CH 27 Behavioral and Psychiatric Emergencies and Suicide

Question 1

H-1) Which of the following is most indicative of a behavioral​ emergency?
A. A terminally ill cancer patient begins giving away her prized possessions.
B. A patient at the scene of a terrorist attack wails with grief at the loss of a spouse.
C. A patient with no apparent awareness of his surroundings speaks in gibberish.
D. A patient in severe respiratory distress begins grunting and collapses to her knees.

Answer 1

C. A patient with no apparent awareness of his surroundings speaks in gibberish

The patient with no apparent awareness of his surrounding and who is speaking in gibberish most likely has an altered mental​ status, because his behavior is at odds with his circumstances. The other patients are responding in normal ways to difficult or​ life-threatening situations.

Question 2

H-2) Which of the following is a common medical cause for behavioral changes in a​ patient?
A. Rapid capillary refill
B. High blood sugar
C. Low blood sugar
D. Slow heart rate

Answer 2

C. Low blood sugar
(Page 748)
Diabetes is a very common disease process that EMTs encounter. When a diabetic​ patient’s blood sugar level gets too low and the patient becomes​ hypoglycemic, the patient starts to have mental and physical changes that may be confused with psychological problems. Err on the side of​ caution, and look for physiological causes first.

Question 3

H-3) When you are dealing with someone who presents with a behavioral​ emergency, remember​ that:
A. you must consider physiological causes.
B. the cause is likely psychological.
C. transport to the hospital is rarely indicated.
D. the patient will likely need to be restrained.

Answer 3

A. you must consider physiological causes.
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You must consider physical​ (non-psychiatric) causes for abnormal​ behavior, because these causes could be​ life-threatening to the​ patient, as in the case of hypoglycemia.

Question 4

H-4) A​ 38-year-old female patient presents with​ restlessness, confusion, and an altered mental status. Which finding below indicates a physiological cause of her bizarre​ behavior?
A. Hypertension
B. Stroke
C. Hypercholesterolemia​ (high blood​ cholesterol)
D. Hypoxia

Answer 4

D. Hypoxia
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Hypoxia can cause​ restlessness, confusion, and an altered mental status.

Question 5

H-5) You respond with the police to a domestic violence call where the wife has sustained superficial injuries. The police inform you that the husband is in custody and may be having a reaction to a drug such as PCP​ (phencyclidine). He is speaking rapidly and appears nervous. The police ask you to check him out before they take him away. What should be your greatest safety concern regarding this​ patient?
A. Use of some drugs can lead to unpredictable behavior and may result in sudden violence.
B. His condition may involve a chemical contamination that poses a safety threat to all near him.
C. His excited state may result in a heart attack or similar medical problem.
D. He will likely attempt to evade arrest by running​ away, posing a threat to others.

Answer 5

A. Use of some drugs can lead to unpredictable behavior and may result in sudden violence.

Your greatest concern is the unpredictability of a patient who is in this condition.

Question 6

H-6) Which patient is showing the least likely sign of aggressive or hostile​ behavior?
A. A patient keeps getting too close to you.
B. A patient keeps slapping away your attempts at a physical examination.
C. A patient is moving and speaking suddenly and unpredictably.
D. A patient expresses remorse for his unhealthy habits.

Answer 6

D. A patient expresses remorse for his unhealthy habits.

Remorse​ doesn’t demonstrate a potential for aggressive or hostile behavior nearly as much as panicky or threatening​ behavior, and slapping away attempts at physical examination actually is hostile behavior.

Question 7

H-7) When a patient is acting irrationally and​ uncooperatively, which of the following is the most effective approach toward gaining the​ patient’s trust and​ cooperation?
A. Making sure other people are around as you interact with the patient
B. Being general and nondescript in your expectations of the patient
C. Displaying a​ calm, confident demeanor
D. Telling the patient what the patient wants to​ hear, even though it may not be the truth

Answer 7

C. Displaying a​ calm, confident demeanor

Showing the patient that you are relaxed and confident helps to reassure the patient that the​ patient’s problems are not unmanageable and that you are the person to help the patient.

Question 8

H-8) Rushing the assessment of a patient who is in an agitated state from a situational stress​ reaction:
A. encourages the patient to give you pertinent information more quickly.
B. makes the situation seem more out of control to the patient.
C. contributes to the​ patient’s perception of your authority.
D. puts the current emergency into better perspective for the patient.

Answer 8

B. makes the situation seem more out of control to the patient.

Rushing the assessment for a patient overwhelmed by stress will likely magnify the​ patient’s feeling that events are out of control.​ Don’t rush, and show a firm control over your actions and the situation.

