A 64-Year-Old Man Comes to the Office Due to Frequent

question 832

Multiple Choice

A 64-year-old man comes to the office due to frequent urination.  He has a history of benign prostatic hyperplasia with mild hesitancy and occasional nocturia.  During the past 8 weeks, he has been bothered by 2 or 3 episodes of nocturia each night and increased urinary urgency.  The patient has no dysuria or hematuria and says that his daytime urinary frequency is unchanged.  He also has shortness of breath with exertion.  His medical history includes hypertension, hypercholesterolemia, and non-ischemic cardiomyopathy with a left ventricular ejection fraction of 40% on an echocardiogram a year ago.  The patient's medications include furosemide, carvedilol, lisinopril, spironolactone, and atorvastatin.
Blood pressure is 140/80 mm Hg, pulse is 76/min, and respirations are 16/min.  Pulmonary examination reveals bilateral basal crackles.  Rectal examination shows a diffusely enlarged prostate.  He has 2+ pitting edema of the bilateral lower extremities.
Serum sodium is 133 mEq/L, potassium is 3.9 mEq/L, and creatinine is 1.1 mg/dL.  Urinalysis is normal.
Which of the following is the most appropriate next step in management of this patient?

• A)Increase furosemide
• B)Start doxazosin
• C)Start finasteride
• D)Start tolterodine
• E)Stop beta blocker

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Definitions:

Cognitive Approach

A psychological viewpoint that focuses on understanding how people process, store, and retrieve information and how this affects behavior.

Teaching Tool

Any item, strategy, or method used to convey knowledge or facilitate learning.

Appropriateness

The quality of being suitable or fitting for a specific context, circumstance, or purpose.

Multicultural

Relating to or containing several cultural or ethnic groups within a society.