(BOOK)PSYCHIATRIC MENTAL HEALTH NURSING SUCCESS A Q & A REVIEW APPLYING CRITICAL THINKING TO TEST TAKING 3RD EDITION By: Cathy Melfi Curtis and Audra Baker Fegley ISBN PAGES

(BOOK)PSYCHIATRIC MENTAL HEALTH NURSING SUCCESS A Q & A REVIEW APPLYING CRITICAL THINKING TO TEST TAKING 3RD EDITION By: Cathy Melfi Curtis and Audra Baker Fegley ISBN 0403 416 PAGES Contents viii Contents 2 Psychiatric Nursing. 35 KEYWORDS 35 QUESTIONS 36 Mental Health Nursing. 36 Role of the Nurse. 37 Nursing Process. 38 Nurse-Client Relationship . 40 Transference/Countertransference . 42 ANSWERS AND RATIONALES 44 Mental Health Nursing. 44 Role of the Nurse. 46 Nursing Process. 48 Nurse-Client Relationship . 51 Transference/Countertransference . 55 3 Communication. 59 KEYWORDS 59 QUESTIONS 60 Therapeutic Communication Facilitators. 60 Blocks to Therapeutic Communication. 62 Therapeutic Communication Interventions . 63 Nonverbal Communication. 65 Cultural Considerations. 66 ANSWERS AND RATIONALES 69 Therapeutic Communication Facilitators. 69 Blocks to Therapeutic Communication. 73 Therapeutic Communication Interventions . 74 Nonverbal Communication. 78 Cultural Considerations. 80 4 Legal and Ethical Considerations . 85 KEYWORDS 85 QUESTIONS 85 Legal and Ethical Concepts. 85 Safety Issues. 86 Client Rights. 86 Voluntary and Involuntary Commitment. 87 Confidentiality. 88 Potential Liability. 89 Advance Directives. 89 ANSWERS AND RATIONALES 90 Legal and Ethical Concepts. 90 Safety Issues. 91 Client Rights. 92 Voluntary and Involuntary Commitment. 93 Confidentiality. 94 Potential Liability. 95 Advance Directives. 96 C Management of Care for Individuals With Psychiatric Disorders 5 Stress Adaptation, Trauma, and Related Disorders . 97 KEYWORDS 97 QUESTIONS 98 Theory. 98 Ego Defense Mechanisms . 99 Contents ix Nursing Process—Assessment . 101 Nursing Process—Diagnosis . 102 Nursing Process—Planning. 103 Nursing Process—Implementation. 104 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Psychopharmacology. 106 ANSWERS AND RATIONALES 107 Theory. 107 Ego Defense Mechanisms . 109 Nursing Process—Assessment . 112 Nursing Process—Diagnosis . 115 Nursing Process—Planning. 117 Nursing Process—Implementation. 117 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 Psychopharmacology. 121 6 Anxiety, Obessessive-Compulsive, and Related Disorders, Issues Related to Sexuality. 123 KEYWORDS 123 QUESTIONS 123 Theory. 123 Defense Mechanisms. 124 Nursing Process—Assessment . 124 Nursing Process—Diagnosis . 127 Nursing Process—Planning. 127 Nursing Process—Implementation. 129 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 Psychopharmacology. 130 ANSWERS AND RATIONALES 133 Theory. 133 Defense Mechanisms. 134 Nursing Process—Assessment . 134 Nursing Process—Diagnosis . 138 Nursing Process—Planning. 139 Nursing Process—Implementation. 141 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144 Psychopharmacology. 144 7 Depressive Disorders and the Suicidal Client. 149 KEYWORDS 149 QUESTIONS 149 Theory. 149 Nursing Process—Assessment . 150 Nursing Process—Diagnosis . 151 Nursing Process—Planning. 152 Nursing Process—Implementation. 152 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Psychopharmacology. 153 ANSWERS AND RATIONALES 156 Theory. 156 Nursing Process—Assessment . 157 Nursing Process—Diagnosis . 160 Nursing Process—Planning. 161 Nursing Process—Implementation. 162 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 Psychopharmacology. 165 x Contents 8 Bipolar and Related Disorders. 171 KEYWORDS 171 QUESTIONS 171 Theory. 171 Nursing Process—Assessment . 171 Nursing Process—Diagnosis . 172 Nursing Process—Planning. 172 Nursing Process—Implementation. 173 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174 Psychopharmacology. 174 ANSWERS AND RATIONALES 177 Theory. 177 Nursing Process—Assessment . 177 Nursing Process—Diagnosis . 178 Nursing Process—Planning. 178 Nursing Process—Implementation. 179 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181 Psychopharmacology. 182 9 Substance-Related and Addictive Disorders. 187 KEYWORDS 187 QUESTIONS 188 Theory. 188 Defense Mechanisms. 188 Nursing Process—Assessment . 189 Nursing Process—Diagnosis . 192 Nursing Process—Planning. 193 Nursing Process—Implementation. 193 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194 Psychopharmacology. 195 ANSWERS AND RATIONALES 197 Theory. 197 Defense Mechanisms. 198 Nursing Process—Assessment . 199 Nursing Process—Diagnosis . 206 Nursing Process—Planning. 207 Nursing Process—Implementation. 208 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210 Psychopharmacology. 211 10 Schizophrenia Spectrum and Other Psychotic Disorders. 215 KEYWORDS 215 QUESTIONS 216 Theory. 