Deck 26: Behavioral Emergencies

Question 1

You have had to restrain a patient who is being involuntarily committed to a psychiatric institution. During the restraint process, the patient vomited. How should you position him on the stretcher?

A) On his stomach with head elevated
B) Left lateral recumbent
C) Prone with head turned to side
D) Supine in a semi-Fowler's position

Answer 1

B

Question 2

You arrive on scene to find that the police have subdued a violent man with a history of behavioral problems. They state they will put the patient on the stretcher. Which one of the following should cause the EMT to take immediate and corrective action?

A) Patient is placed and restrained in a prone position on the stretcher.
B) Patient is supine with straps over the chest, waist, and thighs.
C) Police state that the restraints will not be removed until arrival at the hospital.
D) Police move very quickly to get the patient onto the stretcher.

Answer 2

A

Question 3

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 one of the following is your best course of action?

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

Answer 3

D

Question 4

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

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

Question 5

After taking a patient to the hospital for an unsuccessful suicide attempt, your partner states that this is the fifth suicide call he has had this month. Four of them have been women who were unsuccessful and the fifth was a man who shot himself in the head and was dead on the scene. Which one of the following responses is most accurate?

A) "That is odd since more men than women attempt suicide, and men are generally more unsuccessful than woman."
B) "That seems to make sense, given that more women than men attempt suicide but men are generally more successful."
C) "That is unusual given that women are generally more successful and tend to use more lethal means such as guns."
D) "Studies have shown that there is no difference in the frequency in which men and women attempt or commit suicide."

Question 6

Which one of the following statements made by an EMT shows a proper understanding of what is required when restraining a patient?

A) "To decrease the potential legal problems, it is best to have the patient agree to being restrained and have family members, if present, act as witnesses."
B) "One person should be assigned the task of explaining everything to the patient before, during, and after he has been restrained."
C) "Always come at the patient with more force than you think is needed so the job of restraining can be done quickly and effectively."
D) "Securing the patient's arms and legs to the stretcher with handcuffs is a very effective form of restraint, but should only be used if police are present."

Question 7

An EMT is transporting a restrained patient who is trying to spit on him. Which one of the following would the EMT be justified in doing?

A) Placing a surgical mask over the patient's mouth
B) Releasing the restraints and forcing the patient out of the ambulance
C) Repositioning the patient to a prone position so he cannot spit
D) Placing a roll of gauze loosely into the patient's mouth

Question 8

You have been dispatched to transfer a patient with schizophrenia from a hospital emergency department to a behavioral health unit at another hospital. While en route, your partner states that he cannot remember what schizophrenia is. You should tell him that schizophrenia is a behavioral disorder commonly characterized by:

A) multiple personalities.
B) the need to be around others.
C) delusions and hallucinations.
D) feelings of worthlessness.

Question 9

You have been called to a residence for a complaint of chest pain. On scene you are met by the patient's husband who informs you that his wife suffers from anxiety attacks and that she received bad news tonight concerning her mother. This increased her anxiety, and now she just needs to calm down. He states that her doctor said the chest pain she gets is just a temporary response to the anxiety. Assessment of the 46-year-old woman reveals her to be extremely anxious and complaining of chest pain. In treating this patient, the EMT should first:

A) attach the AED.
B) administer nitroglycerin.
C) contact medical direction.
D) check vital signs.

Question 10

You are by the side of a young male patient with a history of behavioral problems. Friends called 911 after the patient experienced several violent outbursts this evening. Which finding would cause you to suspect a physical cause for this behavior, as opposed to a behavioral one?

A) Dilated pupils that are sluggish to react
B) Difficulty making eye contact with the EMT
C) Hearing his mother's voice in his head
D) Fear that friends are out to steal his money

Question 11

You are responding to a patient with a behavioral problem. While en route, dispatch contacts you and states that there is a mental-health delegate at the scene and you will be transporting the patient to the local psych hospital for treatment of her bipolar disorder. On scene which one of the following patient behaviors should help confirm that the patient is suffering from bipolar disorder?

A) Belief that family members are out to get her
B) Panicked, anxious, and nervous behavior
C) Threats of violence toward the EMTs
D) Happy, excessively cheerful, and elated behavior

Question 12

What is your first priority in managing a patient with a behavioral emergency?

A) Determining if the patient is a threat to him- or herself
B) Evaluating for a preexisting medical condition
C) Ensuring the safety of you and your partner
D) Assessing and managing the patient's airway

Question 13

Which of the following patients would the EMT classify as having a behavioral emergency?

