Deck 23: Behavioral and Psychiatric Emergencies and Suicide

Question 1

Which of the following statements regarding behavioral emergencies is NOT true?

A) Patients experiencing a behavioral emergency are not always dangerous to themselves or others.
B) It would be unusual to find a person with schizophrenia outside a mental health facility.
C) Differences in culture may initially appear to be abnormal behaviors to the EMT.
D) Apparent behavioral emergencies may be due to an underlying medical cause.

Answer 1

It would be unusual to find a person with schizophrenia outside a mental health facility.

Question 2

When managing a patient who may hurt himself or others,you should do all of the following except:

A) make sure only you and the patient are in the room.
B) keep bystanders a safe distance away.
C) watch for sudden changes in the patient's behavior.
D) retreat if the patient becomes threatening.

Answer 2

make sure only you and the patient are in the room.

Question 3

Which of the following may cause a patient to exhibit abnormal behavior?

A) Hypoxia
B) Allergic reaction
C) Gastroenteritis
D) Snakebites

Answer 3

Hypoxia

Question 4

Which of the following actions is the MOST appropriate for the EMT to take when managing a patient with a behavioral emergency?

A) Find out if the patient's insurance covers psychiatric treatment.
B) Remain calm and reassure the patient.
C) Establish control of the situation by a show of force.
D) Quickly perform a head-to-toe exam and transport without delay.

Question 5

It is often difficult to distinguish a true medical emergency from a psychiatric emergency.You are confronted with a patient experiencing personality changes ranging from irritability to irrational behavior,altered mental status,amnesia or confusion,irregular respirations,elevated blood pressure,and decreasing pulse.It appears to be a psychiatric emergency.What else could also likely cause this behavior?

A) Low blood sugar
B) Head injury
C) Lack of oxygen
D) Stroke

Question 6

Which of the following communication strategies should be used in dealing with a patient with a behavioral emergency?

A) Stay 2 to 3 inches from the patient at all times to make him feel secure.
B) Interrupt the patient if he appears to be going off on a tangent about something not concerning the immediate situation.
C) Show deep sympathy for the patient's predicament and let him know he can't control the things that are happening to him.
D) Acknowledge the patient's feelings

Question 7

Which of the following medical conditions may be the underlying cause of an apparent behavioral emergency?

A) Mental illness
B) Stroke
C) Hypoglycemia
D) All of the above

Question 8

Your patient is exhibiting bizarre and aggressive behavior; he starts shouting and becomes violent.He has extra strength and appears insensitive to pain.Drug paraphernalia is visible on-scene.This behavior is known as:

A) chemical delirium.
B) excited delirium.
C) sensory excitement.
D) intoxication reaction.

Question 9

When dealing with a psychiatric emergency,which one of the following would generally be inappropriate behavior on your part?

A) Be as hurried as you can. It is extremely important to resolve the call and get the patient to the hospital as soon as possible.
B) Act in a calm manner, giving the patient time to gain control of his emotions.
C) Let the patient know that you are listening to what he is saying, and explain things to the patient honestly.
D) Stay alert for sudden changes in behavior.

Question 10

Which of the following statements concerning behavioral emergencies is true?

A) Emotional outbursts are considered behavioral emergencies.
B) The person with a behavioral emergency requires prolonged institutionalization.
C) A person with a behavioral emergency is mentally ill.
D) It may be difficult to determine what behavior is abnormal for a given person in a given situation.

Question 11

According to coworkers,your 25-year-old female patient suddenly began acting aggressively and being verbally abusive.She tells you she is "starving" and you notice that she is pale and diaphoretic.Which of the following would be an appropriate general impression?

A) Alcoholic intoxication
B) An underlying physical illness
C) Sudden onset of schizophrenia
D) Alcohol withdrawal

Question 12

Which of the following findings would be helpful in differentiating between a closed head injury and a behavioral emergency?

