Ch. 31

Question 1

In delirium tremens, dysfunction of the autonomic nervous system can lead to:

A) anxiety.
B) death.
C) confusion.
D) sleep disturbances.

Answer 1

B) death.

Page Ref: 721
Objective: 31.1 Define key terms introduced in this chapter.

Question 2

A condition that occurs as a result of panic disorder, phobia, or post-traumatic stress is termed:

A) dementia.
B) manic depression.
C) delirium.
D) anxiety.

Answer 2

D) anxiety.

Page Ref: 721
Objective: 31.1 Define key terms introduced in this chapter; 31.6 Recognize behavioral characteristics of mental health conditions.

Question 3

All of the following are good indicators of affect EXCEPT:

A) posture.
B) movements.
C) religious beliefs.
D) behavior.

Answer 3

C) religious beliefs.

Page Ref: 719
Objective: 31.1 Define key terms introduced in this chapter; 31.2 Explain the importance of being able to recognize and respond to patients suffering from behavioral emergencies.

Question 4

In the treatment of behavioral emergencies, ________ is/are MOST important for the AEMT.

A) interpersonal skills
B) three-point restraints
C) pulse oximetry monitoring
D) vital signs

Answer 4

A) interpersonal skills

Page Ref: 718
Objective: 31.2 Explain the importance of being able to recognize and respond to patients suffering from behavioral emergencies; 31.8 Incorporate the basic principles presented in the text into the assessment, communication, and management of patients with behavioral emergencies.

Question 5

The MOST important assessment technique in evaluating behavioral emergencies is:

A) auscultating lung sounds.
B) conversational skills.
C) defensive tactics.
D) obtaining vital signs.

Answer 5

B) conversational skills.

Page Ref: 718
Objective: 31.2 Explain the importance of being able to recognize and respond to patients suffering from behavioral emergencies; 31.8 Incorporate the basic principles presented in the text into the assessment, communication, and management of patients with behavioral emergencies.

Question 6

A situation in which a person’s behavior is so unusual that it alarms another person or requires intervention is a(n):

A) psychological crisis.
B) emotional dilemma.
C) behavioral emergency.
D) critical affective period.

Answer 6

C) behavioral emergency.

Page Ref: 718
Objective: 31.2 Explain the importance of being able to recognize and respond to patients suffering from behavioral emergencies.

Question 7

Which statement regarding behavioral emergencies is TRUE?

A) Any patient under immense stress will experience a behavioral emergency.
B) Any patient with a diagnosed mental illness will experience frequent behavioral emergencies.
C) Anyone ineffectively coping with stress will experience a behavioral emergency.
D) Anyone may experience a behavioral emergency given the right circumstances.

Answer 7

D) Anyone may experience a behavioral emergency given the right circumstances.

Page Ref: 718
Objective: 31.3 Describe indications of danger associated with response to behavioral emergencies.

Question 8

Problems related to a patient experiencing hallucinations or delusions are related to the patient’s:

A) sensorium.
B) bipolar disorder.
C) cognitive processes.
D) perceptual processes.

Answer 8

D) perceptual processes.

Page Ref: 720
Objective: 31.4 Discuss the underlying physical and psychological causes of behavioral emergencies.

Question 9

As part of the focused medical examination of the behavioral emergency, the AEMT should perform:

A) field sobriety tests.
B) a mental status evaluation.
C) pulse oximetry monitoring.
D) a head-to-toe trauma assessment.

Answer 9

B) a mental status evaluation.

Page Ref: 720
Objective: 31.5 Describe the focus of assessment and history taking for patients experiencing behavioral emergencies.

Question 10

A state of uneasiness, discomfort, apprehension, and restlessness is called:

A) dementia.
B) anger.
C) delirium.
D) anxiety.

Answer 10

D) anxiety.

Page Ref: 721-722
Objective: 31.6 Recognize behavioral characteristics of mental health conditions.

Question 11

An organic brain disease that is characterized by a significant change in behavior and loss of contact with reality is:

A) schizophrenia.
B) bipolar disorder.
C) depression.
D) anxiety.

Answer 11

A) schizophrenia.

Page Ref: 724
Objective: 31.6 Recognize behavioral characteristics of mental health conditions.

Question 12

All of the following are symptoms of a panic attack EXCEPT:

A) numbness and tingling.
B) palpitations.
C) nausea.
D) lethargy.

Answer 12

D) lethargy.

Page Ref: 722
Objective: 31.6 Recognize behavioral characteristics of mental health conditions.

