Psychiatric Emergencies Flashcards
Which of the following is NOT a common pathophysiological cause of behavioral emergencies?
Question 1 options:
A)
Underlying psychiatric illness
B)
Use of recreational drugs and alcohol
C)
The environment
D)
Psychosocial stressors
the environment
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?
Question 2 options:
A)
Apply a cardiac monitor, IV, oxygen
B)
Make the patient comfortable on the stretcher, no ALS interventions
C)
Start an IV, and request orders for haloperidol
D)
Restrain the patient with four-point restraints, no ALS interventions
make the patient comfortable on the stretcher, no ALS interventions
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:
Question 3 options:
A)
habituation.
B)
tolerance.
C)
physical dependence.
D)
psychological dependence.
psychological dependence
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?
Question 4 options:
A)
Tell the patient that you want to help her, but you can’t unless she calms down.
B)
Tell the patient that you cannot help her unless she talks to you.
C)
Sit down so that you are at eye level with the patient.
D)
Maintain a distance of 3 to 5 feet from the patient.
sit down so that you are at eye level with the patient
Which of the following helps assess a patient’s potential for violence?
Question 5 options:
A)
Age
B)
Body language
C)
Gender
D)
Ethnicity
body language
Which of the following is described as the visible indication of mood?
Question 6 options:
A)
Level of consciousness
B)
Behavior
C)
Affect
D)
Mental status
affect
Which of the following statements about patient restraint is TRUE?
Question 7 options:
A)
Four-point restraints should be used.
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)
Restraints can be released once the patient is in control of himself.
four point restraints should be used
Which of the following is most likely to effectively gain the cooperation of a psychologically disturbed patient for physical examinations?
Question 8 options:
A)
Asking the patient’s permission to examine him
B)
Standing closer to and using more physical contact with the patient than usual
C)
Telling the patient you must examine him
D)
Telling the patient you cannot help him unless you do a thorough physical examination
asking the patients permission to examine him
Which of the following is the best method of communicating with an emotionally disturbed patient?
Question 9 options:
A)
Tell the patient you understand how he feels.
B)
Explain that you are concerned with the patient’s welfare.
C)
Agree with everything the patient says.
D)
Ignore statements that are irrelevant to the situation.
explain that you are concerned with the patients welfare
Which of the following is most relevant to your decisions about how to handle a potentially violent patient?
Question 10 options:
A)
Whether or not the patient is taking antipsychotic medications
B)
The patient’s current behavior
C)
The fact that you have transported this patient many times and he has never become violent
D)
The family’s reassurances that the patient never harmed anyone
the patients current behavior
Which of the following statements about consent is accurate?
Question 11 options:
A)
People who are alert and oriented to person, place, and time may not be transported against their will.
B)
Competent people may not be transported against their will.
C)
People cannot be transported against their will unless a first-degree relative (spouse, adult child, parent, or sibling) agrees.
D)
People cannot be transported against their will unless there is a court order to do so.
competent people may not be transported against their will
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?
Question 12 options:
A)
The patient requires medical treatment.
B)
Suicide is not likely as long as the husband remains supportive.
C)
Postpartum depression is common, but it is not linked to suicide.
D)
She should be advised not to have additional children.
the patient requires medical treatment
Which of the following best describes perceived loss of physical functioning without medical or traumatic cause?
Question 13 options:
A)
Catatonia
B)
Body dismorphic disorder
C)
Somatization disorder
D)
Conversion disorder
conversion disorder
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?
Question 14 options:
A)
Schizoaffective disorder
B)
Methamphetamine use
C)
Cocaine use
D)
Bipolar disorder
bipolar disorder
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?
Question 15 options:
A)
The paramedic is using direct questioning about suicidal intentions.
B)
The patient has had three glasses of wine since the fight.
C)
The patient has access to a method of suicide.
D)
The patient has called her sister to come and get her dog.
the paramedic is using direct questioning about suicidal intentions
Which of the following best describes a feeling of alarm at the expectation of danger?
Question 16 options:
A)
Rage
B)
Fear
C)
Stress
D)
Phobia
fear
Which of the following statements about patient restraint is FALSE?
Question 17 options:
A)
Verbal methods of deescalation should be tried before considering physical restraint.
B)
Neuromuscular blocking agents should never be used to restrain a patient.
C)
Restraining the thighs just above the knees can be more effective at preventing kicking than restraining at the ankles.
D)
Patients should be transported in a prone position.
patients should be transported in a prone position
Which of the following best describes the position or bearing of the body?
Question 18 options:
A)
Affect
B)
Facies
C)
Stature
D)
Posture
posture
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?