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

Question 14

You are on the scene of a male patient who threatened to take pills to end his life. In talking with the patient, he informs you that he just got a new job that requires more of his time and his wife has been giving him a hard time about it. Tonight, he had enough and just made the comment because he was mad at her. He says that although he is still upset, he doesn't plan to do anything drastic. Before taking further action, which one of the following facts about the patient should raise the EMT's suspicion that he is indeed at a higher risk for suicide?

A) New job with increased stress
B) Scar on the patient's neck
C) New diagnosis of high blood pressure
D) Unsuccessful attempt three years ago

Question 15

A patient states that she cannot leave the house to go to the hospital "because I am scared I will do something idiotic and lose it and then everyone will look at me and laugh." She states she rarely leaves the house and the last time she did, she began to hyperventilate. This caused her to return home immediately. Based on this information, the EMT should recognize the patient as suffering from:

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

Question 16

Bystanders called 911 for a female patient who was screaming obscenities in a store parking lot. On arrival you find the patient to be sitting in the middle of the parking lot muttering incomprehensible phrases. After conducting the primary assessment and finding no immediate life-threatening conditions, you move her to the ambulance. Additional assessment findings include abrasions to her arm and urinary and fecal incontinence. She also has a bottle of Prozac in her pocket. You reference Prozac in your medication book and find it to be used to treat depression. With this information, how will you treat this patient?

A) Assist her in taking one dose of Prozac.
B) Arrange for transport to the halfway home where she lives.
C) Consider supplemental oxygen and transport on her left side.
D) Transport to the psychiatric hospital where she has been a patient.

Question 17

A woman has called you for her middle-aged friend who has stopped eating and talking and has frequent crying spells. Your history reveals that the woman lost her husband a few months ago and has been withdrawn and despondent ever since. Throughout the assessment, the alert and oriented woman continually states she wants to be left alone. When you bring the stretcher into the room, the woman states, "I do not want to go to the hospital. Let me sign whatever I need to sign." What is your best response to this situation?

A) Contact medical direction and ask for advisement.
B) Recheck mental status and orientation, and then have her sign a refusal.
C) Allow the patient to sign a refusal as long as her friend stays with her.
D) Contact law enforcement to restrain the patient for transport.

Question 18

According to family, a 24-year-old female suddenly began to act in a hostile manner. After assessing her, you determine that she cannot remember her name or present location and is drooling. Based on these findings, you should suspect a:

A) psychological emergency caused by alcohol consumption.
B) behavioral emergency without physical cause.
C) psychological condition related to a traumatic experience.
D) behavioral emergency resulting from a physical condition.

Question 19

Given the research related to suicide, which one of the following patients should the EMT recognize as the highest risk for a suicidal action?

A) 22-year-old male who has just broken up with his girlfriend of six months
B) 18-year-old male who was just arrested for possession of marijuana
C) 72-year-old widow who was just informed of a diagnosis of Alzheimer's disease
D) 34-year-old male in and out of prison who was just convicted of receiving stolen property

Question 20

You are loading a 24-year-old male for transport to the hospital after he stated that he wanted to kill himself. The patient's father pulls you aside and tells you that his son repeatedly has been in the hospital for suicidal statements but is then released and comes home and the whole cycle repeats itself. He is worried that one day his son will actually commit suicide and wonders if there is anything he can do to decrease the chance of this happening. In regards to the most common means by which people commit suicide, you should respond by saying:

A) "Lock up all of the household cleaning products since these are commonly ingested."
B) "The chance of him committing suicide is low since he has never actually attempted it."
C) "I would suggest gathering up all guns and removing them from the house."
D) "It would be best to get rid of all the beer, wine, and alcohol in the house."

Question 21

A 48-year-old female with a history of depression has called for help because she feels suicidal. During transport, the patient refuses to talk to you despite repeated attempts for her past medical history and the events leading up to her call for help. Which one of the following statements is most appropriate at this time?

A) "It's okay if you do not want to talk, I will be right here if you change your mind."
B) "I know that people with depression seem to get better very quickly by taking medications. Have you thought about taking some?"
C) "Talking often helps people feel better. If you talk to me, I am sure that it will help."
D) "I really must have information related to your medical history; therefore, you must talk to me."

Question 22

While transporting a patient with schizophrenia, he suddenly screams, "Do you see that snake? It is right next to you! Kill it!" How should you respond to this patient?

