Chapter 23 Workbook

Question 1

A state of delusion in which the person is out of touch with reality

Answer 1

Psychosis

Question 2

A complex disorder that can involve delusions, hallucinations, a lack of interest in pleasure, and erratic speech

Answer 2

Schizophrenia

Question 3

Condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions

Answer 3

Delirium

Question 4

A persistent feeling of sadness or despair

Answer 4

Depression

Question 5

An illness with psychological or behavioral symptoms that may result in impaired functioning

Answer 5

Psychiatric disorder

Question 6

What you can see of a person’s response to the environment; his or her actions

Answer 6

Behavior

Question 7

Abnormal operation of an organ that cannot be traced to an obvious change in the structure or physiology of the organ

Answer 7

Functional disorder

Question 8

When a patient shows agitation or violence and becomes a threat to themselves or others

Answer 8

Behavioral health emergency

Question 9

Similar to a behavioral health emergency but typically less serious

Answer 9

Behavioral crisis

Question 10

A temporary or permanent dysfunction of the brain caused by a disturbance in brain tissue function

Answer 10

Organic brain syndrome

Question 11

Which of the following is NOT typically linked to a psychological or behavioral crisis?
A. Mind-altering substances
B. An underlying medical problem
C. History of smoking
D. Stress

Answer 11

C. History of smoking

Question 12

Which of the following is a normal reaction to a crisis situation?
A. Being sad the majority of days for weeks on end
B. Feeling blue after the breakup of a long-term relationship
C. Feeling depressed week after week with no discernible cause
D. Thoughts of suicide

Answer 12

B. Feeling blue after the breakup of a long-term relationship

Question 13

Which of the following statements is FALSE?
A. You may be able to predict whether a person will become violent.
B. Scene safety is always your primary concern.
C. Behavior problems may be the result of drug or alcohol abuse.
D. Most people with a mental illness are dangerous.

Answer 13

D. Most people with a mental illness are dangerous.

Question 14

Learning to adapt to a variety of situations in daily life, including stresses and strains, is called:
A. disruption
B. coping
C. behavior
D. functional

Answer 14

B. coping

Question 15

If a patient becomes agitated, violent, or uncooperative and may become a danger to themselves or others, it is considered a ________ crisis.
A. mental health
B. functional
C. behavioral
D. psychogenic

Answer 15

C. behavioral

Question 16

Patients may show agitation or violence or become a threat to themselves or others when they experience a(n) ________ emergency.
A. psychiatric
B. behavioral
C. functional
D. adjustment

Answer 16

B. behavioral

Question 17

Which of the following is NOT considered a possible cause of a psychiatric disorder?
A. Social disturbance
B. Chemical disturbance
C. Biologic disturbance
D. Emotional disturbance

Answer 17

D. Emotional disturbance

Question 18

An altered mental status may arise from:
A. an oxygen saturation of 98%
B. moderate temperatures
C. inadequate blood flow to the brain
D. adequate glucose levels in the blood

Answer 18

C. inadequate blood flow to the brain

Question 19

Organic brain syndrome may be caused by:
A. daily stress
B. seizure disorders
C. myocardial infarction
D. thoracic spinal cord injury

Answer 19

B. seizure disorders

Question 20

All of the following are examples of a functional disorder EXCEPT:
A. anxiety
B. depression
C. organic brain syndrome
D. schizophrenia

Answer 20

C. organic brain syndrome

Question 21

When documenting abnormal behavior, it is important to:
A. document restraints only when leather restraints are used
B. document everything that happened on the call
C. avoid quoting the patient’s own words
D. interject your interpretations of the patient’s thoughts

Answer 21

B. document everything that happened on the call

Question 22

Safety guidelines for behavioral emergencies include all of the following EXCEPT:
A. assessing the scene
B. being prepared to spend extra time
C. encouraging purposeful movement
D. determining the underlying psychiatric disorder

Answer 22

D. determining the underlying psychiatric disorder

Question 23

In evaluating a situation that is considered a behavioral emergency, the first things to consider are:
A. airway and breathing
B. scene safety and patient response
C. history of medications
D. respiratory and circulatory status