A) Irrational behavior
B) Unequal pupils
C) Confusion
D) Combativeness

Question 13

It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered level of consciousness due to a physical issue.Which of the following statements are true?
1)Consider patients who are exhibiting crisis or unusual behavior to be having an altered mental status from a nonpsychiatric cause until proven otherwise.
2)Many medical and traumatic conditions are likely to alter a patient's behavior.
3)Lack of oxygen may cause restlessness and confusion,cyanosis (blue or gray skin),and altered mental status.
4)Stroke or inadequate blood to the brain may cause confusion or dizziness and what appears to be erratic behavior.

A) 1, 2
B) 1, 2, 3
C) 1, 3, 4
D) 1, 2, 3, 4

Question 14

When a person acts in a manner that is unacceptable to himself or those around him,this would be considered which of the following?

A) Mental illness
B) Psychotic episode
C) Behavioral emergency
D) Psychosomatic reaction

Question 15

Which of the following is acceptable when managing the patient with a behavioral or psychiatric emergency?

A) Make supportive statements such as, "That must have been very hard for you."
B) Sit as close to the patient as you can to reassure him that you will not abandon him.
C) Allow family members to confront the patient about his behavior.
D) Go along with the patient's hallucinations or false beliefs.

Question 16

EMTs may come across a situation where a patient begins to act extremely agitated or psychotic.Elevated temperature and sometimes alcohol or drug intoxication may be present.The patient will soon cease struggling,and often within minutes the patient develops inadequate or absent respirations and subsequently dies.It is important for the EMT to be alert for this sequence of events in a patient who exhibits this behavior and monitor the patient constantly throughout the call.This condition is called:

A) excited or agitated delirium.
B) psychotic delirium.
C) excited psychosis.
D) bipolar disorder.

Question 17

There are general rules when dealing with psychiatric emergencies.Which of the following is NOT one of those rules and would be considered inappropriate?

A) Identify yourself and your role.
B) Speak slowly and clearly, using a calm and reassuring tone.
C) Never make eye contact with the patient, as it will just increase his nervousness.
D) Listen to the patient. You can show you are listening by repeating part of what the patient says back to him.

Question 18

Which of the following traumatic conditions may account for signs and symptoms of a behavioral emergency?

A) Fractured lumbar vertebra
B) 10% BSA partial thickness burn
C) Fractured tibia
D) Internal hemorrhage

Question 19

When a patient or bystander at the scene of an emergency displays fear,anger,or grief,this is best described as which of the following?

A) Neurosis
B) Stress reaction
C) Post-traumatic stress disorder
D) Catharsis

Question 20

Which one of the following statements is NOT true?

A) In any given year, 26.2% of adult Americans suffer from a diagnosable mental disorder.
B) Almost 10% of the population of adult Americans has a mood disorder such as depression.
C) Just over 20% of the population of adult Americans has anxiety or panic issues.
D) It is very unusual for an EMT to be called for a psychiatric emergency.

Question 21

You are on the scene of a possible overdose.You find a 30-year-old man pacing about his living room.There is evidence of illicit drug use and the apartment is in disarray.The patient seems agitated and nervous.Attempts at calming the patient should include which of the following?

A) Speak quickly to give the patient all of the important information without delay.
B) Repeat part of what the patient is saying to show that you are listening to him.
C) Stand still with your arms crossed to instill a sense of control and authority.
D) Sit close to him with your arm around his shoulders to show that you are truly concerned.

Question 22

Which of the following is the BEST defense for an EMT when facing allegations of misconduct from a mentally ill patient?

A) Hiring a background investigator to discredit the accuser
B) Having a clean employment record and lack of a criminal background
C) Providing accurate and complete documentation, supported by a third-party witness
D) Making sure you and your partner get your stories straight before talking to anyone

Question 23

Which of the following patients would be considered to be at the greatest risk for suicide?

