Chapter 28 Psychiatric Emergencies

Almost all disoriented behavior: A. has an underlying physical etiology that may be life threatening. B. represents a person's effort to adapt to internal or external stress. C. is the result of an acute behavioral crisis that requires intervention. D. can be identified and treated definitively in the prehospital setting.

B. represents a person's effort to adapt to internal or external stress.

People who are overly concerned with their physical health and appearance MOST likely have a(n): A. dissociative disorder. B. somatoform disorder. C. compulsive disorder. D. personality disorder.

B. somatoform disorder.

Most psychotropic medications exert their therapeutic effects by: A. enhancing the effects of the thyroid gland. B. targeting the autonomic nervous system. C. suppressing cerebellar function. D. inhibiting endocrine function.

B. targeting the autonomic nervous system.

Many paramedics are reluctant to broach the subject of suicide with a depressed patient for fear that: A. the patient may become violent and homicidal. B. they might put ideas into the patient's head. C. the patient will be offended by such a question. D. the patient will become even more depressed.

B. they might put ideas into the patient's head.

An alteration in one's perception of reality is MOST characteristic of:

a dissociative disorder.

Common signs and symptoms of a panic attac

a prolonged loss of consciousness.

Signs and symptoms of depression that last for at least 2 years:

are highly suggestive of dysthymic disorder.

Disorganization and disorientation:

are ways that certain psychiatric conditions may present themselves.

A man who smiles pleasantly when he tells you of the recent death of his wife:

has an inappropriate affect.

Which of the following questions would be the MOST appropriate initial question to ask when broaching the subject of suicide with a depressed patient?

"Have you ever thought that life wasn't worth living?"

Which of the following conditions has been associated with death following exposure to a TASER device? A. Excited delirium B. Spinal cord injury C. Electrocution injury D. Rhabdomyolysis

A. Excited delirium

Which of the following is NOT an identified risk factor for suicide? A. Hispanic woman older than 55 years of age B. A sudden improvement in depression C. Recent loss of a significant relationship D. Financial setback or loss of a job

A. Hispanic woman older than 55 years of age

Which of the following conditions would be the LEAST likely to produce psychotic symptoms? A. Hyperglycemia B. Low cardiac output C. Temporal lobe seizures D. Closed head injury

A. Hyperglycemia

Psychomotor abnormalities associated with depression include: A. agitation and pacing. B. a flat affect. C. distractibility. D. fatigue and insomnia.

A. agitation and pacing.

If a patient with a behavioral emergency misperceives reality, you should: A. avoid arguing about the patient's misperception. B. agree with the patient to facilitate his or her cooperation. C. disagree and correct the patient's perception. D. conclude that he or she is suffering from schizophrenia.

A. avoid arguing about the patient's misperception.

Repetitive actions that are carried out to relieve the anxiety of obsessive thoughts are called: A. compulsions. B. perseverations. C. confabulations. D. stereotyped movements.

A. compulsions.

You are transporting a 22 year old man whose violent behavior required physical restraint. A law enforcement officer is in the back of the ambulance with you. The patient tells you that he is sorry for his behavior and did not mean to take it out on you and your partner. You should: A. continue to talk to the patient and monitor his peripheral circulation. B. tell the patient that his behavior is inexcusable and keep him restrained. C. loosen the restraints if the patient promises to cooperate with you. D. administer droperidol IM and then remove the restraints.

A. continue to talk to the patient and monitor his peripheral circulation.

A psychiatric emergency: A. exists when a person's abnormal behavior threatens the safety and wellbeing of himself or herself or others. B. generally occurs following the use of an illicit drug or excessive consumption of alcohol. C. is generally the result of a shortterm emotional crisis that is treated effectively with behavior modification. D. is caused by a chemical imbalance in the brain but does not interfere with activities of daily living.

