Chapter 12: Behavioral Emergencies
A 29 y/o woman was sexually assaulted. Your primary assessment reveals no life-threatening injuries. As you proceed with your secondary assessment, the patient, who is conscious and alert, tells you that she does not want to go to the hospital and that she wants you to get away from her. You should: A) request a rescuer who is the same sex as the patient, unless one is already present at the scene B) tell the patient the law requires that all sexual assault victims must be transported to the hospital C) advise the patient that she cannot bathe or use the toilet because this will destroy any potential evidence D) remain at least 4' away from the patient and ask her to provide a detailed account of what happened to her
A
Behavior that is characterized by defective or lost contact with reality is called: A) psychotic behavior B) situational behavior C) psychological behavior D) schizophrenic behavior
A
During the _____________ phase of the abuse cycle, the victim may try to minimize or deny the abuse. A) tension B) chronic C) make-up D) explosive
A
How well you can help the dying patient and his or her family largely depends on: A) your own personal feelings about death B) the condition from which the patient is dying C) the ability to repress your personal emotions D) the number of dying people you have treated
A
If you are unable to withdraw from an unsafe scene, your FIRST action should be to: A) attempt to remain calm B) avoid making threatening moves C) avoid turning your back on the patient D) tell the patient that you are there to help
A
Imagining yourself in another person's situation, sharing his or her feelings and ideas, is called: A) empathy B) remorse C) sympathy D) redirection
A
The MOST difficult emotional reaction for the emergency medical responder (EMR) to deal with objectively is: A) anger B) denial C) remorse D) depression
A
The MOST important assessment skill to use when caring for a patient with behavioral emergency is: A) effective communication B) interpretation of vital signs C) gathering of medical history data D) a basic knowledge of psychiatry
A
The first and MOST important step in crisis management is to: A) talk to the patient B) request a paramedic C) demonstrate sympathy D) request law enforcement
A
Which of the following is NOT an effective way to avoid a violent situation? A) physically restraining the patient before trying to communicate B) not allowing yourself to be cut off from a route of quick retreat C) using good interpersonal communication skills with the patient D) listening carefully to the information provided by the dispatcher
A
Which of the following statements regarding the explosive phase of the abuse cycle is correct? A) most injuries to the victim occur during this phase B) the victim usually tries to deny or minimize the abuse C) during this phase the abuser makes all sorts of promises D) the explosive phase is the longest part of the abuse cycle
A
A 44 y/o man shot himself in the head with a small-caliber handgun. Law enforcement personnel are at the scene and have the weapon in their possession. The patient is unconscious and is bleeding heavily from the gunshot wound. His wife, who is also present at the scene, tells you that her husband had been severely depressed after losing his job. You should: A) wait for law enforcement to take pictures of the patient and then open the patient's airway B) control the bleeding from the wound and then assess the status of the patient's airway and breathing C) provide immediate emotional support to the patient's wife and tell her that his suicide attempt is not her fault D) obtain a thorough history of the incident from the patient's wife and then begin treating the patient's injury
B
All of the following factors increase the risk for violence in the workplace, EXCEPT: A) working alone B) working in large numbers C) working in high-crime areas D) working early in the morning
B
During a crisis situation, it is often easier for the patient or a family member to vent his or her feelings of anger on: A) him- or herself B) an unknown person C) a distant relative D) a close family friend
B
If you are confronted by a person who is armed with a gun, knife, or other weapon, you should: A) distract the patient and attempt to disarm him or her B) immediately attempt to withdraw from the situation C) diplomatically ask the patient to give you the weapon D) ask the patient why he of she would want to harm you
B
If you suspect that a person has been abused, your initial responsibility is to: A) report the situation to law enforcement B) maintain safety for yourself and the patient C) immediately update the responding EMS unit D) objectively document your assessment findings
B
Redirection is a technique used to: A) show a person that you understand what he or she is saying B) focus a patient's attention on the immediate situation or crisis C) distract a person's attention so that you can perform a procedure D) focus a patient's attention away from the immediate situation or crisis
B
