Behavioral Health Emergencies

Question 1

Patients with OCD or panic disorder (do/ do not) require emergent psychiatric consultation

Answer 1

do not

Question 2

Patient with acute psychosis and homicidal ideation (do/ do not) require emergent consultation

Answer 2

do

Question 3

The death of a patient within 24 hours of using a restraint is considered a ____ event.

Answer 3

sentinel

Question 4

you need an order from a ILP within __ hour of initiating restraints.
Independent licensed practitioner with do a face to face eval within __ hour

Answer 4

one

1

Question 5

The most common causes of acute mental status changes are ____, not ____

Answer 5

organic

psychiatric

Question 6

Organic causes include

6

Answer 6

metabolic issues, unrecognized head injuries, medications, drug intoxication, withdrawal, illnesses that cause delirium.

Question 7

Patients who present with SI, HI, or acute psychosis require psychiatric consultation. Any patient with panic disorder, and OCD require psychiatric treatment but not on an _____ basis.

Answer 7

emergent

Question 8

restrain as needed” or “restrain for the duration of visit” is not an acceptable order, there must be a ____.

Answer 8

timeframe

Question 9

For an adult, restraint orders are to be renewed every __ hour, __ hours for ages 9-17, and __ hour for ages under 9

Answer 9

4
2
1

Question 10

The two classes of medications that are used as chemical restraints are ____ and ____.

Answer 10

Benzodiazepines and antipsychotic.

Question 11

The most common type of psychiatric disorder to present in the emergency dept are ____ disorders, they may range from mild to incapacitating. They may be resulting from a normal response to a threatening situation.

Answer 11

anxiety

Question 12

Anxiety: Things worth documenting are such as

7

Answer 12

changes in behavior, somatic symptoms such as HA and dizziness, previous psych issues, affect, speech pattern, comprehension, memory.

Question 13

Placing a patient in isolation does not generally treat ____

Answer 13

anxiety

Question 14

Before a dx of ____ is made, causes of medications, medical illness, substance abuse, and metabolic disorder must be ruled out.

Answer 14

anxiety

Question 15

____ disorder may include somatic symptoms such as hyperventilation, palpitations, dizziness, vertigo, faintness, shakiness. Psychological symptoms include fears of unreality, going insane, losing control, death.

Answer 15

Panic

Question 16

Panic disorder is usually accompanied with (4)

Answer 16

OCD, PTSD, social phobias, generalized anxiety disorder.

Question 17

Conditions that can mimic panic disorder include

6

Answer 17

asthma, dysrhythmia, metabolic problems, thyroid storm, hypoxia, hypoglycemia

Question 18

____ can be caused by a genetically inherited neurochemical dysfunction such as autonomic imbalance, increased adenosine-receptor function, increased cortisol level, diminished benzodiazepine-receptor function, and disturbances in serotonin, norepinephrine, gamma-aminobutyric acid, dopamine, cholecystokinin, and interleukin-1 beta.

Answer 18

Panic

Question 19

Panic disorder may be related to a genitc disturbance in the neurotransmitter ____

Answer 19

norepinephrine

Question 20

____ used for treatment include Ativan (fast acting), and BuSpar

Answer 20

Benzodiazepines

Question 21

____ ____ can be used for associated tachycardia, not to reduce intrinsic anxiety.

Answer 21

Beta blockers

Question 22

Medications for depression include

3

Answer 22

Cyclic antidepressants
SSRI
MOI

Question 23

these medications block the reuptake of norepinephrine and serotonin from the postsynaptic membrane

Answer 23

Cyclic antidepressants

Question 24

These medications block the reuptake of serotonin from the postsynaptic membrane

Answer 24

SSRI- Selective serotonin reuptake inhibitors

Question 25

These medications prevent the activity of the enzyme monoamine oxidase at the central nervous system storage sites, leading to increased levels of epinephrine, serotonin, and dopamine at neuronal receptor sites

Answer 25

MOI- Monoamine Oxidase Inhibitors

Question 26

Medications for Bipolar disorder include

5

Answer 26

Lithium, Carbamazepine (tegretol), valproic acid ((depakote) or other anticonvulsants), olanzapine (Zyprexa) or other antipsychotics, Clonzapam (klonopin) or other antianxiety agents

Question 27

another name for Carbamazepine is

Answer 27

tegretol

Question 28

another name for depakote is

Answer 28

valproic acid

Question 29

another name for olanzapine is

Answer 29

Zyprexa

Question 30

another name for Clonzapam is

Answer 30

Klonopin

Question 31

Complications associated with the use of antipsychotics include
(6)

Answer 31

Fever, muscle rigidity, confusion- may be signs of neuroleptic malignant syndrome, life-threatening adverse effect
Heatstroke from the inhibition of sweating
Dystonia
Tardive dyskinesia

Question 32

what is Tardive dyskinesia?

Answer 32

full orientation to time and place, involuntary movements of the tongue, trunk, face and extremities with normal mental status.

Question 33

Medical causes may be ruled out by ordering tests such as

Answer 33

Obtain specimens such as BMP, CBC, toxicology, thyroid, CXR, radiology for organic brain disorder. ABG to rule out acid base abnormalities
Anxiety is associated with the neurotransmitters norepinephrine, serotonin, and gamma-aminobutyric acid.

Question 34

Some Eating disorder Physical characteristics include

4

Answer 34

cachexia, flat affect, thinning hair, psychomotor alterations

Question 35

Metabolic considerations regarding eating disorder include

Answer 35

protein deficiency, hypothermia, hypoglycemia, electrolyte disturbances such as; hypo- calcemia, natremia (dehydration), kalemia (starvation or laxative abuse), hypochloremic alkalosis (from vomiting)

Question 36

____ syrup, an over the counter available product can be used to induce vomiting after poisoning, can cause cardiomegaly when used chronically for bulimia nervosa

Answer 36

Ipecac

Question 37

pH; (renal manifestations) abnormalities caused by eating disorders include

Answer 37

metabolic alkalosis from vomiting, metabolic acidosis from laxative use.

Question 38

with eating disorders, you may encounter Increased uric acid level from ____ use or volume depletion.

Answer 38

diuretic

Question 39

What are Carpopedal spasms?

Answer 39

painful spasms of the hands and feet due to electrolyte imbalance

Question 40

Common complaints of Bulimia nervosa are

7

Answer 40

muscle weakness, abdominal pain (possible Mallory-weiss tear), heartburn, sore throat, muscle cramps, carpopedal spasms, menstrual irregularity.

Question 41

Treatment for bulimia nervosa will include

Answer 41

thiamine, multivitamins, and magnesium

Question 42

Cachexia is another name for

Answer 42

wasting syndrome

Question 43

With depression, The primary neurotransmitters involved are ____ and ____, but ____ has also been a related cause.

Answer 43

norepinephrine and serotonin, but dopamine has also been a related cause.