Question 9

H-9) You have arrived at the scene of a patient with a psychiatric condition that has led to a behavioral emergency. The scene has been declared​ safe, and you have explained to the patient why you are there. What should be your next​ step?
A. Obtain a history from the patient.
B. Obtain the​ patient’s vital signs.
C. Conduct a primary assessment of the patient.
D. Prepare for​ transport, with the plan of completing your assessment en route to the hospital.

Answer 9

C. Conduct a primary assessment of the patient

After determining scene​ safety, the next priority is to conduct a primary assessment. Obtaining a history and obtaining vital signs from the patient are parts of the secondary assessment process. Primary assessments must be accomplished on all patients before transporting.

Question 10

H-10) In your assessment of a​ 50-year-old female with​ confusion, irrational​ behavior, and​ agitation, you discover that the patient has a history of high blood​ pressure, diabetes, previous heart​ attacks, arthritis, and gallstones. Part of your continued assessment for this patient should​ be:
A. summoning​ paramedics, as this patient is most likely having a heart attack.
B. trending the​ patient’s blood pressure by obtaining at least three readings.
C. a thorough examination of the​ abdomen, to reveal the presence of gallstones.
D. obtaining the​ patient’s blood glucose level.

Answer 10

D. obtaining the​ patient’s blood glucose level.

Hypoglycemia is a likely cause of this​ patient’s mental​ status, so you should obtain her blood glucose​ level, if protocol permits

Question 11

H-11) Which of the following is recommended when interacting with a behavioral​ patient?
A. Acknowledging the​ patient’s feelings
B. Showing pity
C. Agreeing with whatever the patient says
D. Speaking quickly

Answer 11

A. Acknowledging the​ patient’s feelings
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It is good to acknowledge the​ patient’s feelings. The other choices are not appropriate.
Show COMPASSION, NOT pity (Bullet Point 5)
Speak slowly and clearly (Bullet Point 1)

Question 12

H-12) When transporting a patient who you believe to be having a behavioral emergency as the result of a medical​ emergency, what is your first​ concern?
A. Performing a detailed secondary examination
B. Assessment of the​ airway, breathing, and circulation
C. Transporting the patient to the nearest ED
D. Collecting a thorough history

Answer 12

B. Assessment of the​ airway, breathing, and circulation

Your first treatment priority for any emergent patient is to ensure that the​ airway, breathing, and circulation are all intact and​ protected, and to treat any​ life-threatening problems. All other concerns are secondary.

Question 13

H-13) When you are responding to a call involving a behavioral​ emergency, you should ensure throughout the call that​ you:
A. develop a definitive diagnosis of the​ patient’s condition.
B. remain alert for personal and scene safety problems.
C. carefully avoid touching or coming too near the patient.
D. gather evidence ruling out a psychiatric cause.

Answer 13

B. remain alert for personal and scene safety problems.

Throughout each call involving a behavioral​ emergency, be alert for personal and scene safety problems.

Question 14

H-14) What is it important to do in response to a​ patient’s exhibiting signs of​ depression?
A. Counsel the patient that depression is an insufficient coping mechanism.
B. Take the​ patient’s depression seriously and​ don’t dismiss it.
C. Refer the patient immediately to a mental health team.
D. Tell the patient that everyone has bad days but things always work out.

Answer 14

B. Take the​ patient’s depression seriously and​ don’t dismiss it.

Take seriously a​ patient’s feelings and expressions of despair or suicidal thoughts without dismissing or judging the​ patient’s behavior.

Question 15

H-15) When you are called to care for a patient who may be about to attempt​ suicide, your first concern should​ be:
A. for your own safety.
B. to restrain the patient.
C. to establish your authority over the patient.
D. to call law enforcement.

Answer 15

A. for your own safety

Whenever you are called to care for a patient who has attempted or may be about to attempt​ suicide, your first concern must be your own safety. Not all patients will wish to harm​ you, but the mechanism used to attempt suicide will be capable of causing death. It could intentionally or accidentally be turned on you.

Question 16

H-16) You should leave a patient who is suicidal​ alone:
A. when law enforcement arrives on the scene.
B. if you feel that the patient is likely to commit suicide.
C. only if you are at risk of physical harm.
D. if the patient is verbally abusive and irrational.

Answer 16

C. only if you are at risk of physical harm.

Question 17

H-17) For a psychiatric​ patient:
A. reassessment should be confined to trending vital signs.
B. take the​ patient’s history only from family​ members, not the patient.
C. you may not be able to complete a detailed examination.
D. you will never perform a physical exam.

Answer 17

C. you may not be able to complete a detailed examination.

A physical exam may be difficult with a psychiatric patient. Because of​ this, you may not be able to begin or complete the physical exam.

