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Free NREMT practice questionsFree AEMT practice questions · Medical/Obstetrics/Gynecology

6 free AEMT practice questions: Behavioral and Psychiatric Emergencies

These are real questions from the same bank the app draws from. Each one is written to the NREMT AEMT content specifications and kept inside the AEMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 6

A 31-year-old patient with a history of schizophrenia is found on the floor of a restroom stall at a shopping center. The patient is shouting incoherently, cannot give the date or location, and swings at security staff who approach. Staff say the patient smells of alcohol. The vital signs are BP 150/92, P 112, R 22, SpO₂ 97% on room air, and T 99°F. The blood glucose level is 102 mg/dL. Which additional finding would best show that the behavior has a cause other than the psychiatric history or alcohol?

Show the answer and rationale

Correct answer · A bite mark along the side of the tongue

A bite mark on the side of the tongue points to a seizure. This patient is confused and combative, has schizophrenia, and smells of alcohol. The schizophrenia and the alcohol could each explain the behavior. A tongue bite does not come from alcohol or a psychiatric crisis. A patient coming out of a seizure is confused and sleepy and clears slowly over 5 to 30 minutes. The behavior alone looks the same for all three causes. Check the mouth. Ask what happened before the patient was found. Do not let the history stand in for the cause.

Why the others are wrong

Pressured speech that jumps between unrelated topics: Pressured speech supports the psychiatric explanation, and the question asks for a finding that points away from it. Speech that jumps between topics shows up in a psychotic or manic patient, and this patient has schizophrenia.

Slurred speech with an unsteady, wide-based gait: Slurred speech and an unsteady, wide-based gait point straight back to the alcohol this patient smells of. The question asks for a finding that shows a cause other than the alcohol or the psychiatric history.

Pupils that are equal and reactive to light: Equal, reactive pupils are a normal finding, and a normal finding does not separate the causes. Schizophrenia, alcohol, and a seizure can all leave the pupils normal.

Question 2 of 6

A 66-year-old patient who takes metoprolol is found on the kitchen floor by a neighbor, confused, shouting, and pushing the neighbor away. The skin is pale, cool, and wet with sweat. The vital signs are BP 130/78, P 64, R 18, SpO₂ 97% on room air, and T 98°F. The blood glucose level is 36 mg/dL. Which of the following best explains why the pulse is not faster?

Show the answer and rationale

Correct answer · The metoprolol is blocking the heart's response to the sympathetic surge from the low glucose

This patient has hypoglycemia, and the metoprolol is keeping the pulse from speeding up. The blood glucose level is 36 mg/dL, the skin is pale, cool, and wet with sweat, and the patient takes metoprolol, a beta blocker. A low glucose starves the brain, which causes the confusion and the shouting. A low glucose also sets off a sympathetic surge, which normally gives you a fast pulse. Metoprolol blocks the heart's response to that surge. The sweating still happens, because the sweat glands run on acetylcholine. That's why a pulse of 64 does not argue against hypoglycemia. Trust the glucometer over the pulse, and treat the low glucose.

Why the others are wrong

The rising pressure inside the skull is slowing the heart after a head injury: Rising pressure inside the skull can slow the heart after a head injury, and being found on the floor suggests a fall. The slowing from a head injury comes as part of Cushing's triad. Cushing's triad is a rising blood pressure with a widening pulse pressure, a falling heart rate, and irregular breathing. This patient has a BP of 130/78 and a regular respiratory rate of 18. The triad is not there, and the glucose of 36 mg/dL already explains the behavior.

The low glucose is starving the brain without triggering a sympathetic response: A low glucose does starve the brain, and the starving brain causes the confusion and the shouting. A low glucose also sets off a surge that normally speeds up the pulse. The pale, cool, wet skin shows the surge is happening. The heart is the part not responding, because of the metoprolol.

The sweating is cholinergic, so the parasympathetic system is slowing the heart: The parasympathetic system slows the heart, and the parasympathetic system uses acetylcholine. Sweating runs on acetylcholine too. The acetylcholine here is working on the sweat glands, not on the heart. The beta blocker is what is holding the heart rate down. Acetylcholine explains why the sweating is still there, not why the pulse stays slow.

Question 3 of 6

An 84-year-old patient is found by family sitting on the living room floor, moaning and disoriented, unable to state the day or where they are, though family reports the patient recognized them earlier this morning before becoming difficult to arouse an hour ago. Family states the patient was completely normal and independent until yesterday afternoon, when they became unusually drowsy and started talking about people who are not there. The patient is diaphoretic and warm to touch. The vital signs are BP 102/64, P 118, R 22, and SpO₂ 94% on room air, with T 103.1°F and a blood glucose level of 132 mg/dL. Which condition is most likely responsible for these findings?

Show the answer and rationale

Correct answer · Delirium

This patient has delirium. The patient was normal and independent until yesterday afternoon. Since then the patient has become drowsy, talks about people who are not there, and is now hard to wake up. The temperature is 103.1°F. A fever like that means an infection or another illness in the body is behind the sudden change in mental status. Delirium is the brain reacting to an acute medical problem. Dementia is a slow decline over time, and this patient changed in a single day. Look for the cause, like an infection, and treat that cause instead of calling this the patient's baseline.

Why the others are wrong

Depression: can look like dementia, with slow thinking, a flat expression, and trouble with memory. That look is called pseudodementia. Depression does not cause a fever, and depression does not make a patient hard to keep awake.

