Exam question troubleling me.....

  1. 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?
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  2. 56 Comments

  3. by   Nili927
    I forgot to mention that I chose the patient w/ high cholesterol.... I hope I made the best choice!
    Last edit by Nili927 on Apr 20, '07 : Reason: spelling
  4. by   Esther2007
    Most focus is on the major risk factor which is (LDL Cholesterol). I think u answered the question correctly.
  5. by   Thedreamer
    I think the patient with high cholestrol would be the BEST choice. High LDL Cholestrol is a bad boy.
  6. by   KrysyRN
    I would have picked DM.
  7. by   Spidey's mom
    Quote from krysy
    I would have picked DM.
    Me too.

    steph
  8. by   Daytonite
    Wow! All three are likely answers. However, I think maybe the diabetes is the correct answer and I have information from a website to back that up. This sounds like the answer to this might be something that was covered in a lecture.

    http://www.fpnotebook.com/CV260.htm - Coronary Risk Factors
  9. by   Thedreamer
    1. diabetes mellitus
      1. more than doubles risks of coronary artery disease
      2. considered coronary artery disease equivalent
    wow. i was under the impression that high ldl and dm were in the same boat but apparently as daytonite pointed out, dm most definitely takes that cake. my rational was that high ldl was most likely attributed to poor diet/lack of exercise or perhaps like with some people bad genetics and predisposition and was more common then the dm. however it seems that dm simply has more complications which make it a higher candidate for cad. thanks daytonite! nclex question im sure!
  10. by   llg
    Quote from thedreamer
    1. diabetes mellitus
      1. more than doubles risks of coronary artery disease
      2. considered coronary artery disease equivalent
    wow. i was under the impression that high ldl and dm were in the same boat but apparently as daytonite pointed out, dm most definitely takes that cake. my rational was that high ldl was most likely attributed to poor diet/lack of exercise or perhaps like with some people bad genetics and predisposition and was more common then the dm. however it seems that dm simply has more complications which make it a higher candidate for cad. thanks daytonite! nclex question im sure!
    how much does an elevated ldl raise the risk? knowing the added risk with dm is knowing only half the information. how does it compare to the increased risk with elevated ldl?

    i'm sorry if i sound nit-picky. but to answer the question, you need to be able to compare the degree of risk with all 3 of the conditions in the possible answers.
  11. by   Melina
    How much does an elevated LDL raise the risk? Knowing the added risk with DM is knowing only half the information. How does it compare to the increased risk with elevated LDL?
    DM (insulin resistance) itself causes complications, including increased LDL, that increase CAD risk. DM can cause hyperinsulinemia, dyslipidemia, hyperglycemia, and atherosclerosis. Hyperinsulinemia can result in dyslipidemia (decreased levels of HDL and increased LDL).
    Hyperglycemia increases free radical production, which causes oxidation of LDL and macrophages in the vascular endothelium (foam cells), which then build up and form fatty streaks.

    ~Mel'
  12. by   llg
    Quote from Melina
    DM (insulin resistance) itself causes complications, including increased LDL, that increase CAD risk. DM can cause hyperinsulinemia, dyslipidemia, hyperglycemia, and atherosclerosis. Hyperinsulinemia can result in dyslipidemia (decreased levels of HDL and increased LDL).
    Hyperglycemia increases free radical production, which causes oxidation of LDL and macrophages in the vascular endothelium (foam cells), which then build up and form fatty streaks.

    ~Mel'
    I know -- but that doesn't answer the question. The question posed by the test in the original post (and that I asked in my response) asked the students to compare the increased risk posed by DM, cholesterol, and smoking. Knowing all about DM isn't enough information to answer the question. To properly analyze the question, the student must know the amount of increased risk caused by the 3 conditions and then compare them.

    That's one reason why students often have so much trouble answering test questions. They get sidetracked by a bunch of extraneous information. The core idea of this test question is to compare the amount of risk posed by the 3 conditions. I still haven't seen anybody do that yet in this thread.
  13. by   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.
    That's one reason why students often have so much trouble answering test questions. They get sidetracked by a bunch of extraneous information. The core idea of this test question is to compare the amount of risk posed by the 3 conditions. I still haven't seen anybody do that yet in this thread.
    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'
    Last edit by Melina on Apr 20, '07 : Reason: oops, bad spelling!
  14. by   jjjoy
    Isn't there enough else to cover in nursing school? It would seem enough for most nurses to simply know that both DM and high cholesterol are CAD risk factors. Or is the point here that it only states that the cholesterol is "elevated" but isn't said to be "high"? Ugh! Why make it more difficult than it need to be? And why not make test questions more clinically relevant? Sigh.

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