Sexual assault

7. Three weeks after a client 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." The nurse should reply "Becoming mentally ill is a frightening thought for you?" "These are a normal response to stress and will decrease with time and therapy." "You are right to be concerned. I can give you a referral for treatment." "Would it help if you took some time off from work and stayed home?"

"These are a normal response to stress and will decrease with time and therapy." Correct These symptoms are part of the response to rape trauma and parallel symptoms experienced by other victims of PTSD

6. What verbal nursing intervention in the immediate post-rape period would be designed to lower client anxiety and increase feelings of safety? "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." Correct The presence of the nurse is reassuring, especially when the client is experiencing disorganization and the environment is confusing.

1. The nurse is caring for a patient in the emergency department who has been raped just hours earlier. Which behaviors should the nurse expect if the patient were exhibiting controlled-style reactions? 1. Shock, numbness 2. Volatility, anger 3. Crying, sobbing 4. Smiling, laughing

ANS: 1 Rationale: Patients who exhibit controlled -style reactions may present with ambiguous behaviors such as calmness, a subdued appearance, shock, numbness, and distractibility. Volatility, anger, crying, sobbing, smiling, and laughter are associated with expressed styles of behavior.

5. What reaction is most commonly displayed by rape victims in the immediate aftermath of the rape? Disorganization Philosophical acceptance Total withdrawal from reality Display of seductive actions

Disorganization Correct The acute phase of the rape trauma syndrome occurs immediately after the assault and may last for a few weeks. This stage is seen by ED personnel. Nurses are the ones most involved in dealing with these initial reactions. During this phase a great deal of disorganization in the person's lifestyle and somatic symptoms are common. Awarded 0.0 points out of 1.0 possible points.

9. The emergency department nurse planning care for a rape victim must realize that the emotional reaction displayed by many rape victims during assessment and treatment while in the emergency department is fear. eagerness. suspicion. 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 raped often carries an additional burden of shame, guilt, fear, anger, distrust, and embarrassment. Awarded 1.0 points out of 1.0 possible points.

1. A client tells the college health nurse she was raped by her date several weeks ago. Which reason is the client most likely to give for waiting to tell someone? Feeling embarrassed about having a physical examination Feeling guilty for somehow having caused it Fear that no one would believe her Fear of contracting a sexually transmitted disease

Feeling guilty for somehow having caused it Correct Many rape victims feel that they are somehow at fault for the rape and harbor feelings of guilt. This guilt stands in the way of reporting the rape to the authorities. Text page: 618

2. Which statistic concerning rape is true? Most male rape victims do not report the crime. Male rape is perpetrated by homosexual men. The peak incidence of rape is ages 25 to 29 years. Most rapes occur after abductions.

Most male rape victims do not report the crime. Correct Option 1 is the only true statement. Awarded 1.0 points out of 1.0 possible points.

6. Which statement reflects a truth about rape? Many women want to be raped. Rapists are oversexed. Most rapes are planned. Most women are raped by strangers.

Most rapes are planned. Correct Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated. Awarded 0.0 points out of 1.0 possible points.

3. 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." Correct Rapes have little to do with whether the victim dresses seductively because rape is a crime of violence rather than a crime of sex. Text page: 616

5. A sexual assault victim tells the nurse "I should have tried to fight him off! But I was so terrified that I could not move. My whole body felt as though it was made of lead. I should have tried harder." A supportive response for the nurse to make would be "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." Correct 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.

9. A client who comes to the emergency department states she has just been raped. She displays a blank face and a rather calm appearance. During the assessment interview, however, she seems shocked about the event and confused regarding the details. The nurse can assess this behavior as indicating the client may be lying about the rape. an expressed style of impact reaction to the rape. a controlled style of impact reaction to the rape. a somatic reaction to stress from the rape.

a controlled style of impact reaction to the rape. Correct This reaction is consistent with the controlled style of response. Other styles are expressed, somatic, and emotional. Text page: 612

8. A rape victim in the emergency department repeats "I don't know why he did it." Although the nurse does not necessarily give the answer at this juncture, the nurse correctly identifies the motivation for most perpetrators of rape as anxiety relief. overwhelming sexual desire. a desire to dominate and humiliate. a wish to be apprehended and punished.

a desire to dominate and humiliate. Correct Power and domination as well as humiliation of the victim are the motivations for rape. In this scenario the nurse understands that rape is not a sexual act. Rape is a violent expression of aggression, anger, and the need for power. Awarded 0.0 points out of 1.0 possible points.

Women who have been raped by ____ frequently develop symptoms that prevent them from participating in normal sexual relations.

acquaintances

1.ID: 45507922 Rape is best described as 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. Correct Rape is a violent crime. Sex is only the medium for perpetrating the crime. Awarded 1.0 points out of 1.0 possible points.

2. K calls a rape crisis hotline and reports having been raped. The nurse advises K to go to the nearest emergency department for treatment. K states "I'll think it over while I take a shower." The nurse should question her regarding the circumstances of the rape. advise her not to take too long before seeking treatment. explain that showering or changing clothes will destroy evidence. ask if she may call a police woman to accompany her to the hospital.

explain that showering or changing clothes will destroy evidence. Correct Showering, washing, and changing clothes will destroy evidence such as semen and hairs shed from the perpetrator's body. Victims should be advised regarding what to do to preserve evidence.

