Author Question: A patient has been grieving the loss of a spouse and seems to be doing surprisingly well when a ... (Read 31 times)

Medesa · **on:** Jul 11, 2018

A patient has been grieving the loss of a spouse and seems to be doing surprisingly well when a beloved pet dies

The patient demonstrates extreme signs of sadness and despair, saying, I can-not possibly go on without Kitty. When working with the family, what does the nurse suggest?
a. Get the patient another cat.
b. Suggest the patient see the physician.
c. Refer the patient to a grief therapist.
d. Suggest they take the patient on a trip.

Question 2

An older patient takes warfarin (Coumadin). The patient's international normalized ratio (INR) is 1.0. What action by the nurse is best?

a. Nothing; this level is therapeutic.
b. Assess the patient's diet history.
c. Prepare to administer vitamin K.
d. Double the warfarin dose.

hugthug12 · **Reply #1 on:** Jul 11, 2018

Answer to Question 1

C
This patient is demonstrating a delayed or postponed grief reaction. Doing surprisingly well may indicate a lack of grief response at the original loss, then an exaggerated reaction to a small-er, subsequent loss. The most appropriate action is to refer the patient and family to a grief counselor who can help the patient work through both losses. Getting another cat dismisses the importance of the first one. A physician visit may be needed, but a grief counselor is more ap-propriate. Taking the patient on a trip will not help resolve the situation.

Answer to Question 2

B
The therapeutic INR is 2-3 (2-3.5 in some sources), so this level is not therapeutic. Foods rich in vitamin K antagonize warfarin. Before consulting the provider about adjusting the dose, the nurse should first assess the patient's diet history to see if too many vitamin Krich foods are being eaten. The dose may need adjustment. Vitamin K would be given for an overdose.