The term "restatement" is defined as: A) asking a person a question and having him or her repeat your question back to you B) rephrasing a person's words and thoughts and repeating them back to the person C) repeating a person's words and thoughts word for word back to the person D) asking a person a question and then asking him or her to rephrase it and repeat it back to you
B
When dealing with a patient who is exhibiting abnormal behavior, your initial action should be to: A) tell the patient that you are there to help B) conduct a careful size-up of the scene C) perform a primary assessment of the patient D) determine if the patient has a psychiatric history
B
Which of the following MOST accurately defines a behavioral emergency? A) a psychiatric patient experiences a sudden deterioration in his or her condition and becomes suicidal B) a person exhibits abnormal, unacceptable behavior that cannot be tolerated by family, friends, or the community C) a person who was otherwise acting normally suddenly becomes irritable and displays abnormal or bizarre behavior D) a patient requires medical assistance because of a progressive change in his or her behavior
B
Which of the following events would MOST likely cause post-traumatic stress disorder (PTSD)? A) marital problems B) childhood neglect C) financial difficulty D) military commendation
B
Which of the following findings is LEAST indicative of a patient who may become violent? A) inability to sit still B) large body size C) shouting obcenities D) use of alcohol
B
Which of the following is NOT an appropriate response when acknowledging a patient's or family member's anger? A) "what's the matter?" B) "get control of yourself." C) "what can I do to help you" D) "is there anyone I can call for you"
B
Which of the following is caused by a sudden and disruptive event such as a physical illness or death of a loved one? A) chronic stress B) situational crisis C) psychiatric illness D) psychotic behavior
B
Which of the following statements regarding suicide is correct? A) patients who attempt suicide have an untreatable psychiatric illness B) many patients who fail to kill themselves will attempt suicide again C) most suicide attempts are impulsive acts in otherwise normal people D) the suicidal patient should be told that he or she is behaving selfishly
B
You are attempting to communicate with a severely depressed man who lives in a small apartment. In addition to you, there are three law enforcement officers and two fire fighters in the apartment. The patient appears anxious and will not answer your questions. You should: A) reassure the patient that all of you want to help him B) ask all nonessential personnel to leave the room C) tell the patient that it is alright for him to speak freely D) ask everyone to leave so that you can be alone with the patient
B
You arrive at an apartment complex where a young woman is experiencing an acute emotional crisis. Law enforcement is present, and the scene is safe. As you enter the patient's apartment, you find her sitting on her couch. She is crying and in obvious emotional distress. You should: A) ask the patient if she has any thoughts of hurting herself B) introduce yourself to the patient and ask her what her name is C) establish immediate and constant eye contact with the patient D) ensure that you physical positioning is higher than that of the patient
B
Common principles used when assessing patients with a behavioral crisis include all of the following, EXCEPT: A) asking questions in a calm, reassuring voice B) informing the patient of what you are doing C) asking the patient if he or she has any children D) allowing the patient to tell you what happened
C
If you must treat an unarmed patient who is or may become violent, you should first: A) ask the patient's family if he or she has a past history of violence B) wait for paramedics to administer a sedative medication to the patient C) immediately attempt to establish verbal and eye contact with the patient D) have law enforcement restrain the patient before you begin any treatment
C
Noting a patient's appearance; ;activity; speech; orientation to person, place, and time; and memory are MOST useful when assessing his or her: A) feelings B) thoughts C) mental status D) violence potential
C
One of the main causes of suicide in older people is: A) drug abuse B) schizophrenia C) terminal disease D) domestic problems
C
Signs and symptoms of extreme stress include all of the following, EXCEPT: A) weight changes B) inability to sleep C) increased sex drive D) increased alcohol use
C
To treat an emotionally disturbed patient against his or her will, you must: A) be able to prove that the patient is intoxicated or under the influence of drugs B) obtain consent from a member of the patient's family or a close family friend C) have a reasonable belief that the patient would harm himself, herself, or others D) obtain a court order and also obtain authorization from your medical director
C
Which of the following actions would NOT reassure an emotionally disturbed patient that you are interested in helping him or her? A) speaking to the patient in a calm, steady voice B) demonstrate confidence and taking your time C) telling the patient that everything will be alright D) maintaining constant eye contact with the patient
C
