Chapter 29 Sexual assault

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."

During the immediate post-rape period what verbal nursing intervention would best lower patient anxiety and increase feelings of safety? 1. "You are safe here. I will stay with you while you have your examination." 2. "I know you feel confused. We will make all the necessary decisions for you." 3. "Please tell me as much about the details of the rape as you can remember." 4. "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."

1. "You are safe here. I will stay with you while you have your examination."

Statistics about sexual violence in the United States: 1. Are unreliable because rape is underreported 2. Show more men than women are victimized by rape 3. Show that white women are the most common racial group victimized by rape 4. Show male rape victims experience more psychological trauma than physical trauma

1. Are unreliable because rape is underreported

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

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.

The nurse is providing discharge teaching to a patient who was recently raped. What should the nurse say regarding the psychological effects of the assault? 1. "You may feel hyperactive and notice an increased surge of energy." 2. "It is normal to experience depression after being sexually assaulted." 3. "People often report the need to be social after a sexual assault incident." 4. "Let the healthcare provider know immediately if you feel scared or worried."

2. "It is normal to experience depression after being sexually assaulted."

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. I should have tried harder." What would be a supportive response from the nurse? 1. "Try not to think about it. Put it out of your mind." 2. "The way you behaved was the right thing to do at the time." 3. "Do you think others will think badly of you for not trying to fight?" 4. "We each behave in characteristic ways in a crisis. That was your way."

2. "The way you behaved was the right thing to do at the time."

An emergency department nurse assesses a woman who reports being raped in the parking lot at a local shopping mall. The woman's clothes are torn and bloody. What should the nurse do with the woman's clothing? 1. Place the clothing in a plastic bag for return to the woman. 2. Label and save the clothing in accordance with agency policy. 3. Place the clothing in the facility's contaminated waste disposal. 4. Ask the woman, "What would you like for me to do with your clothing?"

2. Label and save the clothing in accordance with agency policy.

A rape victim is discharged home after initial treatment. Which method of giving follow-up instructions is most appropriate? 1. Provide oral instructions. 2. Provide written instructions. 3. Provide instruction to friends. 4. Provide instruction to the family.

2. Provide written instructions.

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 is assessing an adolescent patient who has been raped by a stranger. What question should the nurse ask the patient to assess the likelihood of pregnancy? 1. "Do you have nausea and vomiting?" 2. "Why do you think you might be pregnant?" 3. "What is the date of your last menstrual period?" 4. "Would you please describe the incident of rape?"

3. "What is the date of your last menstrual period?"

A victim of date rape is hospitalized with agitation, bradycardia, and hypothermia. Laboratory reports reveal G-hydroxybutyric acid (GHB) in the patient's blood. Which nursing intervention helps manage bradycardia? 1. Intubating the patient 2. Inducing vomiting in the patient 3. Administering atropine to the patient 4. Administering a benzodiazepine to the patient

3. Administering atropine to the patient

The nurse is preparing to assess a patient who is in the emergency room accompanied by friends. The friends report that the patient may have been "roofied." What does the nurse immediately assess to check for symptoms of an overdose? 1. Pulse 2. Vision 3. Airway 4. Reflexes

3. Airway

In the emergency department, a rape victim is examined and evidence is collected. How will this care be reimbursed? 1. Private foundations pay for the care. 2. The victim's insurance will pay for the care. 3. Government or tribal resources pay for the care. 4. The hospital writes off the expense as community service.

3. Government or tribal resources pay for the care.

Which of the following would be an appropriate long-term outcome for a rape victim? 1. Repress feelings of shame, embarrassment, and self-blame. 2. Blame the rapist rather than blame him- or herself for the situation. 3. Integrate the rape event and resume an optimal level of functioning. 4. Identify and develop coping skills necessary to reduce level of anxiety.