Question 18

H-18) Restraining a​ patient:
A. is always indicated for any patient in a behavioral emergency.
B. involves careful planning and adequate assistance.
C. is a decision​ you’ll likely make in the moment.
D. should be as forceful as possible to ensure success.

Answer 18

B. involves careful planning and adequate assistance.

Restraining a patient involves having a​ well-delineated plan of action before attempting the restraint and having adequate assistance

Question 19

H-19) Once you decide to restrain a​ patient, how quickly should the intervention be carried​ out?
A. Only after the patient agrees to restraints
B. As quickly as possible
C. Without police assistance
D. Slowly

Answer 19

B. As quickly as possible

Carrying out the procedure as quickly as possible not only will take the patient by​ surprise, which may work to your​ advantage, but also will eventually result in the​ de-escalation of the scene so that you can begin treating the patient.

Question 20

H-20) Why is it dangerous to restrain a patient in the prone​ position?
A. It takes more rescuers to restrain a patient that way.
B. It can be the cause of positional asphyxia and lead to cardiac arrest.
C. Patients are harder to place on the stretcher that way.
D. The police will not allow that to be done.

Answer 20

B. It can be the cause of positional asphyxia and lead to cardiac arrest

Never restrain a patient in the prone​ position, as the patient may seem to calm down but may actually be going into respiratory or cardiac arrest as a result of positional asphyxia.

Question 21

H-21) You are transporting a stable patient with a behavioral problem. You​ should:
A. put a​ same-sex provider in the back with the​ patient, if possible.
B. restrain the patient for transport.
C. request that law enforcement ride in with you.
D. leave the patient unattended in the back.

Answer 21

A. put a​ same-sex provider in the back with the​ patient, if possible

Emotionally disturbed patients sometimes accuse EMS personnel of sexual misconduct. If​ possible, EMTs of the same sex as the patient should attend to the emergency care of a disturbed patient.

Question 22

H-22) Which of the following is true of excited​ delirium?
A. The patient is usually hypersensitive to pain.
B. The patient often has a history of dementia.
C. It is often associated with alcohol withdrawal.
D. It is often associated with cocaine or amphetamine use.

Answer 22

D. It is often associated with cocaine or amphetamine use

Excited delirium entails bizarre​ and/or aggressive​ behavior, shouting,​ paranoia, panic, violence toward​ others, insensitivity to​ pain, unexpected physical​ strength, and/or​ hyperthermia, usually associated with cocaine or amphetamine use

Question 23

H-23) Inadequate breathing or respiratory arrest caused by a body position that restricts breathing​ is:
A. circumstantial hypoxia.
B. restraint dyspnea.
C. positional asphyxia.
D. receptive aphasia.

Answer 23

C. positional asphyxia

Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing

Question 24

H-24) You are at the scene of a​ middle-aged man who attempted to take his own life by cutting both of his wrists deeply. He is distraught over the death last week of his wife of 30 years. He is conscious and refuses any care or​ transport, and he warns you and your partner to stay away from him. He is unarmed but bleeding freely. Which of the following is the best course of​ action?
A. Wait until the patient bleeds sufficiently to cause​ unconsciousness, and then treat him.
B. Request law enforcement assistance and contact medical direction for advice.
C. Immediately restrain the patient against his will and treat him accordingly.
D. Follow the​ patient’s commands and leave the scene immediately.

Answer 24

B. Request law enforcement assistance and contact medical direction for advice

It will always be beneficial to have the police present if the patient must be restrained as a matter of safety. You may also be required to contact medical direction about the psychiatric patient who refuses care

Question 25

PT-1) Early signs of potential impending violence​ include:
A. refusing to talk or interact with you.
B. anxiety and panicky behavior.
C. ​long, rambling conversations.
D. quietly sitting and crying.

Answer 25

B. anxiety and panicky behavior.

Question 26

PT-2) If a​ patient's erratic, confused behavior suddenly subsides into calm and​ rationality, the least likely cause of the​ erratic, confused behavior​ was:
A. hypoxia.
B. hypoglycemia.
C. head trauma.
D. ​mind-altering substances.

Answer 26

C. head trauma

Question 27

PT-3) You are restraining a patient who continues to spit at you. What should you​ do?
A. Restrain the patient in the prone position
B. Put a surgical mask on the patient
C. Consider tightening the restraints so that they are painful
D. Refuse to transport the patient

Answer 27

B. Put a surgical mask on the patient

Question 28

PT-4) Regarding caring for a patient who is experiencing a situational stress​ reaction, which of the following statements is true or​ appropriate?
A. The patient can be snapped out of the reaction by a​ stern, loud command.
B. Tell the patient immediately that whatever is causing stress​ isn’t important.
C. Engaging in a quiet and careful review of the​ patient’s situation is best.
D. Taking a​ zero-tolerance attitude toward anything the patient does that you find unacceptable is essential.

