CCS Patient Assessment & Documentation 2 — Questions and Answers
Question 1: When documenting a patient's chest pain, which PQRST element addresses what makes the pain better or worse?
- P - Provocation/Palliation (Correct answer)
- Q - Quality
- R - Radiation
- S - Severity
Correct answer: P - Provocation/Palliation
The 'P' in PQRST stands for Provocation/Palliation, capturing aggravating and relieving factors for chest pain.
Question 2: A patient presents with bilateral pitting edema to the ankles. How should this finding be graded using the standard 4-point scale?
- Grade the depth of the pit and time to rebound (Correct answer)
- Measure circumference only
- Document color change only
- Record skin temperature alone
Correct answer: Grade the depth of the pit and time to rebound
Pitting edema is graded 1+ to 4+ based on pit depth (2–8 mm) and rebound time (rapid to >20 seconds).
Question 3: Which component of the cardiovascular history is most important when assessing a patient's risk for sudden cardiac death?
- Family history of sudden cardiac death or arrhythmia (Correct answer)
- Dietary sodium intake
- Exercise frequency per week
- Current occupation
Correct answer: Family history of sudden cardiac death or arrhythmia
A family history of sudden cardiac death or inherited arrhythmia syndromes (e.g., Long QT, HCM) is the strongest heritable risk factor for SCD.
Question 4: During auscultation, an S3 gallop is most commonly associated with which condition?
- Heart failure with reduced ejection fraction (Correct answer)
- Aortic stenosis
- Mitral valve prolapse
- Pericarditis
Correct answer: Heart failure with reduced ejection fraction
An S3 gallop reflects rapid ventricular filling in a dilated, poorly compliant ventricle and is a hallmark of systolic heart failure.
Question 5: A CCS is reviewing a patient's medication reconciliation. Which cardiovascular medication requires documentation of the patient's pulse rate before administration?
- Digoxin (Correct answer)
- Aspirin
- Furosemide
- Atorvastatin
Correct answer: Digoxin
Digoxin has a narrow therapeutic window and should be withheld if the apical pulse is below 60 bpm, requiring pre-dose pulse documentation.
Question 6: When recording a blood pressure of 158/94 mmHg in a patient's chart, per ACC/AHA 2017 guidelines, this reading is classified as:
- Stage 2 Hypertension (Correct answer)
- Stage 1 Hypertension
- Elevated blood pressure
- Hypertensive crisis
Correct answer: Stage 2 Hypertension
Per 2017 ACC/AHA guidelines, Stage 2 Hypertension is defined as SBP ≥140 mmHg or DBP ≥90 mmHg.
Question 7: A patient reports dyspnea that awakens them from sleep and is relieved by sitting upright. This symptom should be documented as:
- Paroxysmal nocturnal dyspnea (Correct answer)
- Orthopnea
- Exertional dyspnea
- Platypnea
Correct answer: Paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea (PND) is sudden breathlessness that wakes a patient from sleep and is relieved by sitting or standing up.
CCS Patient Assessment & Documentation 2
When documenting a patient's chest pain, which PQRST element addresses what makes the pain better or worse?