Mental Health - Chapter 29 - Sexual Assault
A sexual assault victim asks to be given "the morning-after pill" to prevent conception. The nurse does not believe in abortion. What action should the nurse take? 1 Report and document the request. 2 Refer the woman for social services counseling. 3 Ask the supervising nurse to reassign the patient. 4 Ask the patient to reevaluate her request after 24 hours.
1 Report and document the request. The nurse's ethical beliefs should never interfere with patient rights. The nurse should report and document the patient's request. If the drug is prescribed, however, the nurse can request that another nurse administer the drug.
What are the categories of rape? Select all that apply. 1 Targeted rape 2 Attempted rape 3 Intentional rape 4 Completed rape 5 Unintentional rape
2 Attempted rape 4 Completed rape Rape is categorized as completed or attempted. Completed rape is the penetration of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person. Attempted rape includes threats of rape or intention to rape another person, but the act is not carried out or is unsuccessful. Targeted, intentional, or unintentional rape are not established categories of rape.
Three weeks after a patient was raped she tells the nurse, "I am going crazy. I have nightmares and wake up screaming. Then during the day all sorts of thoughts about the rape intrude into whatever I am concentrating on. I can't get anything done at work." How should the nurse reply? 1 "Is becoming mentally ill a frightening thought for you?" 2 "Would it help if you took some time off from work and stayed home?" 3 "You are right to be concerned. I can give you a referral for treatment." 4 "These are normal responses to stress and will decrease with time and therapy."
4 "These are normal responses to stress and will decrease with time and therapy." These symptoms are part of the response to rape trauma and parallel symptoms experienced by other victims of post-traumatic stress disorder.
When the nurse finishes addressing a group of college women about rape, the following comments are heard during the discussion period. Which comment calls for additional teaching by the nurse? 1 "So if you dress conservatively, your risk of being raped is small." 2 "Who would have guessed that most rape victims know the rapist?" 3 "It makes sense that rape is a crime of violence, not a crime of sex." 4 "I always thought rapes happened at night, but now I know that isn't true."
1 "So if you dress conservatively, your risk of being raped is small." Rapes have little to do with whether the victim dresses seductively because rape is a crime of violence rather than a crime of sex.
The nurse assesses a victim of incest who is receiving psychiatric therapy. Which finding could indicate that the patient may be experiencing avoidance? 1 Feelings of guilt 2 Frightening thoughts 3 Difficulty completing daily tasks 4 A decreased ability to feel happiness
1 Feelings of guilt The patient experiences guilt, which is a type of avoidance. This is demonstrated when the patient avoids going to certain places that will remind him or her about the traumatic event. Recurring frightening thoughts related to the abuse indicate that the patient is experiencing intrusive symptoms. Arousal symptoms are suspected when the patient has difficulty in completing daily tasks. In the avoidance phase of acute stress dissorder, some patients have a decreased ability to experience emotions such as happiness.
Anticipatory teaching of a rape victim should include information that a common survivor problem that often develops with acute stress disorder is 1 Intrusive thoughts 2 Denial of the event 3 Shock and numbness 4 Headaches and fatigue
1 Intrusive thoughts With acute stress disorder, intrusive memories and dreams haunt the rape victim. Knowing this is a common occurrence is reassuring to the patient, who often is frightened by the symptom. Denial of the event, headaches and fatigue, or shock and numbness are not associated with the reorganizational phase of rape trauma.
Which statement reflects a truth about rape? 1 Most rapes are planned. 2 Some women want to be raped. 3 Most charges of rape are unfounded. 4 Most women are raped by strangers.
1 Most rapes are planned. Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated. Some women want to be raped, most charges of rape are unfounded, and most women are raped by strangers are not true statements.
Which statement is currently true regarding the existence of sexual assault in the United States? Select all that apply. 1 Nearly one in five women has been raped within her lifetime. 2 Nearly a third of male victims were raped by intimate partners. 3 The male is likely to have been victimized by several assailants. 4 Rape statistics show little variance when race and ethnicity are considered. 5 The first rape experience in female victims happens before the age of 25 the majority of the time.