Answer 23

B. scene safety and patient response

Question 24

________ is a behavior that is characterized by restlessness and irregular physical activity.
A. Agitation
B. Aggression
C. Anxiety
D. Apathy

Answer 24

A. Agitation

Question 25

Which of the following is NOT considered a risk factor for suicide? A. Alcohol abuse B. Recent marriage C. Family history of suicide D. Depression

Answer 25

B. Recent marriage

Question 26

Which of the following is NOT a risk factor to consider when assessing a suicidal patient? A. Does the patient appear to be well groomed? B. Is the environment unsafe? C. Is there an imminent threat to the patient or others? D. Is there evidence of self-destructive behavior?

Answer 26

A. Does the patient appear to be well groomed?

Question 27

Signs and symptoms of agitated delirium include all of the following EXCEPT: A. diarrhea B. tachycardia C. vivid hallucinations D. dilated pupils

Answer 27

A. diarrhea

Question 28

You should request the assistance of a ________ when a mentally impaired patient refuses to go to the hospital. A. physician B. court order C. law enforcement officer D. psychologist

Answer 28

C. law enforcement officer

Question 29

When restraining a patient without an appropriate order, legal actions may involve charges of: A. abandonment B. negligence C. battery D. breach of duty

Answer 29

C. battery

Question 30

When restraining a patient on a stretcher, it is necessary to constantly reassess the patient’s: A. level of consciousness B. respiration and circulation status C. emotional status D. pain status

Answer 30

B. respiration and circulation status

Question 31

Dean, a man in his 50s, is acting irrationally. His wife states that he thinks he is the dictator of a small country, and he is wearing nothing but a baseball cap and a belt with a small handgun attached to it. What is your best course of action? A. Call ALS. B. Assess Dean from a distance. C. Have his wife take the gun from him. D. Call for police backup.

Answer 31

D. Call for police backup.

Question 32

Dean, a man in his 50s, is acting irrationally. His wife states that he thinks he is the dictator of a small country, and he is wearing nothing but a baseball cap and a belt with a small handgun attached to it. The scene is safe. Dean now tells you he is “God” and can do anything he wants to. Which of the following should you NOT consider? A. He is probably not a threat to you. B. He may have a history of psychiatric problems. C. He could be suffering from an underlying medical problem. D. Alcohol or drugs could be a factor in his behavior.

Answer 32

A. He is probably not a threat to you.

Question 33

Dean, a man in his 50s, is acting irrationally. His wife states that he thinks he is the dictator of a small country, and he is wearing nothing but a baseball cap and a belt with a small handgun attached to it. What are some tactics you can use to have Dean cooperate with your assessment? A. Reflective listening B. Threatening him with restraints C. Aggressive communication D. Passive listening

Answer 33

A. Reflective listening

Question 34

Dean, a man in his 50s, is acting irrationally. His wife states that he thinks he is the dictator of a small country, and he is wearing nothing but a baseball cap and a belt with a small handgun attached to it. Dean becomes agitated and states, “You’ll never take me alive.” A decision is made to restrain Dean. How many people should ideally be present to restrain Dean? A. Two B. Five C. Six D. Eight

Answer 34

B. Five

Question 35

True/False Depression lasting 8 months after being fired from a job is a normal mental health response.

Answer 35

False

Question 36

True/False Low blood glucose or lack of oxygen to the brain may cause behavioral changes to the degree that a psychiatric emergency could exist.

Answer 36

True

Question 37

True/False A disturbed patient should always be transported with restraints.

Answer 37

False

Question 38

True/False It is sometimes helpful to allow a patient with a behavioral emergency some time alone to calm down and collect his or her thoughts.

Answer 38

False

Question 39

True/False It is important to maintain eye contact with the patient when dealing with a behavioral crisis.

Answer 39

True

Question 40

True/False A patient should never be asked if he or she is considering suicide.

Answer 40

False

Question 41

True/False Urinary tract infections can cause behavioral changes in elderly patients.