A. exists when a person's abnormal behavior threatens the safety and wellbeing of himself or herself or others.

Unlike a person with bulimia nervosa, a person with anorexia nervosa: A. experiences weight loss that may cause poor health or even death. B. is less likely to experience problems related to electrolyte imbalance. C. compensates for binge eating by using various purging methods. D. commonly describes his or her eating disorder as "out of control."

A. experiences weight loss that may cause poor health or even death.

At a minimum, you should be able to assess an emotionally disturbed patient's: A. general appearance. B. ability to recall. C. blood pressure. D. blood sugar level.

A. general appearance.

A patient who is confused: A. has an impaired understanding of his or her surroundings. B. should be given 50% dextrose to rule out hypoglycemia. C. can usually be redirected by providing emotional support. D. cannot recall the events that preceded his or her illness.

A. has an impaired understanding of his or her surroundings.

A state of delusion in which a person is out of touch with reality is MOST appropriately termed: A. psychosis. B. tangential thinking. C. derealization. D. schizophrenia.

A. psychosis.

When painful memories are repressed, __________ is impaired. A. recall B. retention C. registration D. recognition

A. recall

A psychotic person may have thought insertions, which are defined as: A. the belief that thoughts are being thrust into his or her mind by another person. B. a gross distortion of your comments into what he or she believes to be true. C. the fear that his or her thoughts are being broadcast aloud and heard by others. D. strange or pressured speech because of unusual words the patient has invented.

A. the belief that thoughts are being thrust into his or her mind by another person.

When asking an emotionally disturbed patient a series of questions, you should: A. use words such as "how" and "what" whenever possible. B. keep your questions as indirect as you possibly can. C. simplify the process by asking closed-ended questions. D. try to ask questions that can be answered with a yes or no.

A. use words such as "how" and "what" whenever possible.

When evaluating a patient with a behavioral emergency, virtually all of the diagnostic information you obtain must come from: A. your conversation with the patient. B. the patient's family members. C. the patient's general mood and affect. D. the medical histor

A. your conversation with the patient.

When assessing a patient with a behavioral emergency, the MOST important assessment tool you have is: A. your mind. B. a glucometer. C. a penlight. D. cardiac monitoring.

A. your mind.

Which of the following is NOT a general guideline to follow when caring for a patient with a psychiatric problem? A. Remain confident in your abilities. B. Be indirect when possible. C. Provide honest reassurance. D. Maintain a nonjudgmental attitude.

B. Be indirect when possible.

Commonly used antidepressants include all of the following, EXCEPT: A. Celexa. B. Xanax. C. Paxil. D. Zoloft.

B. Xanax.

When a person has a personality disorder: A. medication therapy generally is not indicated. B. another psychiatric illness typically is present. C. the disorder most often stems from fear. D. the paramedic can influence the patient easily.

B. another psychiatric illness typically is present.

Patients who alternate between mania and depression: A. have multiple personalities. B. are referred to as bipolar. C. present with a flat affect. D. have a history of schizophrenia.

B. are referred to as bipolar.

The BEST way to ensure that no one is harmed during an EMS call is to: A. routinely ask the police to respond to the scene with you. B. assess the potential for violence on every EMS call. C. ensure that all EMS providers wear body armor. D. stand to the side of the patient's door when knocking.

B. assess the potential for violence on every EMS call.

A patient who is taking Aventyl: A. is usually hospitalized for debilitating, chronic depression. B. may have nonspecific T-wave changes on the ECG. C. can safely take an MAOI drug at the same time. D. responds better than he or she will respond to treatment with a tricyclic antidepressant.

B. may have nonspecific T-wave changes on the ECG.

An acute dystonic reaction is characterized by: A. a sudden catatonic state that results from oversedation with drugs such as Zyprexa and Mellaril. B. muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug. C. dry mouth, blurred vision, and cardiac dysrhythmias following treatment with a neuroleptic drug. D. intermittent explosive behavior after a person suddenly stops taking medications for schizophrenia.

B. muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug.

Detecting disorders of perception is often difficult because: A. patients experiencing a behavioral emergency are generally agitated and uncooperative. B. patients are often hesitant to answer direct questions regarding hallucinations or illusions. C. it is often difficult for the paramedic to determine the patient's baseline level of mentation. D. the paramedic's line of questioning is often too difficult or impossible for the patient to understand.

B. patients are often hesitant to answer direct questions regarding hallucinations or illusions.

Venlafaxine is the generic name for: A. Lexapro. B. Neurontin. C. Effexor. D. Librium.

C. Effexor.

Which of the following drugs is an MAOI? A. Sinequan B. Pamelor C. Parnate D. Elavil

C. Parnate

Which of the following statements regarding schizophrenia is correct? A. Social influences have not been shown to contribute to schizophrenia. B. Although schizophrenia is a complex disorder, it is easily treated. C. The typical onset of schizophrenia occurs during early adulthood. D. In schizophrenia, dysfunctional symptoms become less prominent over time.

C. The typical onset of schizophrenia occurs during early adulthood.

You are dispatched to a skilled nursing care facility for a 74-year-old male resident who is ill. During your assessment, you note that the patient has his head cocked to the side and is unable to move it. The charge nurse tells you that the patient was placed on Seroquel 2 days ago. Based on this patient's clinical presentation and medication history, you should: A. establish vascular access and administer naloxone. B. expect to find that his blood sugar level is elevated. C. administer 25 to 50 mg of diphenhydramine. D. suspect that the patient has catatonic schizophrenia.

C. administer 25 to 50 mg of diphenhydramine.

Disorders of thinking include all of the following, EXCEPT: A. delusions. B. phobias. C. anxiety. D. obsessions.

C. anxiety.

You are assessing a middle-aged woman who is acutely disoriented. According to her husband, she has bipolar disorder and, to the best of his knowledge, has been compliant with her medication. Her blood pressure is 106/66 mm Hg, pulse rate is 100 beats/min and strong, and he respirations are 14 breaths/min and regular. During your care of this patient, it is MOST important to: A. ask her simple questions that can be answered yes or no. B. establish vascular access and administer naloxone. C. assess her oxygen saturation and blood glucose level. D. attempt to assist her breathing with a bagmask device.

C. assess her oxygen saturation and blood glucose level.

Organic brain syndrome is a term used to describe a condition in which a person's abnormal behavior is: A. irreversible and cannot be linked to a physical abnormality or the influence of illicit substances. B. caused by premature brain cell deterioration that is progressive and cannot be reversed. C. caused by a physical illness or the influence of a substance that interferes with normal cerebral function. D. directly related to an endocrine disturbance that results in the underproduction of key hormones.

C. caused by a physical illness or the influence of a substance that interferes with normal cerebral function.

Metabolic causes of abnormal behavior include: A. thyroid hyperfunction. B. amphetamine toxicity. C. diabetic ketoacidosis. D. vitamin deficiencies.

C. diabetic ketoacidosis

When confronted with a feared object or situation, the phobic person: A. is usually able to mitigate his or her fear with redirection. B. typically becomes catatonic and unable to communicate. C. experiences intolerable anxiety and autonomic symptoms. D. truly believes that his or her fear is completely reasonable.

C. experiences intolerable anxiety and autonomic symptoms.

A person who is neologistic: A. repeats what he or she hears. B. has accelerated or pressured speech. C. invents words. D. talks with grossly slurred speech.

C. invents words.

A confused, bedridden resident in a skilled nursing facility who tells you that he or she cooks dinner for the other residents each night: A. is experiencing delirium. B. has a disorder of affect. C. is confabulating. D. is experiencing echolalia.

C. is confabulating.

Side effects of MAOI antidepressants include: A. hypersomnia. B. suicidal behavior. C. orthostatic hypotension. D. acute bradycardia.

C. orthostatic hypotension.

An agitated man with an antisocial personality: A. is at highest risk for suicidal behavior. B. may be demanding and dictate your care. C. will not think twice about hurting you. D. has a morbid fear of crowded environments.

