Chapter 27 Test EMT

You are confronted with a patient experiencing personality changes ranging from irritability to irrational​ behavior, altered mental​ status, amnesia or​ confusion, irregular​ respirations, elevated blood​ pressure, and decreasing pulse. It appears to be a psychiatric emergency. What else could cause this​ behavior?

a) Lack of oxygen

b) Head injury

c) Stroke

d) Low blood sugar

b) Head injury

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?

a) Quickly check the​ patient's carotid pulse

b) Ask the wife to step outside with you so you can get information from her

c) Stay a safe distance away

d) Ask the wife to step into the other room so you can speak with the patient alone

c) Stay a safe distance away

Which of the following is not an acceptable method or adjunct in restraining a​ patient?

a) Securing all four limbs with leather restraints

b) Restraining the patient​ face-up

c) Placing a surgical mask over the​ patient's face to prevent spitting

d) Hog-tying the patient

d) Hog-tying the patient

It is important​ that, as an EMS​ provider, you avoid creating a situation where positional asphyxia could occur. Which of the following is positional​ asphyxia?

a) Positional asphyxia is the position the person is seated in when you approach him

b) Positional asphyxia is a birth defect that causes psychiatric issues and is initiated because of the way the fetus was positioned in the uterus

c) Positional asphyxia is the name for the position someone assumes after she has been hit with a taser

d) Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing

d) Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing

You are called to the scene of an attempted suicide. You arrive to find a​ 25-year-old man sitting on the sofa who apparently cut his wrists. Family members have bandaged​ them, and there does not appear to be any bleeding risk at this time. The scene is secure. Which action would not be appropriate in treating this​ patient?

a) Contact the receiving hospital and report on current mental status and other essential information

b) Take charge of the​ situation; let the patient know that what he has done is wrong and tell him he is coming with you whether he likes it or not

c) Watch for sudden changes in the​ patient's behavior and physical condition

d) As soon as​ possible, perform a history and physical exam and provide emergency care on the​ wrist, if necessary

b) Take charge of the​ situation; let the patient know that what he has done is wrong and tell him he is coming with you whether he likes it or not

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?

a) Catharsis

b) Post-traumatic stress disorder

c) Neurosis

d) Stress reaction

d) Stress reaction

You are on the scene of a possible overdose. You find a​ 30-year-old man pacing around 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?

a) Sit close to him with your arm around his shoulders to show that you are truly concerned

b) Stand still with your arms crossed to instill a sense of control and authority

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

d) Speak quickly to give the patient all of the important information without delay

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

When restraining a​ patient, which of the following is not a​ consideration?

a) Number of people available to carry out the required actions

b) Patient's size and strength

c) How to position the patient

d) ​Patient's informed consent

d) ​Patient's informed consent

Which of the following actions is the most appropriate for the EMT to take when managing a patient with a behavioral​ emergency?

a) Find out if the​ patient's insurance covers psychiatric treatment

b) Remain calm and reassure the patient

c) Establish control of the situation by a show of force

d) Quickly perform a​ head-to-toe exam and transport without delay

b) Remain calm and reassure the patient

Which of the following may cause a patient to exhibit abnormal​ behavior?

a) Snakebites

b) Gastroenteritis

c) Hypoxia

d) Allergic reaction

c) Hypoxia

When managing a patient who may hurt himself or​ others, you should do all of the following except​:

a) make sure only you and the patient are in the room

b) retreat if the patient becomes threatening

c) watch for sudden changes in the​ patient's behavior

d) keep bystanders a safe distance away

a) make sure only you and the patient are in the room

There are general rules for dealing with psychiatric emergencies. Which of the following is not one of those rules and would not be considered​ appropriate?

a) Never make eye contact with the​ patient, as it will just increase his nervousness

b) Speak slowly and​ clearly, using a calm and reassuring tone

c) Listen to the patient. You can show you are listening by repeating part of what the patient says back to him

d) Identify yourself and your role

a) Never make eye contact with the​ patient, as it will just increase his nervousness

