Behavioral Emergencies: Scene Safety and Assessment Practice Questions

25 multiple-choice questions on Behavioral emergencies: scene safety and assessment for paramedic and EMT students, from Chapter 29 (Psychiatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. You are dispatched to a 'man acting violently' at a residence. Your first priority is to:

   1. A. Obtain a full psychiatric history first
   2. B. Check the patient's blood glucose
   3. C. Call medical control for sedation
   4. D. Make sure the scene is safe for you
   Show answer

   Answer: D. Make sure the scene is safe for you

   No care can begin until the scene is safe, so stage until law enforcement secures a potentially violent scene. Glucose testing is important, but only once you can reach the patient safely.

2. An organic cause of abnormal behavior is one that:

   1. A. Arises from a psychiatric disorder with no lesion
   2. B. Results mainly from a stressful life event
   3. C. Has a physical or chemical basis, such as hypoxia
   4. D. Is a learned pattern copied from family members
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   Answer: C. Has a physical or chemical basis, such as hypoxia

   Organic causes include hypoglycemia, hypoxia, head injury, infection, and drugs. Functional disorders such as schizophrenia have no identifiable physical cause, and they should never be assumed until organic causes are considered.

3. A 58-year-old man with diabetes is confused, combative, and sweating heavily. Once he is safely approachable, the most important early test is:

   1. A. Detailed mental status exam
   2. B. Blood glucose level
   3. C. Pupil size and reactivity
   4. D. Twelve-lead ECG tracing
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   Answer: B. Blood glucose level

   Hypoglycemia is a common, rapidly reversible organic cause of agitation and can cause permanent brain injury if missed. A mental status exam describes the behavior but will not find the cause.

4. Which presentation most suggests an organic rather than a functional cause of abnormal behavior?

   1. A. Sudden onset, disorientation, and abnormal vital signs
   2. B. Gradual onset with long-standing auditory hallucinations
   3. C. Several prior similar episodes with full recovery
   4. D. Intact orientation with fixed paranoid beliefs
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   Answer: A. Sudden onset, disorientation, and abnormal vital signs

   Acute onset, impaired orientation or attention, and abnormal vitals point to a medical or toxic cause. Psychiatric disorders usually leave orientation intact and develop more gradually.

5. Visual hallucinations are most suggestive of:

   1. A. Schizophrenia with paranoid delusions
   2. B. A major depressive episode
   3. C. Generalized anxiety disorder
   4. D. A medical or toxicologic cause
   Show answer

   Answer: D. A medical or toxicologic cause

   Visual, tactile, and olfactory hallucinations suggest delirium, intoxication, or withdrawal. Schizophrenia classically causes auditory hallucinations.

6. The mnemonic AEIOU-TIPS is most useful in behavioral emergencies to:

   1. A. Score a patient's risk of suicide on scene
   2. B. Recall organic causes of altered mentation
   3. C. Guide the order of verbal de-escalation
   4. D. Select a sedative for an agitated patient
   Show answer

   Answer: B. Recall organic causes of altered mentation

   It lists alcohol, epilepsy, insulin, overdose, uremia, trauma, infection, psychiatric, and stroke, reminding you that psychiatric is only one of many possibilities.

7. Asking a patient to state the date and where he is now assesses:

   1. A. Affect
   2. B. Insight
   3. C. Orientation
   4. D. Thought content
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   Answer: C. Orientation

   Orientation to person, place, time, and event is part of cognitive assessment. Insight is the patient's awareness of his own illness, which a date question does not test.

8. In a mental status exam, affect refers to:

   1. A. The emotion the patient visibly displays
   2. B. The patient's sustained inner emotional state
   3. C. The logical flow and order of the patient's ideas
   4. D. The patient's awareness of having an illness
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   Answer: A. The emotion the patient visibly displays

   Affect is what you observe (flat, blunted, labile, or inappropriate). Mood is the sustained emotion the patient reports, so describing mood as 'what you see' confuses the two.

9. A woman tells you she feels 'great' while sobbing throughout the interview. This finding is best described as:

   1. A. Flight of ideas between unrelated topics
   2. B. Loose associations in speech
   3. C. Affect incongruent with stated mood
   4. D. Pressured, rapid speech
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   Answer: C. Affect incongruent with stated mood

   Her displayed emotion does not match her stated mood. Flight of ideas and loose associations describe thought process, not emotion.

10. A patient jumps rapidly from his job to fishing to his brother's wedding, each idea sparked by the last. This is:

    1. A. Flight of ideas
    2. B. Thought blocking
    3. C. Perseveration
    4. D. Poverty of speech
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    Answer: A. Flight of ideas

    Flight of ideas is a rapid flow of loosely connected thoughts, typical of mania. Perseveration is the opposite problem: repeating the same idea or answer over and over.

11. A delusion is best defined as:

    1. A. A false sensory perception with no outside stimulus
    2. B. A fixed false belief not shared by one's culture
    3. C. A misinterpretation of a real stimulus, like a shadow
    4. D. A persistent, unwanted thought the patient resists
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    Answer: B. A fixed false belief not shared by one's culture

    Delusions are beliefs that do not change with evidence. A perception without a stimulus is a hallucination, and a misread real stimulus is an illusion.

12. A man with schizophrenia says he is not ill and needs no medicine, despite repeated hospitalizations. This reflects poor:

    1. A. Orientation
    2. B. Memory
    3. C. Attention
    4. D. Insight
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    Answer: D. Insight

    Insight is awareness of one's own condition. He may be fully oriented and attentive while still lacking insight.