216 Nursing Process—Assessment . 216 Nursing Process—Diagnosis . 219 Nursing Process—Planning. 220 Nursing Process—Implementation. 220 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222 Psychopharmacology. 222 ANSWERS AND RATIONALES 226 Theory. 226 Nursing Process—Assessment . 227 Nursing Process—Diagnosis . 233 Nursing Process—Planning. 235 Nursing Process—Implementation. 237 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239 Psychopharmacology. 240 Contents xi 11 Personality Disorders and Impulse Control Disorders. 247 KEYWORDS 247 QUESTIONS 247 Theory. 247 Defense Mechanisms. 248 Nursing Process—Assessment . 248 Nursing Process—Diagnosis . 250 Nursing Process—Planning. 251 Nursing Process—Implementation. 252 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 Psychopharmacology. 254 ANSWERS AND RATIONALES 255 Theory. 255 Defense Mechanisms. 256 Nursing Process—Assessment . 256 Nursing Process—Diagnosis . 262 Nursing Process—Planning. 263 Nursing Process—Implementation. 265 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267 Psychopharmacology. 268 12 Somatic Symptom and Dissociative Disorders. 271 KEYWORDS 271 QUESTIONS 271 Theory. 271 Nursing Process—Assessment . 272 Nursing Process—Diagnosis . 273 Nursing Process—Planning. 273 Nursing Process—Implementation. 274 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275 Psychopharmacology. 276 ANSWERS AND RATIONALES 277 Theory. 277 Nursing Process—Assessment . 278 Nursing Process—Diagnosis . 280 Nursing Process—Planning. 282 Nursing Process—Implementation. 283 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .284 Psychopharmacology. 286 13 Neurocognitive Disorders. 287 KEYWORDS 287 QUESTIONS 287 Theory. 287 Nursing Process—Assessment . 288 Nursing Process—Diagnosis . 289 Nursing Process—Planning. 289 Nursing Process—Implementation. 290 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290 Psychopharmacology. 291 ANSWERS AND RATIONALES 292 Theory. 292 Nursing Process—Assessment . 292 Nursing Process—Diagnosis . 295 Nursing Process—Planning. 296 Nursing Process—Implementation. 296 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .298 Psychopharmacology. 298 xii Contents 14 Eating Disorders. 299 KEYWORDS 299 QUESTIONS 299 Theory. 299 Nursing Process—Assessment . 300 Nursing Process—Diagnosis . 301 Nursing Process—Planning. 301 Nursing Process—Implementation. 302 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303 Psychopharmacology. 303 ANSWERS AND RATIONALES 305 Theory. 305 Nursing Process—Assessment . 306 Nursing Process—Diagnosis . 308 Nursing Process—Planning. 309 Nursing Process—Implementation. 309 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 Psychopharmacology. 312 15 Children and Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315 KEYWORDS 315 QUESTIONS 315 Theory. 315 Nursing Process—Assessment . 316 Nursing Process—Diagnosis . 317 Nursing Process—Planning. 317 Nursing Process—Implementation. 318 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319 Psychopharmacology. 319 ANSWERS AND RATIONALES 321 Theory. 321 Nursing Process—Assessment . 322 Nursing Process—Diagnosis . 324 Nursing Process—Planning. 326 Nursing Process—Implementation. 327 Nursing Process—Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .329 Psychopharmacology. 330 16 Comprehensive Final Examination. 333 QUESTIONS 333 ANS WERS AND RATIONALES 347 Glossary of English Words Commonly Encountered on Nursing Examinations. 375 Index. 379 Psychiatric Mental Health Nursing Success A Q & A Review Applying Critical Thinking to Test Taking Third Edition 1 INTRODUCTION Definition of Critical Thinking Critical thinking is a cognitive strategy by which you reflect on and analyze your thoughts, actions, and decisions. Critical thinking often is integrated into traditional linear processes. Linear processes usually follow a straight line, with a beginning and a product at the end. Some linear-like processes, such as the nursing process, are considered cyclical because they repeat themselves. Some formal reasoning processes include: • Problem Solving—involves identifying a problem, exploring alternative interventions, implementing selected interventions, and arriving at the end product, which is a solution to the problem. • Decision Making—involves carefully reviewing significant information, using methodical reasoning, and arriving at the end product, which is a decision. • Diagnostic Reasoning—involves collecting information, correlating the collected information to standards, identifying the significance of the collected information, and arriving at the end product, which is a conclusion or nursing diagnosis. • The Scientific Method—involves identifying a problem to be