not
influenced by the patient's muscle mass or inflammation. In frail geriatrics, cachexia
masks creatinine elevations. A penKid level above 89 pmol/L confirms acute filtration
failure in real-time, allowing the practitioner to halt nephrotoxic drugs instantly before
, irreversible necrosis occurs.
Q3: According to the expansion of the Medicare Physician Fee Schedule (MPFS) in 2026,
how should a practitioner correctly utilize the G2211 complexity add-on code? A) Billed
exclusively with acute care inpatient codes to reflect high-acuity deterioration. B) Appended to
surgical procedural codes to capture the extra time required for older adults. C) Appended to
home and residence E/M codes (99341–99350) when the practitioner serves as the continuing
focal point for the patient's longitudinal care. D) Billed independently without a base E/M code
for asynchronous telehealth check-ins.
● The Answer: C (Appended to home and residence E/M codes (99341–99350) when the
practitioner serves as the continuing focal point for the patient's longitudinal care).
● Distractor Analysis: Options A, B, and D violate statutory billing laws. G2211 is strictly
an add-on code for E/M visits, and it cannot be appended to procedural codes with a
modifier 25 in most routine scenarios.
● The Mentor's Analysis: Managing a complex, multimorbid elder in their home requires
profound cognitive overhead—coordinating caregivers, reconciling polypharmacy, and
adapting to environmental deficits. CMS recognized this "invisible work" in 2026. Failing to
append G2211 to a qualifying home visit represents a critical failure of operational practice
management.
Q4: Under the One Big Beautiful Bill Act (OBBBA) of 2025 (Public Law 119-21), what is the
legal status of the CMS minimum staffing rule (3.48 HPRD and 24/7 RN) for long-term care
facilities? A) Facilities must strictly adhere to the mandate or face immediate federal closure. B)
Facilities are subject to a 10-year federal moratorium on the mandate until 2034. C) Facilities
must replace all RNs with LPNs to meet the new rural budget constraints. D) Facilities are
exempt only if they maintain a daily census of fewer than 50 patients.
● The Answer: B (Facilities are subject to a 10-year federal moratorium on the mandate
until 2034).
● Distractor Analysis: Option A applies to the defunct 2024 CMS rule. Options C and D
are fabricated administrative policies that endanger patients and violate state nursing
practice acts.
● The Mentor's Analysis: Public Law 119-21 legally halted the enforcement of arbitrary
numeric staffing minimums to prevent mass facility closures in rural zones. However, the
professional practitioner understands this shifts liability directly back to the unit level. Safe
staffing must now be justified through dynamic, localized patient acuity assessments
rather than relying on suspended federal quotas.
Q5: The 2026 Wasteful and Inappropriate Service Reduction (WISeR) Model imposes
strict technology-enabled prior authorization for 13 specific outpatient services. Which of
the following is targeted under this model? A) Routine cataract extraction. B) Application of
bioengineered skin substitutes for chronic lower-extremity wounds. C) Placement of a
Percutaneous Endoscopic Gastrostomy (PEG) tube. D) Administration of intravenous antibiotics
in the emergency department.
● The Answer: B (Application of bioengineered skin substitutes for chronic lower-extremity
wounds).
● Distractor Analysis: Options A, C, and D are not included in the WISeR 13-procedure
target list. Option D is an emergency service, which is explicitly exempt from WISeR
delays.
● The Mentor's Analysis: WISeR leverages AI to block payment for high-cost, high-abuse
outpatient procedures in traditional Medicare. Skin substitutes for diabetic or venous
ulcers are a primary target. The professional must secure AI-affirmed prior authorization
