Chapter 29 Questions - 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 the nurse should take? Refer the woman for social services counseling. Report and document the request. Ask the supervising nurse to reassign the client. Ask the client to reevaluate her request after 24 hours.
Report and document the request. The nurse's ethical beliefs should never interfere with client rights. The nurse should report and document the client's request
How is the act of rape best described? An act of violence using sex as the weapon Assault by a stranger on an unsuspecting victim Sexual desire satisfied inappropriately An act prompted by early childhood neglect
An act of violence using sex as the weapon Rape is a violent crime. Sex is only the medium for perpetrating the crime. None of the remaining options accurately and thoroughly describe the act of rape
Which racial identification places a woman at the greatest risk of being sexually assaulted in her lifetime? multiracial american indian black non-hispanic caucasian
multiracial
A young woman named Carly was raped behind the restaurant where she works after closing shift. Six months have passed and Carly has not been able to return to work, refuses to go out to eat, and feels that she has less value as a woman now that she has been raped. Carly's clinical presentation suggests: Re-experiencing Hyperarousal Avoidance Physical effects
Avoidance
Considering the guilt that women feel after being sexually assaulted, which nursing assessment question has priority? "Do you want the police to be called?" "Did you recognize the person who assaulted you?" "Do you have someone you trust that can stay with you?" "Do you have any thoughts about harming yourself?"
"Do you have any thoughts about harming yourself?"
Which statement is an accurate depiction of sexual assault? rape is a sexual act most rapes occur in the home rape is usually an impulsive act women are usually raped by strangers
most rapes occur in the home
ATI CH 33 - 3. A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of teaching? "I will administer prophylactic treatment for sexually transmitted infections like chlamydia" "I am not required to obtain informed consent before the sexual assault nurse examiner collects forensic evidence" "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder" "I should use narrative documentation when documenting subjective data"
"I will administer prophylactic treatment for sexually transmitted infections like chlamydia"
ATI CH 33 - 5. A community health nurse is leading a discussion about a rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching? "rape is a crime of passion" "Acquaintance rape often involved alcohol" "Young adults are the typical victims of sexual assault" "The majority of rapists are unknown to the victims"
"Acquaintance rape often involved alcohol"
Which statement best illustrates support in giving care to a patient who has just been sexually assaulted? "I'm so sorry for what you have been through." "Don't worry. It's hard now, but everything will be alright." "I am going to stay with you. We can talk as long as you want to." "Let's talk about new coping skills you can use."
"I am going to stay with you. We can talk as long as you want to." The most effective approach for counseling in the emergency department or crisis center is to provide nonjudgmental care and optimal emotional support. Sympathy is not a therapeutic response and does not focus on the patient. Telling the patient not to worry is false reassurance. It is too soon to try to learn new coping skills because the patient is in an acute stress phase.
It has been 6 months since a woman was raped. Which statement by the client would indicate that counseling has helped her to achieve an important long-term outcome? "I'm not having as many nightmares about the rape so I do get a little sleep at night." "My husband has been very supportive during this whole thing." "I am not going to let that rapist be in control of my life. I know things will keep getting better." "I am not pressing charges because I want this whole thing to be over with so I can move on."
"I am not going to let that rapist be in control of my life. I know things will keep getting better." The correct option expresses empowerment and hope for the future. Long-term outcome includes the absence of any residual symptoms after the trauma and would be indicated by healing of physical injuries, relief of anger in nondestructive ways, comfort in relationships, and feelings of empowerment and expression of hope. While there has been an improvement, having nightmares and not sleeping well indicates that the patient is still going through acute stress related to the rape. The fact that the husband is supportive is a positive statement regarding her husband but doesn't express her own indicators of recovery. Not pressing charges may indicate that the patient may not be dealing with the event in a healthy way by avoiding the trauma.
A sexual assault survivor tells the nurse, "I should have tried to fight him off! But I was so terrified that I could not move. I should have tried harder." Which response should the nurse make to reassure the client? "Try not to think about it. Put it out of your mind." "We each behave in characteristic ways in a crisis. That was your way." "Do you think others will think badly of you for not trying to fight?" "The way you behaved was the right thing to do at the time."
"The way you behaved was the right thing to do at the time." The victim should always be told that staying alive was the priority and that whatever she did to that end was the right thing to do. None of the other options provide reassurance as effectively as the correct option.