You are dispatched to a local​ fast-food restaurant for a​ "nature unknown" call. You arrive​ on-scene and find a​ 47-year-old male in front of the counter repeatedly singing​ "Happy Birthday" to himself. Police are​ on-scene and the scene is safe. Which of the following would be considered appropriate​ care?

a) Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can

b) Have your partner join you in approaching the patient and explain to him that he has to stop singing or you will have him arrested

c) Quickly approach the patient and take charge. Tell him he has to come with you to be evaluated

d) Have the police take​ charge, restrain the​ patient, and have him brought into your ambulance

a) Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can

Which of the following statements regarding behavioral emergencies is false​?

a) Cultural differences may cause a​ patient's behavior to initially appear abnormal to the EMT

b) Patients experiencing a behavioral emergency are not always dangerous to themselves or others

c) Apparent behavioral emergencies may be due to an underlying medical cause

d) It is unusual to find a person with schizophrenia outside a mental health facility

d) It is unusual to find a person with schizophrenia outside a mental health facility

Which of the following communication strategies should be used when dealing with a patient with a behavioral​ emergency?

a) Acknowledge the​ patient's feelings

b) Interrupt the patient if he appears to be going off on a tangent about something not concerning the immediate situation

c) Play along with any visual or auditory hallucinations the patient is experiencing

d) Stay 2 to 3 inches from the patient at all times to make him feel secure

a) Acknowledge the​ patient's feelings

When dealing with a psychiatric​ emergency, which one of the following would generally be inappropriate behavior on your​ part?

a) Stay alert for sudden changes in behavior

b) Be as hurried as you can. It is extremely important to resolve the call and get the patient to the hospital as soon as possible

c) Let the patient know that you are listening to what he is​ saying, and explain things to the patient honestly

d) Act in a calm​ manner, giving the patient time to gain control of his emotions

b) Be as hurried as you can. It is extremely important to resolve the call and get the patient to the hospital as soon as possible

Which of the following traumatic conditions could account for signs and symptoms of a behavioral​ emergency?

a) Fractured tibia

b) Hemorrhage

c) Fractured lumbar vertebra

d) Partial thickness burn

b) Hemorrhage

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. You have sought assistance from law enforcement on scene. Which of the following is the best​ action?

a) Contact medical direction for further advice

b) Find a relative or neighbor to come over and stay with the patient

c) Stay with the patient until he has stopped vomiting

d) Obtain a witnessed refusal

a) Contact medical direction for further advice

Which of the following situations generally allows the EMT to transport a patient with a behavioral emergency against his or her​ wishes?

a) The​ patient's insurance company agrees to​ pay, even though the patient has not given consent

b) The patient is a threat to himself or others

c) A family member gives consent and is willing to accompany the patient

d) The​ patient's personal physician gives you permission

b) The patient is a threat to himself or others

EMTs may come across a situation where a patient begins to act extremely agitated or psychotic. Uncontrolled psychiatric illness and sometimes drug intoxication may be present. The patient may suddenly cease​ struggling, and often within minutes the patient develops inadequate or absent respirations and subsequently dies. It is important for the EMT to be alert for this sequence of events in a patient who exhibits this behavior and monitor the patient constantly throughout the call. This condition is​ called:

a) psychotic delirium

b) excited psychosis

c) bipolar disorder

d) excited or agitated delirium

d) excited or agitated delirium

Neurotransmitters are chemicals within the body that transmit the message from the distal end of one neuron​ (presynaptic neuron) to the proximal end of the next neuron​ (postsynaptic neuron). While it sounds like a complicated​ process, it takes only milliseconds. Which one of the following sentences is false​?

a) The receptors on the postsynaptic neuron receive the neurotransmitter

b) This is the mechanism by which the impulse is moved along the nervous system

c) After the impulse is​ transmitted, the neurotransmitter goes through a process called​ reuptake, in which the neurotransmitter is returned to the postsynaptic neuron

d) Neurotransmitters are released from a​ neuron, then travel across the synapse to the next neuron

c) After the impulse is​ transmitted, the neurotransmitter goes through a process called​ reuptake, in which the neurotransmitter is returned to the postsynaptic neuron