1 Nearly one in five women has been raped within her lifetime. 2 Nearly a third of male victims were raped by intimate partners. 3 The male is likely to have been victimized by several assailants. 5 The first rape experience in female victims happens before the age of 25 the majority of the time. An estimated 19.3%, or one in five, women in the United States have been raped at some time in their lives. Intimate partners raped 29% of male victims and 45% of female victims. A male who is raped is more likely to experience physical trauma and to have been victimized by several assailants. Among female victims of completed rape, the first rape experience happened before age 25 years in nearly 79% of victims. Race and ethnicity are important variables in rape statistics.
What interventions should be included during a rape examination? Select all that apply. 1 Palpating for signs of invisible injury 2 Recording injuries in written and photographic form 3 Asking the patient to recount the events leading to the attack 4 Conducting a superficial genital examination and speculum exam 5 Make all the decisions for the patient as he or she is traumatized
1 Palpating for signs of invisible injury 2 Recording injuries in written and photographic form 4 Conducting a superficial genital examination and speculum exam Rape is a psychological emergency, as well as a medical one, so the nurse should be aware of the patient's emotional needs during this time. The nurse should only ask questions about the rape that directly pertain to the injuries sustained, but the nurse should not ask about the events leading to the attack as the victim may be embarrassed or traumatized by these details. Recent injuries may not yet exhibit visible bruising, so the nurse should palpate the skin and ask the patient to confirm any pain that could indicate injury. The nurse should thoroughly document the injuries both in pictorial and descriptive form by detailing the size, appearance, color, and shape of the injuries. Superficial and detailed genital examination with a speculum is conducted to detect any internal signs of injury. The nurse should also question a victim of rape regarding the date of her last menstrual period. This will help assess the likelihood of pregnancy and enable suitable preventive measures. The nurse should allow the patient to participate in all decisions in order to help the rape victim regain a sense of control.
A nurse is assessing emotional trauma in a patient who was sexually assaulted. What action does the nurse take while performing the assessment? Select all that apply. 1 The nurse encourages the patient to talk at a comfortable pace. 2 The nurse asks the patient, "Are you having any suicidal intentions?" 3 The nurse says to the patient, "It is very painful to be in a situation like this." 4 The nurse asks the family about the patient's behavior before the incident. 5 The nurse says to the patient, "Are you considering yourself responsible for this?"
1 The nurse encourages the patient to talk at a comfortable pace. 2 The nurse asks the patient, "Are you having any suicidal intentions?" The patient who has been sexually assaulted may have extreme emotional trauma, so the nurse should assess the emotional state of the patient. The nurse should encourage the patient to talk at a comfortable pace. It helps the patient to state all the details of the incident without getting agitated or depressed. The nurse should assess the presence of suicidal intentions in the patient. The nurse should ask the questions directly, like, "Are you having any suicidal intentions?" It helps the nurse to plan interventions to enhance the patient's self-esteem. The nurse should avoid showing sympathy to the patient by saying, "It is very painful to be in a situation like this." It makes the patient feel depressed and worthless. The nurse should assess only the details of assault while taking the history of the patient. It helps to identify the immediate physical and psychological needs of the patient. Asking about the patient's family behavior before the incident is not required for the immediate treatment. Patients who are the victims of assault blame themselves. The nurse should reassure the patients that they are not responsible for the event. The nurse should not ask the patient directly if the patient feels responsible for the incident; this can make the patient feel rejected.
The nurse is assessing a patient with rape-trauma syndrome. The patient killed the perpetrator in an attempt to save herself. The patient tells the nurse, "I am a murderer. I killed that man. I should have tried to run away. Why did I have to kill the man?" What should be the response given by the nurse to the patient? 1 "Please calm down and start thinking logically." 2 "You have done the correct thing to save your life." 3 "I don't think that the law enforcement would take actions against you." 4 "Running away would have been a better solution to save yourself."
