Deck 11: Psychiatric and Behavioral Disorders

Question 1

Which of the following is the best method of communicating with an emotionally disturbed patient?

A) Ignore statements that are irrelevant to the situation.
B) Tell the patient you understand how he feels.
C) Explain that you are concerned with the patient's welfare.
D) Agree with everything the patient says.

Answer 1

Explain that you are concerned with the patient's welfare.

Question 2

Your patient is a 34-year-old female, eight weeks postpartum. She is alert and oriented but crying and extremely depressed. She states she "just can't go on like this." Her husband called EMS because she is distraught and cannot care for herself or the baby. Which of the following statements about this situation is TRUE?

A) Postpartum depression is common, but it is not linked to suicide.
B) The patient requires medical treatment.
C) Suicide is not likely as long as the husband remains supportive.
D) She should be advised not to have additional children.

Answer 2

The patient requires medical treatment.

Question 3

Which of the following is NOT associated with anorexia nervosa?

A) Intense fear of obesity
B) Cessation of menstruation
C) Excessive fasting
D) Intentionally inducing vomiting after eating

Answer 3

Intentionally inducing vomiting after eating

Question 4

Which of the following helps assess a patient's potential for violence?

A) Gender
B) Body language
C) Ethnicity
D) Age

Question 5

Which of the following is most relevant to your decisions about how to handle a potentially violent patient?

A) The fact that you have transported this patient many times and he has never become violent
B) The family's reassurances that the patient never harmed anyone
C) The patient's current behavior
D) Whether or not the patient is taking antipsychotic medications

Question 6

Your patient is a 34-year-old male who is threatening to kill himself. Which of the following does NOT indicate an increased risk for suicide?

A) The patient having ingested a substantial amount of alcohol
B) The patient having a father who committed suicide when the patient was a teenager
C) A previous nonlethal attempt at suicide
D) The patient's being married

Question 7

Which of the following statements about patient restraint is FALSE?

A) Patients should be transported in a prone position.
B) Restraining the thighs just above the knees can be more effective at preventing kicking than restraining at the ankles.
C) Verbal methods of deescalation should be tried before considering physical restraint.
D) Neuromuscular blocking agents should never be used to restrain a patient.

Question 8

Your patient is a 50-year-old male who has been detained by mall security officers. The patient is distraught, stating that he needs to "get away from the terrorists." The security officers state the patient was found climbing into a trash dumpster behind the mall and became distressed when they took him away from it. Your physical exam is unremarkable except for noting neglect of hygiene and nutrition. His skin is warm and dry. HR = 98, BP = 114/78, RR = 12, SaO₂ = 99%, blood glucose = 80 mg/dL. You offer him transport to the ED, which he accepts. Which of the following is most appropriate during transport of this patient?

A) Apply a cardiac monitor, IV, oxygen
B) Restrain the patient with four-point restraints, no ALS interventions
C) Start an IV, and request orders for haloperidol
D) Make the patient comfortable on the stretcher, no ALS interventions

Question 9

Which of the following statements about consent is accurate?

A) Competent people may not be transported against their will.
B) People cannot be transported against their will unless there is a court order to do so.
C) People who are alert and oriented to person, place, and time may not be transported against their will.
D) People cannot be transported against their will unless a first-degree relative (spouse, adult child, parent, or sibling) agrees.

Question 10

Which of the following is NOT a common pathophysiological cause of behavioral emergencies?

A) Underlying psychiatric illness
B) Psychosocial stressors
C) The environment
D) Use of recreational drugs and alcohol

Question 11

Which of the following statements about patient restraint is TRUE?

A) Restraints can be released once the patient is in control of himself.
B) Roller bandages for restraint do not cause neurovascular damage to the extremities, but leather restraints do.
C) Handcuffs are an acceptable choice for prehospital care.
D) Four-point restraints should be used.

Question 12

Your patient is a 32-year-old female who is depressed and tearful after a fight with her ex-husband. Which of the following would NOT increase the risk of or indicate an increased risk of the patient committing suicide?

A) The patient has access to a method of suicide.
B) The paramedic is using direct questioning about suicidal intentions.
C) The patient has called her sister to come and get her dog.
D) The patient has had three glasses of wine since the fight.

Question 13

Which of the following is most likely to effectively gain the cooperation of a psychologically disturbed patient for physical examinations?