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?

a) Alcohol withdrawal

b) An underlying physical illness

c) Alcoholic intoxication

d) Sudden onset of schizophrenia

b) An underlying physical illness

Which combination of the following is most appropriate when assessing an emotionally disturbed​ patient?

a) Listen to the patient without being judgmental and do not make eye contact

b) Establish eye and verbal contact and listen to the patient without without being judgmental

c) Establish eye and verbal contact and use assertive body language to show you are in control

d) Listen to the patient and maintain a safe distance to avoid upsetting the patient

b) Establish eye and verbal contact and listen to the patient without without being judgmental

You respond to the scene of a private residence for a patient who is known to have​ insulin-dependent diabetes. The patient is combative and cursing as you approach. Should this patient be​ restrained?

a) ​No, this patient is not likely experiencing a behavioral emergency

b) ​Yes, he is combative and all combative patients can be restrained

c) Yes, he likely has a medical condition that requires treatment

d) There is not enough information to answer this question

d) There is not enough information to answer this question

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?

a) Have a female EMT attend to the patient

b) Transport the​ patient, but do not speak to her or perform an assessment

c) Refuse to transport the patient without a police escort

d) Ask that the patient be given a tranquilizer injection prior to transport

a) Have a female EMT attend to the patient

When responding to an attempted​ suicide, which of the following is the​ EMT's primary​ concern?

a) Managing the​ patient's airway

b) Contacting law enforcement because suicide is illegal

c) Determining whether the patient suffers from clinical depression

d) Personal safety

d) Personal safety

Which of the following must be treated by the EMT if present in a patient with an apparent behavioral​ emergency?

a) Acute alcohol intoxication

b) Severe clinical depression

c) Hypoglycemia

d) Suicidal ideology

c) Hypoglycemia

You are dispatched to a psychiatric emergency for a​ 68-year-old male. Dispatch provides no other information​ and, when questioned by​ you, they do not have any more information. Although all steps are important for dealing with this​ situation, which step is the most​ important?

a) Vital signs and SAMPLE history

b) Primary assessment

c) Scene​ size-up

d) Secondary assessment

c) Scene​ size-up

You are dispatched to a suicide attempt. You arrive to find a​ 16-year-old who is extremely agitated and pacing up and down in the living room of his house.​ Apparently, he threatened to go​ out, get a​ gun, and shoot himself. His parents called it in as an attempted suicide. The scene is safe and there are apparently no weapons accessible to the patient. Which of the following would not be appropriate in caring for this​ patient?

a) Make certain the patient gets between you and the door. The patient should always feel he has an escape route

b) Do not take any action that may be considered threatening by the​ patient; doing so may bring about hostile behavior directed against you or others

c) Always be on the watch for weapons

d) Do not isolate yourself from your partner or other sources of help

a) Make certain the patient gets between you and the door. The patient should always feel he has an escape route

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?

a) Transport the patient against his will with the assistance of law enforcement

b) Respect the​ patient's wishes; he is​ alert, oriented, and capable of giving consent

c) Contact the​ patient's family to find out what their wishes are

d) Leave the scene and allow law enforcement to handle the situation

a) Transport the patient against his will with the assistance of law enforcement

Which of the following statements concerning people who have made prior suicide attempts is true​?

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

b) They do not require psychological counseling like a person who is depressed

c) They should be allowed to sign a release if their injuries are not serious

d) They are usually just making a cry for help but do not want to die

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

When providing emergency care to an aggressive or hostile​ patient, what is the highest​ priority?

a) Checking the patient for possible physical causes of the behavior

b) Calming the patient down

c) Finding out if the patient is oriented to​ person, time, and place

d) Performing a scene​ size-up

d) Performing a scene​ size-up

Which of the following medical conditions could be the underlying cause of an apparent behavioral​ emergency?

a) Stroke

b) Mental illness

c) Hypoglycemia

d) All of the above

d) All of the above

All of the following are general rules for dealing with a psychiatric patient except​:

a) do not be​ judgmental; instead, show​ pity, because he needs to know that you understand him

b) speak slowly and​ clearly, and use a calm and reassuring tone

c) make eye contact with the patient

d) listen to the​ patient, showing you are listening by repeating part of what the patient says back to him

a) do not be​ judgmental; instead, show​ pity, because he needs to know that you understand him

It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered mental status due to a physical issue. Which of the following statements are true​?

