Chapter 11 Psychiatric and Behavioral Disorders Part 2

28) Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness? A) Depression B) Paranoia C) Anxiety D) Mania Answer: C Diff: 1 Page Ref: 451 Standard: Medicine (Psychiatric) Objective: 1, 2, 4 29) Which of the following is NOT an organic cause of a behavioral emergency? A) Tumor B) Hypoglycemia C) Alcoholic encephalopathy D) Dementia Answer: B Diff: 1 Page Ref: 446-447 Standard: Medicine (Psychiatric) Objective: 2, 4 30) You have been called to a college dormitory where campus police are talking to a 20-yearold male who was threatening to jump from his eighteenth-floor window. The patient admits that he was upset because he is failing most of his courses and his girlfriend broke up with him but says he was just "psyching out" his roommate and had no intention of jumping. Campus police tell you that the patient was sitting on the balcony railing with his feet over the edge when they arrived. The patient was cooperative when they asked him to come back inside the room. Which of the following is the best course of action? A) Consider it a police matter, and mark in service. B) Have the police place the patient under immediate detention, and transport the patient in restraints. C) Tell the patient you must take his suicide threat seriously and transport him for evaluation. D) Have the patient sign a refusal form as long as the roommate will take responsibility for staying with him. Answer: C Diff: 2 Page Ref: 456-457 Standard: Medicine (Psychiatric) Objective: 5, 11 202 31) Your patient is a 28-year-old male with a history of panic attacks. He states that symptoms began about 20 minutes ago and that he has been unable to get them under control. He complains of shortness of breath, chest pain, dizziness, and a feeling that he is going to die. His skin is warm and moist. HR = 132, BP = 138/98, RR = 26 and shallow. You spend 15 minutes on-scene with him attempting to "talk him down" without success. Which of the following is most appropriate? A) Oxygen, IV, nitroglycerin, aspirin, morphine B) IV, diazepam C) Oxygen D) IV, haloperidol Answer: B Diff: 2 Page Ref: 451 Standard: Medicine (Psychiatric) Objective: 3, 6 32) Which of the following best describes a state of disorientation or disorganized thought? A) Delusion B) Confabulation C) Neurosis D) Confusion Answer: D Diff: 1 Page Ref: 450 Standard: Medicine (Psychiatric) Objective: 1, 4 33) Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder? A) Failure to keep counseling appointments B) Situational stresses C) Being released from an institution back into the public D) Noncompliance with medications Answer: D Diff: 1 Page Ref: 446, 449 Standard: Medicine (Psychiatric) Objective: 4 34) Which of the following best describes a person's state of cerebral functioning? A) Mental status B) Affect C) Level of consciousness D) Intelligence Answer: A Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 1, 2 203 35) Your patient is a 28-year-old male who tells you his hands and arms are turning green. He states that he was held captive by some people for a month and forced to make movies. While the patient is undoubtedly convinced he is turning green, you cannot see it. The patient's brother tells you that he has not been missing for the past month but that he has stopped taking his medication. Which of the following is most consistent with this situation? A) Schizotypal personality disorder B) Bipolar disorder C) Acute dystonic reaction D) Schizophrenia Answer: D Diff: 2 Page Ref: 450-451 Standard: Medicine (Psychiatric) Objective: 3, 4 36) Which of the following best describes four-point restraints? A) Straps restraining the patient across the chest, hips, thighs, and legs B) A separate restraint on each of the four extremities C) A commercially manufactured restraint device D) Restraint of the head, torso, arms, and legs Answer: B Diff: 1 Page Ref: 461-462 Standard: Medicine (Psychiatric) Objective: 10 37) Which of the following best describes the correct positioning of a restrained patient? A) Prone, sandwiched between the cot and a long backboard to prevent movement B) Prone, ensuring the restraints are not loose enough to allow patient movement C) Left lateral recumbent, ensuring the restraints are not tight enough to affect breathing or circulation D) Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing Answer: D Diff: 1 Page Ref: 461-462 Standard: Medicine (Psychiatric) Objective: 10 38) Your patient is in four-point restraints and starts to spit at you during transport. You should: A) put a nonrebreather mask on the patient but do not administer oxygen. B) place the patient prone, with his face turned away from you. C) place a surgical mask over the patient's mouth and nose. D) wear a HEPA respirator or an N-95 mask. Answer: C Diff: 2 Page Ref: 461-462 Standard: Medicine (Psychiatric) Objective: 10, 11 204 39) An example of a direct injury that may be sustained by a behavioral patient who has been TASERed would be: A) the muscle contractions that occur as a result of the electrical impulse. B) the damage caused by the impact of the probe. C) the ignition of the combustible gases that are present after firing the TASER. D) the resultant blunt force trauma caused by the fall that ensues after the electrical impulse. Answer: B Diff: 2 Page Ref: 458-459 Standard: Medicine (Psychiatric) Objective: 9 40) You are caring for a patient that was TASERed by the police for being physically aggressive. This type of restraint works by what mechanism? A) It temporarily stuns the cerebral hemispheres. B) It paralyses the lower extremities. C) It renders the patient