Answer 28

C. Engaging in a quiet and careful review of the​ patient’s situation is best

Question 29

PT-5) What adjective best describes the attitude you should take toward a patient experiencing a situational stress​ reaction?
A. Lofty
B. Fawning
C. Dominant
D. Attentive

Answer 29

D. Attentive

Question 30

PT-6) Physical contact and eye contact with a patient in a psychiatric emergency should​ be:
A. avoided no matter what.
B. direct and frequent.
C. natural and necessary for the situation.
D. prolonged and constant.

Answer 30

C. natural and necessary for the situation

(Page 751)
Bullet 3 - Make eye contact with patient
Bullet 8 - Do not enter a patient’s personal space. Stay at least 3 feet from your patient.

So, the question is actually not a great question, because you can do BOTH - maintain eye contact, WITHOUT entering the patient’s personal space. You do NOT want to make either of these “prolonged and constant” as this makes EVERYONE uncomfortable.
You additionally, do not want to avoid eye contact, regardless of how long it takes to get the trust of your patient and be able to make physical contact.
The direct and constant, is not something you do on ANY patient, much less a patient with a patient in a psychiatric emergency.

Question 31

PT-7) ​Bizarre, aggressive behavior is exhibited by patients​ with:
A. anxiety.
B. depression.
C. excited delirium.
D. phobia.

Answer 31

C. excited delirium

Question 32

PT-8) A patient who threatens to harm himself or his wife because he is sure she is plotting against him with her sister; although both she and her sister deny it; ​is:
A. in a behavioral emergency if he is lying.
B. certainly lying but not in a behavioral emergency.
C. in a behavioral emergency.
D. possibly telling the​ truth, and behaving​ normally, if so.

Answer 32

C. in a behavioral emergency

Question 33

PT-9) The manner in which someone acts is known​ as:
A. schizophrenia.
B. behavior.
C. bipolar disorder.
D. phobia.

Answer 33

B. behavior.

Question 34

PT-10) Which example best demonstrates providing reassurance to a patient who appears to be​ suicidal?
A. You listen carefully to the​ patient’s concerns and indicate that hospital treatment is best.
B. You relate your own struggles with dark thoughts.
C. You ask the patient if he feels his emotional pain is somehow unique.
D. You validate the​ patient’s emotions by agreeing that life is often overwhelming.

Answer 34

A. You listen carefully to the​ patient’s concerns and indicate that hospital treatment is best.

Question 35

PT-11) Which of the following actions or risk factors is the least indicative of a potential suicide​ attempt?
A. Previous suicide attempts
B. Having a detailed plan for suicide
C. Calling 911 for help
D. Recent improvements from deep depression

Answer 35

C. Calling 911 for help

Question 36

PT-12) Which of the following should you do when interacting with a behavioral​ patient?
A. Avoid discussing what is troubling the patient
B. Lie to the patient if it assists with your assessment
C. Limit the interaction to no more than 15 minutes
D. Encourage the patient to discuss what is troubling the patient

Answer 36

D. Encourage the patient to discuss what is troubling the patient

(Page 753)
Do this, but DO NOT dwell on stressors or situations that escalate the current behavior

Question 37

PT-13) What is least likely to be a sign of a psychiatric​ emergency?
A. A patient appears to be panicked and anxious.
B. A patient cries out in pain.
C. A patient appears to be unable to use appropriate words to express himself.
D. A patient is engaged in​ obsessive, repetitive movements of his hands and arms.

Answer 37

B. A patient cries out in pain

Question 38

PT-14) Which of the following is defined as a situation in which a​ patient's behavior becomes so​ bizarre, threatening, or dangerous that it alarms the patient or others and requires​ intervention?
A. Abnormal behavior
B. Overdose
C. Psychosis
D. Behavioral emergency

Answer 38

D. Behavioral emergency

Question 39

PT-15) You are caring for a​ 27-year-old male who is screaming and throwing dishes in the kitchen. The family called EMS because they are concerned about his behavior. They inform you that his father just died that day. What can you reasonably​ conclude?
A. That the​ patient’s behavior is normal in the circumstances and deserves support and monitoring
B. That the​ patient’s behavior should simply be accepted and ignored until it stops
C. That the​ patient’s behavior is unacceptable and​ intolerable, even if the reason is understandable
D. That the patient is in a behavioral emergency brought on by grief

Answer 39

A. That the​ patient’s behavior is normal in the circumstances and deserves support and monitoring

(Page 747)
Behavioral Emergencies are looked at in the context of “within a given situation.” In this situation, the patient found out about his father dying that day. Part of a situation such as this include screaming, crying, throwing things, or other outbursts. So, in this context, the patients, behavior would not be unusual, but would deserve support and monitoring of the patient.

