Chapter 20 EMT

1. ____________ is what you can see of a person's response to the environment. A. Affect B. Behavior C. Neurosis D. Psychosis

2. The term "behavioral crisis" is MOST accurately defined as: A. a sudden, violent outburst of an otherwise mentally stable person toward a family member. B. any reaction that interferes with activities of daily living or is deemed unacceptable by others. C. a situation in which a patient demonstrates bizarre behavior and becomes a risk to other people. D. a period of severe depression that lasts longer than 2 weeks and cannot be controlled with medications.

3. From a mental health standpoint, an abnormal or disturbing pattern of behavior is a matter of concern if it lasts for at least: A. 1 week. B. 2 weeks. C. 3 weeks. D. 1 month.

4. In contrast to a behavioral crisis, a psychiatric emergency occurs when a person: A. demonstrates agitation or violence or becomes a threat to himself or herself, or to others. B. experiences feelings of sadness and despair for longer than a month. C. exhibits impaired functioning due to a chemical or genetic disturbance. D. experiences a sudden attack of panic secondary to a stressful situation.

5. 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. avoid asking questions about suicide because this may give the patient ideas. C. check his or her blood glucose level only if he or she has a history of diabetes. D. carefully document his or her perception of what is causing the patient's behavior.

6. Organic brain syndrome is MOST accurately defined as: A. bizarre behavior secondary to a chemical imbalance or disturbance in the brain. B. a dysfunction of the brain caused by abnormal physical or physiological function. C. a disorder that cannot be traced to the abnormal structure or function of an organ. D. a change in behavior or mental status secondary to inadequate cerebral blood flow.

7. 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. transport the patient to a psychiatric facility. B. inquire about the possibility of head trauma. C. conclude that the patient's blood sugar is high. D. allow the patient to refuse transport if she wishes.

8. Which of the following conditions or factors would be the LEAST likely to result in a change in behavior? A. low blood glucose levels B. antihypertensive medications C. exposure to excess heat or cold D. inadequate blood flow to the brain

9. Which of the following is an example of a functional behavioral disorder? A. head trauma B. drug addiction C. schizophrenia D. Alzheimer's disease

10. The first step in assessing a patient with a behavioral emergency is to: A. take vital signs. B. restrain the patient. C. ensure your safety. D. obtain proper consent

11. 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. ask the husband to attempt to reason with his wife. B. remain in a safe place and request law enforcement. C. get in your ambulance and leave the scene immediately. D. go upstairs with caution and attempt to talk to the patient.

12. General guidelines for managing a patient with a behavioral emergency include: A. firmly identifying yourself as an EMS provider. B. placing the patient between yourself and an exit. C. allowing the patient to be alone if he or she wishes. D. being prepared to spend extra time with the patient.

13. 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.

14. 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.

15. 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 unconscious and cyanotic. An empty bottle of hydromorphone (Dilaudid) is found on an adjacent table. You should: A. open the patient's airway and assess his respirations. B. ask the police to handcuff the patient for safety purposes. C. provide care after determining what Dilaudid is used for. D. wait for the police to examine him before providing care

16. 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. conclude that the patient has Alzheimer's disease. B. ask the daughter how her father normally behaves. C. carefully restrain the patient and transport at once. D. advise the patient that his behavior is unacceptable.

17. 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. active listening. B. passive listening. C. intuitive listening. D. reflective listening.

18. 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. A physical examination for a behavioral problem may be difficult to perform but may provide clues to the patient's state of mind and thought processes. 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. 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.

19. 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. rapid eye movement C. excessive tearing or crying D. consistent eye contact

20. Assessing the blood pressure and oxygen saturation of a patient with a behavioral crisis should be performed: A. within the first few minutes after making patient contact. B. at least every 5 minutes in order to detect signs of shock. C. only if you will be transporting the patient to the hospital. D. if doing so will not worsen his or her emotional distress.

21. In addition to ensuring his or her own safety, the EMT's responsibility when caring for a patient with a behavioral emergency is to: A. diffuse and control the situation and safely transport the patient. B. diagnose the patient's problem and provide definitive treatment. C. transport the patient directly to a specialized psychiatric facility. D. determine the underlying cause of the problem and offer advice.

22. Common causes of acute psychotic behavior include all of the following, EXCEPT: A. intense stress. B. schizophrenia. C. Alzheimer's disease. D. mind-altering substance use.

23. The single most significant factor that contributes to suicide is: A. depression. B. drug abuse. C. advanced age. D. a chronic illness.

24. 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. Ask the patient if she has developed a suicidal plan. B. Leave the scene and have a neighbor check in on her. C. Have law enforcement place her in protective custody. D. Encourage the patient to remain quiet during transport.

25. 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. children with parents addicted to alcohol. D. substance abusers.

26. It is MOST important for the EMT to remember that suicidal patients may: A. inject illicit drugs. B. be self-destructive. C. be homicidal as well. D. have a definitive plan.

27. Signs of agitated delirium include: A. pallor, hypotension, and constricted pupils. B. diaphoresis, tachycardia, and hallucinations. C. slurred speech, bradycardia, and a high fever. D. subdued behavior, crying, and suicidal thoughts.

28. Law enforcement personnel request your assistance for a 30-year-old man who they 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. quickly rule out any life-threatening conditions and then perform a detailed secondary assessment as he is being restrained. 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. recognize that he is experiencing a complex psychiatric crisis, quickly load him into the ambulance, and transport without delay.

29. 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. try to gain the patient's trust by telling him that you see the vampires too. B. request that the police officers arrest him and take him to the hospital. C. restrain the patient with appropriate force in order to treat his injuries. D. approach the patient and calm him by placing your hand on his shoulder.

30. 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. the broken window C. his shouting of obscenities D. his large body