A) Telling the patient you cannot help him unless you do a thorough physical examination
B) Standing closer to and using more physical contact with the patient than usual
C) Asking the patient's permission to examine him
D) Telling the patient you must examine him

Question 14

Which of the following best describes the position or bearing of the body?

A) Stature
B) Facies
C) Affect
D) Posture

Question 15

Which of the following is described as the visible indication of mood?

A) Mental status
B) Behavior
C) Affect
D) Level of consciousness

Question 16

Your patient is a 27-year-old female who is distraught and crying after having her children taken by child protective services. Her sister called EMS because the patient threatened to cut her wrists. On your arrival you find that she has not attempted to harm herself and has no weapons within reach. However, she does not wish to speak with you. Which of the following actions is most likely to be effective when communicating with this patient?

A) Maintain a distance of 3 to 5 feet from the patient.
B) Sit down so that you are at eye level with the patient.
C) Tell the patient that you cannot help her unless she talks to you.
D) Tell the patient that you want to help her, but you can't unless she calms down.

Question 17

Which of the following best describes perceived loss of physical functioning without medical or traumatic cause?

A) Somatization disorder
B) Conversion disorder
C) Catatonia
D) Body dismorphic disorder

Question 18

Your patient is a 32-year-old male who has been successfully treated for depression with a selective serotonin reuptake inhibitor. The patient's wife is concerned, because over the past few days her husband has not slept and has been spending most of his time trading stocks online and making extravagant purchases. He has been talking about taking a trip to Spain to run with the bulls in Pamplona. She states that he is talking incessantly and seems "wired." The patient had a similar episode about a month ago that came on suddenly but resolved when the patient "crashed" and slept for several days. Which of the following is most consistent with this situation?

A) Cocaine use
B) Schizoaffective disorder
C) Methamphetamine use
D) Bipolar disorder

Question 19

Which of the following best describes a feeling of alarm at the expectation of danger?

A) Fear
B) Rage
C) Phobia
D) Stress

Question 20

A 19-year-old female states that she is addicted to Vicodin because it makes her feel good, and she cannot stop taking the pills. She states that she craves them all the time, and when she runs out she does not feel sick but becomes preoccupied with how she can get more. Assessment reveals no abnormalities, and vital signs are within acceptable limits. This patient's condition is most consistent with:

A) physical dependence.
B) habituation.
C) psychological dependence.
D) tolerance.

Question 21

Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder?

A) Medical illness
B) Following the same routine daily
C) Stressful situations
D) Taking recreational drugs and using alcohol

Question 22

Your patient is a 76-year-old male who is alert and oriented. The patient's neighbor called EMS because of general concern about the patient's health. He states that the patient hasn't been himself since his wife's death six months ago. He hasn't taken care of his usually meticulous lawn and house, and he has lost a lot of weight. The patient says he misses his wife but doesn't need medical care. Which of the following is the best course of action?

A) Tell the patient you cannot leave him and that if he refuses to go to the hospital, you will have to call the police and have him placed under immediate detention for psychiatric treatment.
B) Explain to the neighbor that the patient is behaving as expected and the only treatment is time.
C) Have the patient sign a refusal of service form, but let him know he can call you back if he changes his mind.
D) Explain to the patient that it is common for people in his situation to feel depressed, and you would like to help him by transporting him to the hospital.

Question 23

You have been called to a college dormitory where campus police are talking to a 20-year-old male who was threatening to jump from his eighteenth-floor window. The patient admits that he was upset because he is failing most of his courses and his girlfriend broke up with him but says he was just "psyching out" his roommate and had no intention of jumping. Campus police tell you that the patient was sitting on the balcony railing with his feet over the edge when they arrived. The patient was cooperative when they asked him to come back inside the room. Which of the following is the best course of action?

A) Consider it a police matter, and mark in service.
B) Have the police place the patient under immediate detention, and transport the patient in restraints.
C) Tell the patient you must take his suicide threat seriously and transport him for evaluation.
D) Have the patient sign a refusal form as long as the roommate will take responsibility for staying with him.

Question 24

Your patient is a 45-year-old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The patient's wife called EMS because he has refused to take his lithium and is "driving her crazy with his hyperactive attitude." She insists that you transport him to the hospital. The patient admits to voluntary noncompliance with his lithium, stating, "I didn't like the way it made me feel." He denies any suicidal thoughts and states that he has not felt "this good for a long time." He is curious about your job and wants to know how he could get into a paramedic class. He states that he's also thinking about going to law school but wants to finish his Ph.D. first. The physical examination is unremarkable. HR = 82, BP = 122/80, RR = 10, SaO₂ = 99%. He says, "See, I told you I'm fine. I don't need to go to the hospital." Which of the following is the best course of action?