Question 40

PT-16) As you physically examine a patient who might be in a behavioral​ emergency, you​ should:
A. be alert for any relevant medical and traumatic conditions.
B. make the examination as rapid and abbreviated as possible.
C. stop at the first sign that appears to point to a psychiatric cause for the​ patient’s behavior.
D. expect to find clear evidence of mental illness.

Answer 40

A. be alert for any relevant medical and traumatic conditions

Question 41

PT-17) Which patient is least likely to be in danger of committing​ suicide?
A. A patient who tells you he feels hopeless about the world
B. A patient who has just been fired after 20 years of service
C. A patient who is drunk and seems violent
D. A patient in respiratory distress who is displaying anxiety

Answer 41

D. A patient in respiratory distress who is displaying anxiety

This would be a medical situation versus the other ones which are in the lines of a behavioral/suicide threat situation

Question 42

PT-18) You are caring for a​ 19-year-old male patient who has multiple superficial lacerations over each​ wrist, in different stages of healing. When you ask him what the marks are​ from, he states that he sustained them when he was trying to climb over a chain link fence. You suspect multiple attempts at suicide. What should you​ do?
A. Report your suspicions to the staff at the receiving hospital
B. Inform the patient that he needs to be honest about any suicide attempts
C. State that transport must be delayed until an exact cause for injuries may be determined
D. Accept the​ patient’s explanation, and simply remind him to be more careful

Answer 42

A. Report your suspicions to the staff at the receiving hospital

Question 43

PT-19) What is a​ physical, non-psychiatric cause for strange​ behavior?
A. Obsessive-compulsive disorder
B. Posttraumatic stress disorder
C. Schizophrenia
D. Hypoxia

Answer 43

D. Hypoxia

Question 44

PT-20) What is the most likely reason medical control would direct you to forcibly restrain a​ patient?
A. The patient has verbally threatened EMS workers.
B. The patient is clinically depressed.
C. The patient is a danger to self.
D. The patient has a​ life-threatening condition.

Answer 44

C. The patient is a danger to self

Question 45

PT-21) A patient who told his friend that he planned to commit suicide is refusing ambulance transportation but is agreeable to going to the hospital via a​ friend’s private vehicle. What action should you take at this​ point?
A. Allow the friend to transport the patient via private vehicle.
B. Have your partner accompany the patient in the​ friend’s car.
C. Have the patient sign a refusal of care and transportation form.
D. Contact medical direction for assistance.

Answer 45

D. Contact medical direction for assistance

Question 46

PT-22) If a patient becomes​ violent, your first action should be​ to:
A. restrain the patient.
B. try to calm the patient.
C. call for additional resources.
D. retreat from the​ scene, if possible.

Answer 46

D. retreat from the​ scene, if possible

Question 47

CT-1) When managing a patient who may hurt himself or​ others, you should do all of the following except​:
A. keep bystanders a safe distance away.
B. watch for sudden changes in the​ patient’s behavior.
C. make sure only you and the patient are in the room.
D. retreat if the patient becomes threatening.

Answer 47

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

You want to avoid isolating yourself

Question 48

CT-2) Which of the following medical conditions could be the underlying cause of an apparent behavioral​ emergency?
A. Stroke
B. Mental illness
C. Hypoglycemia
D. All of the above

Answer 48

D. All of the above

Question 49

CT-3) Which of the following factors suggest that a patient is at risk for​ suicide?
A. Sudden improvement in depression
B. Alcohol and drug abuse
C. Recent emotional trauma
D. All of the above

Answer 49

D. All of the above

Question 50

CT-4) 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. sensory excitement.
B. excited delirium.
C. chemical delirium.
D. delusions.

Answer 50

B. excited delirium

Question 51

CT-5) Which of the following statements concerning forcible restraint of patients is true​?
A. This is normally considered to be within the jurisdiction of law enforcement.
B. This is necessary only with mentally ill individuals.
C. It is easily accomplished by two EMTs with a good plan.
D. It causes irreparable emotional harm to most patients.

Answer 51

A. This is normally considered to be within the jurisdiction of law enforcement.

Question 52

CT-6) 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 into the other room so you can speak with the patient alone.
B. Quickly check the​ patient’s carotid pulse.
C. Stay a safe distance away.
D. Ask the wife to step outside with you so you can get information from her.