8. Which statement would be an appropriate outcome for a rape client? The client will integrate the rape event and resume an optimal level of functioning. identify and develop coping skills necessary to reduce level of anxiety. blame the rapist rather than blame herself for the situation. repress feelings of shame, embarrassment, and self-blame.

integrate the rape event and resume an optimal level of functioning. Correct 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.

Sexual distress is more common among women who have been sexually assaulted by ____

intimates;

4. Care planning for the rape victim is facilitated if the nurse understands that the rape trauma syndrome is actually a variant of posttraumatic stress disorder. a maturational crisis. a dissociative disorder. generalized anxiety disorder.

posttraumatic stress disorder. Correct 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 PTSD Awarded 1.0 points out of 1.0 possible points.

10. In the acute phase of the rape trauma syndrome, nursing interventions should focus on teaching stress management techniques to the client. helping the client's family clarify feelings. providing client support and safety. ensuring case management.

providing client support and safety. Correct Helping the client feel safe and giving emotional support are two important interventions to combat the disorganization common during the acute phase of the rape trauma syndrome. Awarded 1.0 points out of 1.0 possible points. Continue

3. To provide discharge treatment and support, the nurse should realize that the most common sequelae of acquaintance rape is the development of symptoms of sexual distress. anxiety and fear of men. a paranoid psychosis. an eating disorder.

symptoms of sexual distress. Correct Depression occurs in both groups.

fear and anxiety are more common in those assaulted by ____

strangers.

4. The nurse is working at a telephone hotline center when a rape victim calls. If the rape victim states she is fearful of going to the hospital, what is the appropriate nursing response? 1. "You don't need to go to the hospital if you don't want to." 2. "I'm here to listen to you, and we can talk about your feelings." 3. "Did you do something to make the other person attack you?" 4. "Why are you afraid to seek medical attention?"

ANS: 2 Rationale: When a nurse speaks with a rape victim, the most helpful thing the nurse can do is to listen and let the survivor talk. A victim who feels understood is no longer alone and feels more in control of the situation. It is critical to avoid placing blame on the victim. Once the nurse has established a rapport with the victim and established trust by listening non-judgmentally, the nurse will be better poised to explain the importance of medical attention.

3. A patient who has been raped has chosen to accept pregnancy prophylaxis medication. If the nurse does not believe in abortion, what is the appropriate nursing action? 1. Examine own feelings about abortion before entering the patient's room. 2. Encourage patient to take more time to consider her options. 3. Provide the patient with the number to Planned Parenthood. 4. Administer the pregnancy prophylaxis medication as ordered.

ANS: 1 Rationale: Nurses must continually be aware of their own feelings about issues such as abortion. Nurses who examine their personal feelings and reactions before encountering a rape survivor are better prepared to give empathetic and effective care.

5. The nurse is caring for a patient who is in the long-term reorganization phase of rape-trauma syndrome. Which symptom(s) should the nurse anticipate? Select all that apply. 1. Development of fear of locations that resemble the rape location 2. Emergence of acceptance of the rape 3. Dreams with violent content 4. A shift from anxiety to calm 5. Onset of phobia of being alone

ANS: 1, 3, 5 Rationale: Patients in the long-term reorganization phase of rape-trauma syndrome are likely to experience emotions such as intrusive thoughts, increased activity, increased emotional liability, and development of fears and phobias. Acceptance of the rape and an air of calmness are not noted within this phase.

2. The nurse is caring for a patient who has just been raped. Which is the appropriate initial nursing response? 1. "I will get you the number for the crisis intervention specialist." 2. "May I get your consent to test you for pregnancy and HIV?" 3. "You are safe here." 4. "I need to look at your bruises and cuts."

ANS: 3 Rationale: The initial message that the rape victim needs to hear is that he or she is safe. This provides a nonjudgmental and empathetic approach and establishes trust between the patient and nurse. Although the nurse will eventually assist with obtaining laboratory tests, assessment of physical appearance, and education regarding crisis intervention, the first message should indicate to the patient that they are now in a safe environment.

7. Anticipatory teaching of a rape victim should include information that a common survivor problem often developing during the long-term reorganization phase of rape trauma syndrome is denial of the event. headaches and fatigue. shock and numbness. intrusive thoughts.

intrusive thoughts. Correct 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 this is a common occurrence is reassuring to the client, who often is frightened by the symptom. Awarded 0.0 points out of 1.0 possible points.

4. A sexual assault victim asks to be given "the morning-after pill" to prevent conception. The nurse does not believe in abortion. The action the nurse should take is to "forget" to mention this to the physician. 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. Correct The nurse's ethical beliefs should never interfere with client rights. The nurse should report and document the client's request. If the drug is ordered, however, the nurse can request that another nurse administer the drug.

10. The nurse working with a rape victim in the week after the event tells her about the possibility of experiencing intrusive thoughts, increased motor activity, and fears and phobias in the next few weeks. The reason for this intervention is to help the client redevelop a sense of control over herself. that anticipatory guidance allows planning to decrease stress. that talking about feelings reduces their intensity. that self-destructive behaviors develop out of negative feelings.

that anticipatory guidance allows planning to decrease stress. Correct Anticipatory guidance helps the client understand what to expect. When the expected occurs it is not as great a shock. Knowing what to expect also allows the client to plan for ways to cope. Text page: 613 Awarded 1.0 points out of 1.0 possible points.