investigated, collecting data, formulating a hypothesis, testing the hypothesis through experimentation, evaluating the hypothesis, and arriving at the end product, which is acceptance or rejection of the hypothesis. • The Nursing Process—involves collecting information (Assessment); determining significance of information and making a nursing diagnosis (Analysis/Diagnosis); identifying goals, expected outcomes, and planning interventions (Planning); implementing nursing interventions (Implementation/Intervention); and assessing the client’s response to interventions and comparing the actual to expected outcomes (Evaluation) ultimately to arrive at the end product of meeting a person’s needs. Each of these methods of manipulating and processing information incorporates critical thinking. They all are influenced by intellectual standards, such as being focused, methodical, deliberate, logical, relevant, accurate, precise, clear, comprehensive, creative, and reflective. It is helpful to incorporate critical thinking into whatever framework or structure works for you. MAXIMIZE YOUR CRITICAL-THINKING ABILITIES Be Positive: You Can Do It! Assuming responsibility for the care one delivers to a client and desiring a commendable grade on a nursing examination raise anxiety because a lot is at stake: to keep the client safe, Introduction Fundamentals of Critical A Thinking Related to Test Taking 2 Psychiatric Mental Health Nursing Success to achieve a passing grade, to become a nurse ultimately, and to support one’s self-esteem. The most important skill that you can learn to help you achieve all of these goals is to be an accomplished critical thinker. We use critical-thinking skills every day in our lives when we explore, “What will I have for breakfast?” “How can I get to school from my home?” and “Where is the best place to get gas for my car?” Once you recognize that you are thinking critically already, it is more manageable to think about thinking critically. If you feel threatened by the idea of critical thinking, then you must do something positive to confront the threat. You need to be disciplined and to work at increasing your sense of control, which contributes to confidence! You can do it! Overcome Barriers to a Positive Mental Attitude Supporting a positive mental attitude requires developing discipline and confidence. Discipline is defined as self-command or self-direction. The disciplined person will work in a planned manner, explore all options in an organized and logical way, check for accuracy, and seek excellence. When you work in a planned and systematic manner with conscious effort, you are more organized and, therefore, more disciplined. Disciplined people generally have more control over the variables associated with an intellectual task. Effective critical thinkers are disciplined, and discipline helps to develop confidence. Confidence is defined as poise, self-reliance, or self-assurance. Confidence increases as one matures in the role of the student nurse. Understanding your strengths and limitations is the first step to increasing confidence. When you know your strengths, you can draw on them, and when you know your limitations, you know when it is time to seek out the instructor or another resource to help you in your critical thinking. Either way, you are in control! For example, ask the instructor for help when critically analyzing a case study, share with the instructor any concerns you have about a clinical assignment, and seek out the instructor in the clinical area when you feel the need for support. Failing to use your instructor is like putting your head in the sand. Learning needs must be addressed, not avoided. Although your instructor is responsible for your clinical practice and for stimulating your intellectual growth as a nursing student, you are the consumer of your nursing education. As the consumer, you must be an active participant in your own learning by ensuring that you get the assistance and experiences you need to build your abilities and confidence. When you increase your theoretical and experiential knowledge base, you will increase your sense of control, which ultimately increases your confidence. This applies not just to beginning nursing students but to every level of practice because of the explosion in information and technology. When you are disciplined, you are more in control; when you are more in control, you are more confident; and when you are more confident, you have a more positive mental attitude. Be Reflective: You Need to Take One Step Backward Before Taking Two Steps Forward! Reflection is the process of thinking back or recalling a situation or event to rediscover its meaning. It helps