Question 13

While it is normal for MOST people to experience some mild depression such as that experienced when a loved one dies, if depression is prolonged and severe, the patient is said to be having:

A) a major depressive episode.
B) delirium.
C) chronic anxiety.
D) PTSD.

Answer 13

A) a major depressive episode.

Page Ref: 723
Objective: 31.6 Recognize behavioral characteristics of mental health conditions.

Question 14

Chronic depression greatly increases the possibility of:

A) PTSD.
B) suicide.
C) chronic anxiety.
D) panic attacks.

Answer 14

B) suicide.

Page Ref: 723
Objective: 31.7 Describe risk factors associated with violence toward others and suicide.

Question 15

The MOST important factor in treating any behavioral problem is:

A) collecting evidence for examination at the hospital.
B) ensuring all patients are restrained prior to transport.
C) ensuring scene safety prior to approaching the patient.
D) obtaining a detailed examination of all patients.

Answer 15

C) ensuring scene safety prior to approaching the patient.

Page Ref: 719-720
Objective: 31.8 Incorporate the basic principles presented in the text into the assessment, communication, and management of patients with behavioral emergencies.

Question 16

Severe anxiety MOST closely resembles:

A) dementia.
B) schizophrenia.
C) delirium.
D) cardiac and respiratory conditions.

Answer 16

D) cardiac and respiratory conditions.

Page Ref: 721
Objective: 31.9 Prioritize patient care needs in terms of managing physical and behavioral problems.

Question 17

Your patient is experiencing hallucinations and is sure that there are bugs crawling on the inside of the ambulance. You should:

A) avoid recognizing the hallucination and act as if it is not happening.
B) use the hallucination to your advantage in keeping the patient safe.
C) agree with the patient, but assure the patient that they are safe.
D) assure the patient that there are no bugs, but acknowledge the patient’s feelings.

Answer 17

D) assure the patient that there are no bugs, but acknowledge the patient’s feelings.

Page Ref: 720
Objective: 31.10 Explain the importance of ongoing assessment of patients with behavioral emergencies.

Question 18

Which of the following patients has the GREATEST potential for violent behavior?

A) A patient who has witnessed the death of a spouse
B) A patient with delusions of being someone else
C) A patient with a knife who is stabbing a stuffed animal
D) A patient talking to himself

Answer 18

C) A patient with a knife who is stabbing a stuffed animal

Page Ref: 719
Objective: 31.11 Evaluate the need for involving law enforcement on behavioral emergency calls.

Question 19

You are on a scene with a patient who up until a few seconds ago was calm and compliant. Now he is brandishing a knife and threatening to kill you and your partner if you do not immediately leave. The man is intoxicated and police have been notified but have not yet arrived. Which of the following is your BEST course of action?

A) Attempt to “talk down” the patient.
B) Encourage the man’s wife to calm him down.
C) Remove yourself, your partner, and family from the house.
D) Immediately physically restrain the patient.

Answer 19

C) Remove yourself, your partner, and family from the house.

Page Ref: 719
Objective: 31.11 Evaluate the need for involving law enforcement on behavioral emergency calls; 31.18 Discuss substance abuse as a mental illness; 31.19 Describe the acute and long-term behavioral and physiologic effects of alcohol abuse and alcohol withdrawal.

Question 20

A group of five AEMTs is preparing to restrain a large and violent patient. Which one of the following instructions given by the team leader is MOST appropriate?

A) “I’ll explain to the patient what is happening and apply the restraints, and the rest of you will come at him from different directions, each taking a separate limb.”
B) “You grab his head and the rest of us will grab his legs and chest, and then let’s get him face down on the stretcher.”
C) “Since you are trained in martial arts, try to give him a kick to his stomach, then when he goes down, the rest of us will grab his arms and legs.”
D) “Two of us will get him from the front and the other two from the back. Let us do this slowly so no one gets hurt.”

Answer 20

A) “I’ll explain to the patient what is happening and apply the restraints, and the rest of you will come at him from different directions, each taking a separate limb.”

Page Ref: 726
Objective: 31.11 Evaluate the need for involving law enforcement on behavioral emergency calls; 31.13 Follow principles of safe physical restraint of patients.

Question 21

An alert and oriented 18-year-old woman has threatened to hurt herself but is refusing transport to the hospital. She is calm and states that she knows her rights and taking her would constitute false imprisonment. Her family is present and wants her to go to the hospital for help. Given the situation and the patient’s threat, what is your BEST course of action?

