Question 1

Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder?
A) Medical illness
B) Following the same routine daily
C) Stressful situations
D) Taking recreational drugs and using alcohol

Accepted Answer

Following the same routine daily may provide a sense of stability and predictability, which can actually have a positive impact on the emotional and behavioral status of a patient with a psychiatric disorder. The other options (A, C, and D) are all likely to have negative impacts on their mental health. Medical illness can exacerbate psychiatric symptoms and vice versa, stressful situations can trigger or worsen symptoms, and substance use can interfere with medication efficacy and exacerbate symptoms.

Question 2

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?
A) 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.
B) Explain to the neighbor that the patient is behaving as expected and the only treatment is time.
C) Have the patient sign a refusal of service form, but let him know he can call you back if he changes his mind.
D) 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.

Accepted Answer

The best course of action is to 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. As an EMT, it is important to assess the patient's mental and emotional state, and offer appropriate care and resources. While the patient may refuse care at first, it is important to address potential mental health concerns and provide transportation to the hospital for further evaluation and treatment if necessary. Option A is not appropriate as it violates the patient's rights and autonomy, and should only be considered in rare situations where the patient is a danger to themselves or others. Option B is not appropriate as it dismisses the patient's concerns and symptoms, and does not offer any helpful interventions. Option C allows the patient to refuse care, but also provides the option for further assistance if he changes his mind. However, it may not adequately address potential mental health concerns and the patient's well-being.

Question 3

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?
A) Consider it a police matter, and mark in service.
B) Have the police place the patient under immediate detention, and transport the patient in restraints.
C) Tell the patient you must take his suicide threat seriously and transport him for evaluation.
D) Have the patient sign a refusal form as long as the roommate will take responsibility for staying with him.

Accepted Answer

Any suicide threat should always be taken seriously, even if the patient claims to be "psyching out" someone else. The fact that the patient was sitting on the balcony with his feet over the edge is a serious concern. The patient needs to be transported for evaluation to ensure that he is safe and to address the underlying issues that led to the suicidal thoughts.

Question 4

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? A) Contact medical direction. B) 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. C) Restrain the patient if necessary and transport. D) Request law enforcement assistance for legal detention of the patient for transport to the ED.

Accepted Answer

Contacting medical direction is the best course of action because the patient is alert, oriented, and not exhibiting behavior that immediately endangers himself or others. This allows for professional guidance on how to proceed given the patient's refusal to take medication and the lack of immediate psychiatric crisis.

Question 5

Which of the following is NOT considered an appropriate method of controlling a combative patient in the prehospital setting?
A) Droperidol
B) Leather restraints
C) Pepper spray
D) Verbal deescalation

Accepted Answer

Pepper spray is not an appropriate method of controlling a combative patient in the prehospital setting, as it can cause harm and potentially escalate the situation. The best choice(s) would be D (Verbal deescalation) and A (Droperidol, if appropriate and administered by a licensed healthcare provider). Leather restraints may be used as a last resort if other methods have failed and the patient is a danger to themselves or others, but they should be applied correctly and monitored closely.

Question 6

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?
A) Schizotypal personality disorder
B) Bipolar disorder
C) Acute dystonic reaction
D) Schizophrenia

Accepted Answer

The patient's symptoms of delusions (believing his arms are turning green) and the possible auditory or visual hallucinations that may have contributed to the delusions point towards a diagnosis of schizophrenia. The fact that the patient stopped taking his medication may have triggered a relapse of his symptoms. Schizotypal personality disorder, bipolar disorder, and acute dystonic reaction do not fully capture the patient's symptoms and history.

Question 7

Which of the following is NOT an organic cause of a behavioral emergency?
A) Tumor
B) Hypoglycemia
C) Alcoholic encephalopathy
D) Dementia

Accepted Answer

The answer of Which of the following is NOT an...

Question 8

Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness?
A) Depression
B) Paranoia
C) Anxiety
D) Mania

Accepted Answer

Uneasiness, discomfort, apprehension, and restlessness are all symptoms of anxiety. Depression involves feelings of sadness and hopelessness, paranoia involves irrational suspicions and mistrust, and mania involves excessive excitement and energy.

Question 9

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?
A) Lorazepam
B) Diazepam
C) Droperidol
D) Physical restraint

Accepted Answer

Droperidol should be avoided in patients with a long QT interval, which is similar to a long QRS interval mentioned by the patient's wife. This can cause further prolongation of the QT interval and potentially lead to a dangerous arrhythmia. Lorazepam and diazepam are appropriate treatments for agitation in this patient population. Physical restraint should only be used as a last resort for the safety of the patient and others involved.

Question 10

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?
A) Bipolar disorder
B) Schizoaffective disorder
C) Dysthymia
D) Depression

Accepted Answer

The symptoms described are characteristic of depression. Bipolar disorder and schizoaffective disorder also involve mood symptoms, but they have additional features that distinguish them from depression. Dysthymia is a subtype of depression that involves persistent low mood for at least two years, but it does not necessarily include all of the specific symptoms described.

Question 11

Which of the following best describes a state of disorientation or disorganized thought?
A) Delusion
B) Confabulation
C) Neurosis
D) Confusion

Accepted Answer

Confusion is the state of being disoriented or having disorganized thoughts. Delusion refers to a fixed false belief, confabulation is the act of filling in gaps in memory with fabricated information, and neurosis is a broad term for a mental disorder characterized by anxiety or distress.