A) "Where do you see the snake? Can you describe its color? Do you see more than one?"
B) "There is not a snake in the ambulance. They could not live in here because there is no food."
C) "I do not see a snake; I see a stethoscope. I do not doubt that you see a snake."
D) "What do you mean a snake? This is a new ambulance. I hope that it did not come with a snake!"

Question 23

When on the scene of a patient who has attempted suicide, which of the following is the most immediate priority?

A) Preserving evidence
B) Crew safety
C) Assessing life-threatening conditions
D) Patient safety and well-being

Question 24

You are assessing and treating a young girl who superficially cut her wrists in a self-stated suicide attempt. Bleeding was not significant and has clotted. While transporting the patient, which one of the following statements is most appropriate?

A) "Can you tell me why you tried something like this?"
B) "This really has upset your parents. How does that make you feel?"
C) "These cuts are not significant. You didn't really want to do this, did you?"
D) "I am going to clean these cuts with some water and then wrap them."

Question 25

How can the EMT best keep a behavioral patient calm and avoid provoking a violent outburst?

A) Inform the patient of all that is going on and use a calm voice throughout care.
B) Establish that the EMT is in control of the situation and that how the call goes depends on the patient.
C) Inform the patient that he is responsible for all of his actions that occur throughout the call.
D) Involve law enforcement early in the call as a deterrent for violence.

Question 26

You are responding to a home for injuries resulting from a domestic altercation. In preparation for patient contact, what would you tell your partner?

A) "Stand above the patient to achieve a stature of dominance."
B) "Let's go in and assess the situation, and then come up with a plan."
C) "Always keep the patient in front of you and your eyes on the door."
D) "Do not let the patient get between you and the door."

Question 27

You are transporting a restrained 23-year-old female with a past history of sexual abuse and multiple behavioral problems. She is very upset with being restrained as well as going to the hospital. She informs you that she will take you to court for your actions. Consequently, you are concerned about false accusations. Which one of the following is your best protection?

A) Meet with your service's attorney to discuss the call.
B) Have your partner sign the prehospital care report.
C) Remove the restraints during transport if she is cooperative.
D) Thoroughly document everything that happens on the call.

Question 28

After restraining a patient on the stretcher, what action is it essential that the EMT perform first?

A) Check the tightness of the chest strap.
B) Check the extremities for pulses and motor ability.
C) Inform the patient of what will occur during transport.
D) Obtain a set of vital signs, excluding temperature.

Question 29

You have been called to an assisted living facility for a 43-year-old male 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 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) Restrain and transport the patient.
C) Check his blood glucose level.
D) Recheck the blood pressure.

Question 30

After taking a young, depressed female to the hospital your partner says, "I am tired of running all of these psych patient calls. There are real patients with real emergencies and pain out there. It is just a waste of our time!" Which one of the following is your best response?

A) "If we do our jobs right, many behavioral patients can make a solid and quick recovery."
B) "It is a sad fact that little can be done to help these patients, but they still need to get help."
C) "Those with behavioral emergencies are suffering from emotional pain and injuries, which can be just as real as physical pain."
D) "As EMTs, our concern is getting the patients to the hospital where they can get the help they need."

Question 31

You have been called to the post office to assist police with a disorderly male. On scene you find a middle-aged male patient stating that he needs to be protected because the CIA is out to get him for something he did not do. As a knowledgeable EMT, you should recognize the patient's behavior as:

A) phobia.
B) bipolar.
C) anxiety.
D) paranoia.

Question 32

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

A) "Two of us will get him from the front and the other two from the back. Let's do this slowly so no one gets hurt."
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) "You distract him by coming at him from the front and the rest of us will come at him from different directions, each taking a separate limb."
D) "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."

Question 33

Your partner is assessing a patient who has a history of antisocial disorder and who just got into a heated verbal exchange with his neighbor. He threatened to kill his neighbor and 911 was called. As you observe the patient, which of the following is the strongest indication that the patient may be ready to have a violent outburst?

A) Avoiding eye contact
B) Clenching of both fists
C) Refusal to answer questions
D) Increased sighing

Question 34

You are preparing to transport a patient with a behavioral emergency to the hospital. As he is being loaded into the ambulance, he smiles and says, "What if I decide to just go crazy and hurt you during the ride to the hospital?" Which one of the following is your best response?

A) "I am in charge here and you will do as I say. Understand?"
B) "That is impossible because you are in restraints."
C) "If you threaten me again, I will tighten the strap on your chest so it is hard to breathe."
D) "If you touch or hurt me, you will be physically restrained immediately. No exceptions."

