Chapter 23

Question 1

Question 1
A 22-year-old male with a history of clinical depression called 9-1-1 and stated that he has attempted to kill himself. Your unit and law enforcement officers arrive at the scene simultaneously. You find the patient lying supine on the living room floor. He is unresponsive and cyanotic. An empty bottle of hydromorphone (Dilaudid) is found on an adjacent table. You should:
provide care after determining what Dilaudid is used for.
wait for the police to examine him before providing care.
open the patient’s airway and assess his respirations.
ask the police to handcuff the patient for safety purposes.

Answer 1

“open the patient’s airway and assess his respirations.”

Question 2

Question 2
A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing things in his house. You are familiar with the patient and have cared for him in the past for unrelated problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage this situation is to:
try to gain the patient’s trust by telling him that you see the vampires too.
request that the police officers arrest him and take him to the hospital.
approach the patient and calm him by placing your hand on his shoulder.
restrain the patient with appropriate force in order to treat his injuries.

Answer 2

“restrain the patient with appropriate force in order to treat his injuries.”

Question 3

Question 3
A 40-year-old male intentionally cut his wrist out of anger after losing his job. Law enforcement has secured the scene prior to your arrival. As you enter the residence and visualize the patient, you can see that he has a towel around his wrist and a moderate amount of blood has soaked through it. You should:
tell the patient that you want to help.
quickly tend to the bleeding wound.
calmly identify yourself to the patient.
approach the patient with caution.

Answer 3

“calmly identify yourself to the patient.”

Question 4

Question 4
A 78-year-old female presents with an acute change in her behavior. The patient’s son tells you that his mother has type 2 diabetes and was diagnosed with Alzheimer’s disease 6 months ago. The patient’s speech is slurred and she is not alert to her surroundings. You should:
allow the patient to refuse transport if she wishes.
transport the patient to a psychiatric facility.
conclude that the patient’s blood sugar is high.
inquire about the possibility of head trauma.

Answer 4

“inquire about the possibility of head trauma.”

Question 5

Question 5
After ensuring his or her own safety, the EMT’s next priority when caring for a patient with a behavioral emergency is to:
determine the underlying cause of the problem and offer advice.
transport the patient directly to a specialized psychiatric facility.
assess the patient’s response to his or her environment.
diagnose the patient’s problem and provide definitive treatment.

Answer 5

“assess the patient’s response to his or her environment.”

Question 6

Question 6
A physiologic disorder that impairs bodily function when the body seems to be structurally normal is called a:
seizure
drug and alcohol abuse
functional disorder
traumatic brain injury

Answer 6

“functional disorder”

Question 7

Question 7
A technique used to gain insight into a patient’s thinking, which involves repeating in question form what the patient has said, is called:
intuitive listening.
reflective listening.
active listening.
passive listening.

Answer 7

“reflective listening”

Question 8

Question 8
Common causes of acute psychotic behavior include all of the following, EXCEPT:
Alzheimer’s disease.
mind-altering substance use.
intense stress.
schizophrenia.

Answer 8

“Alzheimer’s disease.”

Question 9

Question 9
General guidelines for managing a patient with a behavioral emergency include:
placing the patient between yourself and an exit.
being prepared to spend extra time with the patient.
firmly identifying yourself as an EMS provider.
allowing the patient to be alone if he or she wishes.

Answer 9

“being prepared to spend extra time with the patient.”

Question 10

Question 10
In which position should you restrain a physically uncooperative patient?
With hands tied behind the back
Prone
With arms and legs bound together
Supine

Answer 10

“Supine”

Question 11

Question 11
Law enforcement personnel request your assistance for a 30-year-old man who was pulled over for erratic driving. The patient became acutely violent while he was being questioned, which required one of the officers to subdue him with a Taser. When you arrive and assess the patient, you find that he is very agitated and is experiencing apparent hallucinations. His skin is flushed and diaphoretic. You should:
limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to communicate with you.
suspect that he is acutely hypoglycemic, consider giving him one tube of oral glucose, and transport with lights and siren.
recognize that he is experiencing a complex psychiatric crisis, quickly load him into the ambulance, and transport without delay.
quickly rule out any life-threatening conditions and then perform a detailed secondary assessment as he is being restrained.

Answer 11

“limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to communicate with you.”

Question 12

Question 12
Posttraumatic stress disorder can happen after:
alcohol withdrawal.
extended periods of hyperthermia or hypothermia.
exposure to or injury from a traumatic occurrence.
a bout with depression.

Answer 12

“exposure to or injury from a traumatic occurrence.”

Question 13

Question 13
Signs of excited delirium include:
pallor, hypotension, and constricted pupils.
diaphoresis, tachycardia, and hallucinations.
slurred speech, bradycardia, and a high fever.
subdued behavior, crying, and suicidal thoughts.

Answer 13

“diaphoresis

Question 14

Question 14
The term ‘behavioral crisis’ is MOST accurately defined as:
a period of severe depression that lasts longer than 2 weeks and cannot be controlled with medications.
a medical illness with psychological symptoms that may lead to limited motor functioning.
a situation in which a patient of any age exhibits agitated, violent, or uncooperative behavior.
a sudden, violent outburst of an otherwise mentally stable person toward a family member.

Answer 14

“a situation in which a patient of any age exhibits agitated

Question 15

Question 15
Which of the following is an example of a functional behavioral disorder?
Schizophrenia
Drug addiction
Alzheimer’s disease
Head trauma

Answer 15

“Schizophrenia”

Question 16

Question 16
You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her entire world is crashing down around her. She further states that she has had frequent thoughts of suicide, but is not sure if she can actually go through with it. How should you manage this situation?
Encourage the patient to remain quiet during transport.
Ask the patient if she has developed a suicidal plan.
Have law enforcement place her in protective custody.
Leave the scene and have a neighbor check in on her.

Answer 16

“Ask the patient if she has developed a suicidal plan.”

Question 17

Question 17
You are assessing a conscious 55-year-old male with a sudden change in behavior. Which of the following clinical findings would be MOST suggestive of dysfunction of this patient’s central nervous system?
Excessive tearing or crying
Rapid eye movement
Consistent eye contact
An irregular pulse

Answer 17

“Rapid eye movement”

Question 18

Question 18
You may not be able to determine whether a person has a mental illness, but you can predict the person’s likelihood of becoming:
psychotic.
suicidal.
diabetic.
violent.

Answer 18

“violent”

Question 19

Question 19
You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive of this patient’s potential for violence?
The broken window
His shouting of obscenities
His large body size
His clenched fists

Answer 19

“His large body size”

Question 20

Question 20
You respond to a call for an unknown emergency. When you arrive at the scene, the patient’s husband meets you at the door and states that his wife has been depressed and has locked herself in an upstairs bedroom. He further tells you that he keeps his handgun in the bedroom. You should:
ask the husband to attempt to reason with his wife.
get in your ambulance and leave the scene immediately.
remain in a safe place and request law enforcement.
go upstairs with caution and attempt to talk to the patient.

Answer 20

“remain in a safe place and request law enforcement.”