ENA TEST: Forensic Nursing in the ER

Which statement accurately characterizes manual strangulation? A. Visible injuries to the neck are usually present. B. It commonly causes incontinence. C. Point tenderness in the area rarely occurs. D. The patient usually can be discharged rapidly.

B Patients who are strangled until they become unconscious or near-unconscious may experience a loss of bladder or bowel control. You should explain that incontinence commonly occurs with strangulation and reassure the patient that it is okay to share that information. Visible neck injuries after manual strangulation can be rare even though the risk of death from strangulation is high. Although bruises and fingernail scratch marks may be absent on the neck, you should assess for point tenderness, changes in voice quality, or pain on swallowing. With or without visible findings, patients who survive strangulation need hospitalization and close supervision with 24-hour pulse oximetry monitoring in a setting where they can be promptly intubated if respiratory complications develop.

What action should the emergency nurse take upon the discovery of a needle on the stretcher of the victim of a violent crime? A. Pick it up with clean gauze and place it in an airtight container. B. Dispose of it properly in a sharps container. C. Pick it up with Kelly clamps and place it in an appropriate box. D. Carefully place it in a gauze-filled container, using gloved hands.

D To prevent contamination, always wear gloves when collecting or handling potential evidence. Place a needle in a glass tube or a gauze-filled specimen container with air holes to allow ventilation. If a sharp object may cause injury, use rubber-tipped forceps to safely retrieve the object. Do not handle the object using forceps without rubber tips because that may scratch the object.

Which definition correctly describes an excited utterance by the victim of a violent crime? A. A spontaneous statement made under duress B. An expletive spoken by a patient impaired by substance abuse C. An unintentional curse word used by a healthcare team member D. A declaration of pain by the patient during an assessment or treatment

Your correct answer: A An excited utterance is a spontaneous statement made under duress, such as when a trauma patient being wheeled into the emergency department yells, "My husband shot me! He said he's going to kill our kids. You've got to find my kids before he does." The other descriptions are not considered excited utterances.

Forensic nursing traces its origin to the care of which population? A. Rape victims B. Violent crime victims C. Elder abuse victims D. Pediatric abuse victims

Your correct answer: A Forensic nursing began in 1972 with the development of the rape victim advocate movement and the creation of the first sexual assault forensic evidence kits. Forensic nurses now are being trained to also provide care for the victims of violent crime, elder abuse, and pediatric abuse.

Which action most accurately reflects the preservation of evidence? A. Collect the sheet from the emergency medical services stretcher and hospital stretcher. B. When removing clothing, cut through damaged areas to preserve gun residue. C. After the clothing is removed, pick up each piece and place it in a separate plastic bag. D. Expect law enforcement officials to document the articles of clothing removed from the patient.

Your correct answer: A If possible, collect the sheet from the emergency medical services stretcher, hospital stretcher, or both because debris or trace evidence may have fallen from the patient. Do not cut through a damaged area of the clothing, such as an area with a bullet hole, because this can distort its appearance. To avoid contamination, do not place clothes directly on the floor. Instead, place two clean hospital sheets on the floor, one on top of the other, before the trauma patient's arrival. As articles of the patient's clothing are removed, lay each one separately on top of the two sheets. With gloved hands, place each piece of clothing or sheet in an individual clean paper bag. Do not use plastic bags. The person who collects the clothing is responsible for documenting the clothes that were collected and providing a brief description of each item.

Which statement accurately characterizes a bruise? A. The age of a bruise can be documented based on the patient's history. B. Bruise color charts help determine the age of a bruise. C. The suspected age of a bruise should be documented based on its color. D. The skin color is related to aging or the use of certain medications.

Your correct answer: A If the patient is a good historian, you can document that the estimated age of the bruise is consistent with the history provided. Bruise color charts may still appear in nursing textbooks but were not developed using evidence-based research. No one can accurately estimate the age of a bruise solely by looking at its color. Ecchymosis, not a bruise, is usually caused by a slow, hemorrhagic blood leak into the skin due to aging, medications, or a medical or hematologic disorder.

Which evidence is considered intangible? A. Excited utterances B. The medical record C. Deoxyribonucleic acid (DNA) D. Clothing

Your correct answer: A Intangible evidence includes the patient's reported history, excited utterances, and odors. The medical record, deoxyribonucleic acid, and clothing are considered tangible evidence.

What is the appropriate action to take if the emergency nurse notes a suspicious stain on the arm of a victim of a violent crime? A. Swab the stain with a sterile, cotton-tipped applicator that is moistened with sterile water. B. Place the swab immediately into the proper container to prevent cross-contamination. C. Label the container with patient's name and date of birth. D. Initial the container and then seal it with tape.

