CH 29

Question 1

In hypochondriasis, patients have significant anxiety or fear that they:

• will attempt to hurt others.
• will go to sleep and not awake.
• may have a serious disease.
• are being undermedicated.

Answer 1

May have a serious disease

Question 2

Which of the following assessment findings is suggestive of an organic cause of abnormal behavior?

• Auditory hallucinations
• Skin that is cool and dry
• Multiple tattoos
• Unusual breath odor

Answer 2

Unusual breath odor

Question 3

A confused, bedridden resident in a skilled nursing facility who tells you that they cook dinner for the other residents each night:

• is experiencing echolalia.
• is confabulating.
• is experiencing delirium.
• has a disorder of affect.

Answer 3

Is confabulating

Question 4

Metabolic causes of abnormal behavior include:

• thyroid hyperfunction.
• vitamin deficiencies.
• diabetic ketoacidosis.
• amphetamine toxicity.

Answer 4

Diabetic ketoacidosis

Question 5

Which of the following statements regarding schizophrenia is correct?

• The typical onset of schizophrenia occurs during early adulthood.
• Social influences have not been shown to contribute to schizophrenia.
• In schizophrenia, dysfunctional symptoms become less prominent over time.
• Although schizophrenia is a complex disorder, it is easily treated.

Answer 5

The typical onset of schizophrenia occurs during early adulthood.

Question 6

When asking an emotionally disturbed patient a series of questions, you should:

• keep your questions as indirect as you possibly can.
• try to ask questions that can be answered with a yes or no.
• use words such as “how” and “what” whenever possible.
• simplify the process by asking closed-ended questions.

Answer 6

use words such as “how” and “what” whenever possible.

Question 7

A state of delusion in which a person is out of touch with reality is called:

• derealization.
• psychosis.
• acute dementia.
• schizophrenia.

Answer 7

Psychosis

Question 8

People who are overly concerned with their physical health and appearance most likely have a:

• dissociative disorder.
• personality disorder.
• compulsive disorder.
• somatoform disorder.

Answer 8

Somatoform disorder

Question 9

The most important aspect in the care of a patient who is at risk for suicide is:

• eliciting the help of family members.
• never leaving the patient alone.
• identifying the patient’s plan.
• acknowledging the patient’s feelings.

Answer 9

Never leaving the patient alone

Question 10

Many paramedics are reluctant to broach the subject of suicide with a depressed patient for fear that:

• the patient will be offended by such a question.
• the patient may become violent and homicidal.
• the patient will become even more depressed.
• they might put ideas into the patient’s head.

Answer 10

They might put ideas into the patients head

Question 11

A hallmark sign of mania is:

• memory distortion.
• persistent insomnia.
• an elated affect.
• speech disorder.

Answer 11

An elated effect

Question 12

You receive a call to an apartment complex for a patient with an unknown behavioral problem. The scene has been secured by law enforcement prior to your arrival. The patient, a 39-year-old man, appears very anxious and worried. He tells you that he has obsessive-compulsive disorder and stopped taking his prescribed medication a week ago because he did not like its side effects. He tells you that he has had fleeting thoughts of suicide, but denies homicidal thoughts. You should:

• transport him to the hospital and ask a police officer to accompany you.
• safely transport him to the hospital and monitor his behavior en route.
• make contact with his psychiatrist to apprise them of the situation.
• tell him that stopping his medications abruptly could result in death.

Answer 12

safely transport him to the hospital and monitor his behavior en route.

Question 13

A psychiatric emergency:

• generally occurs following the use of an illicit drug or excessive consumption of alcohol.
• exists when a person’s abnormal behavior threatens the safety and well-being of him- or herself or others.
• is generally the result of a short-term emotional crisis that is treated effectively with behavior modification.
• is caused by a chemical imbalance in the brain but does not interfere with activities of daily living.

Answer 13

exists when a person’s abnormal behavior threatens the safety and well-being of him- or herself or others.