Question 19 options:
A)
The patient having a father who committed suicide when the patient was a teenager
B)
A previous nonlethal attempt at suicide
C)
The patient’s being married
D)
The patient having ingested a substantial amount of alcohol
the patient’s being married
Which of the following is NOT associated with anorexia nervosa?
Question 20 options:
A)
Intense fear of obesity
B)
Excessive fasting
C)
Intentionally inducing vomiting after eating
D)
Cessation of menstruation
intentionally inducing vomiting after eating
Which of the following best describes an emotional reaction characterized by rage?
Question 21 options:
A)
Irrationality
B)
Anger
C)
Emotional lability
D)
Dread
anger
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?
Question 22 options:
A)
Contact medical direction.
B)
Request law enforcement assistance for legal detention of the patient for transport to the ED.
C)
Restrain the patient if necessary and transport.
D)
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.
contact medical direction
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?
Question 23 options:
A)
Have the patient sign a refusal of service form, but let him know he can call you back if he changes his mind.
B)
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.
C)
Explain to the neighbor that the patient is behaving as expected and the only treatment is time.
D)
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.
explain to the patient that is is common for people in his situation to feel depressed and you would like to help him by transporting him to the only treatment hospital
Which of the following is NOT considered an appropriate method of controlling a combative patient in the prehospital setting?
Question 24 options:
A)
Pepper spray
B)
Droperidol
C)
Verbal deescalation
D)
Leather restraints
pepper spray
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?
Question 25 options:
A)
Dysthymia
B)
Schizoaffective disorder
C)
Depression
D)
Bipolar disorder
depression
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?
Question 26 options:
A)
Lorazepam
B)
Droperidol
C)
Diazepam
D)
Physical restraint
droperidol
Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder?
Question 27 options:
A)
Taking recreational drugs and using alcohol
B)
Medical illness
C)
Stressful situations
D)
Following the same routine daily
following the same routine daily
Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness?
Question 28 options:
A)
Paranoia
B)
Mania
C)
Anxiety
D)
Depression
anxiety
Which of the following is NOT an organic cause of a behavioral emergency?
Question 29 options:
A)
Tumor
B)
Alcoholic encephalopathy
C)
Hypoglycemia
D)
Dementia
hypoglycemia
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?
Question 30 options:
A)
Have the police place the patient under immediate detention, and transport the patient in restraints.
B)
Have the patient sign a refusal form as long as the roommate will take responsibility for staying with him.
C)
Consider it a police matter, and mark in service.
D)
Tell the patient you must take his suicide threat seriously and transport him for evaluation.
tell the patient that you must take his suicide threat seriously and transport him for evaluation
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?
Question 31 options:
A)
IV, haloperidol
B)
Oxygen, IV, nitroglycerin, aspirin, morphine
C)
IV, diazepam
D)
Oxygen
IV diazepam
Which of the following best describes a state of disorientation or disorganized thought?
Question 32 options:
A)
Confabulation
B)
Neurosis
C)
Delusion
D)
Confusion
confusion
Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder?
Question 33 options:
A)
Situational stresses
B)
Being released from an institution back into the public
C)
Failure to keep counseling appointments
D)
Noncompliance with medications
noncompliance with medications
Which of the following best describes a person’s state of cerebral functioning?
Question 34 options:
A)
Intelligence
B)
Level of consciousness
C)
Affect
D)
Mental status
mental status
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?
Question 35 options:
A)
Bipolar disorder
B)
Schizophrenia
C)
Acute dystonic reaction
D)
Schizotypal personality disorder
schizophrenia
Which of the following best describes four-point restraints?
Question 36 options:
A)
Straps restraining the patient across the chest, hips, thighs, and legs
B)
A commercially manufactured restraint device
C)
A separate restraint on each of the four extremities
D)
Restraint of the head, torso, arms, and legs
a separate restraint on each of the extremities
Which of the following best describes the correct positioning of a restrained patient?
Question 37 options:
A)
Prone, ensuring the restraints are not loose enough to allow patient movement
B)
Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing
C)
Left lateral recumbent, ensuring the restraints are not tight enough to affect breathing or circulation
D)
Prone, sandwiched between the cot and a long backboard to prevent movement
supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing
Your patient is in four-point restraints and starts to spit at you during transport. You should:
Question 38 options:
A)
wear a HEPA respirator or an N-95 mask.
B)
place a surgical mask over the patient’s mouth and nose.
C)
put a nonrebreather mask on the patient but do not administer oxygen.
D)
place the patient prone, with his face turned away from you.
place a surgical mask over the patients mouth and nose
An example of a direct injury that may be sustained by a behavioral patient who has been TASERed would be:
Question 39 options:
A)
the ignition of the combustible gases that are present after firing the TASER.
B)
the resultant blunt force trauma caused by the fall that ensues after the electrical impulse.
