EMT Chapter 23 Behavioral Health Emergencies

A 78-year-old female presents with an acute change in her behavior. The patient's son tells you that his mother has type 2 diabetes and was diagnosed with Alzheimer's disease 6 months ago. The patient's speech is slurred, and she is not alert to her surroundings. You should:

A. conclude that the patient's blood sugar is high.

B. transport the patient to a psychiatric facility.

C. inquire about the possibility of head trauma.

D. allow the patient to refuse transport if she wishes.

C. inquire about the possibility of head trauma

Which of the following conditions or situations would MOST likely make excited delirium worse?

A. Limited physical contact

B. Elevated blood glucose

C. Dimly lit environment

D. Alcohol withdrawal

D. Alcohol withdrawal

In which position should you restrain a physically uncooperative patient?

A. With hands tied behind the back

B. Prone

C. Supine

D. With arms and legs bound together

C. Supine

You respond to a call for an unknown emergency. When you arrive at the scene, the patient's husband meets you at the door and states that his wife has been depressed and has locked herself in an upstairs bedroom. He further tells you that he keeps his handgun in the bedroom. You should:

A. get in your ambulance and leave the scene immediately.

B. remain in a safe place and request law enforcement.

C. go upstairs with caution and attempt to talk to the patient.

D. ask the husband to attempt to reason with his wife.

B. remain in a safe place and request law enforcement

Signs of excited delirium include:

A. slurred speech, bradycardia, and a high fever.

B. pallor, hypotension, and constricted pupils.

C. subdued behavior, crying, and suicidal thoughts.

D. diaphoresis, tachycardia, and hallucinations.

D. diaphoresis, tachycardia, and hallucinations

When caring for a patient experiencing excited delirium, the EMT should remember that:

A. sudden death can occur if the patient's violence is not controlled.

B. excited delirium is worsened by nervous system depressant drugs.

C. lights and siren are effective in redirecting the patient's behavior.

D. most patients will have low blood pressure and hyperglycemia.

A. sudden death can occur if the patient's violence is not controlled

Organic brain syndrome is defined as:

A. a dysfunction of the brain caused by abnormal physical or physiological function.

B. a change in behavior or mental status secondary to decreased cerebral blood flow.

C. bizarre behavior secondary to a chemical imbalance or disturbance in the brain.

D. a disorder that cannot be traced to the abnormal structure or function of an organ.

A. a dysfunction of the brain caused by abnormal physical or physiological function

A patient with a history of schizophrenia called EMS because he was experiencing abdominal pain. When law enforcement arrived, the patient became violent, necessitating the placement of handcuffs. When you assess the patient, he tells you that killing someone will make his abdominal pain go away. His vital signs are stable. How should you manage this situation?

A. Request that a police officer transport him to the hospital.

B. Transport the patient in a prone position on the stretcher.

C. Refuse to transport the patient because of his homicidal threat.

D. Request a police officer to accompany you in the ambulance.

D. Request a police officer to accompany you in the ambulance

A technique used to gain insight into a patient's thinking, which involves repeating in question form what the patient has said, is called:

A. intuitive listening.

B. passive listening.

C. active listening.

D. reflective listening.

D. reflective listening

Which of the following statements regarding the physical examination of a patient with a behavioral problem is correct?

A. It is only appropriate to perform a physical examination on a patient with a behavioral problem if he or she is unconscious or is being physically restrained.

B. Performing a physical examination on a patient with a behavioral problem will likely cause him or her to become violent and should be avoided in the field.

C. The physical examination of a patient with a behavioral problem often yields crucial information and should always be performed, even if the patient is violent.

D. Although the physical exam can be difficult, the patient's emotional state may be determined by noting facial expressions, pulse rate, and respirations.

D. Although the physical exam can be difficult, the patient's emotional state may be determined by noting facial expressions, pulse rate, and respirations

The term "behavioral crisis" is MOST accurately defined as:

A. a medical illness with psychological symptoms that may lead to limited motor functioning.

B. a sudden, violent outburst of an otherwise mentally stable person toward a family member.

C. a period of severe depression that lasts longer than 2 weeks and cannot be controlled with medications.

D. a situation in which a patient of any age exhibits agitated, violent, or uncooperative behavior.

D. a situation in which a patient of any age exhibits agitated, violent, or uncooperative behavior

The single most significant factor that contributes to suicide is:

A. depression.

B. advanced age.

C. drug abuse.

D. a chronic illness.

A. depression

General guidelines for managing a patient with a behavioral emergency include:

A. placing the patient between yourself and an exit.

B. being prepared to spend extra time with the patient.

C. firmly identifying yourself as an EMS provider.

D. allowing the patient to be alone if he or she wishes.

B. being prepared to spend extra time with the patient

Posttraumatic stress disorder can happen after:

A. extended periods of hyperthermia or hypothermia.

B. a bout with depression.

C. alcohol withdrawal.

D. exposure to or injury from a traumatic occurrence.

D. exposure to or injury from a traumatic occurrence

____________ is what you can see of a person's response to the environment.

A. Behavior

B. Neurosis

C. Psychosis

D. Affect

A. Behavior

You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive of this patient's potential for violence?

A. His clenched fists

B. His large body size

C. His shouting of obscenities

D. The broken window

B. His large body size

A 40-year-old male intentionally cut his wrist out of anger after losing his job. Law enforcement has secured the scene prior to your arrival. As you enter the residence and visualize the patient, you can see that he has a towel around his wrist and a moderate amount of blood has soaked through it. You should:

A. approach the patient with caution.

B. quickly tend to the bleeding wound.

C. tell the patient that you want to help.

D. calmly identify yourself to the patient.

D. calmly identify yourself to the patient

You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her entire world is crashing down around her. She further states that she has had frequent thoughts of suicide, but is not sure if she can actually go through with it. How should you manage this situation?

A. Leave the scene and have a neighbor check in on her.

B. Encourage the patient to remain quiet during transport.

C. Ask the patient if she has developed a suicidal plan.

D. Have law enforcement place her in protective custody.

C. Ask the patient if she has developed a suicidal plan

A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing things in his house. You are familiar with the patient and have cared for him in the past for unrelated problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage this situation is to:

A. approach the patient and calm him by placing your hand on his shoulder.

B. request that the police officers arrest him and take him to the hospital.

C. try to gain the patient's trust by telling him that you see the vampires too.

D. restrain the patient with appropriate force in order to treat his injuries.

D. restrain the patient with appropriate force in order to treat his injuries

In contrast to a behavioral crisis, a behavioral health emergency occurs when a person:

A. experiences a sudden attack of panic secondary to a stressful situation.

B. experiences feelings of sadness and despair for longer than a month.

C. becomes agitated or violent and is a threat to him- or herself or others.

D. exhibits impaired functioning due to a chemical or genetic disturbance.

C. becomes agitated or violent and is a threat to him- or herself or others

Immediately after physically restraining a violent patient, the EMT should:

A. reassess the patient's airway and breathing.

B. inform medical control of the situation.

C. advise the patient why restraint was needed.

D. document the time the restraints were applied.

A. reassess the patient's airway and breathing

Law enforcement personnel request your assistance for a 30-year-old man who was pulled over for erratic driving. The patient became acutely violent while he was being questioned, which required one of the officers to subdue him with a Taser. When you arrive and assess the patient, you find that he is very agitated and is experiencing apparent hallucinations. His skin is flushed and diaphoretic. You should:

A. recognize that he is experiencing a complex psychiatric crisis, quickly load him into the ambulance, and transport without delay.

B. suspect that he is acutely hypoglycemic, consider giving him one tube of oral glucose, and transport with lights and siren.

C. limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to communicate with you.

D. quickly rule out any life-threatening conditions and then perform a detailed secondary assessment as he is being restrained.

C. limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to communicate with you

Common causes of acute psychotic behavior include all of the following, EXCEPT:

A. Alzheimer's disease.

B. schizophrenia.

C. mind-altering substance use.

D. intense stress.

A. Alzheimer's disease

You may not be able to determine whether a person has a mental illness, but you can predict the person's likelihood of becoming:

A. diabetic.

B. psychotic.

C. suicidal.

D. violent.

D. violent

Which of the following is an example of a functional behavioral disorder?

A. Alzheimer's disease

B. Schizophrenia

C. Drug addiction

D. Head trauma

B. Schizophrenia

When assessing a patient who is displaying bizarre behavior, the EMT should:

A. consider that an acute medical illness may be causing the patient's behavior.

B. check his or her blood glucose level only if he or she has a history of diabetes.

C. avoid asking questions about suicide because this may give the patient ideas.

D. carefully document his or her perception of what is causing the patient's behavior

A. consider that an acute medical illness may be causing the patient's behavior

You are assessing a conscious 55-year-old male with a sudden change in behavior. Which of the following clinical findings would be MOST suggestive of dysfunction of this patient's central nervous system?