Question 14

An acute dystonic reaction is characterized by:

• muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug.
• intermittent explosive behavior after a person suddenly stops taking medications for schizophrenia.
• dry mouth, blurred vision, and cardiac dysrhythmias following treatment with a neuroleptic drug.
• a sudden catatonic state that results from oversedation with drugs such as Zyprexa and Mellaril.

Answer 14

muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug.

Question 15

Which of the following drugs is an MAOI?

• Pamelor
• Elavil
• Sinequan
• Parnate

Answer 15

Parnate

Question 16

Law enforcement personnel request your assistance in caring for a violent patient. When you arrive at the scene, the patient, a 48-year-old man, is yelling obscenities and is threatening to kill anyone who comes near him. Despite your attempts to calm him verbally, he continues his threatening behavior. It is most important for you to:

• ensure that you have a route for rapid egress and visually scan the patient for potential weapons.
• leave the scene immediately and allow law enforcement personnel to take control of the situation.
• ask law enforcement to immobilize the patient with a TASER so you can assess his blood glucose level.
• utilize at least four people to physically restrain the patient so you can administer haloperidol.

Answer 16

Ensure that you have a route for rapid egress and visually can the patient for potential weapons

Question 17

If a psychotic person’s level of consciousness is fluctuating, you should:

• consider administering haloperidol.
• immediately assess blood pressure.
• administer 25 g of dextrose.
• suspect an organic brain syndrome.

Answer 17

Suspect and organic brain syndrome

Question 18

Which of the following steps of caring for a patient with a psychiatric emergency would most likely give the patient the feeling that something is being done to help?

• Remaining calm and confident
• Asking direct questions
• Developing a specific plan
• Encouraging the patient to talk

Answer 18

Developing a specific plan

Question 19

When caring for a patient experiencing a psychotic episode, you should:

• clearly identify yourself to the patient.
• involve people the patient trusts.
• be calm, direct, and straightforward.
• first assess the situation for danger.

Answer 19

First assess the situation for danger

Question 20

You are dispatched to a residence for a patient who has overdosed. You immediately recognize the address as that of a patient with a known psychiatric condition. Law enforcement is at the scene and has ensured its safety. When you arrive and enter the residence, you find the patient, a man in his mid-20s, sitting on the floor. He is conscious and appears anxious. Which of the following questions should you ask the patient first?

• “How are you feeling right now?”
• “Did you attempt to kill yourself?”
• “What medication did you take?”
• “How long ago did this happen?”

Answer 20

What medication did you take?

Question 21

While assessing a patient, you note that she is making repetitive hand gestures as though she is trying to grasp at something. This is an example of which type of movement?

• Stereotyped
• Obsessive
• Compulsive
• Circumstantial

Answer 21

Stereotyped

Question 22

A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient’s vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should:

• use reasonable force to physically restrain the patient, administer a sedative, and transport.
• contact medical control and advise them that you will be transporting the patient against her will.
• remain with the patient, contact medical control, and request law enforcement intervention.
• respect her wishes because she is coherent, but leave her with a trusted family member.

Answer 22

remain with the patient, contact medical control, and request law enforcement intervention.

Question 23

Which of the following questions would be the most appropriate initial question to ask when broaching the subject of suicide with a depressed patient?

• “Have you ever thought that life wasn’t worth living?”
• “Do you ever feel that you’d be better off dead?”
• “Do you have the means to carry out a suicide attempt?”
• “Have you ever thought of causing harm to yourself?”

Answer 23

Have you ever thought that life wasn’t worth living

Question 24

In anxiety disorders, the dominant moods are:

• fear and apprehension.
• euphoria and elation.
• confusion and apathy.
• anger and agitation.

Answer 24

Fear and apprehension

Question 25

Psychomotor abnormalities associated with depression include: - distractibility. - agitation and pacing. - a flat affect. - fatigue and insomnia

Answer 25

Agitation and pacing

Question 26

Which of the following is a general guideline to follow when caring for a patient with a psychiatric problem? - Avoid eye contact with the patient. - Maintain silence to comfort the patient. - Maintain a nonjudgmental attitude. - Be indirect whenever possible.