Answer 52

C. Stay a safe distance away

Question 53

CT-7) Which of the following does not indicate that a patient may be about to become​ violent?
A. Rapid speech and movement
B. Tense body posture or clenched fists
C. Crying
D. Rapid pulse and breathing

Answer 53

C. Crying

Question 54

CT-8) Which of the following is appropriate when assessing an emotionally disturbed​ patient?
A. Establish eye and verbal contact.
B. Both A and B
C. Use assertive body language to show you are in control.
D. Listen to the patient without being judgmental.

Answer 54

B. Both A and B

There IS no B!!!

Question 55

CT-9) Which of the following statements concerning people who have made prior suicide attempts is true​?
A. They should be allowed to sign a release if their injuries are not serious.
B. They are usually just making a cry for help but do not want to die.
C. They are at an increased risk for a subsequent successful suicide.
D. They do not require psychological counseling like a person who is depressed.

Answer 55

C. They are at an increased risk for a subsequent successful suicide.

Question 56

CT-10) 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 is a threat to himself or others.
B. The​ patient’s personal physician gives you permission.
C. A family member gives consent and is willing to accompany the patient.
D. The​ patient’s insurance company agrees to​ pay, even though the patient has not given consent.

Answer 56

A. The patient is a threat to himself or others.

Question 57

CT-11) Which of the following actions is the most appropriate for the EMT to take when managing a patient with a behavioral​ emergency?
A. Remain calm and reassure the patient.
B. Quickly perform a​ head-to-toe exam and transport without delay.
C. Establish control of the situation by a show of force.
D. Find out if the​ patient’s insurance covers psychiatric treatment.

Answer 57

A. Remain calm and reassure the patient

Question 58

CT-12) Which of the following statements concerning behavioral emergencies is true​?
A. Emotional outbursts are considered behavioral emergencies.
B. A person with a behavioral emergency is mentally ill.
C. The person with a behavioral emergency requires prolonged institutionalization.
D. It may be difficult to determine what behavior is abnormal for a given person in a given situation.

Answer 58

D. It may be difficult to determine what behavior is abnormal for a given person in a given situation

Question 59

CT-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 mental status 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 non-psychiatric 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, 3
B. ​1, 2
C. ​1, 2,​ 3, 4
D. ​1, 3, 4

Answer 59

C. ​1, 2,​ 3, 4

Question 60

CT-14) 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. Alcohol withdrawal
C. An underlying physical illness
D. Sudden onset of schizophrenia

Answer 60

C. An underlying physical illness

Question 61

CT-15) Your patient is a​ 15-year-old female who has been 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. Refuse to transport the patient without a police escort.
B. Have a female EMT attend to the patient.
C. Transport the​ patient, but do not speak to her or perform an assessment.
D. Ask that the patient be given a tranquilizer injection prior to transport.

Answer 61

B. Have a female EMT attend to the patient

Question 62

CT-16) 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 she tells you to get away from her. Which of the following should not be​ done?
A. Use Standard Precautions.
B. Call law enforcement for assistance.
C. Keep bystanders away from the patient.
D. Take the razor blade away from her by force.

Answer 62

D. Take the razor blade away from her by force

Question 63

CT-17) Which of the following may cause a patient to exhibit abnormal​ behavior?
A. Gastroenteritis
B. Allergic reaction
C. Snakebites
D. Hypoxia

Answer 63

D. Hypoxia

Question 64

CT-18) When responding to an attempted​ suicide, which of the following is the​ EMT’s primary​ concern?
A. Managing the​ patient’s airway
B. Determining whether the patient suffers from clinical depression
C. Contacting law enforcement because suicide is illegal
D. Personal safety

Answer 64

D. Personal safety

Question 65

CT-19) 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. Behavioral emergency
B. Mental illness
C. Psychosomatic reaction
D. Psychotic episode

Answer 65

A. Behavioral emergency

Question 66

CT-20) 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 for dealing with this​ situation, which step is the most​ important?
A. Secondary assessment
B. Primary assessment
C. Vital signs and SAMPLE history
D. Scene​ size-up

Answer 66

D. Scene​ size-up

Question 67

CT-21) You respond to the scene of a private residence for a patient who is known to have​ insulin-dependent diabetes. 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. There is not enough information to answer this question.
D. ​Yes, he is combative and all combative patients can be restrained.

Answer 67

C. There is not enough information to answer this question.

Question 68

CT-22) You are on the scene of a possible overdose. You find a​ 30-year-old man pacing around 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. Repeat part of what the patient is saying to show that you are listening to him.
B. Stand still with your arms crossed to instill a sense of control and authority.
C. Sit close to him with your arm around his shoulders to show that you are truly concerned.
D. Speak quickly to give the patient all of the important information without delay.