A) Contact medical direction.
B) Explain to the patient that he has no choice; if he is unwilling to take his medication, you must take him to the hospital for evaluation.
C) Restrain the patient if necessary and transport.
D) Request law enforcement assistance for legal detention of the patient for transport to the ED.

Question 25

Which of the following is NOT considered an appropriate method of controlling a combative patient in the prehospital setting?

A) Droperidol
B) Leather restraints
C) Pepper spray
D) Verbal deescalation

Question 26

Your patient is a 28-year-old male who tells you his hands and arms are turning green. He states that he was held captive by some people for a month and forced to make movies. While the patient is undoubtedly convinced he is turning green, you cannot see it. The patient's brother tells you that he has not been missing for the past month but that he has stopped taking his medication. Which of the following is most consistent with this situation?

A) Schizotypal personality disorder
B) Bipolar disorder
C) Acute dystonic reaction
D) Schizophrenia

Question 27

Which of the following is NOT an organic cause of a behavioral emergency?

A) Tumor
B) Hypoglycemia
C) Alcoholic encephalopathy
D) Dementia

Question 28

Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness?

A) Depression
B) Paranoia
C) Anxiety
D) Mania

Question 29

You are on the scene of an agitated male patient with a history of alcohol abuse. He is threatening to "knock your head off" if you get close to him. While you are getting a history from the patient's wife, she states that, "He had something wrong with his EKG. A long QRS, or something like that." Which of the following should you avoid in the treatment of this patient?

A) Lorazepam
B) Diazepam
C) Droperidol
D) Physical restraint

Question 30

Which of the following best describes a profound melancholy characterized by a diminished interest in daily pleasures, hypersomnia, feelings of worthlessness, inability to concentrate, and agitation?

A) Bipolar disorder
B) Schizoaffective disorder
C) Dysthymia
D) Depression

Question 31

Which of the following best describes a state of disorientation or disorganized thought?

A) Delusion
B) Confabulation
C) Neurosis
D) Confusion

Question 32

Your patient is a 28-year-old male with a history of panic attacks. He states that symptoms began about 20 minutes ago and that he has been unable to get them under control. He complains of shortness of breath, chest pain, dizziness, and a feeling that he is going to die. His skin is warm and moist. HR = 132, BP = 138/98, RR = 26 and shallow. You spend 15 minutes on-scene with him attempting to "talk him down" without success. Which of the following is most appropriate?

A) Oxygen, IV, nitroglycerin, aspirin, morphine
B) IV, diazepam
C) Oxygen
D) IV, haloperidol

Question 33

Which of the following best describes a person's state of cerebral functioning?

A) Mental status
B) Affect
C) Level of consciousness
D) Intelligence

Question 34

Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder?

A) Failure to keep counseling appointments
B) Situational stresses
C) Being released from an institution back into the public
D) Noncompliance with medications

Question 35

An example of a direct injury that may be sustained by a behavioral patient who has been TASERed would be:

A) the muscle contractions that occur as a result of the electrical impulse.
B) the damage caused by the impact of the probe.
C) the ignition of the combustible gases that are present after firing the TASER.
D) the resultant blunt force trauma caused by the fall that ensues after the electrical impulse.

Question 36

Which of the following best describes four-point restraints?

A) Straps restraining the patient across the chest, hips, thighs, and legs
B) A separate restraint on each of the four extremities
C) A commercially manufactured restraint device
D) Restraint of the head, torso, arms, and legs

Question 37

Which of the following best describes an emotional reaction characterized by rage?

A) Emotional lability
B) Anger
C) Dread
D) Irrationality

Question 38

You are caring for a patient that was TASERed by the police for being physically aggressive. This type of restraint works by what mechanism?

A) It temporarily stuns the cerebral hemispheres.
B) It paralyses the lower extremities.
C) It renders the patient unconscious.
D) It disrupts voluntary control of skeletal muscles.

Question 39

Your patient is in four-point restraints and starts to spit at you during transport. You should:

A) put a nonrebreather mask on the patient but do not administer oxygen.
B) place the patient prone, with his face turned away from you.
C) place a surgical mask over the patient's mouth and nose.
D) wear a HEPA respirator or an N-95 mask.

