Chapter 11 Psychiatric and Behavioral Disorders Part 1

Chapter 11 Psychiatric and Behavioral Disorders 1) Which of the following is NOT a common pathophysiological cause of behavioral emergencies? A) Underlying psychiatric illness B) Psychosocial stressors C) The environment D) Use of recreational drugs and alcohol Answer: C Diff: 1 Page Ref: 446, 447 Standard: Medicine (Psychiatric) Objective: 2, 4 2) Your patient is a 50-year-old male who has been detained by mall security officers. The patient is distraught, stating that he needs to "get away from the terrorists." The security officers state the patient was found climbing into a trash dumpster behind the mall and became distressed when they took him away from it. Your physical exam is unremarkable except for noting neglect of hygiene and nutrition. His skin is warm and dry. HR = 98, BP = 114/78, RR = 12, SaO2 = 99%, blood glucose = 80 mg/dL. You offer him transport to the ED, which he accepts. Which of the following is most appropriate during transport of this patient? A) Apply a cardiac monitor, IV, oxygen B) Restrain the patient with four-point restraints, no ALS interventions C) Start an IV, and request orders for haloperidol D) Make the patient comfortable on the stretcher, no ALS interventions Answer: D Diff: 2 Page Ref: 450 Standard: Medicine (Psychiatric) Objective: 6, 11 3) A 19-year-old female states that she is addicted to Vicodin because it makes her feel good, and she cannot stop taking the pills. She states that she craves them all the time, and when she runs out she does not feel sick but becomes preoccupied with how she can get more. Assessment reveals no abnormalities, and vital signs are within acceptable limits. This patient's condition is most consistent with: A) physical dependence. B) habituation. C) psychological dependence. D) tolerance. Answer: C Diff: 2 Page Ref: 454 Standard: Medicine (Psychiatric) Objective: 3, 4 194 4) Your patient is a 27-year-old female who is distraught and crying after having her children taken by child protective services. Her sister called EMS because the patient threatened to cut her wrists. On your arrival you find that she has not attempted to harm herself and has no weapons within reach. However, she does not wish to speak with you. Which of the following actions is most likely to be effective when communicating with this patient? A) Maintain a distance of 3 to 5 feet from the patient. B) Sit down so that you are at eye level with the patient. C) Tell the patient that you cannot help her unless she talks to you. D) Tell the patient that you want to help her, but you can't unless she calms down. Answer: B Diff: 2 Page Ref: 448-449 Standard: Medicine (Psychiatric) Objective: 3, 5, 11 5) Which of the following helps assess a patient's potential for violence? A) Gender B) Body language C) Ethnicity D) Age Answer: B Diff: 1 Page Ref: 447-448 Standard: Medicine (Psychiatric) Objective: 3 6) Which of the following is described as the visible indication of mood? A) Mental status B) Behavior C) Affect D) Level of consciousness Answer: C Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 2, 6 7) Which of the following statements about patient restraint is TRUE? A) Restraints can be released once the patient is in control of himself. B) Roller bandages for restraint do not cause neurovascular damage to the extremities, but leather restraints do. C) Handcuffs are an acceptable choice for prehospital care. D) Four-point restraints should be used. Answer: D Diff: 2 Page Ref: 462 Standard: Medicine (Psychiatric) Objective: 10 195 8) Which of the following is most likely to effectively gain the cooperation of a psychologically disturbed patient for physical examinations? A) Telling the patient you cannot help him unless you do a thorough physical examination B) Standing closer to and using more physical contact with the patient than usual C) Asking the patient's permission to examine him D) Telling the patient you must examine him Answer: C Diff: 1 Page Ref: 448-449 Standard: Medicine (Psychiatric) Objective: 3, 6 9) Which of the following is the best method of communicating with an emotionally disturbed patient? A) Ignore statements that are irrelevant to the situation. B) Tell the patient you understand how he feels. C) Explain that you are concerned with the patient's welfare. D) Agree with everything the patient says. Answer: C Diff: 2 Page Ref: 459-460 Standard: Medicine (Psychiatric) Objective: 3, 6 10) Which of the