you to seek and understand the relationships among information, concepts, and principles and to apply them in future clinical or testing situations. Reflection can be conducted internally as quiet, thoughtful consideration; in a one-on-one discussion with an instructor or another student; or in a group. As a beginning nursing student, you are just starting to develop an experiential background from the perspective of a health-care practitioner. However, you have a wealth of experiences, personal and educational, that influence your development as a licensed nurse. Your personal experiences include activities using verbal and written communication, such as delegating tasks to family members or coworkers, setting priorities for daily activities, using mathematics when shopping or balancing a checkbook, and so on. A nursing program of study incorporates courses from a variety of other disciplines, such as anatomy and physiology, chemistry, physics, psychology, sociology, reading, writing, mathematics, and informatics. Every single experience is a potential valuable resource for future learning. Recognize I ntroduction 3 the value of the “you” that you bring to your nursing education and incorporate it into your reflective processes. Engaging in reflection is a highly individualized mental process. One form of reflection is writing a journal. A journal is an objective and subjective diary of your experiences. It is a chronicle that includes cognitive learning, feelings, and attitudes. In addition, it requires you to actively develop skills related to assessing, exploring the meaning of critical incidents, documenting, developing insights into thoughts and actions that compose clinical practice, and evaluating. Journal writing is a rich resource that provides a written record of where you have been, where you are, and where you are going. It helps you to incorporate experiences into the development of your professional being. After an examination, explore your feelings and attitudes regarding the experience. Be honest with yourself. Did you prepare adequately for the test? Did you find the content harder or easier than content on another test? Were you anxious before, during, or after the test, and if so, was your anxiety low, medium, or high? What would a low score or high score on the test mean to you? When you were confronted with a question that you perceived as difficult, how did you feel and how did you cope with the feeling? You do not necessarily have to ask yourself all of these questions. You should ask yourself those questions that have meaning for you. Another form of reflection is making mental pictures. Mental pictures are visual images that can be recalled in the future. For example, when caring for a client who has Parkinson’s disease, compare the client’s signs and symptoms with the classic clinical manifestations associated with the disease. Then make a visual picture in your mind. Visualize the pill-rolling tremors, masklike face, drooling, muscle rigidity, and so on so that, in the future, you can recall the visual picture rather than have to remember a memorized list of symptoms. Retrospective (after the event) reflection involves seeking an understanding of relationships between previously learned information and the application of this information in client care situations or testing experiences. This type of reflection helps you to judge your personal performance against standards of practice. A self-assessment requires the willingness to be open to identifying one’s successful and unsuccessful interventions, strengths and weaknesses, and knowledge and lack of knowledge. The purpose of retrospective reflection is not to be judgmental or to second-guess decisions but rather to learn from the situation. The worth of the reflection depends on the abilities that result from it. When similar situations arise in subsequent clinical practice, previous actions that were reinforced or modified can be accessed to have a current successful outcome. A clinical postconference is an example of retrospective reflection. Students often meet in a group (formally or informally) after a clinical experience to review the day’s events. During the discussion, students have an opportunity to explore feelings and attitudes, consider interventions and alternative interventions, assess decision-making and problem-solving skills, identify how they and other students think through a situation, and so on. You can also review your own thinking when reviewing a client experience by speaking aloud what you were thinking. For example, “When I went into the room to take my postoperative client’s vital signs, I realized that the client had an IV in the right