Answer 68

A. Repeat part of what the patient is saying to show that you are listening to him.

(Page 751)
Bullet 6 - Use positive body language. Avoid crossing your arms or looking uninterested
Bullet 8 - Do not enter patient’s personal space. Stay at least 3’ from the patient (Making the patient feel closed in can cause an emotional outburst)
Bullet 2 - Speak slowly and clearly. Use a calm and reassuring tone

Question 69

CT-23) 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 not be appropriate in treating this​ patient?
A. Contact the receiving hospital and report on current mental status and other essential information.
B. Take charge of the​ situation; let the patient know that what he has done is wrong and tell him he is coming with you whether he likes it or not.
C. Watch for sudden changes in the​ patient’s behavior and physical condition.
D. As soon as​ possible, perform a history and physical exam and provide emergency care on the​ wrist, if necessary.

Answer 69

B. Take charge of the​ situation; let the patient know that what he has done is wrong and tell him he is coming with you whether he likes it or not.

Question 70

CT-24) Which of the following is acceptable when managing the patient with a behavioral or psychiatric​ emergency?
A. Allow family members to confront the patient about his behavior.
B. Make supportive statements such​ as, “That must have been very hard for​ you.”
C. Sit as close to the patient as you can to reassure him that you will not abandon him.
D. Go along with the​ patient’s hallucinations or false beliefs.

Answer 70

B. Make supportive statements such​ as, “That must have been very hard for​ you.”

Question 71

CT-25) 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 cause this​ behavior?
A. Head injury
B. Stroke
C. Low blood sugar
D. Lack of oxygen

Answer 71

A. Head injury

Question 72

CT-26) Which of the following is not an acceptable method or adjunct in restraining a​ patient?
A. Placing a surgical mask over the​ patient’s face to prevent spitting
B. Restraining the patient​ face-up
C. ​Hog-tying the patient
D. Securing all four limbs with leather restraints

Answer 72

C. ​Hog-tying the patient

Question 73

CT-27) 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. ​Post-traumatic stress disorder
C. Stress reaction
D. Catharsis

Answer 73

C. Stress reaction

Question 74

CT-28) 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 inadequate breathing or respiratory arrest caused by a body position that restricts breathing.
C. Positional asphyxia is a birth defect that causes psychiatric issues and is initiated because of the way the fetus was positioned in the uterus.
D. Positional asphyxia is the name for the position someone assumes after she has been hit with a taser.

Answer 74

B. Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing.

Question 75

CT-29) 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. Contact the​ patient’s family to find out what their wishes are.
B. Leave the scene and allow law enforcement to handle the situation.
C. Respect the​ patient’s wishes; he is​ alert, oriented, and capable of giving consent.
D. Transport the patient against his will with the assistance of law enforcement.

Answer 75

D. Transport the patient against his will with the assistance of law enforcement.

Question 76

CT-30) Concerning attempted​ suicide, which of the following statements is true​?
A. There is always an indication that a suicide attempt is imminent.
B. All suicide attempts must be taken seriously.
C. Attempted suicide is a matter for law​ enforcement, not EMS.
D. Truly suicidal patients nearly always leave a note.

Answer 76

B. All suicide attempts must be taken seriously

Question 77

CT-31) When providing emergency care to an aggressive or hostile​ patient, what is the highest​ priority?
A. Performing a scene​ size-up
B. Calming the patient down
C. Finding out if the patient is oriented to​ person, time, and place
D. Checking the patient for possible physical causes of the behavior

Answer 77

A. Performing a scene​ size-up

Question 78

CT-32) Which of the following traumatic conditions could account for signs and symptoms of a behavioral​ emergency?
A. Hemorrhage
B. Fractured tibia
C. Partial thickness burn
D. Fractured lumbar vertebra

Answer 78

A. Hemorrhage

Question 79

CT-33) 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. ​30-year-old married man who has just learned that his employer is transferring him to a different state
C. ​44-year-old woman who has just recovered from a serious illness
D. ​35-year-old female who has a child with a serious illness

Answer 79

A. ​22-year-old man who has lost his job and is getting divorced

Question 80

CT-34) Which of the following statements regarding behavioral emergencies is false​?
A. Patients experiencing a behavioral emergency are not always dangerous to themselves or others.
B. It is unusual to find a person with schizophrenia outside a mental health facility.
C. Apparent behavioral emergencies may be due to an underlying medical cause.
D. Cultural differences may cause a​ patient’s behavior to initially appear abnormal to the EMT.

Answer 80

B. It is unusual to find a person with schizophrenia outside a mental health facility.

Question 81

CT-35) 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 threatened to go​ out, get a​ gun, and shoot himself. His 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; doing so may bring about hostile behavior directed against you or others.
B. Always be on the watch for weapons.
C. Make certain the patient gets between you and the door. The patient should always feel he has an escape route.
D. Do not isolate yourself from your partner or other sources of help.