Answer 41

True

Question 42

True/False All individuals with mental health disorders are dangerous, violent, or otherwise unmanageable.

Answer 42

False

Question 43

True/False When completing the documentation, it is important to record the reasons why you restrained a patient.

Answer 43

True

Question 44

True/False When restraining a patient, at least three people should ideally be present to carry out the restraint.

Answer 44

False

Question 45

True/False A patient should be placed facedown when being restrained to a litter.

Answer 45

False

Question 46

True/False Reassessment of respiratory and circulatory status in restrained patients should take place continuously.

Answer 46

True

Question 47

True/False Tears, sweating, and blushing may be significant indicators of state of mind, such as sadness, nervousness, or embarrassment.

Answer 47

True

Question 48

True/False Most medical or trauma situations will include a behavioral component.

Answer 48

True

Question 49

True/False Military personnel who experienced combat have a low incidence of posttraumatic stress disorder (PTSD).

Answer 49

False

Question 50

True/False Flashbacks are uncontrolled events triggered by sound, sight, or smell.

Answer 50

True

Question 51

True/False A competent adult may not refuse treatment when life-saving treatment is needed.

Answer 51

False

Question 52

________ is what you can see of a person’s response to the environment, such as his or her actions.

Answer 52

Behavior

Question 53

A(n) ________ ________ ________or crisis is any reaction to events that interferes with the activities of daily living or has become unacceptable to the patient, family, or community.

Answer 53

behavioral health emergency

Question 54

Chronic ________, or a persistent feeling of sadness or despair, may be a symptom of an underlying health problem.

Answer 54

depression

Question 55

________ ________ ________ is a temporary or permanent dysfunction of the brain caused by a disturbance in the physical or physiologic functioning of the brain.

Answer 55

Organic brain syndrome

Question 56

Any time you encounter an emotionally depressed patient, you must consider the possibility of ________.

Answer 56

suicide

Question 57

People with ________ may experience symptoms including delusions, hallucinations, a lack of interest in pleasure, and erratic speech.

Answer 57

schizophrenia

Question 58

Violent or dangerous people should be managed by ________ ________ before emergency care is rendered.

Answer 58

law enforcement

Question 59

When a patient is not mentally competent to grant consent, the law assumes that there is ________ ________.

Answer 59

implied consent

Question 60

________ ________ occurs when the person attempts to find an escape from constant internal distress or a particularly disturbing event.

Answer 60

Dissociative PTSD

Question 61

In subduing a disturbed patient, use the ________ force necessary.

Answer 61

minimum

Question 62

Short Answer What three major areas should be considered when evaluating the history of a patient experiencing a behavioral crisis or emergency?

Answer 62

1. Improper functioning of the central nervous system 2. Hallucinogens/drugs or alcohol 3. Significant life changes, symptoms, or illness caused by a mental disorder

Question 63

Short Answer What are three factors to consider in determining the level of force required to restrain a patient?

Answer 63

1. The degree of force necessary to keep the patient from injuring self or others 2. The patient’s gender, size, strength, and mental status (including drug‑induced states) 3. The type of abnormal behavior the patient is exhibiting

Question 64

Short Answer List at least 10 safety guidelines for dealing with behavioral emergencies.

Answer 64

1. Assess the scene. 2. Ensure that you have a means of communication. 3. Know where the exits are. 4. Don personal protective equipment. 5. Have a definite plan of action. 6. Urgently deescalate the patient’s level of agitation. 7. Calmly identify yourself. 8. Be direct. 9. Be prepared to spend extra time. 10. Stay with the patient. 11. Do not get too close to a potentially volatile patient. 12. Express interest in the patient’s story. 13. Avoid fighting with the patient. 14. Be honest and reassuring. 15. Do not judge.

Question 65

Short Answer List at least 10 risk factors for suicide.