3. Integrate the rape event and resume an optimal level of functioning.

Which statement accurately describes the epidemiology of rape? 1. Men are less likely to be raped by another man. 2. More than 25% of women in the United States have been raped. 3. Nearly half of female victims have been raped by an acquaintance. 4. Men are raped more often than women, but incidents are underreported.

3. Nearly half of female victims have been raped by an acquaintance.

The nurse is providing community teaching to a group of adolescents about ways to prevent rape. Which statement made by the adolescent indicates further teaching must occur? 1. "Rape can occur in the home." 2. "Women do not want to be raped." 3. "Rape is not always done for the purpose of sex." 4. "It isn't rape if the participants are in a relationship."

4. "It isn't rape if the participants are in a relationship."

Which is a common drug that is illegally used for victims of date rape and also used to treat narcolepsy? 1. Ketamine 2. Clonazepam 3. Flunitrazepam 4. Gamma-hydroxybutyric acid (GHB)

4. Gamma-hydroxybutyric acid (GHB)

12. A nurse works a rape telephone hotline. Communication with potential victims should focus on: a. explaining immediate steps victims should take. b. providing callers with a sympathetic listener. c. obtaining information for law enforcement. d. arranging counseling.

A The telephone counselor establishes where the victim is and what has happened and provides the necessary information to enable the victim to decide what steps to take immediately. Counseling is not the focus until immediate problems are resolved. The victim remains anonymous. The other distracters are inappropriate or incorrect because counselors are trained to be empathetic rather than sympathetic. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 555-556 | Page 559 TOP: Nursing Process: Implementation

16. A victim of a sexual assault who sits in the emergency department is rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of which stage of rape-trauma syndrome? a. The acute phase reaction c. A delayed reaction b. The long-term phase d. The angry stage

A The victim's response is typical of the acute phase and shows cognitive, affective, and behavioral disruptions. This response is immediate and does not include a display of behaviors suggestive of the long-term (reorganization) phase, anger, or a delayed reaction. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 554-555 | Page 558 (Table 29-2) TOP: Nursing Process: Assessment

11. A nurse interviews a 17-year-old male victim of sexual assault. The victim is reluctant to talk about the experience. Which comment should the nurse offer to this victim? a. "Male victims of sexual assault are usually better equipped than women to deal with the emotional pain that occurs." b. "Male victims of sexual assault often experience physical injuries and are assaulted by more than one person." c. "Do you have any male friends who have also been victims of sexual assault?" d. "Why do you think you became a victim of sexual assault?"

B Few rape survivors seek help, even with serious injury; so, it is important for the nurse to help the victim discuss the experience. The correct response therapeutically gives information to this victim. A male rape victim is more likely to experience physical trauma and to have been victimized by several assailants. Males experience the same devastation, physical injury, and emotional consequences as females. Although they may cover their responses, they too benefit from care and treatment. "Why" questions represent probing, which is a non-therapeutic communication technique. The victim may or may not have friends who have had this experience, but it's important to talk about his feelings rather than theirs. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 553-554 TOP: Nursing Process: Implementation

14. Which situation describes consensual sex rather than rape? a. A husband forces vaginal sex when he comes home intoxicated from a party. The wife objects. b. A woman's lover pleads with her to have oral sex. She gives in but later regrets the decision. c. A person is beaten, robbed, and forcibly subjected to anal penetration by an assailant. d. A dentist gives anesthesia for a procedure and then has intercourse with the unconscious patient.

B Only the key describes a scenario in which the sexual contact is consensual. Consensual sex is not considered rape if the participants are of legal age. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 553 TOP: Nursing Process: Assessment

5. An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important? a. The patient's vital signs b. Consent signed by the patient c. Supervision and credentials of the examiner d. Storage location of the patient's personal effects

B Patients have the right to refuse legal and medical examination. Consent forms are required to proceed with these steps. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 557-558 (Box 29-1) | Page 560 (Nursing Care Plan 29-1) TOP: Nursing Process: Implementation

It has been 6 months since Nicole was raped, and she has undergone counseling. Which statement by Nicole would indicate that an important outcome has been met? A. "I keep having nightmares about the rape and I can't sleep at night." B. "My husband has been very supportive during this whole thing." C. "I am not going to let that rapist be in control of my life. I know things will keep getting better." D. "I am not pressing charges because I want this whole thing to be over with so I can move on."