Question 40

Which of the following best describes the correct positioning of a restrained patient?

A) Prone, sandwiched between the cot and a long backboard to prevent movement
B) Prone, ensuring the restraints are not loose enough to allow patient movement
C) Left lateral recumbent, ensuring the restraints are not tight enough to affect breathing or circulation
D) Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing

Question 41

When caring for a patient who has been TASERed, you should be aware that the primary TASER injury occurs from:

A) the electricity.
B) the darts.
C) falling.
D) There are no primary injuries.

Question 42

Physical restraints deployed by EMS should be:

A) hard restraints.
B) handcuffs.
C) soft restraints.
D) EMS should never restrain a patient.

Question 43

Which of the following should be present to release the TASERed patient to police without EMS transport?

A) Glasgow Coma Scale score of 15
B) Systolic blood pressure above 100 mmHg
C) Pulse below 110
D) All of the above

Question 44

Which of the following is NOT a known risk factor for attempting suicide?

A) Previous attempts
B) Isolation
C) Loss of independence
D) Delirium

Question 45

The third leading cause of death for 15- to 24-year-olds is:

A) trauma.
B) drug abuse.
C) suicide.
D) accidents.

Question 46

A mental status exam on a behavioral emergency should include all of the following EXCEPT:

A) orientation.
B) sensorium.
C) mood and affect.
D) time since diagnosis.

Question 47

Behavioral disorders NOT related to substance abuse or medical conditions are known as:

A) sociocultural disorders.
B) psychosocial disorders.
C) nature behavior.
D) nurture behavior.

Question 48

Observing the patient for clues of violence should include the patient's:

A) appearance and clothing.
B) appearance and financial background.
C) posture and hand gestures.
D) ability to answer your questions.

Question 49

A behavior disorder characterized by relatively rapid onset of widely disorganized thought is:

A) dementia.
B) delirium.
C) delusions.
D) disassociation.

Question 50

A clue that the scene may NOT be safe to enter would be:

A) a messy house.
B) broken-down cars.
C) an overgrown lawn.
D) broken glass and furniture.

Question 51

Ideally, a minimum of how many people should be used to restrain a patient?

A) 3
B) 4
C) 5
D) 2

Question 52

An emergency in which the patient's behavior is unusual, bizarre, threatening, or dangerous is referred to as a:

A) psychiatric emergency.
B) code greens.
C) behavioral emergency.
D) personal assist.

Question 53

Behavior disorders related to a patient's socioeconomic status, social habits, skills, and values are said to be:

A) sociocultural disorders.
B) psychosocial disorders.
C) nature behavior.
D) nurture behavior.

Question 54

Which of the following patients that have been TASERed do NOT meet the acceptable criteria to remove the TASER darts?

A) A patient with a heart rate of 105/min
B) A patient with a room SpO₂ of 96 percent
C) A patient with the TASER dart embedded in the URQ of the abdomen
D) A patient with the TASER dart embedded in the neck

Question 55

When dealing with a geriatric behavior crisis, you should:

A) chemically restrain the patient.
B) medicate the patient as soon as possible.
C) be sure to call the patient by a nickname to establish a rapport.
D) avoid administering any medication.

Question 56

You respond to a patient acting "extremely belligerent" at a nightclub. Law enforcement on the scene informs you that the club is known for MDMA abuse. You should consider:

A) excited delirium and the need for chemical restraint.
B) excited delirium and TASER removal.
C) excited delirium and physical restraints.
D) letting law enforcement transport.

Question 57

A patient has been stunned with a TASER, and as a result you note superficial skin damage from the probe. This type of injury is classified as:

A) direct injury.
B) primary injury.
C) secondary injury.
D) tertiary injury.

Question 58

When dealing with the pediatric patient in a behavioral crisis, you should:

A) give the child some time alone to think.
B) alter the truth to persuade the child.
C) talk to the child like an adult.
D) allow the child to keep a favorite toy or blanket.

Question 59

You respond to a local restaurant for a behavioral emergency. You arrive on the scene with law enforcement to find a patient who is sweating, severely agitated, and wearing inappropriate clothing. You should suspect:

A) excited delirium.
B) dissociative disorder.
C) multiple personality disorder.
D) psychosis.