following is most relevant to your decisions about how to handle a potentially violent patient? A) The fact that you have transported this patient many times and he has never become violent B) The family's reassurances that the patient never harmed anyone C) The patient's current behavior D) Whether or not the patient is taking antipsychotic medications Answer: C Diff: 1 Page Ref: 447-449 Standard: Medicine (Psychiatric) Objective: 3, 6 11) Which of the following statements about consent is accurate? A) Competent people may not be transported against their will. B) People cannot be transported against their will unless there is a court order to do so. C) People who are alert and oriented to person, place, and time may not be transported against their will. D) People cannot be transported against their will unless a first-degree relative (spouse, adult child, parent, or sibling) agrees. Answer: A Diff: 2 Page Ref: 460 Standard: Medicine (Psychiatric) Objective: 6, 11 196 12) Your patient is a 34-year-old female, eight weeks postpartum. She is alert and oriented but crying and extremely depressed. She states she "just can't go on like this." Her husband called EMS because she is distraught and cannot care for herself or the baby. Which of the following statements about this situation is TRUE? A) Postpartum depression is common, but it is not linked to suicide. B) The patient requires medical treatment. C) Suicide is not likely as long as the husband remains supportive. D) She should be advised not to have additional children. Answer: B Diff: 1 Page Ref: 456-457 Standard: Medicine (Psychiatric) Objective: 6, 11 13) Which of the following best describes perceived loss of physical functioning without medical or traumatic cause? A) Somatization disorder B) Conversion disorder C) Catatonia D) Body dismorphic disorder Answer: B Diff: 1 Page Ref: 454 Standard: Medicine (Psychiatric) Objective: 2, 4 14) Your patient is a 32-year-old male who has been successfully treated for depression with a selective serotonin reuptake inhibitor. The patient's wife is concerned, because over the past few days her husband has not slept and has been spending most of his time trading stocks online and making extravagant purchases. He has been talking about taking a trip to Spain to run with the bulls in Pamplona. She states that he is talking incessantly and seems "wired." The patient had a similar episode about a month ago that came on suddenly but resolved when the patient "crashed" and slept for several days. Which of the following is most consistent with this situation? A) Cocaine use B) Schizoaffective disorder C) Methamphetamine use D) Bipolar disorder Answer: D Diff: 2 Page Ref: 453 Standard: Medicine (Psychiatric) Objective: 2, 4 197 15) Your patient is a 32-year-old female who is depressed and tearful after a fight with her exhusband. Which of the following would NOT increase the risk of or indicate an increased risk of the patient committing suicide? A) The patient has access to a method of suicide. B) The paramedic is using direct questioning about suicidal intentions. C) The patient has called her sister to come and get her dog. D) The patient has had three glasses of wine since the fight. Answer: B Diff: 2 Page Ref: 456-457 Standard: Medicine (Psychiatric) Objective: 5, 6, 11 16) Which of the following best describes a feeling of alarm at the expectation of danger? A) Fear B) Rage C) Phobia D) Stress Answer: A Diff: 1 Page Ref: 452 Standard: Medicine (Psychiatric) Objective: 1 17) Which of the following statements about patient restraint is FALSE? A) Patients should be transported in a prone position. B) Restraining the thighs just above the knees can be more effective at preventing kicking than restraining at the ankles. C) Verbal methods of deescalation should be tried before considering physical restraint. D) Neuromuscular blocking agents should never be used to restrain a patient. Answer: A Diff: 2 Page Ref: 462 Standard: Medicine (Psychiatric) Objective: 10 18) Which of the following best describes the position or bearing of the body? A) Stature B) Facies C) Affect D) Posture Answer: D Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 1 198 19) Your patient is a 34-year-old male who is threatening to kill himself. Which of the following does NOT indicate an increased risk for suicide? A) The patient having ingested a substantial amount of alcohol B) The patient having a father who committed suicide when the patient was a