C This 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. Having nightmares and not sleeping 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.

Mindy is the nurse caring for Caitlin, who was raped the night before. Caitlin is considering the morning-after pill to prevent a possible pregnancy that may have resulted from the rape. Caitlin is concerned and states that she does not believe in abortion. Which of the following is the most appropriate action Mindy could take in this situation? a. Examine her own feelings about abortion before discussing this with Caitlin. b. Encourage Caitlin to take more time to consider her options. c. Provide Caitlin with the number to Planned Parenthood. d. Provide Caitlin with medication education.

D

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 is explaining the forensic exam to a patient who was just sexually assaulted. The patient does not want to be examined and says, "I feel like my body just keeps getting violated more and more." Which is the best term used to describe this feeling? 1. Revictimization 2. Acute stress disorder 3. Sexual abuse trauma 4. Posttraumatic stress disorder (PTSD)

1. Revictimization

A nurse is performing a physical examination of a female patient who was sexually abused. Which steps does the nurse follow while performing the assessment? Select all that apply. 1. The nurse explains the examination procedure to the patient. 2. The nurse avoids speculum insertion into the vagina of the patient. 3. The nurse inquires about the date of the patient's last menstrual cycle. 4. The nurse avoids inquiring about sexually transmitted diseases of the patient. 5. The nurse encourages the patient to participate in all the decisions of the assessment.

1. The nurse explains the examination procedure to the patient. 3. The nurse inquires about the date of the patient's last menstrual cycle. 5. The nurse encourages the patient to participate in all the decisions of the assessment.

Rape is best described as A. an act of violence using sex as the weapon. B. assault by a stranger on an unsuspecting victim. C. sexual desire satisfied inappropriately. D. an act prompted by early childhood neglect.

A Rape is a violent crime. Sex is only the medium for perpetrating the crime

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."

A nurse is performing an assessment of a patient who was sexually assaulted. The patient reports being unconscious 10 minutes after having a cool drink. The nurse anticipates that the patient was given flunitrazepam with the drink. Which symptom does the nurse find in the patient? 1. Anxiety 2. Tremors 3. Tachycardia 4. Muscle relaxation

4. Muscle relaxation

A nurse is performing the clinical assessment of a patient who was sexually abused during a date. What appropriate actions does the nurse take during assessment? 1. The nurse avoids interacting with the patient's friends. 2. The nurse asks, "Why didn't you try to escape from the situation?" 3. The nurse considers only the verbal statements made by the patient. 4. The nurse assesses the usefulness of the patient's social support system.

4. The nurse assesses the usefulness of the patient's social support system.

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? a. "I'm here to listen, and we can talk about your feelings." b. "You don't need to go to the hospital if you don't want to." c. "If you don't go to the hospital, we can't collect evidence to help convict your rapist." d. "Why are you afraid to seek medical attention?"

A

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

A 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.

Which statistic concerning rape is true? A. Most male rape victims do not report the crime. B. Male rape is perpetrated by homosexual men. C. The peak incidence of rape occurs in the 25 to 29 age group. D. Most rapes occur after abductions.

A Option A is the only true statement.

The emergency department nurse planning care for a rape victim must realize that the emotional reaction displayed by many rape victims during the initial assessment and treatment is A. fear. B. eagerness. C. suspicion. D. disinterest.

A 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.

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

A The acute phase of rape trauma syndrome occurs immediately after the assault and may last for a few weeks. This stage is seen by emergency department personnel. Nurses are the ones most involved in dealing with these initial reactions. During this phase, a great deal of disorganization is common in the person's lifestyle and somatic symptoms.