arm. I knew that if I took a blood pressure in the arm with an IV it could interfere with the IV so I knew I had to take the blood pressure in the left arm. When I looked at my client, he looked very pale and sweaty. I got a little nervous, but I continued to get the other vital signs. I put the thermometer in the client’s mouth and started to take his pulse. It was very fast and I knew that this was abnormal, so I paid special attention to its rhythm and volume. It was very thready, but it was regular. The temperature and respirations were within the high side of the expected range.” A beginning nursing student may immediately respond by saying, “I don’t know what is going on here, so I better take this information to my instructor.” A more advanced student might say, “What could be happening? Maybe the client is bleeding or has an infection. I think I should inform my instructor, but I’ll inspect the incision first.” When you review an experience like this example, you can identify your thinking skills. Taking the blood pressure reading in the left arm and assessing the rate, rhythm, and volume of the pulse were habits because you did not have to figure out a new method when responding to the situation. Remembering the expected range for the various vital signs used the thinking 4 Psychiatric Mental Health Nursing Success skill of total recall because you memorized and internalized these values. Determining further assessments after obtaining the vital signs required inquiry. You collected and analyzed information and did not take the vital sign results at face value. You recognized abnormalities and gaps in information, collected additional data, considered alternative conclusions, and identified alternative interventions. Another example of retrospective reflection is reviewing an examination. When reviewing each question, determine why you got a question wrong. For example, several statements you might make are: • I did not understand what the question was asking because of the English or medical vocabulary used in the question. • I did not know or understand the content being tested. • I knew the content being tested, but I did not apply it correctly in the question. When a limited English or medical vocabulary prevents you from answering a question correctly, you must spend time expanding this foundation. A list of English words that appear repeatedly in nursing examinations is included in a glossary at the end of this textbook. In addition, nursing/medical keyword lists have been included in each content area in this textbook. You can use these word lists to review key terminology used in nursing-related topics. To expand your vocabulary, keep English and medical dictionaries at your side when studying and look up new words, write flash cards for words you need to learn, and explore unfamiliar words with which you are confronted on tests. When you answered a question incorrectly because you did not understand the content, make a list so that you can design a study session devoted to reviewing this information. This study session should begin with a brief review of what you do know about the topic (5 minutes or less). The majority of your efforts should be devoted to studying what you identified as what you need to know. You should do this after reviewing every test. This exercise is based on the axiom strike while the iron is hot. The test is over, so your anxiety level is reduced and how nursing-related content is used in a test question is fresh in your mind. Study sessions that are goal directed tend to be more focused and productive. When you know the content being tested but have applied the information incorrectly, it is an extremely frustrating experience. However, do not become discouraged. It is motivating to recognize that you actually know the content! Your next task is to explore how to tap into your knowledge successfully. Sometimes restating or summarizing what the question is asking places it into your own perspective, which helps to clarify the content in relation to the test question. Also, you can view the question in relation to specific past experiences or review the information in two different textbooks to obtain different perspectives on the same content. Another strategy to reinforce your learning is to use the left page of your notebook for taking class notes and leave the facing page blank. After an examination, use the blank page to make comments to yourself about how the content was addressed in test questions or add information from your textbook to clarify class notes. How to review thinking strategies in relation to cognitive levels of nursing questions is explored later in this chapter. Examine