Question 35

An alert and oriented 18-year-old female 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) Physically restrain the patient for transport.
B) Contact law enforcement for assistance.
C) Have the patient sign a refusal that is witnessed by family.
D) Transport the patient on her father's consent.

Question 36

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

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

Question 37

You have been called to a nursing home for a 48-year-old male with a history of schizophrenia. On scene you find the patient to be highly agitated and clutching his left hand while complaining that there are bugs in it. After performing the primary assessment and finding no life threats, you should:

A) determine if the patient is compliant with his medications.
B) physically and thoroughly assess his left hand.
C) ask the patient to describe the bugs.
D) reassure the patient that he is safe, and then transport to the hospital.

Question 38

Which one of the following statements shows that the EMT has a good understanding of dealing with a behavioral emergency patient?

A) "It is okay to spend an extended amount of time on scene before transporting patients with behavioral problems."
B) "I avoid making eye contact because the patient may perceive that as a threatening gesture and respond with violence."
C) "Touch conveys concern for the patient, so I try to touch the patient's shoulder or arm as soon as I arrive at his or her side."
D) "If the patient raises his voice to you, you must raise your voice in return. Research has shown that this helps deter violence."

Question 39

You have arrived on the scene where a depressed patient is crying in an upstairs bedroom. When assessing her, which one of the following must be done first?

A) Obtain vital signs.
B) Determine the patient's medications.
C) Check a radial pulse.
D) Assess her for suicide risk.

Question 40

You have been called for a young male patient who has been withdrawn. The patient appears depressed and when you ask him if he is thinking about hurting himself, he answers "yes." The next question asked by the EMT should be:

A) "Do you have a plan?"
B) "Do you take medications?"
C) "Are there guns in the house?"
D) "Do you want to go to the hospital?"

Question 41

What type of hallucination is most dangerous?

A) Command
B) Tactile
C) Visual
D) Dissociative

Question 42

The EMT would recognize a patient as having a phobia when he makes what statement?

A) "I am unemployed and think that I will lose my home."
B) "I found a snake in my house and am having dreams of finding others."
C) "I was just diagnosed with cancer and think that it is terminal."
D) "I cannot eat meat because they put dangerous bacteria in it that can hurt me."

Question 43

During transport, a female patient who is restrained begins to cry and states that she is sorry for becoming violent and will not behave in that manner anymore. She requests that the restraints be removed because they are hurting her legs and she does not wish to be restrained any longer. After ensuring that the restraints are not too tight and not harming the extremities, you would:

A) Remove the leg restraints, but not the arm restraints.
B) Remove the restraints, but reapply if the patient becomes combative.
C) Leave the restraints in place until patient care is transferred to the hospital.
D) Free one leg from the restraint, but leave the rest in place.

Question 44

You have been called for a female patient with a history of bipolar disease who is severely depressed and stated suicidal intentions. As such, you would expect what type of affect?

A) Flat
B) Dystonic
C) Labile
D) Manic

Question 45

On scene, a young male experiencing a behavioral emergency talks very rapidly and constantly interrupts you while you attempt to ask him questions. As such you would recognize that the patient is exhibiting:

A) verbal dystonia.
B) pressured speech.
C) word salad.
D) tardive dyskinesia.

Question 46

A patient experiencing command hallucinations would most likely tell you:

A) his arm is stiff and cannot be bent.
B) his arm is infected with worms and parasites.
C) his arm smells like rotten meat and is dead.
D) his arm must be amputated so he will not die.

Question 47

You are at a community crisis center with a male patient who is depressed. What is the most important question you must ask first in the care of this patient?

A) "Have you been taking your medications?"
B) "Do you feel suicidal or homicidal?"
C) "What behavioral disorders have you been diagnosed with?"
D) "Have your medications been changed?"

Question 48

A male patient with a history of behavioral problems continually smacks his lips, sticks his tongue out, and turns his head to the left. His arm also jerks upward regularly. Which statement, made by a caregiver, would an EMT recognize as most important and relating to this presentation?

A) "He refused to take his morning medications."
B) "He can be very delusional at times."
C) "He has been on psych medications for many years."
D) "Lately, he will only eat potato chips for breakfast."

Question 49

You are called by a husband who states that his wife is bipolar and in need of help at the hospital. Which presentation would make the most sense related to this disorder?

A) Distortion of speech and thought
B) Thoughts of persecution
C) Depressed and not wanting to talk
D) Paranoid with thoughts of persecution