Chapter 23 Behavioral and Psychiatric Emergencies and Suicide Scene Scenario Questions

Which of the following patients would be considered to be at the greatest risk for suicide? Answer A 22-year-old man who has lost his job and is getting divorced A 35-year-old female who has a child with a serious illness A married, 30-year-old man who has just learned that his employer is transferring him to a different state A 44-year-old woman who has just recovered from a serious illness

A 22-year-old man who has lost his job and is getting divorced

Concerning behavioral emergencies, which of the following statements is true? Answer Only a licensed psychiatrist can apply crisis management techniques with a patient having a behavioral emergency. A diabetic problem may mimic signs of a behavioral emergency. It is relatively easy to determine if the underlying cause of a behavioral emergency is related to drug abuse. A patient who does not respond to crisis management techniques must be restrained for transport to a psychiatric facility.

A diabetic problem may mimic signs of a behavioral emergency.

Which of the following factors suggest that a patient is at risk for suicide? Answer Recent emotional trauma Sudden improvement in depression Alcohol and drug abuse All of the above

All of the above

Which of the following medical conditions may be the underlying cause of an apparent behavioral emergency? Answer Mental illness Stroke Hypoglycemia All of the above

All of the above

Concerning attempted suicide, which of the following statements is true? Answer Truly suicidal patients nearly always leave a note. All suicide attempts must be taken seriously, even if the method seems insincere. There is always an indication that a suicide attempt is imminent. Attempted suicide is a matter for law enforcement, not EMS.

All suicide attempts must be taken seriously, even if the method seems insincere.

According to coworkers, your 25-year-old female patient suddenly began acting aggressively and being verbally abusive. She tells you she is "starving" and you notice that she is pale and diaphoretic. Which of the following would be an appropriate general impression? Answer Alcoholic intoxication An underlying physical illness Sudden onset of schizophrenia None of the above

An underlying physical illness

Once you have established with reasonable certainty that your patient is suffering from a behavioral emergency, which of the following is the best course of action? Answer Establish the best way to restrain the patient before he has the opportunity to become violent. Begin intense individual counseling with the patient. Attempt to determine if there is a possible physical cause for the patient's behavior. There is no need to assess for medical conditions if the patient does not have a history of past medical problems. .

Attempt to determine if there is a possible physical cause for the patient's behavior.

When a person acts in a manner that is unacceptable to himself or those around him, this would be considered which of the following? Answer Mental illness Psychotic episode Behavioral emergency Psychosomatic reaction

Behavioral emergency

Which of the following is appropriate when assessing an emotionally disturbed patient? Answer Establish eye and verbal contact. Avoid arguing with the patient. Make it clear that you are in control of the situation, not the patient. Both A and B

Both A and B

Which of the following actions is the MOST appropriate for the EMT to take when managing a patient with a behavioral emergency? Answer Find out if the patient's insurance covers psychiatric treatment. Calm and reassure the patient. Establish control of the situation by a show of force. Quickly perform a head-to-toe exam and transport without delay.

Calm and reassure the patient.

Your patient is a 22-year-old male who has ingested a large amount of alcohol and is vomiting. He is conscious but uncooperative. He allows you to examine him but refuses transport to the hospital. Which of the following is the best action? Answer Contact medical control for further advice. Stay with the patient until he has stopped vomiting. Find a relative or neighbor to come over and stay with the patient. Obtain a witnessed refusal.

Contact medical control for further advice.

Which of the following does NOT indicate that a patient may be about to become violent? Answer Tense body posture or clenched fists Crying Profane language Loud voice and rapid pacing

Crying

You have responded to a call about a "psychiatric patient" to find a 24-year-old woman talking to herself in her home. She is rocking back and forth and you can see from a distance that she is perspiring profusely. You also see an empty medication bottle on the floor. She does not acknowledge your presence. When you attempt to speak to her, she continues to talk to herself as if you were not there. Which of the following should be included in your actions at the scene? Answer Distract her so your partner can look around the house. Look through the house with your partner to try to find some clues to the patient's problem. Ensure that law enforcement is responding and wait for its arrival. Shake the patient's shoulder to check for responsiveness to physical stimuli. .

Ensure that law enforcement is responding and wait for its arrival.

