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

8 free Paramedic 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 Paramedic content specifications and kept inside the Paramedic 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 8

A friend calls EMS for a 19-year-old patient who is crying and breathing fast after an argument. The friend says the patient "has panic attacks" and suggests breathing into a paper bag. The patient has tingling in the fingers and nausea and has vomited twice. The skin is warm and dry, and the breathing is deep as well as fast. The vital signs are BP 98/60, P 122, R 32, and SpO₂ 99% on room air. The EtCO₂ is 14 mmHg. The blood glucose level is 438 mg/dL. What should the paramedic do next?

Show the answer and rationale

Correct answer · Give isotonic crystalloid and transport, leaving the breathing alone

This patient has diabetic ketoacidosis, and the fast breathing is compensation, not panic. Diabetic ketoacidosis builds over hours to days. DKA brings vomiting, warm dry skin, a glucose usually above 300 mg/dL, and deep, rapid Kussmaul respirations. Kussmaul breathing is the body compensating for a metabolic acidosis. This patient has all of those findings, with a glucose of 438 mg/dL. The argument, the panic history, and the tingling fingers fit anxiety. The EtCO₂ of 14 mmHg is low in both conditions, so the EtCO₂ does not separate them. An anxious patient has normal skin and a normal glucose, and breathes fast but not deep. Give isotonic crystalloid and transport, and leave the breathing alone. The deep, rapid breathing is the compensation keeping this patient alive.

Why the others are wrong

Coach slow breathing and monitor the EtCO₂ during transport: Deep breathing, warm dry skin, vomiting, and a glucose of 438 mg/dL say this patient is not anxious. Slowing the breathing takes away the compensation for the acidosis.

Have the patient breathe into a paper bag while monitoring SpO₂: This patient is breathing deep and fast to offset an acidosis, and rebreathing into a bag undoes that. A paper bag is never the treatment for a fast respiratory rate. The EtCO₂ of 14 mmHg is low in both anxiety and DKA, so it does not support the friend's remedy.

Give isotonic crystalloid and coach slow, calm breathing during transport: D does not work because the deep, fast breathing is the patient compensating for an acidosis. Talking the breathing slower undoes that compensation. Give the fluid and leave the breathing alone.

Question 2 of 8

A 53-year-old patient who has drunk heavily every day for years is found on the floor after a witnessed generalized seizure that lasted about one minute and has stopped. A neighbor says the last drink was about two days ago and the patient has barely eaten since. The patient is trembling and sweating and responds only to painful stimulus. BP 160/92, P 122, R 20, SpO₂ 96%, blood glucose level 34 mg/dL. Which treatment is most appropriate?

Show the answer and rationale

Correct answer · Intravenous dextrose with thiamine, then recheck the blood glucose level

This patient has severe hypoglycemia, with a blood glucose level of 34 mg/dL. The patient drinks every day, has barely eaten for two days, had a seizure, and now responds only to pain. Tremor, sweating, and a seizure fit both withdrawal and low blood glucose. The reading of 34 mg/dL is the problem you can fix in the next minute. A patient who responds only to pain cannot protect the airway, so the sugar goes in through a vein. Dextrose works no matter what the liver has stored. Thiamine goes in with the dextrose. A malnourished drinker can be pushed into Wernicke's encephalopathy when sugar is given alone. Give IV dextrose with thiamine, then recheck the blood glucose level.

Why the others are wrong

Oral glucose gel with intravenous thiamine, then recheck the blood glucose level: B does not work because this patient responds only to pain and cannot protect the airway. Nothing goes in by mouth, so the sugar has to go in through a vein.

Intravenous lorazepam to prevent another seizure, then recheck the blood glucose level: The seizure has already stopped, so there is no active seizure for lorazepam to stop. Lorazepam is a benzodiazepine, the usual treatment for alcohol withdrawal, and it does nothing for a reading of 34 mg/dL. It can also slow breathing in a patient who responds only to pain.

Intravenous thiamine alone, then recheck the blood glucose level: Thiamine alone does not raise a blood glucose level of 34 mg/dL, so the low reading goes untreated. Thiamine goes in with the dextrose, not instead of it.

Question 3 of 8

A 78-year-old patient is found by family members to be confused and agitated, a sudden change from two days ago when the patient was at baseline. The patient's daughter reports the patient has been increasingly drowsy at times and unusually alert and talkative at other times throughout the day, along with a productive cough for the past three days. The patient is diaphoretic and appears confused when asked the day of the week. The vital signs are BP 102/64, P 118, R 26, SpO₂ 91% on room air, T 102.6°F, and blood glucose level 110 mg/dL. What is the most likely differential diagnosis?