Which of the following statements by a woman who was sexually assaulted a year ago would indicate that she has recovered from the trauma? "I don't walk home alone anymore because I am terrified it may happen again." "I am sleeping better but still only get about 5 hours of sleep at night because of bad dreams about the rape." "I realize that I was partly to blame for the rape because of walking in an unsafe neighborhood." "My husband and I are having sex again and I enjoy it."
"My husband and I are having sex again and I enjoy it." Sexual assault survivors are considered to be recovered if they are relatively free of any signs or symptoms of acute stress disorder and posttraumatic stress disorder. Signs of recovery include sleeping well with few instances of nightmares or dreams, being only mildly fearful, having positive self-regard, and returning to prerape sexual functioning and interest. The closer the survivor's lifestyle is to how it was before the rape, the more complete the recovery has been. Not walking home because of being terrified indicates a high level of fear. Only sleeping 5 hours at night indicates sleeping is still seriously disturbed. Stating that she is partly to blame indicates that the patient is placing the blame for the rape on herself instead of the perpetrator
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? "It makes sense that rape is a crime of violence, not a crime of sex." "Who would have guessed that most rape victims know the rapist?" "So if you dress conservatively, your risk of being raped is small." "I always thought rapes happened at night, but now I know that isn't true."
"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 other options represent accurate information regarding the act of rape
Which statement made by a sexual assaulted patient strongly suggests the drug gamma-hydroxybutyrate acid (GHB) was involved in the attack? "I remember everything that happened, but felt too tired to fight back" "The drink I was given had a salty taste to it" "They tell me I was unconscious for 24 hours" "I heard that I was fighting the nursing staff and saying that they were trying to kill me"
"The drink I was given had a salty taste to it"
During the immediate post-rape period what verbal nursing intervention would best lower client anxiety and increase feelings of well-being? "You are safe here. I will stay with you while you have your examination." "I know you feel confused. We will make all the necessary decisions for you." "Please tell me as much about the details of the rape as you can remember." "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."
"You are safe here. I will stay with you while you have your examination." The presence of the nurse is reassuring, especially when the client is experiencing disorganization and the environment is confusing. Safety is the primary concern for both the client and the nurse. The nurse's presence conveys a sense of safety to the client. None of the other options address safety and well-being
ATI CH 33 - 4. 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 responses should the nurse make? "Your actions had nothing to do with what happened" "You should focus on recovery rather than blaming yourself for what happened" "You believe this wouldn't have happened if you hadn't been out alone?" "Why do you feel that you should not have been alone on the street at night?"
"You believe this wouldn't have happened if you hadn't been out alone?"
Perpetrators of sexual assault are often incarcerated but frequently do not undergo therapy. Samuel, convicted of rape and sentenced to 15 years in prison, has requested to see a therapist. The psychiatric nurse practitioner is surprised to learn of the request as many perpetrators: Boast of their assault history Feel regret and remorse Do not acknowledge the need for change Are unable to recognize rape as a crime
Do not acknowledge the need for change
Which statement would be an appropriate long-term outcome for a rape client? Integrate of the rape event and resumption of an optimal level of functioning. Identify and develop coping skills necessary to reduce level of anxiety. Appropriately blame the rapist rather than blaming herself for the situation. Repress feelings of shame, embarrassment, and self-blame.
Integrate of the rape event and resumption of an optimal level of functioning. This is the ideal long-term result of treatment for rape trauma syndrome, that life will go on and the client will return to the usual pre-trauma level of functioning. Repressing is not a healthy coping mechanism. While not inappropriate, the remaining options are not long-term goals for such a client.
Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of which psychiatric disorder? Posttraumatic stress disorder (PTSD) A maturational crisis A dissociative disorder Obsessive compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD) 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 posttraumatic stress disorder (PTSD). None of the other options are associated with this type of trauma
Ron is a victim of assault and has revealed to his family and friends the fact that he was raped. The family reacts with horror and disgust, and the nurse caring for Ron recognizes: Ron's family is being judgemental Ron's family should leave the hospital Ron's family will also need support Dysfunctional family dynamics
Ron's family will also need support
To provide discharge treatment and support, the nurse should realize that the most common outcome of acquaintance rape is which psychosocial dysfunction? Sexual distress Fear of men Depression Anxiety
Sexual distress Women who have been raped by acquaintances frequently develop symptoms that prevent them from participating in normal sexual relations. Sexual distress is more common among women who have been sexually assaulted by intimates; fear and anxiety are more common in those assaulted by strangers. Depression occurs in both groups
Which of the following are myths surrounding rape? Select all that apply. Women are usually raped by a stranger. Women do not "ask" to be raped by their behavior or dress. Most rapes occur away from home areas such as alleys and behind buildings. Documented rape cases include women from 8 to 70 years old. Rape is an expression of aggression and anger. Rape is usually an impulsive, spur-of-the-moment decision by the rapist. Unless the assailant is armed, most women should be able to get away and avoid the rape.