A) 22-year-old man who has lost his job and is getting divorced
B) 35-year-old female who has a child with a serious illness
C) Married, 30-year-old man who has just learned that his employer is transferring him to a different state
D) 44-year-old woman who has just recovered from a serious illness

Question 24

Once you have established with reasonable certainty that your patient is suffering from a behavioral emergency,which of the following is the best course of action?

A) Establish the best way to restrain the patient before he has the opportunity to become violent.
B) Begin intense individual counseling with the patient.
C) Attempt to determine if there is a possible physical cause for the patient's behavior.
D) There is no need to assess for medical conditions if the patient does not have a history of past medical problems.

Question 25

Which of the following must be treated by the EMT if present in a patient with an apparent behavioral emergency?

A) Acute alcohol intoxication
B) Hypoglycemia
C) Suicidal ideology
D) Severe clinical depression

Question 26

Neurotransmitters are chemicals within the body that transmit the message from the distal end of one neuron (presynaptic neuron)to the proximal end of the next neuron (postsynaptic neuron).While it sounds like a complicated process,it takes only milliseconds.Which one of the following sentences is false?

A) Neurotransmitters are released from a neuron, then travel across the synapse to the next neuron.
B) The receptors on the postsynaptic neuron receive the neurotransmitter.
C) This is the mechanism by which the impulse is moved along the nervous system.
D) After the impulse is transmitted, the neurotransmitter goes through a process called reuptake, in which the neurotransmitter is returned to the postsynaptic neuron.

Question 27

Concerning attempted suicide,which of the following statements is true?

A) Truly suicidal patients nearly always leave a note.
B) All suicide attempts must be taken seriously, even if the method seems insincere.
C) There is always an indication that a suicide attempt is imminent.
D) Attempted suicide is a matter for law enforcement, not EMS.

Question 28

When providing emergency care to an aggressive or hostile patient,what is the highest priority?

A) Checking the patient for possible physical causes of the behavior
B) Finding out if the patient is oriented to person, time, and place
C) Calming the patient down
D) Performing a scene size-up

Question 29

You are dispatched to a local fast-food restaurant for a "nature unknown" call.You arrive on-scene and find a 47-year-old male in front of the counter repeatedly singing "Happy Birthday" to himself.Police are on-scene and the scene is safe.Which of the following would be considered appropriate care?

A) Quickly approach the patient and take charge. Tell him he has to come with you to be evaluated.
B) Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can.
C) Have the police take charge, restrain the patient, and have him brought into your ambulance.
D) Have your partner join you in approaching the patient and explain to him that he has to stop singing or you will have him arrested.

Question 30

Which of the following factors suggest that a patient is at risk for suicide?

A) Recent emotional trauma
B) Sudden improvement in depression
C) Alcohol and drug abuse
D) All of the above

Question 31

You have responded to a call about a "psychiatric patient" to find a 24-year-old woman talking to herself in her home.She is rocking back and forth and you can see from a distance that she is perspiring profusely.You also see an empty medication bottle on the floor.She does not acknowledge your presence.When you attempt to speak to her,she continues to talk to herself as if you were not there.Which of the following should be included in your actions at the scene?

A) Distract her so your partner can look around the house.
B) Look through the house with your partner to try to find some clues to the patient's problem.
C) Ensure that law enforcement is responding and wait for their arrival.
D) Shake the patient's shoulder to check for responsiveness to physical stimuli.

Question 32

As an EMT,it is important that you be able to do all of the following except:

A) control your own emotions when dealing with patients who say upsetting things to you.
B) provide counseling and advice to patients with personal problems.
C) ensure your safety and that of others at the scene.
D) deal with a wide variety of emotions and behaviors.

Question 33

All of the following are general rules in dealing with a psychiatric patient except:

A) speak slowly and clearly, and use a calm and reassuring tone.
B) make eye contact with the patient.
C) listen to the patient, showing you are listening by repeating part of what the patient says back to him.
D) do not be judgmental; instead, show pity, as he needs to know that you understand him.