1. Consider patients who are exhibiting crisis or unusual behavior to be having an altered mental status from a nonpsychiatric cause until proven otherwise.

2. Many medical and traumatic conditions are likely to alter a​ patient's behavior.

3. Lack of oxygen may cause restlessness and​ confusion, cyanosis​ (blue or gray​ skin), and altered mental status.

4. Stroke or inadequate blood to the brain may cause confusion or dizziness and what appears to be erratic behavior.

a) 1, 2, 3

b) ​1, 2

c) ​1, 2,​ 3, 4

d) ​1, 3, 4

c) ​1, 2,​ 3, 4

Which of the following does not indicate that a patient may be about to become​ violent?

a) Rapid speech and movement

b) Rapid pulse and breathing

c) Tense body posture or clenched fists

d) Crying

d) Crying

Which of the following factors suggest that a patient is at risk for​ suicide?

a) Alcohol and drug abuse

b) Sudden improvement in depression

c) Recent emotional trauma

d) All of the above

d) All of the above

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:

a) chemical delirium

b) excited delirium

c) delusions

d) sensory excitement

b) excited delirium

Why is it important to gather a detailed medical history when dealing with a psychiatric​ emergency?

a) It will alert you to past issues as well as medication

b) It is not. You want to get the call resolved as quickly as possible and this will just delay it

c) It will help you to determine whether the police are needed

d) It will help you to determine whether you need to restrain the patient

a) It will alert you to past issues as well as medication

Which of the following patients would be considered to be at the greatest risk for​ suicide?

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

b) ​30-year-old married man who has just learned that his employer is transferring him to a different state

c) ​35-year-old female who has a child with a serious illness

d) 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

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 she tells you to get away from her. Which of the following should not be​ done?

a) Keep bystanders away from the patient

b) Use Standard Precautions

c) Take the razor blade away from her by force

d) Call law enforcement for assistance

c) Take the razor blade away from her by force

Which of the following statements concerning forcible restraint of patients is true​?

a) It is easily accomplished by two EMTs with a good plan

b) It causes irreparable emotional harm to most patients

c) This is necessary only with mentally ill individuals

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

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

When a person acts in a manner that is unacceptable to himself or those around​ him, this would be considered which of the​ following?

a) Mental illness

b) Psychotic episode

c) Psychosomatic reaction

d) Behavioral emergency

d) Behavioral emergency

Concerning attempted​ suicide, which of the following statements is true​?

a) All suicide attempts must be taken seriously

b) There is always an indication that a suicide attempt is imminent

c) Truly suicidal patients nearly always leave a note

d) Attempted suicide is a matter for law​ enforcement, not EMS

a) All suicide attempts must be taken seriously

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?

a) Begin intense individual counseling with the patient

b) Attempt to determine whether there is a possible physical cause for the​ patient's behavior

c) Establish the best way to restrain the patient before he has the opportunity to become violent

d) There is no need to assess for medical conditions if the patient does not have a history of past medical problems

b) Attempt to determine whether there is a possible physical cause for the​ patient's behavior

Which of the following is acceptable when managing the patient with a behavioral or psychiatric​ emergency?

a) Sit as close to the patient as you can to reassure him that you will not abandon him

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

c) Go along with the​ patient's hallucinations or false beliefs

d) Allow family members to confront the patient about his behavior

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

Which of the following statements concerning behavioral emergencies is true​?

a) A person with a behavioral emergency is mentally ill

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

c) The person with a behavioral emergency requires prolonged institutionalization

d) Emotional outbursts are considered behavioral emergencies

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