Answer 81

C. Make certain the patient gets between you and the door. The patient should always feel he has an escape route.

Question 82

CT-36) Why is it important to gather a detailed medical history when dealing with a psychiatric​ emergency?
A. It will help you to determine whether you need to restrain the patient.
B. It will help you to determine whether the police are needed.
C. It is not. You want to get the call resolved as quickly as possible and this will just delay it.
D. It will alert you to past issues as well as medication.

Answer 82

D. It will alert you to past issues as well as medication.

Question 83

CT-37) Which of the following must be treated by the EMT if present in a patient with an apparent behavioral​ emergency?
A. Hypoglycemia
B. Severe clinical depression
C. Suicidal ideology
D. Acute alcohol intoxication

Answer 83

A. Hypoglycemia

Question 84

CT-38) All of the following are general rules for dealing with a psychiatric patient except​:
A. listen to the​ patient, showing you are listening by repeating part of what the patient says back to him.
B. do not be​ judgmental; instead, show​ pity, because he needs to know that you understand him.
C. speak slowly and​ clearly, and use a calm and reassuring tone.
D. make eye contact with the patient.

Answer 84

B. do not be​ judgmental; instead, show​ pity, because he needs to know that you understand him.

(Page 751)
Bullet 5 - Show COMPASSION - NOT PITY

Question 85

CT-39) 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. This is the mechanism by which the impulse is moved along the nervous system.
B. Neurotransmitters are released from a​ neuron, then travel across the synapse to the next neuron.
C. After the impulse is​ transmitted, the neurotransmitter goes through a process called​ reuptake, in which the neurotransmitter is returned to the postsynaptic neuron.
D. The receptors on the postsynaptic neuron receive the neurotransmitter.

Answer 85

C. After the impulse is​ transmitted, the neurotransmitter goes through a process called​ reuptake, in which the neurotransmitter is returned to the postsynaptic neuron.

Question 86

CT-40) 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 direction 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.

Answer 86

A. Contact medical direction for further advice

Question 87

CT-41) There are general rules for dealing with psychiatric emergencies. Which of the following is not one of those rules and would not be considered​ appropriate?
A. Identify yourself and your role.
B. Never make eye contact with the​ patient, as it will just increase his nervousness.
C. Speak slowly and​ clearly, using a calm and reassuring tone.
D. Listen to the patient. You can show you are listening by repeating part of what the patient says back to him.

Answer 87

B. Never make eye contact with the​ patient, as it will just increase his nervousness.

Question 88

CT-42) EMTs may come across a situation where a patient begins to act extremely agitated or psychotic. Uncontrolled psychiatric illness and sometimes drug intoxication may be present. The patient may suddenly 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. psychotic delirium.
B. excited or agitated delirium.
C. bipolar disorder.
D. excited psychosis.

Answer 88

B. excited or agitated delirium

Question 89

CT-43) 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. 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.
B. Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can.
C. Quickly approach the patient and take charge. Tell him he has to come with you to be evaluated.
D. Have the police take​ charge, restrain the​ patient, and have him brought into your ambulance.

Answer 89

B. Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can.

Question 90

CT-44) Which of the following communication strategies should be used when dealing with a patient with a behavioral​ emergency?
A. Play along with any visual or auditory hallucinations the patient is experiencing.
B. Acknowledge the​ patient’s feelings.
C. Interrupt the patient if he appears to be going off on a tangent about something not concerning the immediate situation.
D. Stay 2 to 3 inches from the patient at all times to make him feel secure.

Answer 90

B. Acknowledge the​ patient’s feelings

Question 91

CT-45) When dealing with a psychiatric​ emergency, which one of the following would generally be inappropriate behavior on your​ part?
A. Let the patient know that you are listening to what he is​ saying, and explain things to the patient honestly.
B. 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.
C. Act in a calm​ manner, giving the patient time to gain control of his emotions.
D. Stay alert for sudden changes in behavior.

Answer 91

B. 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

Question 92

CT-46) When restraining a​ patient, which of the following is not a​ consideration?
A. How to position the patient
B. Number of people available to carry out the required actions
C. ​Patient’s size and strength
D. ​Patient’s informed consent

Answer 92

D. ​Patient’s informed consent

Question 93

CT-47) 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. There is no need to assess for medical conditions if the patient does not have a history of past medical problems.
B. Attempt to determine whether there is a possible physical cause for the​ patient’s behavior.
C. Begin intense individual counseling with the patient.
D. Establish the best way to restrain the patient before he has the opportunity to become violent.

Answer 93

B. Attempt to determine whether there is a possible physical cause for the​ patient’s behavior