Your patient is a 15-year-old female who has been diagnosed with a personality disorder. She has no history of violent behavior. The staff at her residential care facility wants her to be transported for evaluation of a possible urinary tract infection. Which of the following is the BEST way to handle this situation? Answer Have a female EMT attend to the patient. Transport the patient, but do not speak to her or perform an assessment. Refuse to transport the patient without a police escort. Ask that the patient be given a tranquilizer injection prior to transport.

Have a female EMT attend to the patient.

Which of the following is NOT an acceptable method or adjunct in restraining a patient? Answer Hog-tying the patient Placing a surgical mask over the patient's face to prevent spitting Restraining the patient face-up Securing all four limbs with leather restraints

Hog-tying the patient

Which of the following must be treated by the EMT if present in a patient with an apparent behavioral emergency? Answer Acute alcohol intoxication Hypoglycemia Suicidal ideology Severe clinical depression

Hypoglycemia

Which of the following may cause a patient to exhibit abnormal behavior? Answer Hypoxia Allergic reaction Gastroenteritis All of the above .

Hypoxia

Which of the following traumatic conditions may account for signs and symptoms of a behavioral emergency? Answer A fractured lumbar vertebra 10 percent BSA partial thickness burn A fractured tibia Internal hemorrhage

Internal hemorrhage

Which of the following statements concerning behavioral emergencies is true? Answer Emotional outbursts are considered behavioral emergencies. The person with a behavioral emergency requires prolonged institutionalization. A person with a behavioral emergency is mentally ill. It may be difficult to determine what behavior is abnormal for a given person in a given situation

It may be difficult to determine what behavior is abnormal for a given person in a given situation.

Which of the following statements regarding behavioral emergencies is NOT true? Answer Patients experiencing a behavioral emergency are not always dangerous to themselves or others. It would be unusual to find a person with schizophrenia outside a mental health facility. Differences in culture may initially appear to be abnormal behaviors to the EMT. Apparent behavioral emergencies may be due to an underlying medical cause.

It would be unusual to find a person with schizophrenia outside a mental health facility.

Which of the following is acceptable when managing the patient with a behavioral or psychiatric emergency? Answer Make supportive statements such as, "That must have been very hard for you." Sit as close to the patient as you can to reassure him that you will not abandon him. Allow family members to confront the patient about his behavior. Go along with the patient's hallucinations or false beliefs. .

Make supportive statements such as, "That must have been very hard for you."

Which of the following communication strategies should be used in dealing with a patient with a behavioral emergency? Answer Stay 2 to 3 inches from the patient at all times to make him feel secure. Interrupt the patient if he appears to be going off on a tangent about something not concerning the immediate situation. Show deep sympathy for the patient's predicament and let him know he can't control the things that are happening to him. None of the above

None of the above

When providing emergency care to an aggressive or hostile patient, what is the highest priority? Answer Checking the patient for possible physical causes of the behavior Finding out if the patient is oriented to person, time, and place Calming the patient down Performing a scene size-up

Performing a scene size-up

When responding to an attempted suicide, which of the following is the EMT's primary concern? Answer Personal safety Determining whether the patient suffers from clinical depression Contacting law enforcement since suicide is illegal Managing the patient's airway

Personal safety

Which of the following is the BEST defense for an EMT when facing allegations of misconduct from a mentally ill patient? Answer Hiring a background investigator to discredit the accuser Having a clean employment record and lack of a criminal background Providing accurate and complete documentation, supported by a third-party witness Making sure you and your partner get your stories straight before talking to anyone

Providing accurate and complete documentation, supported by a third-party witness

You are on the scene of a possible overdose. You find a 30-year-old man pacing about his living room. There is evidence of illicit drug use and the apartment is in disarray. The patient seems agitated and nervous. Attempts at calming the patient should include which of the following? Answer Speak quickly to give the patient all of the important information without delay. Repeat part of what the patient is saying to show that you are listening to him. Stand still with your arms crossed to instill a sense of control and authority. Sit close to him with your arm around his shoulders to show that you are truly concerned.

Repeat part of what the patient is saying to show that you are listening to him.

Your patient is a 37-year-old male sitting on the kitchen floor. His wife is attempting to talk with him, but he does not look at her or answer. He is fidgeting and has apparently thrown some dishes against the wall. What should be your first consideration? Answer Ask the wife to step outside with you so you can get information from her. Ask the wife to step into the other room so you can speak with the patient alone. Quickly check the patient's carotid pulse. Stay a safe distance away.