your test-taking behaviors. For example, if you consistently changed your initial answers on a test, it is wise to explore what factors influenced you to change your answers. In addition, determine how many questions were converted to either right or wrong answers. The information you collect from this assessment should influence your future behaviors. If you consistently changed correct answers to incorrect answers, you need to examine the factors that caused you to change your answers. If you changed incorrect answers to correct answers, you should identify what mental processes you used to arrive at your second choice so that you can use them the first time you look at a question. Reflection is an essential component of all learning. How can you know where you are going without knowing where you have been? Therefore, to enhance your critical-thinking abilities you must take one step backward before taking two steps forward! Overcome Barriers to Effective Reflection Reflecting on your knowledge, strengths, and successes is easy, but reflecting on your lack of knowledge, weaknesses, and mistakes takes courage and humility. Courage is the attitude of confronting anything recognized as dangerous or difficult without avoiding or withdrawing I ntroduction 5 from the situation. Courage is necessary because when people look at their shortcomings, they tend to be judgmental and are their own worst critics. This type of negativity must be avoided because it promotes defensive thinking, interferes with the reception of new information, and limits self-confidence. Humility is having a modest opinion of one’s own abilities. Humility is necessary because it is important to admit your limitations. Only when you identify what you do and do not know can you make a plan to acquire the knowledge necessary to be successful on nursing examinations and practice safe nursing care. Arrogance or a “know-it-all” attitude can interfere with maximizing your potential. For example, when reviewing examinations with students, the students who benefit the most are the ones who are willing to listen to their peers or instructor as to why the correct answer is correct. The students who benefit the least are the ones who consistently and vehemently defend their wrong answers. A healthy amount of inquiry, thoughtful questioning, and not accepting statements at their face value are important critical-thinking competencies; however, a self-righteous or obstructionist attitude more often than not impedes rather than promotes learning. Be Inquisitive: If You Don’t Go There, You’ll Never Get Anywhere! To inquire means to question or investigate. The favorite words of inquisitive people are what, where, when, and, most important, how, why, if . . . then, and it depends. When studying, ask yourself these words to delve further into a topic under consideration. The following are examples: • You raise the head of the bed when a client is short of breath. You recognize that this intervention will facilitate respirations. Ask yourself the question, “How does this intervention facilitate respirations?” The answer could be, “Raising the head of the bed allows the abdominal organs to drop by gravity, which reduces pressure against the diaphragm, which in turn permits maximal thoracic expansion.” • You insert an indwelling urinary catheter and are confronted with the decision as to where to place the drainage bag. Ask yourself what questions. “What will happen if I place the drainage bag on the bed frame?” The answer could be, “Urine will flow into the drainage bag by gravity.” “What will happen if I place the drainage bag on an IV pole?” The answer could be, “Urine will remain in the bladder because the IV pole is above the level of the bladder and fluid does not flow uphill; if there is urine in the bag, it will flow back into the bladder.” • When palpating a pulse, you should use gentle compression. Ask yourself the question, “Why should I use gentle compression?” The answer could be, “Gentle compression allows you to feel the pulsation of the artery and prevents excessive pressure on the artery that will cut off circulation and thus obliterate the pulse.” • The textbook says that in emergencies nurses should always assess the airway first. Immediately ask, “Why should I assess the airway first?” There may be a variety of answers. “In an emergency, follow the ABCs (Airway, Breathing, Circulation) of assessment, which always begin with the airway. Maslow’s hierarchy of needs identifies that physiological needs should be met first. Because an airway is essential for the passage of life-sustaining gases in and out of the lungs, this is the priority.” Although all of these responses answer