2 "You have done the correct thing to save your life." The rape victim killed the perpetrator in an attempt to save herself. Therefore, the nurse should reassure the patient by saying that the patient did the right thing to save her life. This will reduce the feelings of guilt and self-blame. The nurse should listen to the patient when the patient tries to explain her feelings. Asking the patient to calm down and start thinking logically would not reassure the patient. Saying that the law enforcement would not take actions against the patient indicates that the nurse is being judgmental about the patient's actions. Telling the patient that running away would have been a better option indicates that the nurse does not feel that the patient has done the right thing. This will increase the feelings of guilt in the patient and should be avoided.
What measures should the nurse take while assessing a rape victim? Select all that apply. 1 Make use of "why" questions. 2 Ask questions using descriptive terms. 3 Ask questions in a nonjudgmental tone. 4 Ask the patient to talk at a comfortable pace. 5 Ask the patient to explain the assault in detail.
2 Ask questions using descriptive terms. 3 Ask questions in a nonjudgmental tone. 4 Ask the patient to talk at a comfortable pace. While assessing a rape victim, the nurse should ask questions using descriptive terms to avoid any confusion in the patient. The nurse should always ask questions in a nonjudgmental manner to avoid making the patient feel embarrassed and uncomfortable. The nurse should ask the patient to speak in a comfortable pace since the patient has undergone trauma. Asking "why" questions would indicate that the nurse wants a detailed explanation of the incident. The nurse determines only the details of the assault that will be helpful in addressing immediate physical and psychological needs of the patient. Asking the patient to explain the assault in full detail as this can make the patient feel more embarrassed and traumatized.
Which nursing intervention helps reduce severe anxiety in a patient who has been physically abused? 1 Conducting a head-to-toe physical assessment 2 Providing compassionate support for the patient 3 Asking the patient to verbalize his or her thoughts 4 Asking the patient's relatives for details regarding the assault
2 Providing compassionate support for the patient The nurse can reduce the patient's anxiety after a physical assault incident by providing support and care. The nurse should conduct a detailed head-to-toe physical assessment to check for signs of physical injury, but this will not reduce anxiety. Asking the patient to verbalize his or her thoughts enables the nurse to assess the patient's cognitive coping mechanisms, but is not the best intervention for reducing anxiety. The nurse should ask the patient's relatives for details regarding the assault in case the patient is unconscious or disabled. It helps ascertain the patient's support system, but it will not help reduce anxiety in the patient.
A nurse is caring for a patient who was sexually assaulted. Which nursing interventions does the nurse follow to avoid rape-trauma syndrome in the patient? Select all that apply. 1 The nurse administers contraceptive pills to the patient. 2 The nurse refers the patient to a rape advocacy program. 3 The nurse arranges for a person to stay with the patient. 4 The nurse leaves the patient alone at the patient's request. 5 The nurse educates the patient about human immunodeficiency virus testing.
2 The nurse refers the patient to a rape advocacy program. 3 The nurse arranges for a person to stay with the patient. 5 The nurse educates the patient about human immunodeficiency virus testing. Patients who are the victims of sexual assault may develop rape-trauma syndrome. The nurse should follow the interventions to give emotional and physical support to the patients to avoid rape-trauma syndrome. The nurse should refer the patient to a rape advocacy program. It helps the patient to gain faith and confidence. The patient feels lonely and can develop suicidal intentions; therefore, the nurse should arrange for a person to stay with the patient and provide emotional support. The nurse should inform the patient about human immunodeficiency virus (HIV) testing, as the victims of sexual assault may become infected with sexually transmitted diseases. The nurse should not decide to administer contraceptive pills to the patient. The nurse should not leave the patient alone as the patient can self-harm.
A patient who was sexually assaulted was treated effectively and discharged. What appropriate action should the nurse follow while discharging the patient? 1 The nurse should avoid calling the patient after the discharge. 2 The nurse should give printed follow-up instructions to the patient. 3 The nurse should instruct the patient to follow up every 6 months. 4 The nurse should refrain from taking contact information from the patient.
