Sexual Assault & Trauma Syndrome

A 17-year-old high school student who was recently raped is reluctant to discuss the event. She can no longer use tampons during her period because she becomes dizzy and nauseated when trying to insert them. She states that she will never have another boyfriend because "I'm ruined." Which of the following nursing diagnoses is most appropriate for this client? a Rape-trauma Syndrome: silent reaction b Post-trauma Syndrome c Rape-trauma Syndrome: compound reaction d Sexual Dysfunction

A. The client is unable to talk about the trauma, has developed a phobic reaction to tampons, and is renouncing future relationships with men. Rape-trauma syndrome: compound reaction indicates reactivation of a physical or mental illness or use of addictive substances to cope with the trauma. The client is not displaying symptoms such as nightmares, hypervigilance, insomnia, panic attacks, flashbacks, or intrusive memories that are associated with a diagnosis of post-traumatic stress disorder (PTSD). There are no indications of a physical inability that would limit sexual activity.

The care plan formulated with a client includes the goal: client describes self as a rape survivor. For which client would this goal be inappropriate? a. Client in the emergency department immediately after the rape b. Client in individual therapy 1 month after a rape c. Client in the emergency department with a panic attack that the client relates with a rape 6 months ago d. Client in primary care setting 3 months after a rape

A. Immediately after the rape is too soon to expect the client to see herself as a survivor. The goals for this client might be to have the client make choices about treatment or to identify current feelings. Clients who are 1, 3, and 6 months after the rape might consider themselves as survivors. However, this does not mean they are free of the fears and feelings related to the rape.

A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following is an appropriate response by the nurse? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do feel that you should not have been alone on the street at night?"

A. INCORRECT: This responses offers the nurse's opinion, which is a nontherapeutic communication technique. B. INCORRECT: This responses indicates disapproval, which is a nontherapeutic communication technique. C. CORRECT: This response uses the therapeutic communication technique of restating, which promotes reflection and verbalization of feelings. D. INCORRECT: This responses asks a "why" question, which is a nontherapeutic communication technique

A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates the need for further teaching? A. "Rape is a crime of aggression." B. "Acquaintance rape often involves alcohol." C. "Both men and women can be victims of rape." D. "The majority of rapists are unknown to the victims."

A. INCORRECT: This statement does not require further teaching. Rape is a crime of violence, aggression, anger, and power. B. INCORRECT: This statement does not require further teaching. Drugs and alcohol are often associated with date or acquaintance rape. C. INCORRECT: This statement does not require further teaching. Both men and women can be victims of rape. D.CORRECT: This statement requires further teaching. The majority of rapists are known to the victims.

A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements indicates the need for further teaching? A. "I will administer prophylactic treatment for sexually transmitted infections like chlamydia." B. "I need to obtain informed consent before the sexual assault nurse examiner obtains forensic evidence." C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D. "I should perform a self-assessment before caring for a client who has been raped."

A. INCORRECT: This statement does not require further teaching. The nurse should administer prophylactic treatment for infections such as chlamydia according to the Centers for Disease Control and Prevention. B. INCORRECT: This statement does not require further teaching. The nurse must obtain informed consent to collect data that can be used as legal evidence. C. CORRECT: This statement requires further teaching. Manifestations of rape-trauma syndrome are similar to posttraumatic stress disorder rather than bipolar disorder. D. INCORRECT: This statement does not require further teaching. The nurse should perform a self-assessment prior to client care to ensure he is able to provide empathetic, objective, and nonjudgmental care.

The nurse is teaching coping skills to clients who have experienced sexual trauma. Which of the following demonstrates that the teaching has been successful? (Select all that apply.) a. The client talks of the past more than the present. b. The client enjoys an intimate relationship with a significant other. c. The client restructures negative thoughts and makes positive self-statements. d. The client verbalizes feelings of anger and despair from past sexual abuse. e. The client practices deep breathing techniques when intrusive memories occur.

B, C, D, E The client who is able to enjoy an intimate relationship with a significant other is demonstrating the ability to relate to another; this is a barrier for those who have experienced sexual trauma.Verbalizing feelings of anger and despair from past sexual abuse allows the client explore these feelings before moving on to self-forgiveness and more complete healing. Practicing deep breathing techniques when intrusive memories occur is an effective stress management technique to self-soothe one's anxiety. Ability to restructure negative thoughts and make positive self-statements demonstrates a cognitive ability to monitor irrational thoughts and replace them with rational ones. Talking of the past more than the present indicates that the client is dwelling on past sexual abuse and is not able to move forward with life.

Identify at least four interventions that are appropriate during the physical examination.

Provide a private, secure environment. Provide nonjudgmental and empathetic care. Assist the sexual assault nurse examiner with obtaining, documenting, and preserving legal evidence. Treat any injuries and document care given. Administer prophylactic treatment for the prevention of STIs. Evaluate the client for pregnancy risk. Call the client's available personal support system, if the client gives permission. Encourage the client to verbalize her story and emotions. Use therapeutic communication techniques.