C)
the damage caused by the impact of the probe.
D)
the muscle contractions that occur as a result of the electrical impulse.
damage caused by the impact of the probe
You are caring for a patient that was TASERed by the police for being physically aggressive. This type of restraint works by what mechanism?
Question 40 options:
A)
It renders the patient unconscious.
B)
It disrupts voluntary control of skeletal muscles.
C)
It paralyses the lower extremities.
D)
It temporarily stuns the cerebral hemispheres.
it disrupts voluntary control of the skeletal muscles
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:
Question 41 options:
A)
direct injury.
B)
tertiary injury.
C)
secondary injury.
D)
primary injury.
direct injury
An emergency in which the patient’s behavior is unusual, bizarre, threatening, or dangerous is referred to as a:
Question 43 options:
A)
behavioral emergency.
B)
psychiatric emergency.
C)
personal assist.
D)
code greens.
behavioral emergency
Behavioral disorders NOT related to substance abuse or medical conditions are known as:
Question 44 options:
A)
sociocultural disorders.
B)
nature behavior.
C)
psychosocial disorders.
D)
nurture behavior.
psychosocial disorders
Which of the following patients that have been TASERed do NOT meet the acceptable criteria to remove the TASER darts?
Question 42 options:
A)
A patient with a room SpO2 of 96 percent
B)
A patient with the TASER dart embedded in the URQ of the abdomen
C)
A patient with the TASER dart embedded in the neck
D)
A patient with a heart rate of 105/min
a patient with the taser dart embedded in the neck
Behavior disorders related to a patient’s socioeconomic status, social habits, skills, and values are said to be:
Question 45 options:
A)
sociocultural disorders.
B)
psychosocial disorders.
C)
nature behavior.
D)
nurture behavior.
sociocultural disorders
A clue that the scene may NOT be safe to enter would be:
Question 46 options:
A)
an overgrown lawn.
B)
broken-down cars.
C)
a messy house.
D)
broken glass and furniture.
broken glass ad furniture
Observing the patient for clues of violence should include the patient’s:
Question 47 options:
A)
appearance and clothing.
B)
ability to answer your questions.
C)
appearance and financial background.
D)
posture and hand gestures.
posture and hand gestures
A mental status exam on a behavioral emergency should include all of the following EXCEPT:
Question 48 options:
A)
sensorium.
B)
orientation.
C)
mood and affect.
D)
time since diagnosis.
time sense diagnosis
A behavior disorder characterized by relatively rapid onset of widely disorganized thought is:
Question 49 options:
A)
disassociation.
B)
delusions.
C)
dementia.
D)
delirium.
delirium
The third leading cause of death for 15- to 24-year-olds is:
Question 50 options:
A)
accidents.
B)
suicide.
C)
drug abuse.
D)
trauma.
suicide
Which of the following is NOT a known risk factor for attempting suicide?
Question 51 options:
A)
Previous attempts
B)
Isolation
C)
Delirium
D)
Loss of independence
Delirium
When dealing with a geriatric behavior crisis, you should:
Question 52 options:
A)
chemically restrain the patient.
B)
be sure to call the patient by a nickname to establish a rapport.
C)
avoid administering any medication.
D)
medicate the patient as soon as possible.
avoid administering any medication
When dealing with the pediatric patient in a behavioral crisis, you should:
Question 53 options:
A)
talk to the child like an adult.
B)
alter the truth to persuade the child.
C)
allow the child to keep a favorite toy or blanket.
D)
give the child some time alone to think.
allow the child to keep a favorite toy or blanket
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:
Question 54 options:
A)
multiple personality disorder.
B)
psychosis.
C)
dissociative disorder.
D)
excited delirium.
excited delerium
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:
Question 55 options:
A)
excited delirium and physical restraints.
B)
excited delirium and TASER removal.
C)
letting law enforcement transport.
D)
excited delirium and the need for chemical restraint.
excited delirium and the need for chemical restraints
When caring for a patient who has been TASERed, you should be aware that the primary TASER injury occurs from:
Question 56 options:
A)
the electricity.
B)
the darts.
C)
There are no primary injuries.
D)
falling.
the darts
Which of the following should be present to release the TASERed patient to police without EMS transport?
Question 57 options:
A)
Systolic blood pressure above 100 mmHg
B)
Glasgow Coma Scale score of 15
C)
All of these
D)
Pulse below 110
all of these
Physical restraints deployed by EMS should be:
Question 58 options:
A)
handcuffs.
B)
soft restraints.
C)
hard restraints.
D)
EMS should never restrain a patient.
soft restraints
Ideally, a minimum of how many people should be used to restrain a patient?
Question 59 options:
A)
5
B)
2
C)
4
D)
3
5
