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A 54-Year-Old Man Comes to the Emergency Department Due to Progressive

question 184

Multiple Choice

A 54-year-old man comes to the emergency department due to progressive shortness of breath, lower extremity swelling, and decreased urine output for the past week. The patient has a history of nonischemic cardiomyopathy and heart failure with reduced ejection fraction. Medications include metoprolol succinate, lisinopril, spironolactone, and furosemide. He has been on stable doses of medication for the past 6 months but admits that he "misses some doses now and then." Temperature is 98.5 F (36.9 C) , blood pressure is 112/64 mm Hg, pulse is 90/min, and respirations are 20/min. Oxygen saturation is 93% on room air. Physical examination shows jugular venous distension. S1 and S2 are normal and there are no murmurs. An S3 is heard. Crackles are heard at the bilateral lung bases. The abdomen is distended and there is 2+ pitting lower extremity edema bilaterally. Laboratory results (current and from 3 weeks ago) are as follows: $A 54-year-old man comes to the emergency department due to progressive shortness of breath, lower extremity swelling, and decreased urine output for the past week. The patient has a history of nonischemic cardiomyopathy and heart failure with reduced ejection fraction. Medications include metoprolol succinate, lisinopril, spironolactone, and furosemide. He has been on stable doses of medication for the past 6 months but admits that he misses some doses now and then. Temperature is 98.5 F (36.9 C) , blood pressure is 112/64 mm Hg, pulse is 90/min, and respirations are 20/min. Oxygen saturation is 93% on room air. Physical examination shows jugular venous distension. S1 and S2 are normal and there are no murmurs. An S3 is heard. Crackles are heard at the bilateral lung bases. The abdomen is distended and there is 2+ pitting lower extremity edema bilaterally. Laboratory results (current and from 3 weeks ago) are as follows: Urinalysis is unremarkable. Which of the following is the most likely cause of this patient's acute kidney injury? A) Elevated central venous pressure B) Glomerular hyperfiltration C) Low blood oncotic pressure D) Reduced left ventricular preload E) Renal artery stenosis$ Urinalysis is unremarkable. Which of the following is the most likely cause of this patient's acute kidney injury?

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Impasses

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Psychological mechanisms used unconsciously by individuals to protect themselves from anxiety and to manage emotional distress.

Divided Life

Describes a state of living where an individual's life is split between different roles, responsibilities, or inner conflicts, leading to a sense of fragmentation.

Gestalt Therapy

A form of psychotherapy that emphasizes personal responsibility and focuses on the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments they make as a response to their situation.