During the immediate post-rape period what verbal nursing intervention would best lower client anxiety and increase feelings of safety? A. "You are safe here. I will stay with you while you have your examination." B. "I know you feel confused. We will make all the necessary decisions for you." C. "Please tell me as much about the details of the rape as you can remember." D. "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."

A The presence of the nurse is reassuring, especially when the client is experiencing disorganization and the environment is confusing.

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

A 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.

To provide discharge treatment and support, the nurse should realize that the most common sequela(e) of acquaintance rape is the development of A. symptoms of sexual distress. B. anxiety and fear of men. C. a paranoid psychosis. D. an eating disorder.

A 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.

7. A rape victim says to the nurse, "I always try to be so careful. I know I should not have walked to my car alone. Was this attack my fault?" Which communication by the nurse is most therapeutic? a. Support the victim to separate issues of vulnerability from blame. b. Emphasize the importance of using a buddy system in public places. c. Reassure the victim that the outcome of the situation will be positive. d. Pose questions about the rape and help the patient explore why it happened.

A Although the victim may have made choices that made her vulnerable, she is not to blame for the rape. Correcting this distortion in thinking allows the victim to begin to restore a sense of control. This is a positive response to victimization. The distracters do not permit the victim to begin to restore a sense of control or offer use of non-therapeutic communication techniques. In this interaction, the victim needs to talk about feelings rather than prevention. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 556-557,559-560 TOP: Nursing Process: Implementation

19. A victim of a violent rape was treated in the emergency department. As discharge preparation begins, the victim says softly, "I will never be the same again. I can't face my friends. There is no reason to go on." Select the nurse's most appropriate response. a. "Are you thinking of harming yourself?" b. "It will take time, but you will feel the same as before the attack." c. "Your friends will understand when you explain it was not your fault." d. "You will be able to find meaning from this experience as time goes on."

A The patient's words suggest hopelessness. Whenever hopelessness is present, so is suicide risk. The nurse should directly address the possibility of suicidal ideation with the patient. The other options attempt to offer reassurance before making an assessment. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 555 | Page 557 TOP: Nursing Process: Assessment

3. An emergency department nurse prepares to assist with examination of a sexual assault victim. What equipment will be needed to collect and document forensic evidence? Select all that apply. a. Camera b. Body map c. DNA swabs d. Pulse oximeter e. Sphygmomanometer

A, B, C Body maps, DNA swabs, and photographs are used to collect and preserve body fluids and other forensic evidence. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 555-556 | Page 557-558 (Box 29-1) | Page 560-561 (Nursing Care Plan 29-1) TOP: Nursing Process: Planning

2. A patient was abducted and raped at gunpoint by an unknown assailant. Which nursing interventions are appropriate while caring for the patient in the emergency department? Select all that apply. a. Allow the patient to talk at a comfortable pace. b. Place the patient in a private room with a caregiver. c. Pose questions in nonjudgmental, empathetic ways. d. Invite the patient's family members to the examination room. e. Put an arm around the patient to demonstrate support and compassion.

A, B, C Neutral, nonjudgmental care and emotional support are critical to crisis management for the rape victim. The rape victim should have privacy but not be left alone. The rape victim's anxiety may escalate when touched by a stranger, even when the stranger is a nurse. Some rape victims prefer not to have family involved. The patient's privacy may be compromised by family presence. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 555-556 | Page 560-561 (Nursing Care Plan 29-1) TOP: Nursing Process: Implementation

1. When an emergency department nurse teaches a victim of rape-trauma syndrome about reactions that may occur during the long-term phase of reorganization, which symptoms should be included? Select all that apply. a. Development of fears and phobias b. Decreased motor activity c. Feelings of numbness d. Flashbacks, dreams e. Syncopal episodes

A, C, D These reactions are common to the long-term phase. Victims of rape frequently have a period of increased motor activity rather than decreased motor activity during the long-term reorganization phase. Syncopal episodes would not be expected. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 560-561 (Nursing Care Plan 29-1) TOP: Nursing Process: Implementation