C. will not think twice about hurting you.

Which of the following words would MOST likely deescalate the symptoms of a panic attack to a more manageable level? A. Care B. Help C. Relax D. Safe

D. Safe

You are dispatched to a residence for a patient who has overdosed. You immediately recognize the address as that of a patient with a known psychiatric condition. Law enforcement is at the scene and has ensured its safety. When you arrive and enter the residence, you find the patient, a man in his mid 20s, sitting on the floor. He is conscious and appears anxious. Which of the following questions should you ask the patient FIRST? A. "How are you feeling right now?" B. "Did you attempt to kill yourself?" C. "How long ago did this happen?" D. "What medication did you take?"

D. "What medication did you take?"

You are assessing a 34-year-old woman who appears to be depressed. You were summoned to see the patient by her husband, who tells you that she won't talk to him. During your interview of the patient, which of the following questions or comments would MOST likely yield a response from the patient? A. "Do you want to hurt anyone?" B. "Are you under psychiatric care?" C. "Are you mad at your husband?" D. "You appear to be very sad."

D. "You appear to be very sad."

Which of the following scenarios is MOST indicative of posttraumatic stress disorder? A. An elderly woman who is afraid of losing her independence becomes agitated when being told that she is being admitted to a skilled nursing care facility B. An experienced paramedic who had a nightmare regarding a case of sudden infant death syndrome cries at the scene of a cardiac arrest involving an infant C. An advanced EMT student who has a morbid fear of needles experiences a syncopal episode during IV skills practice during class D. A paramedic whose son was struck and killed by a car becomes acutely anxious upon arriving at the scene of a motor vehicle versus pedestrian incident

D. A paramedic whose son was struck and killed by a car becomes acutely anxious upon arriving at the scene of a motor vehicle versus pedestrian incident

Which of the following statements regarding a person's intelligence is MOST correct? A. All individuals possess the same basic level of intelligence. B. Intelligence is generally a reflection of a person's past education. C. Patients with Down syndrome typically lack basic intelligence. D. A person with mental retardation has a disorder of intelligence.

D. A person with mental retardation has a disorder of intelligence.

Which of the following steps of caring for a patient with a psychiatric emergency would MOST likely give the patient the feeling that something is being done to help? A. Remaining calm and confident B. Asking direct questions C. Encouraging the patient to talk D. Developing a definite plan

D. Developing a definite plan

Which of the following assessment findings is MOST suggestive of an organic cause of abnormal behavior? A. Multiple tattoos B. Auditory hallucinations C. Skin that is cool and dry D. Unusual breath odor

D. Unusual breath odor

Klonopin and BuSpar: A. block the reuptake of serotonin. B. are both benzodiazepines. C. are used to control seizures. D. are anxiolytic medications.

D. are anxiolytic medications.

When extreme anxiety occurs in conjunction with restlessness, a patient: A. is not distractible. B. often becomes suicidal. C. presents with a flat affect. D. becomes agitated.

D. becomes agitated.

Law enforcement personnel request your assistance in caring for a violent patient. When you arrive at the scene, the patient, a 48-year-old man, is yelling obscenities and is threatening to kill anyone who comes near him. Despite your attempts to calm him verbally, he continues his threatening behavior. It is MOST important for you to: A. utilize at least four people to physically restrain the patient so you can administer haloperidol. B. ask law enforcement to immobilize the patient with a TASER so you can assess his blood glucose level. C. leave the scene immediately and allow law enforcement personnel to take control of the situation. D. ensure that you have a route for rapid egress and visually scan the patient for potential weapons.

D. ensure that you have a route for rapid egress and visually scan the patient for potential weapons.

A psychotic episode MOST often leads to violence because of: A. the patient's family's reaction. B. overreaction of the paramedic. C. the influence of an illicit drug. D. exaggerated fear or paranoia.