Show the answer and rationale

Correct answer · Delirium

This patient has delirium. Two days ago, the patient was at baseline. Now the patient is confused and agitated. The daughter says the patient swings between drowsy and unusually alert and talkative through the day. Delirium is sudden confusion that comes and goes, caused by an underlying medical problem. The fever of 102.6°F, the productive cough for three days, and the SpO₂ of 91% point to pneumonia as the cause. With delirium, you look for the illness causing the confusion and treat it. You do not just document a chronic memory problem.

Why the others are wrong

Dementia: Two days ago the patient was at baseline, and dementia builds slowly over months to years. With dementia, alertness stays steady, and this patient swings between drowsy and unusually alert through the day.

Acute ischemic stroke: The confusion is all over, and a stroke shows up as a sudden deficit in one area, like facial droop, arm weakness, or slurred speech. The fever, cough, and low oxygen point to an infection causing the confusion.

Alcohol withdrawal: No drinking history or tremor is described here, and the fever and productive cough point to an infection instead. Alcohol withdrawal brings tremor, hallucinations, and unstable vital signs about one to three days after the last drink in a heavy drinker.

Question 4 of 8

An 81-year-old patient is evaluated at an assisted living facility for word-finding difficulty. The patient's spouse reports that the patient has gradually lost the ability to recall recent conversations and has gotten lost while walking in familiar hallways over the past two years, a pattern that has slowly worsened but has not changed this week. The patient is calm, fully alert, and talks appropriately about events from decades ago, though repeatedly forgets the current date. There is no fever, no cough, and no recent illness. The vital signs are BP 128/76, P 74, R 16, SpO₂ 98% on room air, T 98.0°F, and blood glucose level 96 mg/dL. What is the most likely differential diagnosis?

Show the answer and rationale

Correct answer · Dementia

This patient has dementia. The memory loss has built slowly over two years, and the spouse says nothing has changed this week. The patient is calm and fully alert. The patient talks easily about events from decades ago but keeps forgetting the current date and has gotten lost in familiar hallways. Dementia is a slow decline in the brain, and memory goes first while alertness stays normal. A patient who stays alert through a long, steady decline like this one is not in an acute confusional state. You do not need to hunt for a new medical cause behind a change that has been there for two years.

Why the others are wrong

Acute ischemic stroke: An acute ischemic stroke causes sudden deficits like one-sided weakness or slurred speech. Those changes show up within minutes to hours. This patient's changes came on slowly over two years, with no weakness and no sudden onset.

Delirium: comes on fast, over hours to days. Alertness rises and falls through the day. A medical problem is causing the confusion, like an infection, low oxygen, or a low blood glucose level. This patient has stayed alert the whole time, and nothing has changed this week.

Major depressive disorder: Getting lost in familiar hallways comes from a decline in the brain, not from low mood. A patient with depression complains of poor memory, and the memory gets better when you engage and redirect them. This patient has a real memory loss that has slowly gotten worse over two years.

Question 5 of 8

A 79-year-old patient with a documented eight-year history of Alzheimer disease is found by family sitting calmly in a chair, oriented to person only, which the family states is unchanged from the patient's baseline for the past year. There is no fever, no recent illness, and the family denies any new medications. The vital signs are BP 132/78, P 82, R 16, SpO₂ 97% on room air, T 98.4°F, and blood glucose level 102 mg/dL. What should the paramedic do next?

Show the answer and rationale

Correct answer · Transport without further intervention

This patient's mental status is the baseline from Alzheimer disease, a type of dementia. The family says being calm and oriented to person only is how the patient has been for the past year. The temperature is 98.4°F, the blood glucose level is 102 mg/dL, and the SpO₂ is 97%. Nothing here is new, and nothing needs to be reversed. Dementia is a slow, permanent decline. A stable patient like this one needs routine transport for evaluation, not a drug for a cause that is not there.

Why the others are wrong

Administer dextrose: Dextrose is for altered mental status caused by a low blood glucose level. Those patients usually have sudden confusion, sweating, and a reading well below normal. This patient's blood glucose level is 102 mg/dL. There is no low sugar to correct.

Administer naloxone: Naloxone reverses an opioid. A patient with altered mental status from an opioid usually has slow or shallow breathing and constricted pupils. Nothing here suggests an opioid. There are no new medications, and the respiratory rate is 16.

Administer supplemental oxygen: Oxygen helps confusion caused by hypoxia. Hypoxia usually shows up as a low SpO₂, often with fast breathing. This patient's SpO₂ is 97% on room air, so the patient is getting enough oxygen.