A. An irregular pulse

B. Consistent eye contact

C. Excessive tearing or crying

D. Rapid eye movement

D. rapid eye movement

After ensuring his or her own safety, the EMT's next priority when caring for a patient with a behavioral emergency is to:

A. transport the patient directly to a specialized psychiatric facility.

B. determine the underlying cause of the problem and offer advice.

C. assess the patient's response to his or her environment.

D. diagnose the patient's problem and provide definitive treatment.

C. assess the patient's response to his or her environment

The first step in assessing a patient with a behavioral emergency is to:

A. obtain proper consent.

B. restrain the patient.

C. ensure your safety.

D. take vital signs.

C. ensure your safety

A 66-year-old male presents with bizarre behavior. His daughter states that he did not seem to recognize her and was very rude to her. The patient is conscious and has a patent airway and adequate breathing. You should:

A. ask the daughter how her father normally behaves.

B. advise the patient that his behavior is unacceptable.

C. carefully restrain the patient and transport at once.

D. conclude that the patient has Alzheimer's disease.

A. ask the daughter how her father normally behaves

People at risk for suicide include all of the following, EXCEPT:

A. married males older than 30 years.

B. those with a recent diagnosis of a serious illness.

C. substance abusers.

D. children with parents addicted to alcohol.

A. married males older than 30 years

A 22-year-old male with a history of clinical depression called 9-1-1 and stated that he has attempted to kill himself. Your unit and law enforcement officers arrive at the scene simultaneously. You find the patient lying supine on the living room floor. He is unresponsive and cyanotic. An empty bottle of hydromorphone (Dilaudid) is found on an adjacent table. You should:

A. ask the police to handcuff the patient for safety purposes.

B. open the patient's airway and assess his respirations.

C. provide care after determining what Dilaudid is used for.

D. wait for the police to examine him before providing care.

B. open the patient's airway and assess his respirations

A physiologic disorder that impairs bodily function when the body seems to be structurally normal is called a:

A. drug and alcohol abuse

B. traumatic brain injury

C. seizure

D. functional disorder

D. functional disorder

It is MOST important for the EMT to remember that suicidal patients may:

A. have a definitive plan.

B. inject illicit drugs.

C. be self-destructive.

D. be homicidal as well.

D. be homicidal as well

When assessing a patient with a behavioral crisis, you should:

A. be direct and clearly state your intentions.

B. frisk the patient for the presence of weapons.

C. spend as little time with the patient as possible.

D. ask the police to handcuff the patient for safety

A. be direct and clearly state your intentions

A 78-year-old female presents with an acute change in her behavior. The patient's son tells you that his mother has type 2 diabetes and was diagnosed with Alzheimer's disease 6 months ago. The patient's speech is slurred, and she is not alert to her surroundings. You should:

A. allow the patient to refuse transport if she wishes.

B. conclude that the patient's blood sugar is high.

C. transport the patient to a psychiatric facility.

D. inquire about the possibility of head trauma.

D. inquire about the possibility of head trauma

General guidelines for managing a patient with a behavioral emergency include:

A. allowing the patient to be alone if he or she wishes.

B. being prepared to spend extra time with the patient.

C. firmly identifying yourself as an EMS provider.

D. placing the patient between yourself and an exit.

B. being prepared to spend extra time with the patient

You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her entire world is crashing down around her. She further states that she has had frequent thoughts of suicide, but is not sure if she can actually go through with it. How should you manage this situation?

A. Leave the scene and have a neighbor check in on her.

B. Have law enforcement place her in protective custody.

C. Ask the patient if she has developed a suicidal plan.

D. Encourage the patient to remain quiet during transport.

C. ask the patient if she has developed a suicidal plan

Organic brain syndrome is defined as:

A. a change in behavior or mental status secondary to decreased cerebral blood flow.

B. bizarre behavior secondary to a chemical imbalance or disturbance in the brain.

C. a disorder that cannot be traced to the abnormal structure or function of an organ.

D. a dysfunction of the brain caused by abnormal physical or physiological function

D. a dysfunction of the brain caused by abnormal phsyical or physiological function

When caring for a patient experiencing excited delirium, the EMT should remember that:

A. lights and siren are effective in redirecting the patient's behavior.

B. most patients will have low blood pressure and hyperglycemia.

C. sudden death can occur if the patient's violence is not controlled.

D. excited delirium is worsened by nervous system depressant drugs.

C. sudden death can occur if the patient's violence is not controlled