2 The nurse should give printed follow-up instructions to the patient. The patient who was sexually assaulted has mild anxiety even after effective treatment. The patient has reduced concentration due to anxiety, so the patient may not remember verbal instructions. The nurse must give printed information to the patient for reference. The information on victim compensation, legal matters, emotional reactions, and so on is provided in the printed material. It serves as a referral to the health care provider for the continuity of treatment and care of the patient in the future. The nurse should call the patient within 24 to 48 hours of discharge to reassess the patient's emotional state. The nurse should instruct the patient to follow up at least 2, 4, and 6 weeks after the initial evaluation. The patient is assessed for psychological progress and sexually transmitted diseases during the follow-up visits. The nurse should take the updated contact information of the patient. It helps to assess the patient's condition and to refer to support systems if the patient needs any legal assistance or counseling.
Which of the following is the best description of completed rape? 1 Sexual desire satisfied inappropriately 2 An act prompted by early childhood neglect 3 Penetration without the consent of the victim 4 Assault by a stranger on an unsuspecting victim
3 Penetration without the consent of the victim Completed rape is defined by the FBI as "penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim." Assault by a stranger on an unsuspecting victim, sexual desire satisfied inappropriately, and an act prompted by early childhood neglect are not accurate definitions of completed rape.
The nurse observes as a student nurse assists with the discharge of a patient who was raped. Which actions made by the student nurse cause the nurse to intervene? Select all that apply. 1 Asking the patient if a support person is available to help him or her in times of distress or anxiety 2 Printing a variety of resource materials for the patient to take home and read when anxiety has subsided 3 Telling the patient to call the hospital in a few days to receive a list of support groups in the community 4 Verbally telling the patient about legal matters, online resources, and potential physical concerns that the patient will experience 5 Calling the patient's primary care provider to inform him or her about the discharge date, helping to schedule a follow-up appointment for the patient
3 Telling the patient to call the hospital in a few days to receive a list of support groups in the community 4 Verbally telling the patient about legal matters, online resources, and potential physical concerns that the patient will experience When discharging a patient who was raped, the nurse provides referral information and printed follow-up materials and instructions for the patient. The nurse should not provide this information verbally because the emotional trauma and anxiety can make it difficult to process information. Written materials can be referred to later without the risk of forgetting it. The patient should not be instructed to call the hospital back for resources at a later time; this information should be provided at discharge. It is appropriate for the nurse to print helpful materials, ask the patient about support, and provide continuity of care by collaborating with the primary care provider.
A nurse is caring for a patient who was sexually assaulted at a party. The nurse teaches cognitive coping skills to the patient. Which response by the patient indicates effective teaching by the nurse? 1 "It is my fault; my mother suggested that I not go to the party." 2 "I am still confused; how did I become unconscious suddenly?" 3 "I am thankful to you; you have been a strong support to me." 4 "It is now my turn to support my parents and take care of them."
4 "It is now my turn to support my parents and take care of them." The victims of sexual assault have chronic low self-esteem and reduced coping skills. The nurse should teach cognitive skills to the patient to reduce negative feelings like worthlessness, self-blame, and so on. The statement "It is now my turn to support my parents and take care of them" indicates that the patient has developed a positive approach toward life. The statement "It is my fault" indicates that the patient blames oneself and is not a positive response. The statement that the patient is confused and unable to remember the event indicates that the patient is unable to accept the truth. The statement "I am thankful to you; you have been a strong support to me" indicates that the patient shows gratitude toward the nurse.
Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of which of the following? 1 A maturational crisis 2 A dissociative disorder 3 Generalized anxiety disorder 4 Post-traumatic stress disorder
4 Post-traumatic stress disorder Most of those who have been raped are eventually able to resume their previous lives after supportive services and crisis counseling. However, many carry with them a constant emotional trauma: flashbacks, nightmares, fear, phobias, and other symptoms associated with post-traumatic stress disorder. Such trauma is not maturational in nature because it is not associated with a developmental stage. A dissociative disorder or generalized anxiety disorder are not usual post-assault outcomes.