Answer 26

Maintain a nonjudgmental attitude

Question 27

When a person has a personality disorder: - the disorder most often stems from fear. - medication therapy generally is not indicated. - another psychiatric illness typically is present. - the paramedic can influence the patient easily

Answer 27

another psychiatric illness typically is present

Question 28

Which of the following statements about panic disorder is correct? - Men are two-thirds more likely to experience panic disorder than women. - Panic disorder is characterized by sudden, unexpected fear and dread. - Panic disorder is a random disorder that usually does not run in the family. - Most initial panic attacks occur without a known precipitating stressor.

Answer 28

Panic disorder is characterized by sudden, unexpected fear and dread.

Question 29

An agitated person with an antisocial personality: - has a morbid fear of crowded environments. - will not think twice about hurting you. - may be demanding and dictate your care. - is at highest risk for suicidal behavior

Answer 29

Will not think twice about hurting you

Question 30

Which of the following scenarios is indicative of posttraumatic stress disorder? - An experienced paramedic who had a nightmare regarding a case of sudden infant death syndrome cries at the scene of a cardiac arrest involving an infant. - An advanced EMT student who has a morbid fear of needles experiences a syncopal episode during IV skills practice during class. - An elderly woman who is afraid of losing her independence becomes agitated when being told that she is being admitted to a skilled nursing care facility. - A paramedic whose son was struck and killed by a car becomes acutely anxious upon arriving at the scene of a motor-vehicle-versus-pedestrian incident.

Answer 30

Paramedic whose son was truck and killed by a car becomes acutely anxious arriving at the scene of motor vehicle versus pedestrian incident

Question 31

Which of the following disease states can produce psychotic symptoms? - Stable angina pectoris - Mononucleosis - Low cardiac output - Hypertension

Answer 31

Low cardiac output

Question 32

Accelerated thinking in which the mind skips very rapidly from one thought to the next is called: - circumstantial thinking. - flight of ideas. - confabulation. - perseveration

Answer 32

Flight of ideas

Question 33

At a minimum, you should be able to assess an emotionally disturbed patient's: - blood sugar level. - general appearance. - ability to recall. - blood pressure.

Answer 33

General appearance

Question 34

A psychotic person may have thought insertions, which are defined as: - the belief that thoughts are being thrust into their mind by another person. - the fear that their thoughts are being broadcast aloud and heard by others. - strange or pressured speech because of unusual words the patient has invented. - a gross distortion of your comments into what they believe to be true.

Answer 34

The belief that thoughts are being thrust into his or her mind by another person

Question 35

You are dispatched to a skilled nursing care facility for a 74-year-old male resident who is ill. During your assessment, you note that the patient has his head cocked to the side and is unable to move it. The charge nurse tells you that the patient was placed on Seroquel 2 days ago. Based on this patient's clinical presentation and medication history, you should: - administer 25 to 50 mg of diphenhydramine. - establish vascular access and administer naloxone. - expect to find that his blood sugar level is elevated. - suspect that the patient has catatonic schizophrenia.

Answer 35

Administer 25 to 50 mg of diphenhydramine

Question 36

Abnormal behavior that stems from a psychosocial etiology would most likely occur in a patient who: - is under severe stress caused by work. - recently experienced the death of a loved one. - experienced emotional trauma as a child. - resorts to alcohol to mitigate daily stress.

Answer 36

Experienced emotional trauma as a child

Question 37

A man who smiles pleasantly when he tells you of the recent death of his wife: - is thinking circumstantially. - has a disorder of perception. - has delusions of persecution. - has an inappropriate affect.

Answer 37

Has an inappropriate affect

Question 38

An example of an impulse control disorder is: - pathologic gambling. - obsessing over one's health. - fear of public spaces. - uncontrollable worrying.

Answer 38

Pathologic gambling

Question 39

Unlike a person with bulimia nervosa, a person with anorexia nervosa: - is less likely to experience problems related to electrolyte imbalance. - experiences weight loss that may cause poor health or even death. - compensates for binge eating by using various purging methods. - commonly describes his or her eating disorder as “out of control.”

