CCS Patient Care & Risk Management 3 — Questions and Answers
Question 1: A nurse asks a CCS about the correct technique for measuring ankle-brachial index (ABI). Which ABI value is diagnostic of peripheral arterial disease?
- ABI > 1.4
- ABI 0.9–1.0
- ABI ≤ 0.9 (Correct answer)
- ABI 1.0–1.2
Correct answer: ABI ≤ 0.9
An ABI ≤0.9 is diagnostic of peripheral arterial disease, reflecting reduced arterial perfusion to the lower extremities.
Question 2: Which medication class is the FIRST-LINE pharmacologic treatment for reducing LDL-C in patients with established atherosclerotic cardiovascular disease?
- Fibrates
- Niacin
- Statins (Correct answer)
- Bile acid sequestrants
Correct answer: Statins
High-intensity statins are the cornerstone of LDL-C lowering therapy in patients with established ASCVD per ACC/AHA guidelines.
Question 3: A patient recovering from percutaneous coronary intervention (PCI) with drug-eluting stent placement is asking about dual antiplatelet therapy (DAPT). What is the minimum recommended DAPT duration for stable CAD treated with DES?
- 1 month
- 3 months
- 6 months (Correct answer)
- 12 months
Correct answer: 6 months
Current ACC/AHA guidelines recommend at least 6 months of DAPT after DES placement in stable CAD to prevent stent thrombosis.
Question 4: A 55-year-old male smoker with hypertension has no known CAD. His LDL is 145 mg/dL and 10-year ASCVD risk is 11%. A coronary artery calcium (CAC) score is obtained and is 0. How should this result influence statin therapy?
- Statin therapy should be started immediately
- The CAC score of 0 favors withholding statin therapy and reassessing in 5–10 years (Correct answer)
- The CAC score is irrelevant; treat based on risk score alone
- Aspirin should be started instead of a statin
Correct answer: The CAC score of 0 favors withholding statin therapy and reassessing in 5–10 years
A CAC score of 0 identifies very low short-term risk and can appropriately support deferring statin initiation with reassessment, especially in intermediate-risk patients.
Question 5: Which of the following is a CONTRAINDICATION to cardiac rehabilitation enrollment?
- Compensated heart failure with LVEF 35%
- Stable angina with good functional capacity
- Unstable angina with rest symptoms within the past 48 hours (Correct answer)
- Recent PCI more than 1 week ago without complications
Correct answer: Unstable angina with rest symptoms within the past 48 hours
Unstable angina with recent rest symptoms is an absolute contraindication to cardiac rehabilitation until the condition is stabilized.
Question 6: A post-CABG patient is being discharged. Which of the following is MOST important to assess for medication adherence in secondary prevention?
- The patient's insurance copay for medications
- The patient's favorite dietary habits
- The patient's understanding of why each medication is necessary (Correct answer)
- Whether the patient has family members with cardiovascular disease
Correct answer: The patient's understanding of why each medication is necessary
Patient understanding of the rationale for each secondary prevention medication is the strongest predictor of long-term adherence.
Question 7: A patient with chronic stable heart failure (HFrEF, LVEF 30%) develops symptomatic hypotension when ACE inhibitor dose is increased. What is the BEST next step?
- Discontinue the ACE inhibitor permanently
- Add a vasopressor medication
- Reduce the ACE inhibitor to the previously tolerated dose and reassess volume status (Correct answer)
- Switch immediately to digoxin
Correct answer: Reduce the ACE inhibitor to the previously tolerated dose and reassess volume status
Symptomatic hypotension from ACE inhibitor up-titration in HFrEF is managed by returning to the last tolerated dose and evaluating for volume depletion.
CCS Patient Care & Risk Management 3
A nurse asks a CCS about the correct technique for measuring ankle-brachial index (ABI).
Which ABI value is diagnostic of peripheral arterial disease?