Question 12

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?
A) Oxygen, IV, nitroglycerin, aspirin, morphine
B) IV, diazepam
C) Oxygen
D) IV, haloperidol

Accepted Answer

The patient is exhibiting signs and symptoms of a panic attack, and attempts at verbal de-escalation have been unsuccessful. IV diazepam (Valium) is a benzodiazepine that can help to calm the patient and alleviate symptoms. Oxygen may be given for shortness of breath, but the patient's oxygen saturation is not provided in the scenario, so it is not clear if it is warranted. The other medication options (nitroglycerin, aspirin, morphine, and haloperidol) are not indicated in this scenario.

Question 13

Which of the following best describes a person's state of cerebral functioning?
A) Mental status
B) Affect
C) Level of consciousness
D) Intelligence

Accepted Answer

Mental status is a term used to describe a person's state of cerebral functioning. It includes a person's level of consciousness, orientation, memory, and ability to think and reason.

Question 14

Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder?
A) Failure to keep counseling appointments
B) Situational stresses
C) Being released from an institution back into the public
D) Noncompliance with medications

Accepted Answer

Noncompliance with medication is the most frequent cause of deterioration in patients with psychiatric disorders. It is essential to take medications as prescribed by a healthcare provider to manage symptoms and prevent relapse. Failure to take medication can lead to worsening of symptoms and may even require hospitalization.

Question 15

An example of a direct injury that may be sustained by a behavioral patient who has been TASERed would be:
A) the muscle contractions that occur as a result of the electrical impulse.
B) the damage caused by the impact of the probe.
C) the ignition of the combustible gases that are present after firing the TASER.
D) the resultant blunt force trauma caused by the fall that ensues after the electrical impulse.

Accepted Answer

The impact of the probe can cause direct injury to the patient, including puncture wounds, lacerations, and contusions. The other choices are potential but less likely injuries that may result from TASER use.

Question 16

Which of the following best describes four-point restraints?
A) Straps restraining the patient across the chest, hips, thighs, and legs
B) A separate restraint on each of the four extremities
C) A commercially manufactured restraint device
D) Restraint of the head, torso, arms, and legs

Accepted Answer

Four-point restraints refer to separate restraints being used on each of the four extremities (two wrists and two ankles) to immobilize a patient. This method of restraint is typically reserved for the most extreme cases and is only used when all other alternatives have failed. Straps across the chest, hips, thighs or legs would not be considered four-point restraints, nor is it necessary to restrain the head for this type of restraint. There is no commercially manufactured restraint device specifically called four-point restraints.

Question 17

Which of the following best describes an emotional reaction characterized by rage?
A) Emotional lability
B) Anger
C) Dread
D) Irrationality

Accepted Answer

Rage is an intense emotion characterized by anger, often resulting in an outburst or aggressive behavior. Emotional lability refers to quickly changing emotions, dread is a feeling of great fear or apprehension, and irrationality refers to behavior that is not based on reason or logic.

Question 18

You are caring for a patient that was TASERed by the police for being physically aggressive. This type of restraint works by what mechanism?
A) It temporarily stuns the cerebral hemispheres.
B) It paralyses the lower extremities.
C) It renders the patient unconscious.
D) It disrupts voluntary control of skeletal muscles.

Accepted Answer

TASERs work by delivering an electric shock that disrupts voluntary control of skeletal muscles, causing temporary paralysis. This allows for the patient to be safely restrained if they are being physically aggressive.

Question 19

Your patient is in four-point restraints and starts to spit at you during transport. You should:
A) put a nonrebreather mask on the patient but do not administer oxygen.
B) place the patient prone, with his face turned away from you.
C) place a surgical mask over the patient's mouth and nose.
D) wear a HEPA respirator or an N-95 mask.

Accepted Answer

Placing a surgical mask over the patient's mouth and nose will prevent the patient from spitting on you while also allowing them to breathe. This is the best option for infection control and staff safety. Restraints should never be used as punishment and should be removed as soon as possible once the patient's behavior has been brought under control. Administering oxygen or placing the patient in a prone position are not appropriate interventions in this situation. Wearing a HEPA respirator or N-95 mask is not necessary unless the patient has a known infectious disease.

Question 20

Which of the following best describes the correct positioning of a restrained patient?
A) Prone, sandwiched between the cot and a long backboard to prevent movement
B) Prone, ensuring the restraints are not loose enough to allow patient movement
C) Left lateral recumbent, ensuring the restraints are not tight enough to affect breathing or circulation
D) Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing

Accepted Answer

The supine position on the cot ensures the patient's airway is not compromised, and the restraints should be secure enough to prevent harm but not so tight as to restrict breathing or circulation.

Quiz 11: Psychiatric and Behavioral Disorders

Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder?

Which of the following is NOT considered an appropriate method of controlling a combative patient in the prehospital setting?

Which of the following is NOT an organic cause of a behavioral emergency?

Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness?

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?

Which of the following best describes a state of disorientation or disorganized thought?

Which of the following best describes a person's state of cerebral functioning?

Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder?

An example of a direct injury that may be sustained by a behavioral patient who has been TASERed would be:

Which of the following best describes four-point restraints?

Which of the following best describes an emotional reaction characterized by rage?

You are caring for a patient that was TASERed by the police for being physically aggressive. This type of restraint works by what mechanism?

Your patient is in four-point restraints and starts to spit at you during transport. You should:

Which of the following best describes the correct positioning of a restrained patient?