unconscious. D) It disrupts voluntary control of skeletal muscles. Answer: D Diff: 2 Page Ref: 458-459 Standard: Medicine (Psychiatric) Objective: 9 41) A patient has been stunned with a TASER, and as a result you note superficial skin damage from the probe. This type of injury is classified as: A) direct injury. B) primary injury. C) secondary injury. D) tertiary injury. Answer: A Diff: 1 Page Ref: 458-459 Standard: Medicine (Psychiatric) Objective: 9 42) Which of the following patients that have been TASERed do NOT meet the acceptable criteria to remove the TASER darts? A) A patient with a heart rate of 105/min B) A patient with a room SpO2 of 96 percent C) A patient with the TASER dart embedded in the URQ of the abdomen D) A patient with the TASER dart embedded in the neck Answer: D Diff: 2 Page Ref: 458-459 Standard: Medicine (Psychiatric) Objective: 9, 11 205 43) An emergency in which the patient's behavior is unusual, bizarre, threatening, or dangerous is referred to as a: A) psychiatric emergency. B) code greens. C) behavioral emergency. D) personal assist. Answer: C Diff: 1 Page Ref: 446 Standard: Medicine (Psychiatric) Objective: 1 44) Behavioral disorders NOT related to substance abuse or medical conditions are known as: A) sociocultural disorders. B) psychosocial disorders. C) nature behavior. D) nurture behavior. Answer: B Diff: 1 Page Ref: 447 Standard: Medicine (Psychiatric) Objective: 1, 2 45) Behavior disorders related to a patient's socioeconomic status, social habits, skills, and values are said to be: A) sociocultural disorders. B) psychosocial disorders. C) nature behavior. D) nurture behavior. Answer: A Diff: 1 Page Ref: 447 Standard: Medicine (Psychiatric) Objective: 1, 2 46) A clue that the scene may NOT be safe to enter would be: A) a messy house. B) broken-down cars. C) an overgrown lawn. D) broken glass and furniture. Answer: D Diff: 1 Page Ref: 447-448 Standard: Medicine (Psychiatric) Objective: 3 206 47) Observing the patient for clues of violence should include the patient's: A) appearance and clothing. B) appearance and financial background. C) posture and hand gestures. D) ability to answer your questions. Answer: C Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 3 48) A mental status exam on a behavioral emergency should include all of the following EXCEPT: A) orientation. B) sensorium. C) mood and affect. D) time since diagnosis. Answer: D Diff: 1 Page Ref: 449 Standard: Medicine (Psychiatric) Objective: 3, 4 49) A behavior disorder characterized by relatively rapid onset of widely disorganized thought is: A) dementia. B) delirium. C) delusions. D) disassociation. Answer: B Diff: 1 Page Ref: 450 Standard: Medicine (Psychiatric) Objective: 1, 4 50) The third leading cause of death for 15- to 24-year-olds is: A) trauma. B) drug abuse. C) suicide. D) accidents. Answer: C Diff: 1 Page Ref: 456 Standard: Medicine (Psychiatric) Objective: 5 207 51) Which of the following is NOT a known risk factor for attempting suicide? A) Previous attempts B) Isolation C) Loss of independence D) Delirium Answer: D Diff: 1 Page Ref: 456-457 Standard: Medicine (Psychiatric) Objective: 5 52) When dealing with a geriatric behavior crisis, you should: A) chemically restrain the patient. B) medicate the patient as soon as possible. C) be sure to call the patient by a nickname to establish a rapport. D) avoid administering any medication. Answer: D Diff: 2 Page Ref: 457 Standard: Medicine (Psychiatric) Objective: 7, 11 53) When dealing with the pediatric patient in a behavioral crisis, you should: A) give the child some time alone to think. B) alter the truth to persuade the child. C) talk to the child like an adult. D) allow the child to keep a favorite toy or blanket. Answer: D Diff: 2 Page Ref: 457 Standard: Medicine (Psychiatric) Objective: 7, 11 54) You respond to a local restaurant for a behavioral emergency. You arrive on the scene with law enforcement to find a patient who is sweating, severely agitated, and wearing inappropriate clothing. You should suspect: A) excited delirium. B) dissociative disorder. C) multiple personality disorder. D) psychosis. Answer: A Diff: 2 Page Ref: 457 Standard: Medicine (Psychiatric) Objective: 3, 4, 8 208 55) You respond to a patient acting "extremely belligerent" at a nightclub. Law enforcement on the scene informs you that the club is known for MDMA abuse. You should consider: A) excited delirium and the need for chemical restraint. B) excited delirium and TASER removal. C) excited delirium and physical restraints. D) letting law enforcement transport. Answer: A Diff: 2 Page Ref: 457 Standard: Medicine (Psychiatric) Objective: 6, 8, 10, 11 56) When caring for a patient who has been TASERed, you should be aware that the primary TASER injury occurs from: A) the electricity. B) the darts. C) falling. D) There are no primary injuries. Answer: B Diff: 1 Page Ref: 458 Standard: Medicine (Psychiatric) Objective: 9, 11 57) Which of the following should be present to release the TASERed patient to police without EMS transport? A) Glasgow Coma Scale score of 15 B) Systolic blood pressure above 100 mmHg C) Pulse below 110 D) All of the above Answer: D Diff: 1 Page Ref: 458 Standard: Medicine (Psychiatric) Objective: 9, 11 58) Physical restraints deployed by EMS should be: A) hard restraints. B) handcuffs. C) soft restraints. D) EMS should never restrain a patient. Answer: C Diff: 1 Page Ref: 461 Standard: Medicine (Psychiatric) Objective: 10 209 59) Ideally, a minimum of how many people should be used to restrain a patient? A) 3 B) 4 C) 5 D) 2 Answer: C Diff: 1 Page Ref: 461 Standard: Medicine (Psychiatric) Objective: 10 210