Question 34

Your patient is a 15-year-old female who has n diagnosed with a personality disorder.She has no history of violent behavior.The staff at her residential care facility wants her to be transported for evaluation of a possible urinary tract infection.Which of the following is the BEST way to handle this situation?

A) Have a female EMT attend to the patient.
B) Transport the patient, but do not speak to her or perform an assessment.
C) Refuse to transport the patient without a police escort.
D) Ask that the patient be given a tranquilizer injection prior to transport.

Question 35

You are dispatched to a psychiatric emergency for a 68-year-old male.Dispatch provides no other information and,when questioned by you,they do not have any more information.Although all steps are important in dealing with this situation,which step is the MOST important?

A) Scene size-up
B) Primary assessment
C) Vital signs and SAMPLE history
D) Secondary assessment

Question 36

Why is it important to gather a detailed medical history when dealing with a psychiatric emergency?

A) It is not. You want to get the call resolved as quickly as possible and this will just delay it.
B) It will alert you to past issues as well as medication.
C) It will help you to determine if the police are needed.
D) It will help you to determine if you need to restrain the patient.

Question 37

Which of the following should NOT be included in documentation of an incident involving a patient with a behavioral or psychiatric emergency?

A) Description of the patient's behavior
B) Whether or not you think the patient is mentally ill
C) Your observations of the patient's surroundings at the scene
D) Your actions

Question 38

When responding to an attempted suicide,which of the following is the EMT's primary concern?

A) Personal safety
B) Determining whether the patient suffers from clinical depression
C) Contacting law enforcement since suicide is illegal
D) Managing the patient's airway

Question 39

Management of the suicidal patient includes all of the following except:

A) a physical examination.
B) psychoanalysis of the patient by the EMT.
C) a SAMPLE history.
D) communication.

Question 40

Which of the following is appropriate when assessing an emotionally disturbed patient?

A) Establish eye and verbal contact.
B) Avoid arguing with the patient.
C) Make it clear that you are in control of the situation, not the patient.
D) Both A and B

Question 41

You are dispatched to a suicide attempt.You arrive to find a 16-year-old,who is extremely agitated and pacing up and down in the living room of his house.Apparently,he had threatened to go out,get a gun,and shoot himself.The parents called it in as an attempted suicide.The scene is safe and there are apparently no weapons accessible to the patient.Which of the following would NOT be appropriate in caring for this patient?

A) Do not take any action that may be considered threatening by the patient. To do so may bring about hostile behavior directed against you or others.
B) Always be on the watch for weapons.
C) Do not isolate yourself from your partner or other sources of help.
D) Make certain the patient gets between you and the door. The patient should always feel he has an escape route.

Question 42

Which of the following statements concerning forcible restraint of patients is true?

A) It is easily accomplished by two EMTs with a good plan.
B) This is necessary only with mentally ill individuals.
C) It causes irreparable emotional harm to most patients.
D) This is normally considered to be within the jurisdiction of law enforcement.

Question 43

You are called to the scene of an attempted suicide.You arrive to find a 25-year-old man sitting on the sofa who apparently cut his wrists.Family members have bandaged them,and there does not appear to be any bleeding risk at this time.The scene is secure.Which action would you NOT take in treating this patient?

A) As soon as possible, perform a history and physical exam and provide emergency care on the wrist, if necessary.
B) Perform a detailed physical exam only if it is safe and you suspect the patient may have an injury.
C) Contact the receiving hospital and report on current mental status and other essential information.
D) Make sure you take charge of the situation. Let the patient know that what he has done is wrong. Tell him he is coming with you whether he likes it or not. Do not worry about gaining the patient's confidence. Take charge. The patient must know that you are the boss.

Question 44

Which of the following situations generally allows the EMT to transport a patient with a behavioral emergency against his or her wishes?

A) The patient's personal physician gives you permission.
B) A family member gives consent and is willing to accompany the patient.
C) The patient is a threat to himself or others.
D) The patient's insurance company agrees to pay, even though the patient has not given consent.