A) Have the patient sign a refusal that is witnessed by family.
B) Physically restrain the patient for transport.
C) Contact law enforcement for assistance.
D) Transport the patient on her father’s consent.

Answer 21

C) Contact law enforcement for assistance.

Page Ref: 719
Objective: 31.11 Evaluate the need for involving law enforcement on behavioral emergency calls; 31.15 Document all information pertinent to calls involving behavioral emergencies and patient restraint.

Question 22

In order to appropriately restrain a patient:

A) handcuffs need to be present.
B) you must believe the patient is a threat to himself or others.
C) more than five people must be present.
D) the patient needs to give prior consent.

Answer 22

B) you must believe the patient is a threat to himself or others.

Page Ref: 726
Objective: 31.12 Recognize indications for physical restraint of a patient; 31.15 Document all information pertinent to calls involving behavioral emergencies and patient restraint.

Question 23

Which one of the following patients is the AEMT justified in restraining?

A) Patient threatening to kill his wife and trying to leave the scene
B) Patient stating that he wants to kill himself and desires transport to the hospital
C) Patient with depression refusing transport
D) Patient with violent outbursts but at the present time is calm

Answer 23

A) Patient threatening to kill his wife and trying to leave the scene

Page Ref: 726
Objective: 31.12 Recognize indications for physical restraint of a patient; 31.14 Comply with legal principles when responding to patients with behavioral emergencies; 31.15 Document all information pertinent to calls involving behavioral emergencies and patient restraint.

Question 24

In general, the use of ________ restraints is discouraged.

A) hard
B) roller gauze
C) soft
D) leather

Answer 24

A) hard

Page Ref: 726
Objective: 31.13 Follow principles of safe physical restraint of patients.

Question 25

Which of the following techniques is preferred when restraining the combative patient who is a threat to himself and the emergency responders?

A) Supine with four-point restraint
B) Prone with four-point restraint
C) Supine with two-point restraint
D) Prone with two-point restraint

Answer 25

A) Supine with four-point restraint

Page Ref: 726
Objective: 31.13 Follow principles of safe physical restraint of patients.

Question 26

When restraining a patient, all of the following apply EXCEPT:

A) using restraint as a punishment.
B) ensuring the safety of your crew.
C) using the least amount of restraint necessary.
D) preserving the dignity of the patient.

Answer 26

A) using restraint as a punishment.

Page Ref: 726
Objective: 31.14 Comply with legal principles when responding to patients with behavioral emergencies.

Question 27

An integral part of care for the patient suffering a psychological emergency should include:

A) police presence.
B) oxygen by nonrebreather mask.
C) an authoritative presence.
D) developing a rapport with the patient.

Answer 27

D) developing a rapport with the patient.

Page Ref: 720
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency.

Question 28

A patient presents with inflated self-esteem, decreased need for sleep, and racing and delusional thoughts. This patient MOST likely suffers from:

A) conversion disorder.
B) schizophrenia.
C) bipolar disorder.
D) depression.

Answer 28

C) bipolar disorder.

Page Ref: 723
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency; 31.17 Consider physiologic differential diagnoses for patients presenting with indications of a psychiatric disorder.

Question 29

You are assessing a patient with schizophrenia. Friends called 911 because he was experiencing hallucinations this morning. He is prescribed thoiridazine and risperidone for his illness. Which of the following questions is MOST pertinent to the current situation and must be asked FIRST?

A) “Has your psychiatrist considered changing the dose of your medications?”
B) “Have you been taking your medications as prescribed?”
C) “Do you think that the hallucinations are real?”
D) “Do you drink alcohol to help get you through the day?”

Answer 29

B) “Have you been taking your medications as prescribed?”

Page Ref: 724
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency; 31.18 Discuss substance abuse as a mental illness.

Question 30

You have been called to an assisted living facility for a 43-year-old man who has a history of anxiety and schizophrenia and who, according to staff, is more confused today. The staff also states that he has refused to take his medications for the past three days. Your assessment reveals him to have no life threats to the ABCs, but he is slurring his speech and not making sense when he talks. As you review paperwork provided to you by staff, you note that he has a history of thyroid problems, diabetes, and hypertension. His pulse is 124, respirations 16, and blood pressure 154/70 mmHg. At this point, which one of the following actions is MOST important?

A) Determine reason for refusing medications.
B) Recheck the blood pressure.
C) Check his blood glucose level.
D) Restrain and transport the patient.

Answer 30

C) Check his blood glucose level.