Women are usually raped by a stranger. Most rapes occur away from home areas such as alleys and behind buildings. Documented rape cases include women from 8 to 70 years old. Rape is usually an impulsive, spur-of-the-moment decision by the rapist. Unless the assailant is armed, most women should be able to get away and avoid the rape.
ATI CH 33 - 2. A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape-trauma syndrome? select all that apply genitourinary syndrome difficulties with low self-esteem sleep disturbances emotional outbursts difficulty making decisions
emotional outbursts difficulty making decisions
The stress of being raped often results in suffering similar to people who have witnessed a murder or had a physiological reaction trauma, resulting in: PTSD Anxiety Deoression All of the above
all of the above
You are working at a telephone hotline center when Abby, a rape victim, calls. Abby states she is afraid to go to the hospital. What is your best response? "I'm here to listen, and we can talk about your feelings" "You don't need to go to the hospital if you don't want to" "If you don't go to the hospital, we can't collect evidence to help convict your rapist" "Why are you afraid to seek medical attention?"
"I'm here to listen, and we can talk about your feelings"
A 28-year-old married client who is seeking treatment after being raped tearfully asks the nurse, "What if I am pregnant?" The nurse's response should be guided by what knowledge? The risk of pregnancy after rape is high, up to 50%. About 5% of women who are raped become pregnant as a result. Reproductive functions shut down during a violent attack, and as a result pregnancy does not occur. The client may be worried about how her spouse will accept the baby.
About 5% of women who are raped become pregnant as a result. About 5% of women who are raped become pregnant as a result (Rape, Abuse & Incest National Network, 2008). Pregnancy prophylaxis can be offered in the emergency department after the results of the pregnancy test are available. The risk of pregnancy is not high after rape. Reproductive functions do not shut down during a violent attack. The patient may be worried about her spouse's reaction; however at this time most important consideration is to give the patient pertinent education regarding rape and pregnancy
The emergency department nurse planning care for a rape survivor must realize that the emotional reaction displayed by many rape victims during the initial assessment and treatment is which emotion? Fear Eagerness Aggression Disinterest
Fear Rape is an act of violence, and sex is the weapon used by the perpetrator. Rape engulfs its victims in fear and anxiety, resulting in withdrawal for some and causing severe panic reactions in others. After being traumatized, the person who has been raped often carries an additional burden of shame, guilt, fear, anger, distrust, and embarrassment. None of the other options are generally associated with this form of trauma
Anticipatory teaching for a rape victim should include information addressing what common survivor problem? Denial of the event Headaches and fatigue Shock and numbness Intrusive thoughts
Intrusive thoughts Just as in posttraumatic stress disorder, intrusive thoughts haunt the rape victim in the weeks and months during which long-term reorganization is occurring. Knowing that this is a common occurrence is reassuring to the client, who often is frightened by the symptom. While the other symptoms can occur they are not commonly associated with rape recovery
Which statement reflects a truth about rape? Some women want to be raped. Rapists are oversexed. Most rapes are planned. Most women are raped by strangers.
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. All the remaining options are common myths about the act of rape
Which signs and symptoms are associated with acute stress disorder and often observed in patients who have been sexually assaulted? select all that apply outbursts of anger depression auditory hallucinations flashbacks amnesia for the event
outbursts of anger depression flashbacks amnesia for the event
ATI CH 33 - 1. A nurse is discussing silent rape reaction with a newly licensed nurse. The nurse should identify which of the following characteristics as expected for this type of reaction? select all that apply sudden development of phobias development of substance use disorder increased level of anxiety during interview reactivation of a prior physical disorder unwillingness to discuss the sexual assault
sudden development of phobias increased level of anxiety during interview unwillingness to discuss the sexual assault