Answer 39

experiences weight loss that may cause poor health or even death.

Question 40

Which of the following is a common sign or symptom of a panic attack? - Prolonged loss of consciousness - Nausea and abdominal discomfort - Bradycardia - Hallucinations

Answer 40

Nausea and abdominal discomfort

Question 41

A patient is speaking rapidly, skipping from one irrelevant topic to another. This is an example of: - confabulation. - circumstantial thinking. - tangential thinking. - perseveration.

Answer 41

Tangential thinking

Question 42

A patient is very demanding and is trying to dictate the care that you provide to him. This is characteristic of which type of personality? - Antisocial - Depressed - Histrionic - Multiple

Answer 42

Histrionic

Question 43

Which of the following is a disorder of thought content? - Euphoria - Delusions - Depression - Anxiety

Answer 43

Delusions

Question 44

You are transporting a 22-year-old woman whose violent behavior required physical restraint. A law enforcement officer is in the back of the ambulance with you. The patient tells you that she is sorry for her behavior and did not mean to take it out on you and your partner. You should: - administer droperidol intramuscularly and then remove the restraints. - tell the patient that her behavior is inexcusable and keep her restrained. - continue to talk to the patient and monitor her peripheral circulation. - loosen the restraints if the patient promises to cooperate with you.

Answer 44

continue to talk to the patient and monitor her peripheral circulation.

Question 45

Which of the following words would likely de-escalate the symptoms of a panic attack to a more manageable level? - Relax - Care - Safe - Help

Answer 45

Safe

Question 46

Which of the following medications would most likely cause prolongation of the QT interval? - Midazolam - Ketamine - Geodon - Inapsine

Answer 46

Inapsine

Question 47

A 50-year-old woman called 9-1-1 after she was suddenly awakened in the middle of the night with the feeling that she was being smothered. Your assessment reveals that she is clearly anxious, is trembling, and complains of chest pain and numbness and tingling to her face and hands. Her blood pressure is 168/96 mm Hg, pulse rate is 160 beats/min, and respirations are 30 breaths/min. Her medications include Xanax, Lipitor, and Vasotec. The most appropriate treatment for this patient includes: - applying a nonrebreathing mask with the flow rate set at 2 L/min, assessing her blood glucose level, administering diazepam for sedation, and transporting her without lights and siren. - coaching her to slow her breathing, monitoring her oxygen saturation and end-tidal carbon dioxide levels, assessing her cardiac rhythm, establishing vascular access, considering a benzodiazepine, and transporting. - attempting to regulate her breathing by asking her to hold her breath, assessing her end-tidal carbon dioxide level, administering 1 g/kg of fentanyl IM for sedation, and transporting. - applying a cardiac monitor, establishing vascular access and administering adenosine, administering oxygen via nasal cannula, considering a beta adrenergic antagonist to lower her blood pressure, and transporting.

Answer 47

coaching her to slow her breathing, monitoring her oxygen saturation and end-tidal carbon dioxide levels, assessing her cardiac rhythm, establishing vascular access, considering a benzodiazepine, and transporting.

Question 48

Manic patients may report that their thoughts are racing and they may rapidly skip from one topic to another. This is called: - thought broadcasting. - confabulation. - circumstantial thinking. - tangential thinking.

Answer 48

Tangential thinking

Question 49

Which of the following is an identified risk factor for suicide? - Financial success - Weight gain over less than 2 months - Hispanic woman older than 55 years of age - A sudden improvement in depression

Answer 49

Sudden improvement in depression

Question 50

The best way to ensure that no one is harmed during an EMS call is to: - ensure that all EMS providers wear body armor. - routinely ask the police to respond to the scene with you. - stand to the side of the patient's door when knocking. - assess the potential for violence on every EMS call.

Answer 50

assess the potential for violence on every EMS call.

Question 51

Signs and symptoms of depression that last for at least 2 years: - are typical of major depressive disorder. - are highly suggestive of dysthymic disorder. - are typically not associated with anxiety. - require long-term hospitalization to treat.

Answer 51

Are highly suggestive of dysthymic disorder