10 free EMT practice questions: Psychiatric & Behavioral Emergencies

A confirmed heart attack: A heart attack can cause chest tightness and a sense of impending doom, exactly like this patient has. The word "confirmed" is what makes B wrong. You cannot confirm a heart attack in the field. The hospital confirms a heart attack or rules one out, and until then you treat the chest tightness as cardiac.

A stroke: shows up as focal neurologic deficits, like facial droop, arm drift, or slurred speech. None of those are in this question. Rapid breathing and chest tightness are not neurologic signs.

A severe allergic reaction: can cause a sense of doom, and narrowed airways can cause chest tightness. Anaphylaxis involves the airway or the blood pressure plus a second body system, most often the skin, after an exposure. The question gives you no exposure, no hives or swelling, and no low blood pressure.

Speak loudly and quickly to establish control of the scene: A loud, fast, commanding voice works on a crowd or a bystander you need to move off a roadway or away from a hazard. Aimed at an anxious, agitated patient, a loud voice sounds like aggression, and the patient matches it. Control on a psychiatric call comes from bringing the patient's agitation down, not from projecting authority.

Avoid speaking to the patient at all: Saying less is part of de-escalation. Unhurried pauses give a patient room to settle. Not speaking at all leaves the patient guessing what you plan to do, and an anxious patient guesses the worst. Your calm voice is the treatment here, so you need to use it.

Physically approach and touch the patient immediately to reassure them: Touch reassures a lot of patients, like a hand on the shoulder of a frightened trauma patient. An agitated patient is the exception. Touch without warning inside their personal space feels like a threat and can set off the strike you are trying to prevent. An agitated patient needs more space, not less.

Enter and attempt to calm the patient using a friendly tone: A calm, friendly tone helps with a lot of behavioral health patients. Your tone does not make a scene with a weapon safe. You still cannot enter until law enforcement secures the scene.

Approach and physically remove the weapon from the patient: Taking a weapon away from someone is a law enforcement job. Trying to grab the weapon puts you at direct risk of getting hurt. Removing a weapon is not part of the EMT's role.

Send only one crew member in first to make contact: Sending one crew member in still puts that person in an unsecured scene with a reported weapon. That crew member faces the same danger the rest of the crew is avoiding. Nobody on the crew goes in until law enforcement secures the scene.

The patient is having a drug-triggered panic attack and will calm down with reassurance and transport to a psychiatric facility: Stimulant drugs can set off a panic attack. Disorientation points to a medical cause, not panic. Panic also does not explain a patient who does not notice pain or who has warm, diaphoretic skin in cool surroundings. Calling this a panic attack that reassurance will fix misses a medical emergency that can kill.

The patient is acutely intoxicated and will gradually become calm during transport; standard restraint and monitoring are sufficient: Standard restraint and monitoring fit a patient who is simply intoxicated and calms down on the ride. This patient is hot, unusually strong, and does not notice pain. Those findings make this excited delirium, not simple intoxication. A patient with excited delirium can go into cardiac arrest suddenly, even after the struggle stops.

The patient is experiencing an acute episode of schizophrenia and will respond well to a calm, supportive approach during transport to the hospital: An acute episode of schizophrenia is a psychiatric problem. The bystanders tie this behavior to a stimulant drug. Warm, diaphoretic skin, disorientation, and not noticing pain point to a medical emergency. A calm, supportive approach alone does nothing for the risk of sudden cardiac arrest.

Anxiety disorder: does cause real agitation, sometimes with panic and trouble cooperating on scene. Anxiety is a psychiatric cause. The cause that gets missed is a medical problem that looks like a psychiatric one.

Post-traumatic stress disorder: can cause agitation after a flashback, and knowing about PTSD changes how you approach the patient. Nothing in this question points to trauma or a trigger. PTSD is also a behavioral cause, not a reversible medical problem that a glucose check catches.