13. An agitated man is pacing near the back door of a small kitchen. When you enter, you should position yourself:

    1. A. Between the patient and his only exit door
    2. B. Close enough to touch him to show your concern
    3. C. With a clear exit for yourself, not blocking his
    4. D. In the far corner of the room, away from doors
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    Answer: C. With a clear exit for yourself, not blocking his

    Neither you nor the patient should feel trapped. Blocking his exit can provoke an attack, while a far corner leaves you with no escape.

14. The single best predictor that a patient may become violent is:

    1. A. A diagnosis of schizophrenia alone
    2. B. A history of violent behavior
    3. C. A depressed or tearful mood
    4. D. Female sex and younger age
    Show answer

    Answer: B. A history of violent behavior

    Past violence predicts future violence far better than any diagnosis. Most people with mental illness are never violent and are more often victims than perpetrators.

15. A 25-year-old man fell from his bicycle, smells of alcohol, and is now agitated and repeating questions. You should treat him as having:

    1. A. Alcohol intoxication and nothing more
    2. B. An acute psychotic episode
    3. C. A panic attack after the fall
    4. D. A possible traumatic brain injury
    Show answer

    Answer: D. A possible traumatic brain injury

    Repetitive questioning after trauma suggests TBI. The smell of alcohol is a common trap: intoxication never rules out head injury.

16. An 80-year-old man with COPD is restless and combative, with an SpO2 of 82%. Your first action is to:

    1. A. Give supplemental oxygen
    2. B. Apply soft wrist restraints
    3. C. Give midazolam intramuscularly
    4. D. Request police assistance
    Show answer

    Answer: A. Give supplemental oxygen

    Hypoxia is a reversible organic cause of agitation. Sedating a hypoxic patient worsens respiratory drive and can cause arrest.

17. Which endocrine disorder can present with anxiety, agitation, tremor, and tachycardia?

    1. A. Hypothyroidism
    2. B. Adrenal insufficiency
    3. C. Hyperthyroidism
    4. D. Diabetes insipidus
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    Answer: C. Hyperthyroidism

    Excess thyroid hormone produces a hypermetabolic, anxious state that can mimic panic or mania. Hypothyroidism more often causes slowing and depression.

18. For a cooperative patient with a behavioral complaint, the physical exam should:

    1. A. Still be done to look for medical causes
    2. B. Be skipped to avoid upsetting the patient
    3. C. Be limited to a single set of vital signs
    4. D. Be deferred until hospital arrival
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    Answer: A. Still be done to look for medical causes

    A focused physical exam can reveal head injury, infection, intoxication, or hypoxia. Skipping it to keep the patient calm is how organic causes are missed.

19. Which statement about patients with a known psychiatric illness is correct?

    1. A. Their new complaints are usually psychiatric ones
    2. B. They rarely have chronic medical conditions
    3. C. They feel physical pain less than others
    4. D. They have medical emergencies like anyone else
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    Answer: D. They have medical emergencies like anyone else

    People with serious mental illness have higher rates of heart disease, diabetes, and early death. Assuming new symptoms are psychiatric (diagnostic overshadowing) delays care.

20. A 45-year-old man with schizophrenia has chest pain and says 'aliens are squeezing my heart.' He is pale and diaphoretic. You should:

    1. A. Reassure him that it is part of his illness
    2. B. Assess and treat the pain as possible ACS
    3. C. Have him take his usual antipsychotic dose
    4. D. Transport him to a psychiatric facility
    Show answer

    Answer: B. Assess and treat the pain as possible ACS

    His delusional explanation does not change the physical findings, which are concerning for ACS. Attributing the complaint to his psychosis is a dangerous form of diagnostic overshadowing.

21. Rapid, loud speech that is difficult to interrupt is most typical of:

    1. A. Mania
    2. B. Major depression
    3. C. Catatonia
    4. D. Dementia
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    Answer: A. Mania

    Pressured speech reflects racing thoughts in mania. Depression usually causes slowed, soft, sparse speech.

22. A patient sits motionless and mute, holding an awkward posture for long periods and resisting repositioning. This is:

    1. A. Conversion disorder
    2. B. A postictal state
    3. C. Catatonia
    4. D. Malingering
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    Answer: C. Catatonia

    Catatonia includes mutism, posturing, rigidity, and negativism, and may occur with mood disorders, schizophrenia, or medical illness. A postictal patient is drowsy and confused but does not hold rigid postures.

23. During a crisis, a woman with bipolar disorder hands you a signed psychiatric advance directive. This document mainly:

    1. A. Is a DNR order for cardiac arrest
    2. B. States her care wishes for a crisis
    3. C. Lets police detain her at any time
    4. D. Is valid only after a court hearing
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    Answer: B. States her care wishes for a crisis

    A psychiatric advance directive is written while a person is well and lists treatment preferences for a future mental health crisis, such as preferred hospitals, medications that helped or harmed, and people to contact. Follow it where state law and safety allow and bring it to the hospital. It is not a DNR, it does not give police detention powers, and it does not require a court hearing to be used.

24. A 66-year-old woman suddenly cannot find words and seems confused; her family says she is 'acting crazy.' You should first:

    1. A. Begin a mental status interview
    2. B. Ask about any psychiatric history
    3. C. Request police for an emergency hold
    4. D. Perform a stroke assessment
    Show answer

    Answer: D. Perform a stroke assessment

    Sudden language difficulty is aphasia until proven otherwise, a time-critical stroke finding. Starting with a psychiatric interview wastes time and frames the problem wrongly.

25. When documenting a behavioral emergency, you should include:

    1. A. Your opinion of the psychiatric diagnosis
    2. B. A general note that the patient was agitated
    3. C. The patient's own words in quotation marks
    4. D. Only the vital signs and treatments given
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    Answer: C. The patient's own words in quotation marks

    Direct quotes and specific observed behaviors support clinical and legal decisions such as holds. Vague labels like 'agitated' do not show why actions were taken.