Exam question troubleling me.....

Nursing Students General Students

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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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I forgot to mention that I chose the patient w/ high cholesterol.... I hope I made the best choice!

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Most focus is on the major risk factor which is (LDL Cholesterol). I think u answered the question correctly.

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Specializes in PCU/Hospice/Oncology.

I think the patient with high cholestrol would be the BEST choice. High LDL Cholestrol is a bad boy.

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I would have picked DM.

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I would have picked DM.

Me too.

steph

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Specializes in med/surg, telemetry, IV therapy, mgmt.

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

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Specializes in PCU/Hospice/Oncology.

  1. diabetes mellitus

    1. more than doubles risks of coronary artery disease
    2. considered coronary artery disease equivalent

      3. 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!

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Specializes in Nursing Professional Development.
  1. diabetes mellitus

    1. more than doubles risks of coronary artery disease
    2. considered coronary artery disease equivalent

      3. 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.

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Specializes in home health, neuro, palliative care.
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'

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Specializes in Nursing Professional Development.
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.

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Specializes in home health, neuro, palliative care.

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'

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