Exam question troubleling me.....

[Nili927]

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:

A patient w/ high cholesterol

A patient w/ DM

A patient who's a smoker

Aren't they all at risk for CAD????:smackingf

Which would you have picked?

[Myxel67]

On lab results for lipids, lab reports will take a ratio between LDL/HDL or Total Chol/HDL and will calculate risk for MI or CAD such as twice the average risk?

Diabetes increases risk of CAD 2 to 4 times. Also people with DM are more likely to have the tiny LDL particle size that is most damaging. My vote still goes to DM.

[Nili927]

Hi everyone I want to thank everyone for responding. I have to say that I've learned alot just be reading everyone's post! We didn't have an exam review for the last exam due to the teacher having a family emergency and having to travel last minute..... which is really frustrating. I did look it up in my textbook, If any of you have the Medical Surgical Nursing book by Lewis (MOSBY) 6th edition, starting on page 802-804 under modifiable risk factors for CAD the book talks about high cholesterol first then hypertension as 2nd major risk factor, smoking as 3rd, Physical inactivity 4th. Then the book goes on to talk about the incidence of CAD being greater among patients with DM than the general public. According to the book DM is classified as a modifiable contributing risk factor but cholesterol, HTN, and smoking are classified as modifiable MAJOR risk factors.

I answered cholesterol on the exam and feel better about that answer after reading that section in the book.

What do you think???

[jjjoy, LPN]

I think it's not a very good exam question

[Daytonite, BSN, RN]

I think it's not a very good exam question

I wholeheartedly agree. I'd be pushing for this question to be thrown out and giving all kinds of documented support for each of the answers being the correct one.

[carolinapooh, BSN, RN]

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!

I would say the DM itself IS the risk factor, just based on what it does to the body.

You can be the best Type I DM patient in the WORLD and still develop complications - despite good A1C's, textbook control, etc. You still have a primary dz process. You are still artificially regulating natural body processes, because you don't make insulin. With Type II, you don't have to be overweight to develop it (although that's the common route; we all know that). I've seen skinny folks with Type II d/t insulin resistance with aging, transplant related DM d/t meds, and other med related causes. The fact is that their LDL can be in the floor, but they can still get CAD d/t the DM disease process.

I picked DM from the start.

[carolinapooh, BSN, RN]

I feel the answer is cholesterol, because smoking has more of a effect on your lungs, d.m. more on the kidneys, but cholesterol can encompass hdl and ldl and as we know they are a direct link to cad. I know d.m. can also lead to that, but not a strongly as high cholesterol levels. You are not supposed to look so deap into a question. This is my humble opinion. P.S.... if you ask me the real answer is missing...genetics!

DM affects every system of the body, otherwise there would be no amputations from it. DM has a profound effect on circulation, metabolism, integument, urinary system, eyes, the liver.....it's not just a pancreatic or kidney issue.

[jonzey]

What was the answer?I picked DM too,from the start.

[Spidey's mom, ADN, BSN, RN]

I would say the DM itself IS the risk factor, just based on what it does to the body.

I picked DM from the start.

Exactly - I picked DM too. DM IS the risk factor.

I am curious about what the teacher said too . . .

steph

[Achoo!, LPN]

Diabetes is the leading cause of CAD. I just had my endocrine exam! ha ha!

[VieraGrl1030]

I am not trying to take away from your question but I have one myself.

Why do you need to know the isotonic levels in blood before inserting an IV?

[jonzey]

WHAT?Never heard of that.Wait a minute,could it have to do with acidotic or alkaline,and that determines what type of fluids to administer? i.e Isotonic,Hypotonic?I would love to know.

[smk1, LPN]

Well unless the patient is in some sort of dehydration state, the blood osmolarity should always be in the isotonic range. I think the OP's answer was a good obvious answer and an argument can be made for any of the three. (how old is the patient, what is the pack load for cigarettes, what type of diabetes and how long have they had it etc...) I can see picking diabetes due to disease process but does it really matter? Why do you need to know that DM carries an arguably higher risk of CAD than Hyperlipidemia or smoking? As long as you know that all three put the patient at high risk and why then you have what you need for patient education. Sigh, just 7 moe months...