Stay a safe distance away.

When a patient or bystander at the scene of an emergency displays fear, anger, or grief, this is best described as which of the following? Answer Neurosis Stress reaction Post-traumatic stress disorder Catharsis

Stress reaction

You are on the scene where a 23-year-old female has attempted suicide by cutting her forearms with a razor. She is sitting in the front yard and has lost a large amount of blood. She is conscious and holding a small razor blade, and tells you to get away from her. Which of the following should NOT be done? Answer Use BSI. Keep bystanders away from the patient. Call law enforcement for assistance. Take the razor blade away from her by force.

Take the razor blade away from her by force.

Which of the following situations generally allows the EMT to transport a patient with a behavioral emergency against his or her wishes? Answer The patient's personal physician gives you permission. A family member gives consent and is willing to accompany the patient. The patient is a threat to himself or others. The patient's insurance company agrees to pay, even though the patient has not given consent.

The patient is a threat to himself or others.

When restraining a patient, which of the following is NOT a consideration? Answer The number of people available to carry out the required actions The patient's size and strength The patient's informed consent How to position the patient

The patient's informed consent

You respond to the scene of a private residence for a patient who is a known insulin-dependant diabetic patient. The patient is combative and cursing as you approach. Should this patient be restrained? Answer Yes, he likely has a medical condition that requires treatment. No, this patient is not likely experiencing a behavioral emergency. Yes, he is combative and all combative patients can be restrained. There is not enough information to answer this question.

There is not enough information to answer this question.

Which of the following statements concerning people who have made prior suicide attempts is true? Answer They are at an increased risk for a subsequent successful suicide. They do not require psychological counseling like a person who is truly depressed. They should be allowed to sign a release if their injuries are not serious. They are usually just making a cry for help but do not want to die.

They are at an increased risk for a subsequent successful suicide.

Which of the following statements concerning forcible restraint of patients is true? Answer It is easily accomplished by two EMTs with a good plan. This is necessary only with mentally ill individuals. It causes irreparable emotional harm to most patients. This is normally considered to be within the jurisdiction of law enforcement

This is normally considered to be within the jurisdiction of law enforcement.

Your patient is a 24-year-old male who is severely depressed. He tells you that he can't "handle the pressure" anymore and that he wants to die. He is refusing transport. Which of the following is the most appropriate decision regarding this patient's care? Answer Transport the patient against his will with the assistance of law enforcement. Contact the patient's family to find out what their wishes are. Leave the scene and allow law enforcement to handle the situation. Respect the patient's wishes; he is alert, oriented, and capable of giving consent.

Transport the patient against his will with the assistance of law enforcement.

Which of the following findings would be helpful in differentiating between a closed head injury and a behavioral emergency? Answer Irrational behavior Unequal pupils Confusion Combativeness

Unequal pupils

Which of the following should NOT be included in documentation of an incident involving a patient with a behavioral or psychiatric emergency? Answer Description of the patient's behavior Whether or not you think the patient is mentally ill Your observations of the patient's surroundings at the scene Your actions

Whether or not you think the patient is mentally ill

Your patient is exhibiting bizarre and aggressive behavior; he starts shouting and becomes violent. He has extra strength and appears insensitive to pain. Drug paraphernalia is visible on-scene. This behavior is known as: Answer chemical delirium. excited delirium. sensory excitement. intoxication reaction.

excited delirium.

Management of the suicidal patient includes all of the following EXCEPT: Answer physical examination. leaving the patient. SAMPLE history. communication.

leaving the patient.

When managing a patient who may hurt himself or others, you should do all of the following EXCEPT: Answer make sure only you and the patient are in the room. keep bystanders a safe distance away. watch for sudden changes in the patient's behavior. retreat if the patient becomes threatening

make sure only you and the patient are in the room.

As an EMT, it is important that you be able to do all of the following EXCEPT Answer control your own emotions when dealing with patients who say upsetting things to you. provide counseling and advice to patients with personal problems. ensure your safety and that of others at the scene. deal with a wide variety of emotions and behaviors

provide counseling and advice to patients with personal problems.