D. exaggerated fear or paranoia.

In anxiety disorders, the dominant moods are: A. confusion and apathy. B. euphoria and elation. C. anger and agitation. D. fear and apprehension.

D. fear and apprehension

Accelerated thinking in which the mind skips very rapidly from one thought to the next is called: A. perseveration. B. circumstantial thinking. C. confabulation. D. flight of ideas.

D. flight of ideas.

In contrast to dementia, delirium: A. is an irreversible process caused by premature cerebral deterioration. B. generally results from conditions such as Alzheimer disease. C. is a chronic process that causes deficits in memory and abstract thinking. D. is characterized by acute global impairment of cognitive function.

D. is characterized by acute global impairment of cognitive function.

A small percentage of clinically depressed patients: A. complain of persistent anorexia. B. experience guilt and self-reproach. C. have pervasive thoughts of suicide. D. may report an increased appetite.

D. may report an increased appetite.

The MOST important aspect in the care of a patient who is at risk for suicide is: A. identifying the patient's plan. B. eliciting the help of family members. C. acknowledging the patient's feelings. D. never leaving the patient alone.

D. never leaving the patient alone.

You receive a call to an apartment complex for a patient with an unknown behavioral problem. The scene has been secured by law enforcement prior to your arrival. The patient, a 39 year old man, appears very anxious and worried. He tells you that he has obsessive compulsive disorder and stopped taking his prescribed medication a week ago because he did not like its side effects. He tells you that he has had fleeting thoughts of suicide, but denies homicidal thoughts. You should: A. transport him to the hospital and ask a police officer to accompany you. B. tell him that stopping his medications abruptly could result in death. Incorrect C. make contact with his psychiatrist to apprise him or her of the situation. D. safely transport him to the hospital and monitor his behavior en route.

D. safely transport him to the hospital and monitor his behavior en route.

Which of the following statements about panic disorder is correct?

Panic disorder is characterized by sudden, unexpected fear and dread.

A 50-year-old woman called 9-1-1 after she was suddenly awakened in the middle of the night with the feeling that she was being smothered. Your assessment reveals that she is clearly anxious, is trembling, and complains of chest pain and numbness and tingling to her face and hands. Her blood pressure is 168/96 mm Hg, pulse rate is 140 beats/min, and respirations are 30 breaths/min. Her medications include Xanax, Lipitor, and Vasotec. The MOST appropriate treatment for this patient includes:

coaching her to slow her breathing, monitoring her oxygen saturation and end-tidal carbon dioxide levels, administering supplemental oxygen, assessing her cardiac rhythm, establishing vascular access, and transporting.

During your assessment of an unresponsive 70-year-old man, the patient's wife tells you that he takes Luvox and BuSpar, among other medications. From this limited information, you should conclude that the patient suffers from:

depression and anxiety.

Abnormal behavior that stems from a psychosocial etiology would MOST likely occur in a patient who:

experienced emotional trauma as a child.

When caring for a patient experiencing a psychotic episode you should:

first assess the situation for danger.

A hallmark sign of mania is:

marked hyperactivity.

In hypochondriasis, patients have significant anxiety or fear that they:

may have a serious disease.

The BEST example of an impulse control disorder is:

pathologic gambling.

Generalized anxiety disorder is characterized by:

persistent and unproductive worrying.

A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient's vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should:

remain with the patient, contact medical control, and request law enforcement intervention.

Any patient who is experiencing a panic attack:

should be evaluated to rule out an underlying medical condition.

If a psychotic person's level of consciousness is fluctuating, you should:

suspect an organic brain syndrome.

Manic patients may report that their thoughts are racing and they may rapidly skip from one topic to another. This is called:

tangential thinking.

Many EMS personnel may experience a lack of confidence in their ability to deal with emotional disturbances for all of the following reasons, EXCEPT:

the uncontrollable fear of personal injury.

When caring for a patient who is experiencing a panic attack:

your manner must convey that everything is under control.