Exam question troubleling me..... - page 2

I just took my 4th exam for Medsurg 2 and there's a question that keeps lingering on my mind. The question is something about which patient has a higher risk for CAD? These were the choices: ... Read More

  1. by   crystalcoastlvr
    I would have chosen the smoker! My rationale......the patient with high cholesterol is at risk, but how long has their cholesterol been high and what do the labs say, furthermore, is the pt's diabetes under control, are they overweight, do they take care of themselves? The patient who is the smoker,,,,is obviously smoking.
    jules
  2. by   Thedreamer
    Can I choose D? All of the above?
  3. by   abundantjoy07
    I would have chosen hyperlipidemia. Because with DM I think of contributing factors being a high A1c or lack of control through diet and exercise. DM alone without risk factors doesn't makes me want to choose that answer.

    With high cholesterol that is definately my choice because the fatty substances coat the lumen of the arteries thus leading to CAD. With DM there are factors that lead to it...but High cholesterol is like a straight shot to CAD.

    With the smoker...you have to take into consideration PPD smoked, pack years, and you have to remember that when a patient stops smoking their risk declines to that of a non-smoker very quickly, regardless of how long they have smoked. Smoking is more about constriction of the arteries because of the toxins in the smoke.

    So...I could be totally wrong or missed some important factors...but high cholesterol is my answer!
  4. by   jonzey
    I would have picked DM,B/C of the disease process.
  5. by   Spidey's mom
    Also, I've read some studies recently that high cholesterol, by itself, is not as much of a risk factor as we've thought.

    Although, you know about studies . . . coffee is good/coffee bad . . . .oatmeal is good/oatmeal does nothing . . .. wine is bad/wine is good . . . ETC.

    steph
  6. by   moongirl
    I choose smoking as the correcto answer.
    Please let us know what it is when you get your grade.
  7. by   JessiekRN
    Nili I am feeling your pain.. I keep telling myself 4 MORE WEEKS and then 3 months away.. it can not come fast enough!! Good luck with your exam.. and finals..!!
  8. by   Mommy TeleRN
    We learned that smoking is a big risk factor..I am thinking it was the biggest risk factor. It damages arterial linings.
    I have this in my lecture notes which are usually straight by the textbook:
    "Cigarette smoking (most significant), hyperlipidema, hypertension and diabetes mellitus"
    Arterial disease is due to atherosclerosis which is majorly cx by smoking.
  9. by   Maverick80
    I pick smoking!!

    Smoking Lowers HDL which is not good, and when i took Advanced med-surg all most all the the problems with heart and lungs smoking put you at increased risk. So i'm going with smoking and i'm not changing it, please let me know what your teacher says the answer is!!
  10. by   RN BSN 2009
    Quote from Thedreamer
    Can I choose D? All of the above?
    Kudos to that...... me too! Lol
  11. by   moongirl
    Quote from Mommy Nurse2b
    We learned that smoking is a big risk factor..I am thinking it was the biggest risk factor. It damages arterial linings.
    I have this in my lecture notes which are usually straight by the textbook:
    "Cigarette smoking (most significant), hyperlipidema, hypertension and diabetes mellitus"
    Arterial disease is due to atherosclerosis which is majorly cx by smoking.
    That is the way I learned it as well. All of the choices the OP was given were correct- but it asks which is the biggest risk factor. Smoking is.

    My hospital's OR-80 percent of their carotid roto-rooter procedures are on long term smokers

    http://www.fda.gov/hearthealth/riskf...s.html#smoking
  12. by   llg
    Quote from Melina
    But that is my point. Diabetes is the biggest risk factor because it can lead to CAD by several mechanisms. High LDL is one of them. There are also issues with hypertension coagulation, circulation, etc. The thing with nursing exams is there are often more than a single "correct" answer.

    Not so sure what was extraneous, or what "core idea" we are supposed to be comparing that we are all missing? Can you elaborate?


    ~Mel'

    If we assume that it is a good test question, then we must assume that 1 of the possible answers has a level of risk that is higher than the others -- making it the one and only 1 correct answer to the question, "Which has the greatest risk?" We must also assume that the students were given the information needed to answer the question (or else it is a bad question and not worth discussing).

    Presumably, either the amount of increased risk for each choice was given to them or else they were told that "xxxx is the single biggest risk factor." Another possibilty is that the students have been taught how to weigh and/or rank different types of risk with certain types of risk being more significant that other types of risks. You are assuming that because DM can increase the risk through more than 1 mechanism, it must therefore be responisible for the greatest amount of risk.

    So, the structure of the question is either:
    A. A straightforward recall question that asks the student to recall the information provided in the readings or in class about the relative risks of each.

    or

    B. A question asking the student to apply a method of ranking the risk (by amount or type of risk) that they were taught in the course.

    As I was not in the course, I do not know whether or not the students were taught a method to use to rank different types or amount of risk. Nor do I know what specific information they were given about the amount of risk for each choice. So, I can't pretend to know the answer that the teacher is looking for. However, I do know that simply knowing the sequence of events through which DM increases the risk is not sufficient to answer the question because that knowledge by itself does not give us the ability to rank the amount or type of risk with DM to the amount and type of risk from the other two. To make the comparison, you need to know the amount and/or type of risk from all three.
    Last edit by llg on Apr 21, '07
  13. by   Daytonite
    llg. . .I agree with you. That's why I thought from the beginning that this question had the air of something coming out of a lecture. I have a current instructor that this this kind of thing on tests all the time.

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