A female was sexually assaulted in the parking lot of a mall and was brought to the emergency department by a friend. Which of the following is improper procedure for conducting a sexual assault assessment? a. At the victim's request, the friend is present during the examination. b. The victim uses the bathroom and washes her hands before the examination begins. c. After obtaining permission, the nurse takes photographs of the victim's injuries. d. The nurse documents the victim's verbal and nonverbal behavior.

B. It is improper procedure for the victim to use the bathroom and wash her hands before the examination begins because valuable forensic evidence may be destroyed. The victim has the right to have friends or family present during the assessment. The victim must give permission before any photographs or other evidence is collected. Careful documentation of the victim's statements and behavior must be done to assist with possible prosecution of the perpetrator.

There are several biopsychosocial theories associated with the causation of rape and intrafamily abuse. However, the nurse knows that: a. The greatest predictor for family rape is the perpetrator's history of abuse as a child. b. None of the contributing factors consistently results in or is predictive of rape. c. Inability to control impulses is a consistent finding. d. Stranger rape has a sexual connotation, while the dynamics associated with family rape relate to power and control.

B. There is no consistent predictor of rape behaviors. Although genetic predisposition may make certain behaviors more likely, it does not make them inevitable. Controlling impulses is not a consistent finding. All rape is about power and control. Although some abused children grow up to become abusers, this factor is not the greatest predictor for family rape.

Compare and contrast rape and date rape

Both rape and date rape are forced sexual intercourse and a form of sexual assault. However, date rape specifically refers to rape by a known acquaintance during a social engagement

A nurse is discussing silent rape reaction with a newly licensed nurse. Which of the following should the nurse identify as a characteristic of this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault

A. CORRECT: Sudden onset of phobic reactions is a characteristic of a silent rape reaction. B. INCORRECT: Development of substance use disorder is a characteristic of a compound rape reaction. C. CORRECT: Increased anxiety during interview is a characteristic of a silent rape reaction. D. INCORRECT: Reactivation of a prior physical disorder is a characteristic of a compound rape reaction. E. CORRECT: No verbalization of the sexual assault is a characteristic of a silent rape reaction.

A nurse is assessing a client who is the victim of sexual assault. Which of the following findings indicate the client is experiencing an initial impact reaction of rape-trauma syndrome? (Select all that apply.) A. Genitourinary soreness from the assault B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outbursts E. Difficulty making decisions

A. INCORRECT: Soreness from the attack indicates a somatic, rather than initial impact, reaction. B. INCORRECT: Difficulties with low self-esteem are an indication of the long-term reorganization phase rather than an initial impact reaction. C. INCORRECT: Sleep disturbances indicates a somatic, rather than initial impact, reaction. D. CORRECT: Emotional outbursts indicate an expressed initial impact reaction during the acute phase of rape-trauma syndrome. E. CORRECT: Difficulty making decisions indicates a controlled initial impact reaction during the acute phase of rape-trauma syndrome.

The nurse is conducting a teaching session at a community center for women about rape. The nurse would include that which individual is at highest risk for experiencing rape? a A 30-year-old married female who works out of the home b A student c A 50-year-old woman living alone who rides a bus to work d An older client in a long-term care facility

B. Studies show that the young, women who are unmarried, women who are unemployed or are from low income groups, and students have the highest incidence of sexual assault. Older women and women who work do not fit into this category.

According to systems theory, families in which sexual abuse occurs, are characterized by: a. Consistent equality within their structure and roles. b. High expressed emotion. c. Fluid boundaries. d. Openness with nonfamily members.

C. In a family with fluid boundaries, an adult may move down in the structure or the child may move up in terms of roles and influence (boundaries). If the father moves downward, he assumes a childlike role and is cared for and nurtured like a child in the family. In this position, the father assumes little parental responsibility. He may then turn to a child as a peer for sexual gratification. Openness with nonfamily members does not affect this process. Consistent equality within their structure and roles is a healthy response. This phenomenon has little to do with expressed emotion.

Which of the following statements would hinder the therapeutic relationship between the nurse and an adult victim of a recent sexual assault? a. "You handled the attack as well as you could; you survived." b. "You may feel anger, guilt, fear or resentment, but these are very normal reactions." c. "You didn't do anything to cause the attack, and it's not your fault you were raped." d. "You may want to have an abortion if you find out you are pregnant."

D. Mentioning abortion hinders the therapeutic relationship because it advises the client to make a personal choice that may be against her values and beliefs. This statement would block further communication about the options that are available to the client. The therapeutic relationship is facilitated by reassuring the client that she acted as rationally and appropriately as anyone could in a life-threatening situation, by letting the client know that the nurse understands the emotions one commonly feels following a violent attack, and by reminding the client of her innocence. Many victims think they could have avoided the rape if they had acted differently.

Identify at least two substances, other than alcohol, commonly associated with date rape. Include the street names for these substances.

Gamma-hydroxybutyrate (GHB) Street names: "G," "liquid ecstasy" Flunitrazepam (Rohypnol) Street names: "roofies," "club drug," "roachies" Ketamine Street names: "black hole," "kit kat," "special K"