Answer 65

1. Depression at any age 2. Previous suicide attempt 3. Current expression of wanting to commit suicide or sense of hopelessness 4. Specific plan for suicide 5. Family history of suicide 6. Age older than 40 years, particularly for single, widowed, divorced, alcoholic, or depressed individuals 7. Recent loss of spouse, significant other, family member, or support system 8. Chronic debilitating illness or recent diagnosis of serious illness 9. Feeling anxious, agitated, angry, reckless, or aggressive 10. Financial setback, loss of job, police arrest, imprisonment, or some sort of social embarrassment 11. Alcohol or substance abuse, particularly with increasing usage 12. Children of an alcoholic or abusive parent 13. Withdrawal from family and friends or a lack of social support, resulting in isolation 14. Significant anniversaries of sentinel events 15. Unusual gathering or new acquisition of things that can cause death, such as purchase of a gun or a large volume of pills

Question 66

Short Answer Explain the process for reflective listening.

Answer 66

A technique used by mental health professionals to gain insight into a patient’s thinking. It involves repeating, in question form, what the patient has said, encouraging the patient to expand on the thoughts.

Question 67

Short Answer List five risk factors to consider when dealing with a potentially violent patient.

Answer 67

1. History 2. Posture 3. The scene 4. Vocal activity 5. Physical activity

Question 68

Ambulance Calls You are dispatched to a nonemergency transport of a girl from a local hospital emergency department to a care facility that provides treatment for emotionally disturbed teenagers. She became violent in the emergency department and was placed in four-point restraints. As you begin transporting the patient, she begins to cry and asks you to remove the restraints. How would you best manage this patient?

Answer 68

Removing restraints (especially when the patient has a known history of recent violence) is ill‑advised and potentially against local protocols. Restraints, although uncomfortable, afford you and your patient a safe environment. You should continually monitor the restraints to ensure that they are not too tight and that no manner of restraints affects the patient’s ability to breathe. Know your local laws regarding the use of restraints and your local protocols for appropriate use and discontinuation.

Question 69

Ambulance Calls You are dispatched to a “suicide attempt” at a private residence. When you arrive on scene, you are greeted by a calm, middle-aged man who appears to have been crying. He tells you that he was on the phone with his sister who lives out of state and that she must have called for the ambulance. The patient tells you that he was just upset, but he’s fine now. Dispatch informed you via cell phone that this man recently lost his wife of 15 years to breast cancer. How would you best manage this patient?

Answer 69

Although he tells you that he is fine, you cannot simply walk away. Those individuals who contemplate suicide often tell people they are “fine.” With information passed along by his sister, you must take action. Because there is no evidence that the patient has tried to harm himself and he did not express directly to you that he intends to, you must use persuasive techniques to gain consent to treatment and transport. If the patient refuses, consider contacting law enforcement for assistance.

Question 70

Ambulance Calls You are dispatched to the residence of a 40 year old woman who is upset over the loss of her mother 5 weeks ago. She tells you that she has no family and has cared for her elderly mother for the past 7 years. She has not eaten for several days and is severely depressed. How would you best manage this patient?

Answer 70

Be understanding and listen. Explain to the patient that he needs medical care. Monitor vital signs and reassure the patient en route.

Question 71

When assessing the history, all of the following are past behaviors you want to know if the patient has exhibited EXCEPT: A. hostile behavior B. overly aggressive behavior C. violent behavior D. cooperative behavior

Answer 71

D. cooperative behavior

Question 72

Physical tension is often a warning signal of impending hostility. What sign might warn you of physical tension? A. Posture B. Eye movement C. Facial expression D. Laughter

Answer 72

A. Posture

Question 73

What warning signs can be detected from the scene? A. Hunting magazines on the table B. Known weapons in the outside shed C. Guns or knives near the patient D. Photos of hunting trips on the wall

Answer 73

C. Guns or knives near the patient

Question 74

What kind of speech may be an indicator of emotional distress? A. Quiet speech B. Obscene speech C. Rational speech D. Organized speech

Answer 74

B. Obscene speech

Question 75

What type of physical activity may be an indicator of risk to the EMT? A. Tense muscles B. Continuous stretching C. Lying down D. Vigorous exercise

Answer 75

A. Tense muscles