Alcohol intoxication: does cause combative behavior. Intoxication is usually easy to spot from the smell, the unsteady walk, or the slurred speech. Crews are quick to assume intoxication, so intoxication rarely gets missed. The mistake crews make is writing a patient off as drunk when the actual problem is low blood sugar.

Accept the refusal, since the patient is alert and fully oriented: Being alert and oriented is needed for capacity, but alert and oriented alone is not enough. Orientation tests whether the patient knows where and when they are. Capacity tests whether the patient can weigh what happens because of the decision. The patient's plan to hurt themselves is direct evidence that this weighing is impaired.

Accept the refusal once a witness has signed the form: A witness signature records that a refusal happened. The signature does not make an invalid refusal valid. A signed form from a patient who may lack capacity still leaves the patient unprotected.

Honor the refusal and request a welfare check afterward: Requesting a welfare check shows you see the risk. The welfare check pushes the protection off to a later visit. This patient has a plan now. The time between your leaving and the welfare check is when the patient is most at risk.

Enter the residence immediately to begin patient care: Going straight in is right when the scene is already secure, or on a medical call with no sign of violence. On those calls, every minute you wait costs the patient. Dispatch says this patient is making threats while holding a knife, and nobody has secured the residence. Going in might reach the patient a few minutes sooner. If the crew gets hurt, nobody gets treated.

Approach the patient calmly to de-escalate the situation: Talking an upset patient down is a real EMS skill. De-escalation works for an agitated patient who is not armed, on a scene that is already secure. You use a calm voice, an open posture, and one person doing the talking. De-escalation is patient care, and patient care starts after the scene is safe. This patient is holding a knife.

Request the family remove the weapon before EMS arrives: Asking family to put away a dog, unlock a door, or gather medications is reasonable. Taking a knife from someone who is making threats is a different thing. A family member who tries puts themselves in the middle of an assault and can make the situation worse. Police are trained, equipped, and legally responsible for handling the weapon.

Accept the denial as reassurance; no further action is needed: A denial can be reassuring when nothing else points to danger. This patient gave away a treasured possession, pulled away from friends, and just lost a job. Those warning signs carry more weight than one denial.

Treat the patient as having full capacity to refuse evaluation: An alert, oriented, cooperative patient can usually refuse care. This is not a routine refusal. The warning signs show an active risk to the patient's safety.

Take no action unless the patient volunteers suicidal thoughts: Waiting for the patient to bring up suicidal thoughts ignores what you already know. The family's concern and what the patient did with the guitar are enough to act on now.

Restrain the patient in a prone position until fully controlled: Some form of safe restraint may be needed for this patient. Prone restraint is not safe. Holding a patient face down can restrict the chest and cause positional asphyxia, and positional asphyxia has killed restrained patients. Never restrain any patient face down.

Treat this as a psychiatric crisis that will resolve with reassurance: Reassurance is how you talk down a psychiatric crisis. Excited delirium is a medical emergency with a real risk of sudden cardiac arrest. Talking will not settle it.

Wait at a distance and take no action until the patient calms down: Waiting at a distance treats this as something that will pass on its own. This patient can go into cardiac arrest, even after the struggle seems to end. Waiting delays the ALS request and the monitoring this patient needs.

Defer to the family member's wishes and allow the patient to walk away: A family member's request does not give this patient the capacity to refuse. This patient is disoriented to person, place, and time and cannot make a safe decision. Letting the patient go means letting a disoriented person walk toward moving traffic.

Assess capacity based on how calm and cooperative the patient appears: A calm, cooperative patient can look like a patient who is thinking clearly. Capacity depends on orientation and understanding, not on how the patient acts. This patient is disoriented to person, place, and time, no matter how calm the patient looks.

Obtain a signed refusal form from the patient regardless of mental status: A signed refusal form is for a patient who has the capacity to refuse. This patient does not have that capacity, so a signature from this patient is not a valid refusal.