Which of the following statements regarding situational crisis is correct? A) a situational crisis is typically the result of an ongoing situation, such as a loved one with a terminal disease B) situational crises are of long duration and usually can be managed by the patient's coping mechanisms C) most situational crises are sudden and unexpected and cannot be handled by a person's usual coping mechanisms D) a situational crisis always causes the patient to exhibit unacceptable, self-destructive, or dangerous behavior
C
While responding in a high-crime area of town for a young man who was shot in the chest, the dispatcher advises you that the patient is unconscious and that the perpetrator may still be at the scene. Law enforcement is in route to the scene as well, but the responding paramedics will be delayed. What should you do? A) advise the dispatcher that the paramedics and law enforcement officers will handle the situation and then return to service B) proceed cautiously to the scene, exit your vehicle and stay low when you arrive, and quickly move the patient to an area of safety C) stop a few blocks away from the scene, stay in your vehicle, and wait for law enforcement to arrive at the scene and ensure that it is safe D) continue to the scene, stay in your vehicle when you arrive, and wait for law enforcement to secure the scene before you exit your vehicle
C
Common factors that contribute to negative behavioral changes include all of the following, EXCEPT: A) low blood sugar levels B) serious injury to a loved one C) use of mind-altering substances D) decreased responsibility at work
D
The BEST person to communicate with a patient who has the potential to become violent is: A) a law enforcement officer because he or she carries a firearm B) a senior EMT or paramedic when he or she arrives at the scene C) a rescuer of the same sex and closest to the patient's age D) the rescuer with whom the patient seems to have the best rapport
D
The first phase of a situational crisis, which is characterized by cool and clammy skin, nausea and vomiting, and general inactivity, is called: A) anger B) denial C) remorse and grief D) emotional shock
D
When a patient or family member has accepted a tragic situation, he or she often feels: A) angry and bitter B) a lack of remorse C) severely depressed D) apologetic or guilty
D
When responding to a situation involving domestic violence, you should: A) not enter the scene until an EMT or paramedic has done so and deemed the scene to be safe B) gain access to the patient as soon as possible in case he or she has life-threatening injuries C) avoid the use of lights and siren while in route to the scene because this may aggravate the situation D) maintain safety for yourself and the patient and be able to perform effective assessment and treatment
D
Which of the following is NOT a common factor to consider if you are required to physically restrain a violent patient? A) the gender of the patient B) the method of restraint you plan to use C) the patient's size and apparent strength D) the exact diagnosis of the patient's illness
D
While assisting paramedics in the attempted resuscitation of a 60 y/o woman in cardiac arrest, the senior paramedic determines that the patient is dead after exhausting all efforts. When you attempt to comfort the patient's husband, he becomes verbally abusive and tells you that you should have been able to save his wife's life. You should: A) reassure the husband that his wife's death is not your fault B) include the husband's comments in your patient care report C) ask the senior paramedic if he or she did everything possible D) realize that the man's behavior is not a personal attack on you
D
You are assisting paramedics who are attempting to resuscitate an elderly man in cardia arrest. The patient's wife, who is emotionally distraught, is standing alone in the corner of the room observing. One of the paramedics asks you to provide emotional support to the wife. What should you say to her? A) "it is not healthy for you to watch this." B) "Do you want us to stop performing CPR?" C) "There is a good chance that he will survive." D) "We are doing everything that we possibly can."
D
You are dispatched to a residence for an injured child. Your unit and a police officer arrive at the scene at the same time. The patient, a 9 y/o boy, has a possible broken arm. The child's father, who appears nervous, tells you that his son wrecked his bike and that he will take his son to the hospital. Your assessment of the child reveals a deformed left arm and multiple bruises of various colors. The child is clearly frightened and looks at his father every time you ask the child a question. You should: A) place the child's arm in a splint and allow the father to transport his son to an appropriate medical facility B) ask the father if he intentionally injured his son and advise him that he will be arrested if he does not tell the truth C) splint the child's arm with the father present and then ask a police officer to arrest the father for abusing his child D) provide care for the child's injury and ask the police officer to speak with the father in another room as you speak to the child
D