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Psychiatric ER Survival Guide

Introduction

1. Management of acute behavioral emergencies and crisis intervention are frequently employed modalities in an emergency room (ER), and psychiatric clinicians must perform rapid assessments and make swift treatment decisions.

A. True

B. False


Emergency Psychiatry Training Objectives

2. When evaluating emergency psychiatric patients, the most critical questions that clinicians should immediately ask include each of the following EXCEPT:

A. Is the patient acutely agitated and/or threatening?

B. Is the patient acutely suicidal and/or intent on self-harm?

C. Is the patient's presenting problem due to neurological damage or acute intoxication?

D. Is this patient sick (medically), suicidal or psychotic?


Substance Use Disorders (The Joker)

3. Which of the following accurately describes issues associated with substance use and withdrawal?

A. Alcohol withdrawal usually develops 1-3 days after the person stops or cuts down on alcohol use, and heavy drinkers may be at risk for hallucinations and decreased blood pressure.

B. Marijuana withdrawal signs include excessive tiredness or sleepiness, vivid, unpleasant dreams, irritability, and depressed mood

C. Excessive use of stimulants and/or alcohol combined with strenuous physical activity can lead to death from dehydration or an exceptionally high fever

D. Heavy, long-term sedative use can result in withdrawal symptoms similar to alcohol, and sedative overdose can easily result in death by slowing or stopping the individual's breathing


Suicide Risk Assessment

4. Static risk factors related to suicide include depression, suicidal plans or intention and available suicide methods.

A. True

B. False


Violence Risk Assessment

5. A Bureau of Justice National Crime Victimization Survey found the annual rate of violent victimization to be 12.6 per 1,000 for all workers, while in comparison, for mental health professionals the rate was _________ per 1,000.

A. 68.2

B. 51.7

C. 37.5

D. 23.8


Summary of Clinical Violence Risk Factors

6. Acute factors that should be considered during a clinical violence risk assessment include major mental illness, childhood abuse, noncompliance of treatment, and impulsivity.

A. True

B. False


7. The basic principle behind the risk management plan is to identify all those risk factors that are amenable to treatment interventions and target them with reasonable treatment interventions.

A. True

B. False


Informed Consent & Competence to Make Treatment Decisions

8. Which of the following is NOT included as part of what a patient needs in order to demonstrate informed concent?

A. The ability to understand information relevant to the decision

B. The ability to appreciatethe situation and its consequences

C. The ability to demonstrate rational cognitive functioning

D. The ability to express a stable, voluntary choice


Does the Patient Need Crisis Intervention

9. Crisis intervention steps should include determining and assessing the patient's perception of the problem, exploring alternatives for solving the problem, and:

A. Offering concrete solutions based on treatment guidelines

B. Allowing a person to choose or accept a plan for resolution

C. Identifying risk factors that may interfere with crisis resolution

D. All of the above


10. While psychiatric emergency room (ER) clinicians are not expected to predict the future, prevent all tragedies, and render continuously flawless care, there is a general expectation that they use reasonable professional judgment based on a thorough consideration of the clinical data.

A. True

B. False


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