Question 45

Your patient is a 37-year-old male sitting on the kitchen floor.His wife is attempting to talk with him,but he does not look at her or answer.He is fidgeting and has apparently thrown some dishes against the wall.What should be your first consideration?

A) Ask the wife to step outside with you so you can get information from her.
B) Ask the wife to step into the other room so you can speak with the patient alone.
C) Quickly check the patient's carotid pulse.
D) Stay a safe distance away.

Question 46

Concerning behavioral emergencies,which of the following statements is true?

A) Only a licensed psychiatrist can apply crisis management techniques with a patient having a behavioral emergency.
B) A diabetic problem never mimics signs of a behavioral emergency.
C) It is relatively easy to determine if the underlying cause of a behavioral emergency is related to drug abuse.
D) A patient who does not respond to crisis management techniques may be restrained for transport to a psychiatric facility.

Question 47

It is important that,as an EMS provider,you avoid creating a situation where positional asphyxia could occur.Which of the following is positional asphyxia?

A) Positional asphyxia is the position the person is seated in when you approach him.
B) Positional asphyxia is a birth defect that causes psychiatric issues and is initiated because of the way the fetus was positioned in the uterus.
C) Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing.
D) Positional asphyxia is the name for the position someone assumes after she has been hit with a taser.

Question 48

Which of the following statements concerning people who have made prior suicide attempts is true?

A) They are at an increased risk for a subsequent successful suicide.
B) They do not require psychological counseling like a person who is truly depressed.
C) They should be allowed to sign a release if their injuries are not serious.
D) They are usually just making a cry for help but do not want to die.

Question 49

Your patient is a 22-year-old male who has ingested a large amount of alcohol and is vomiting.He is conscious but uncooperative.He allows you to examine him but refuses transport to the hospital.You have sought assistance from law enforcement on scene.Which of the following is the BEST action?

A) Contact medical control for further advice.
B) Stay with the patient until he has stopped vomiting.
C) Find a relative or neighbor to come over and stay with the patient.
D) Obtain a witnessed refusal.

Question 50

You respond to the scene of a private residence for a patient who is a known insulin-dependant diabetic patient.The patient is combative and cursing as you approach.Should this patient be restrained?

A) Yes, he likely has a medical condition that requires treatment.
B) No, this patient is not likely experiencing a behavioral emergency.
C) Yes, he is combative and all combative patients can be restrained.
D) There is not enough information to answer this question.

Question 51

Which of the following is NOT an acceptable method or adjunct in restraining a patient?

A) Hog-tying the patient
B) Placing a surgical mask over the patient's face to prevent spitting
C) Restraining the patient face-up
D) Securing all four limbs with leather restraints

Question 52

Your patient is a 24-year-old male who is severely depressed.He tells you that he can't "handle the pressure" anymore and that he wants to die.He is refusing transport.Which of the following is the most appropriate decision regarding this patient's care?

A) Transport the patient against his will with the assistance of law enforcement.
B) Contact the patient's family to find out what their wishes are.
C) Leave the scene and allow law enforcement to handle the situation.
D) Respect the patient's wishes; he is alert, oriented, and capable of giving consent.

Question 53

You are on the scene where a 23-year-old female has attempted suicide by cutting her forearms with a razor.She is sitting in the front yard and has lost a large amount of blood.She is conscious and holding a small razor blade,and tells you to get away from her.Which of the following should NOT be done?

A) Use Body Substance Isolation (BSI).
B) Keep bystanders away from the patient.
C) Call law enforcement for assistance.
D) Take the razor blade away from her by force.

Question 54

Which of the following does NOT indicate that a patient may be about to become violent?

A) Tense body posture or clenched fists
B) Crying
C) Profane language
D) Loud voice and rapid pacing

Question 55

When restraining a patient,which of the following is NOT a consideration?

A) Number of people available to carry out the required actions
B) Patient's size and strength
C) Patient's informed consent
D) How to position the patient