Dementia: a slow, permanent loss of memory over months to years, and the patient stays alert through the day. This patient went from normal to confused in one afternoon and has a fever. Dementia does not come on that fast or cause a fever.

Stroke: A stroke shows up as a sudden focal deficit, like a facial droop, weakness on one side, or slurred speech. No focal finding is described here. A fever with alertness that comes and goes points to an infection, not a stroke.

Question 4 of 6

A 76-year-old patient is found on the floor of the kitchen after tripping over a rug, with a minor scrape on the knee and no loss of consciousness. The patient is awake, alert, and answers questions appropriately about the fall itself, though family reports the patient has needed help finding words and remembering names of grandchildren for the past two years, and now regularly gets lost walking in the neighborhood where they have lived for decades. Family states, "This is exactly how they have been for the last two years, just gradually getting worse." There is no recent illness, no new medication, and the patient has not had any fever. The vital signs are BP 130/78, P 82, R 16, and SpO₂ 98% on room air, with T 98.2°F and a blood glucose level of 104 mg/dL. Which condition is most likely responsible for the patient's cognitive presentation?

Show the answer and rationale

Correct answer · Dementia

This patient has dementia. For two years the patient has needed help finding words and remembering the grandchildren's names. Now the patient gets lost walking in a neighborhood they have lived in for decades. The family says this is exactly how the patient has been, just slowly getting worse. Today the patient is awake, alert, and answers questions about the fall appropriately. Dementia is a permanent loss of brain function that gets worse over time. Nothing about this patient's confusion is sudden or new. Handle the confusion as the patient's stable baseline. You do not need to go looking for a reversible medical cause.

Why the others are wrong

Depression: can cause memory trouble that looks like dementia. This is called pseudodementia. Memory changes from depression usually come with low motivation and a flat mood. This patient has been losing words and getting lost in a steady decline for years. The family confirms that decline is the patient's baseline.

Delirium: comes on over hours to days from a medical cause, like an infection, hypoxia, or a low blood glucose level. Alertness goes up and down through the day. This patient has no fever, a blood glucose level of 104 mg/dL, and a two year course. Nothing here is new or sudden.

Stroke: A stroke causes a sudden focal deficit over minutes, like facial droop, weakness on one side, or slurred speech. This patient's decline has been slow over two years. The patient's answers to questions are normal and appropriate.

Question 5 of 6

A 58-year-old patient is confused and slow to answer, with an open airway and adequate breathing. Which two causes of altered mental status should the AEMT check first?

Show the answer and rationale

Correct answer · Hypoglycemia and hypoxia

Hypoglycemia and hypoxia. With the airway open and breathing adequate, the next job is working through the causes of the confusion. Hypoglycemia and hypoxia are checked first because both are common, both are rapidly lethal, and the AEMT can correct both on scene. A blood glucose check finds the first, and the SpO₂ finds the second, with oxygen given if the saturation is below 94% or the patient is in distress. Altered mental status is a presentation, not a diagnosis. That's why you check a blood glucose level and the SpO₂ before settling on any other explanation, even one that looks obvious.

Why the others are wrong

A drug overdose and uremia: Overdose and uremia are both on the memory aid for altered mental status, along with alcohol, epilepsy, insulin, trauma, infection, psychiatric causes, and stroke. That list organizes the causes without setting the order, and hypoglycemia and hypoxia go first because they're the common, rapidly lethal ones the AEMT can fix.

Alcohol intoxication and head trauma: Intoxication and injury are common on a scene, so either one looks like an easy explanation. Settling on the first plausible explanation is how a treatable low blood glucose level or hypoxia gets missed. The AEMT runs the whole differential instead.

Stroke and a severe infection: both cause confusion, and both are dangerous. Neither can be corrected by the AEMT on scene, and low blood glucose is the most common stroke mimic, which is one more reason the glucose comes first.

Question 6 of 6

An AEMT enters a small room to care for a patient who is pacing, shouting, and clenching both fists. Where should the AEMT stand to stay safe?

Show the answer and rationale

Correct answer · Near the door, with a clear path out of the room

Near the door, with a clear path out of the room. A patient pacing, shouting, and clenching both fists in a small room is a behavioral emergency, and scene safety comes first. The safety rule has two parts: the AEMT keeps an exit path available and avoids being cornered, and the AEMT also avoids cornering the patient. A scene that turns violent after the AEMT is inside is answered by retreating, and a clear path out is what makes retreating possible. Near the door, but not in the doorway, keeps that path open for the AEMT without blocking the patient's way out. The same encounter calls for limiting the number of providers in the patient's space and speaking calmly with simple statements. That's why the AEMT stays near the door with a clear way out and talks to the patient from there.

Why the others are wrong

In the doorway, blocking the patient's way out: Standing in the doorway does keep the AEMT at the exit, which is half the rule. Blocking the patient's way out corners the patient, leaving an agitated patient no way out of the room except through the AEMT, and the rule is to avoid cornering the patient as well as avoid being cornered.

In the far corner, away from the door: Distance from the patient sounds safe, but a far corner away from the door leaves the AEMT cornered, with the whole room to cross to reach the way out. A scene that turns violent is answered by retreating, and from the far corner there is no clear path to retreat through.

Directly in front of the patient, within arm's reach: Close and face to face sounds like the way to calm the patient down, but this patient is already clenching both fists, and arm's reach is within range of a strike. Nothing about that position keeps an exit path open, which is what the AEMT needs if the scene turns violent and the answer is to retreat.

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