Your correct answer: A When caring for a victim of violence, be alert for suspicious stains on the victim's skin, which may yield valuable evidence. If a stain is detected, swab it with a sterile, cotton-tipped applicator that is moistened with sterile water. Then, air-dry the swab before packaging it in a clean envelope or box. On the envelope, record the patient's name; the stain's appearance, location, and date taken; and the case or medical record number. To prevent evidence tampering, tape the container before initialing it.

Who is the most appropriate person to photograph evidence? A. Emergency nurse B. Social worker C. Patient advocate D. Security guard

Your correct answer: A Whenever possible, the emergency nurse should take the photographs and not delegate that task to a social worker or advocate. The emergency nurse is qualified to testify about the injuries in the photographs. Social workers and advocates are not qualified for this type of testimony. The nurse may delegate the photography to police officers (not a security guard) if the patient has agreed to police involvement. The medical record must include the documentation of this decision.

Which action best documents the type of injury or evidence collected? A. Take photographs. B. Complete a body diagram. C. Maintain the chain of custody. D. Follow the standardized collection process.

Your correct answer: B The body diagram should clearly demonstrate the location and type of injury or evidence collected and provide a brief description. Photographs should never replace body diagrams because they may be lost or poorly representative. Ideally, use a body diagram or map and photographs in addition to the written or computerized nursing notes. The chain of custody documents the location and responsible party for the evidence at all times. It does not document the type of injury or evidence collected. Although following the standardized collection process allows for forensic evidence collection without contamination, it does not document the type of injury or evidence collected.

Which action is appropriate when collecting the clothes of a victim of a violent crime? A. Collect the top sheet and place it in a plastic bag. B. Place the clothing in a paper bag and label it properly. C. Have the patient undress while standing on clean hospital sheets. D. Seal the paper bag with staples to ensure evidence preservation.

Your correct answer: C If possible, have the patient undress himself or herself while standing over two hospital sheets, one placed on top of the other. The top sheet will catch any debris or trace evidence that falls off the patient while undressing. Place each piece of clothing in a separate paper bag to prevent cross-contamination. Collect the top sheet that has come in contact with the clothes and patient and place it in a paper bag. Plastic bags allow moisture condensation, resulting in the biologic degradation of evidence. Seal each paper bag with tape because staples can damage the contents or injure the handler.

Mandatory reporting is not required in all states for which patients? A. Child abuse victims B. Elder abuse victims C. Victims of intimate partner violence D. Dependent adult victims of maltreatment

Your correct answer: C In the United States, all 50 states have statutes that require healthcare professionals to report suspected abuse or maltreatment of pediatric, geriatric, and dependent adult patients. However, not all states have statutes that require the mandatory notification of authorities of intimate partner violence or crime victims in general. As an emergency nurse, you must know the mandatory reporting requirements for the state where you work.

Which principle guides the documentation of care for the victim of a violent crime? A. All of the events should be documented as the nurse remembers them. B. The documentation should be handwritten. C. The documentation should be unbiased. D. Specimen collection is the only forensic documentation required.

Your correct answer: C The nursing documentation should provide an accurate and forensically unbiased picture of what the emergency nurse hears, sees, and smells when assessing and caring for the patient in the emergency department. No matter whether the documentation is input into a computer or handwritten, the information should be organized and consistent. Document the events of the entire visit to give the investigators and jury members an objective and detailed account of the patient's experience, which sometimes begins minutes after a traumatic event.

According to the Emergency Nurses Association position statement on forensic evidence collection, which action should emergency nurses perform? A. Serve as arbitrators for the victims of violent crime. B. Delegate evidence collection to law enforcement personnel. C. Act as expert witnesses in legal proceedings. D. Work with other professionals to develop the guidelines for forensic evidence collection.

Your correct answer: D The Emergency Nurses Association supports the collaboration with emergency physician, social service, and law enforcement personnel to develop the guidelines for forensic evidence collection and documentation in the emergency department. The association identifies forensics as a part of the emergency nursing practice; therefore, evidence collection does not need to be delegated to law enforcement personnel. Expert witnesses must have specialized training. Members of legal counsel, not emergency nurses, may serve as arbitrators.

Which action ensures the chain of custody for evidence? A. Air-dry the swabs in the nurses' station before packaging. B. Place evidence in a locked medication room. C. Secure the evidence in an airtight location. D. Document each location and the responsible party for the evidence.

Your correct answer: D To be accepted in court, physical evidence must be accompanied by documentation that demonstrates the item's location and the responsible party at all times. If the chain of custody is not maintained or documented, an entire case may be lost. Keep the evidence in a safe, secure location. Because several nurses can enter the medication room, it is not secure. Ensure adequate air circulation to preserve the samples. Although swabs should be air-dried, they must be in a secure location (not the nurses' station) to ensure the chain of custody.