Question 6 of 8

A 55-year-old patient who was normal this morning is now confused, sweating, and acting strangely, with no psychiatric history. The vital signs are BP 134/80, P 112, R 20, SpO₂ 97%. What should the paramedic do first to look for a medical cause?

Show the answer and rationale

Correct answer · Check a blood glucose level

The question tells you a 55-year-old with no psychiatric history was normal this morning and is now confused, sweating, and acting strangely, with a pulse of 112. A sudden change, no psychiatric history, an age over 40 at first presentation, and abnormal vital signs all argue for a medical cause. The first job on any behavioral call is to find out whether a medical problem is causing the behavior, and hypoglycemia and hypoxia are checked first because both are common, both are rapidly lethal, and both can be corrected on scene. A saturation of 97% makes hypoxia unlikely, and sweating with confusion and a fast pulse is the picture of hypoglycemia. That's why the paramedic checks a blood glucose level first.

Why the others are wrong

Establish intravenous access: Intravenous access is a way to give treatment, not a way to find the cause. It may well be needed if the glucose comes back low, but the reading comes first, and it takes a fingerstick, not a line.

Give a sedative to calm the patient: Chemical sedation is a paramedic skill, but it treats the behavior, not the cause, and nothing here says the patient is a danger to anyone. Sedating a patient whose confusion comes from low blood sugar leaves the low blood sugar untreated.

Ask about a family psychiatric history: This option accepts a psychiatric explanation before a medical one has been looked for. This patient has no psychiatric history and changed suddenly today, and no family history finds or fixes a medical cause on scene.

Question 7 of 8

A 30-year-old patient says, "Nothing matters anymore," and sits quietly after losing a job. The vital signs are normal and the scene is safe. How should the paramedic address the possibility of suicide?

Show the answer and rationale

Correct answer · Ask the patient directly about suicidal thoughts

The question tells you the patient made a hopeless statement after losing a job and is withdrawn, so suicide is a real possibility. Suicidal thoughts are assessed by asking the patient directly, because asking about suicide does not create it. The direct question is also how you learn what sets the risk: a patient with a plan, the means to carry it out, or a recent attempt is high risk and is transported. That's why the paramedic asks the patient directly about suicidal thoughts.

Why the others are wrong

Ask a family member instead of the patient: Asking a family member treats the patient as someone who cannot be asked. A relative may know some of the history, but only the patient can say whether they are thinking about suicide or have a plan.

Ask only if the patient raises it first: Waiting for the patient to raise it sounds respectful, but a withdrawn patient may never bring it up. Starting the question is the paramedic's job, and waiting can leave a high-risk patient unscreened.

Ask about mood only, without using the word suicide: This treats the word suicide as harmful, as if saying it could plant the idea. Asking about suicide does not create it, and a vague question about mood will not reveal whether the patient has a plan or the means.

Question 8 of 8

During transport, a 28-year-old patient who is severely agitated is secured face down on the stretcher with the wrists and ankles restrained behind the back. The patient continues to struggle against the restraints. The vital signs are BP 152/94, P 138, R 36, and SpO₂ 93% on room air. What should the paramedic do?

Show the answer and rationale

Correct answer · Reposition the patient supine on the stretcher

This patient is at risk of restraint asphyxia. Roll the patient supine. Face down with the wrists and ankles restrained behind the back, the patient cannot expand the chest wall or drop the diaphragm normally. The weight of the torso against the stretcher adds to the load on the chest. A struggling patient is making a large acid load. The body needs a high minute volume, which means moving a lot of air every minute, to make up for the acid. Limiting chest movement at that moment is how agitation turns into restraint asphyxia. The respiratory rate is 36 and the SpO₂ is 93% on room air in a 28-year-old. This patient is working against the restriction and losing. Prone restraint is not an accepted position to monitor a patient in any system. Move the patient supine or onto the side with the airway visible, and monitor continuously. Consider chemical sedation so the struggling stops adding to the acid load.

Why the others are wrong

Add a strap across the upper back and shoulders: On a patient who is face down, a strap across the upper back adds a second load right on top of a chest that already cannot expand. Pressure on a chest that cannot expand is the exact cause of restraint asphyxia.

Continue transport and monitor the patient closely: A respiratory rate of 36 and a saturation of 93% on room air in a young patient mean the body is already failing to keep up. Monitoring only records that decline, and watching does not change a mechanical restriction on the chest.

Loosen the wrist restraints and continue transport: Loosening the wrists while the patient stays face down leaves the chest just as compressed. The danger is the prone position and the weight on the torso, not the tension at the wrist. Loosening the wrists also gives back the control that made the restraint necessary.

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