the question why, only the last answer really provides an in-depth answer to the why question. If your response to the original why question still raises a why question, you need to delve deeper. “Why do the ABCs of assessment begin with the airway?” “Why should physiological needs be met first?” • When talking with a client about an emotionally charged topic, the client begins to cry. You are confronted with a variety of potential responses. Use the method of if . . . then statements. If . . . then thinking links an action to a consequence. For example, if I remain silent, then the client may refocus on what was said. If I say, “You seem very sad,” then the client may discuss the feelings being felt at the time. If I respond with an open-ended statement, then the client may pursue the topic in relation to individualized concerns. After you explore a variety of courses of action with the if . . . then method, you should be in a better position to choose the most appropriate intervention for the situation. 6 Psychiatric Mental Health Nursing Success • You will recognize that you have arrived at a more advanced level of critical thinking when determining that your next course of action is based on the concept of it depends. For example, a client suddenly becomes extremely short of breath and you decide to administer oxygen during this emergency. When considering the amount and route of delivery of the oxygen, you recognize that it depends. You need to collect more data. You need to ask more questions, such as, “Is the client already receiving oxygen? Does the client have a chronic obstructive pulmonary disease? Is the client a mouth breather? What other signs and symptoms are identified?” The answers to these questions will influence your choice of interventions. When exploring the how, what, where, when, why, if . . . then, and it depends methods of inquiry, you are more likely to arrive at appropriate inferences, assumptions, and conclusions that will ensure effective nursing care. These same techniques of inquiry can be used when practicing test taking. Reviewing textbooks that have questions with rationales is an excellent way to explore the reasons for correct and incorrect answers. When answering a question, state why you think your choice is the correct answer and why you think each of the other options is an incorrect answer. This encourages you to focus on the reasons why you responded in a certain way in a particular situation. It prevents you from making quick judgments before exploring the rationales for your actions. After you have done this, compare your rationales with the rationales for the correct and incorrect answers in the textbook. Are your rationales focused, methodical, deliberate, logical, relevant, accurate, precise, clear, comprehensive, creative, and reflective? This method of studying not only reviews nursing content but also fosters critical thinking and applies critical thinking to test taking. During or after the review of an examination, these techniques of inquiry also can be employed, particularly with those questions you got wrong. Although you can conduct this review independently, it is more valuable to review test questions in a group. Your peers and the instructor are valuable resources that you should use to facilitate your learning. Different perspectives, experiential backgrounds, and levels of expertise can enhance your inquiry. Be inquisitive. If you don’t go there, you’ll never get anywhere. Overcome Barriers to Being Inquisitive Effective inquiry requires more than just a simplistic, cursory review of a topic. Therefore, critical thinkers must have curiosity, perseverance, and motivation. Curiosity is the desire to learn or know and is a requirement to delve deeper into a topic. If you are uninterested in or apathetic about a topic, you are not going to go that extra mile. Sometimes you may have to “psych yourself up” to study a particular topic. Students frequently say they are overwhelmed by topics such as fluids and electrolytes, blood gases, or chest tubes. As a result, they develop a minimal understanding of these topics and are willing to learn by trial and error in the clinical area or surrender several questions on an examination. Never be willing to let a lack of knowledge be the norm because this results in incompetence, and never give away credits on an examination! Overcome this attitude by maximizing your perseverance. Perseverance means willingness to continue in some effort or course of action despite difficulty or opposition. Critical thinkers never give up until they obtain the information that satisfies their curiosity. To perform a comprehensive inquiry when studying requires