teenager C) A previous nonlethal attempt at suicide D) The patient's being married Answer: D Diff: 2 Page Ref: 456-457 Standard: Medicine (Psychiatric) Objective: 5 20) Which of the following is NOT associated with anorexia nervosa? A) Intense fear of obesity B) Cessation of menstruation C) Excessive fasting D) Intentionally inducing vomiting after eating Answer: D Diff: 1 Page Ref: 455 Standard: Medicine (Psychiatric) Objective: 1, 4 21) Which of the following best describes an emotional reaction characterized by rage? A) Emotional lability B) Anger C) Dread D) Irrationality Answer: B Diff: 1 Page Ref: 448 Standard: Medicine (Psychiatric) Objective: 1, 3 199 22) Your patient is a 45-year-old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The patient's wife called EMS because he has refused to take his lithium and is "driving her crazy with his hyperactive attitude." She insists that you transport him to the hospital. The patient admits to voluntary noncompliance with his lithium, stating, "I didn't like the way it made me feel." He denies any suicidal thoughts and states that he has not felt "this good for a long time." He is curious about your job and wants to know how he could get into a paramedic class. He states that he's also thinking about going to law school but wants to finish his Ph.D. first. The physical examination is unremarkable. HR = 82, BP = 122/80, RR = 10, SaO2 = 99%. He says, "See, I told you I'm fine. I don't need to go to the hospital." Which of the following is the best course of action? A) Contact medical direction. B) Explain to the patient that he has no choice; if he is unwilling to take his medication, you must take him to the hospital for evaluation. C) Restrain the patient if necessary and transport. D) Request law enforcement assistance for legal detention of the patient for transport to the ED. Answer: A Diff: 2 Page Ref: 453 Standard: Medicine (Psychiatric) Objective: 3, 4, 6 23) Your patient is a 76-year-old male who is alert and oriented. The patient's neighbor called EMS because of general concern about the patient's health. He states that the patient hasn't been himself since his wife's death six months ago. He hasn't taken care of his usually meticulous lawn and house, and he has lost a lot of weight. The patient says he misses his wife but doesn't need medical care. Which of the following is the best course of action? A) Tell the patient you cannot leave him and that if he refuses to go to the hospital, you will have to call the police and have him placed under immediate detention for psychiatric treatment. B) Explain to the neighbor that the patient is behaving as expected and the only treatment is time. C) Have the patient sign a refusal of service form, but let him know he can call you back if he changes his mind. D) Explain to the patient that it is common for people in his situation to feel depressed, and you would like to help him by transporting him to the hospital. Answer: D Diff: 2 Page Ref: 452-453 Standard: Medicine (Psychiatric) Objective: 6, 7 200 24) Which of the following is NOT considered an appropriate method of controlling a combative patient in the prehospital setting? A) Droperidol B) Leather restraints C) Pepper spray D) Verbal deescalation Answer: C Diff: 1 Page Ref: 462 Standard: Medicine (Psychiatric) Objective: 10, 11 25) Which of the following best describes a profound melancholy characterized by a diminished interest in daily pleasures, hypersomnia, feelings of worthlessness, inability to concentrate, and agitation? A) Bipolar disorder B) Schizoaffective disorder C) Dysthymia D) Depression Answer: D Diff: 1 Page Ref: 452 Standard: Medicine (Psychiatric) Objective: 4 26) You are on the scene of an agitated male patient with a history of alcohol abuse. He is threatening to "knock your head off" if you get close to him. While you are getting a history from the patient's wife, she states that, "He had something wrong with his EKG. A long QRS, or something like that." Which of the following should you avoid in the treatment of this patient? A) Lorazepam B) Diazepam C) Droperidol D) Physical restraint Answer: C Diff: 2 Page Ref: 462 Standard: Medicine (Psychiatric) Objective: 4, 10, 11 27) Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder? A) Medical illness B) Following the same routine daily C) Stressful situations D) Taking recreational drugs and using alcohol Answer: B Diff: 1 Page Ref: 446-447 Standard: Medicine (Psychiatric) Objective: 2, 4 201