Page Ref: 721
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency; 31.18 Discuss substance abuse as a mental illness.

Question 31

Which one of the following patient descriptions would the AEMT classify as a behavioral emergency?

A) 44-year-old woman with bipolar disorder complaining of a fever of 102.5°F
B) 36-year-old man with no known history who is hearing voices
C) 29-year-old man with diabetes who is suddenly confused
D) 56-year-old man with a history of schizophrenia who has stopped taking his medications

Answer 31

B) 36-year-old man with no known history who is hearing voices

Page Ref: 718
Objective: 31.17 Consider physiologic differential diagnoses for patients presenting with indications of a psychiatric disorder.

Question 32

A patient is found in an alleyway conscious, alert, and breathing. The patient complains of extreme nausea, chills, and is having hallucinations. He keeps asking for a “drink” of beer. You suspect:

A) schizophrenia.
B) a cognitive disorder.
C) bipolar disorder.
D) acute withdrawal.

Answer 32

D) acute withdrawal.

Page Ref: 725
Objective: 31.19 Describe the acute and long-term behavioral and physiologic effects of alcohol abuse and alcohol withdrawal.

Question 33

In your attempt to evaluate an agitated 39-year-old woman, you observe signs that might indicate impending violence. These signs include which of the following?

A) Pacing
B) Profuse sweating
C) Edema
D) Melancholy

Answer 33

A) Pacing

Page Ref: 719
Objective: 31.7 Describe risk factors associated with violence toward others and suicide.

Question 34

You are treating a 19-year-old who is exhibiting the following symptoms: anxiety, confusion, hallucinations, hyperthermia, tachycardia, and diaphoresis. For which of the following findings would the patient’s subjective emotional experience be necessary to ascertain?

A) Level of responsiveness
B) Affect
C) Mood
D) Distractibility

Answer 34

C) Mood

Page Ref: 720
Objective: 31.5 Describe the focus of assessment and history taking for patients experiencing behavioral emergencies.

Question 35

If the patient has a decreased level of responsiveness but appears to be breathing, what should you be MOST concerned about?

A) Protecting the patient’s airway
B) Protecting the patient’s privacy
C) Determining he patient’s mental status
D) Gathering the patient’s past history

Answer 35

A) Protecting the patient’s airway

Page Ref: 720
Objective: 31.9 Prioritize patient care needs in terms of managing physical and behavioral problems.

Question 36

The list of the patient’s medications is extremely important in the assessment of a patient with an apparent behavioral emergency. If a patient were to tell you that he was taking St. John’s wort, what condition might he be trying to treat?

A) Depression
B) Panic attack
C) Psychosis
D) Sleep disorder

Answer 36

A) Depression

Page Ref: 720, Table 31-2
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency.

Question 37

A patient is exhibiting signs of extreme stress, including tachycardia, tachypnea, and diaphoresis, and his family members report that he went blank for a few moments, staring off into space, and during this time was unresponsive to verbal stimuli. The patient does not remember this episode. This was the reason for their call to 911. The patient insists he is fine and does not need medical attention. He appears to be oriented to person, time, and place. Which of the following might be suspected for this patient?

A) Seizure
B) Uremia
C) Drugs
D) Hypoglycemia

Answer 37

A) Seizure

Page Ref: 721, Table 31-3
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency.

Question 38

Upon examination of the patient, you discover that she is currently taking benzodiazepines. Which of the following conditions typically is addressed by these medications?

A) Anxiety
B) Depression
C) Suicidal tendencies
D) Schizophrenia

Answer 38

A) Anxiety

Page Ref: 722
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency.

Question 39

Which of the following results in a person’s behavior being motivated by the desire to assume the sick role or the caretaker of a sick person and receive the associated attention?

A) Anorexia
B) Munchausen syndrome
C) Bipolar disorder
D) Psychosis

Answer 39

B) Munchausen syndrome

Page Ref: 722
Objective: 31.4 Discuss the underlying physical and psychological causes of behavioral emergencies.

Question 40

After assessing a patient experiencing a behavioral disorder, you determine that conducting a mental status exam would be useful. When conducting the MSE, what question might you ask?

A) Why are you behaving so strangely?
B) What is the day, month, and year?
C) What have you recently had to eat and drink?
D) Have you had a fever over the last few days?

Answer 40

B) What is the day, month, and year?

Page Ref: 722
Objective: 31.16 Given a number of patient scenarios, assess and manage patients presenting with indications of a psychiatric disorder or behavioral emergency.