Which of the following are myths surrounding rape? (select all that apply): A. Women are usually raped by a stranger. B. Women do not "ask" to be raped by their behavior or dress. C. Most rapes occur away from home areas such as alleys and behind buildings. D. Documented rape cases include women from 8 to 70 years old. E. Rape is an expression of aggression and anger. F. Rape is usually an impulsive, spur-of-the-moment decision by the rapist. G. Unless the assailant is armed, most women should be able to get away and avoid the rape.

A, C, D, F, G

Josefina was raped 6 months ago. Which symptom(s) should you anticipate for long-term successful outcomes? Select all that apply. a. Evidence of comfort in relationships b. Numbness, shock, and disbelief c. Recognition of the right to be protected from abuse d. Fear of sexual encounters e. Dreams with violent content f. Anxiety being replaced by calmness g. Absence of phobia of being alone

A, C, F, G

4. Which aspects of assessment have priority when a nurse interviews a rape victim in an acute setting? Select all that apply. a. Coping mechanisms the patient is using b. The patient's previous sexual experiences c. The patient's history of sexually transmitted diseases d. Signs and symptoms of emotional and physical trauma e. Adequacy and availability of the patient's support system

A, D, E The nurse assesses the victim's level of anxiety, coping mechanisms, available support systems, signs and symptoms of emotional trauma, and signs and symptoms of physical trauma. The history of STDs or previous sexual experiences has little relevance. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 556-558 TOP: Nursing Process: Assessment

Nicole is a 28-year-old married patient who comes to the emergency department after being raped on her way home from work. You have been with her as she cries and talks about what happened. She asks you, "What if I am pregnant?" Your response is guided by the knowledge that: A. the risk of pregnancy after rape is high, up to 50%. B. about 5% of women who are raped become pregnant as a result. C. reproductive functions shut down during a violent attack, and as a result pregnancy does not occur. D. Nicole may be worried about how her spouse will accept the baby.

B 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 nurse is meeting with a woman who was raped the previous week. The nurse's client education plan includes talking 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 A. to help the client redevelop a sense of control over herself. B. that anticipatory guidance allows planning to decrease stress. C. that talking about feelings reduces their intensity. D. that self-destructive behaviors develop out of negative feelings.

B 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.

When a client tells the nurse she was raped by her date several weeks ago, the most likely reason for taking so long to report the incidence is her A. embarrassment about having a physical examination. B. feelings of guilt for somehow having caused it. C. initial fear that no one would believe her. D. worry over contracting a sexually transmitted disease.

B 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.

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 A. refer the woman for social services counseling. B. report and document the request. C. ask the supervising nurse to reassign the client. D. ask the client to reevaluate her request after 24 hours.

B 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.

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 A. "Becoming mentally ill is a frightening thought for you?" B. "These are a normal response to stress and will decrease with time and therapy." C. "You are right to be concerned. I can give you a referral for treatment." D. "Would it help if you took some time off from work and stayed home?"

B These symptoms are part of the response to rape trauma and parallel symptoms experienced by other victims of post-traumatic stress disorder.

17. A victim of a sexual assault comes to the hospital for treatment but abruptly decides to decline treatment and leaves the facility. While respecting the person's rights, the nurse should: a. say, "You may not leave until you receive prophylactic treatment for sexually transmitted diseases." b. provide written information about physical and emotional reactions the person may experience. c. explain the need and importance of infectious disease and pregnancy tests. d. give verbal information about legal resources in the community.

B All information given to a patient before he or she leaves the emergency department should be in writing. Patients who are anxious are unable to concentrate and therefore cannot retain much of what is verbally imparted. Written information can be read and referred to later. Patients may not be kept against their will or coerced into treatment. This constitutes false imprisonment. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 558 (Box 29-1) | Page 561 TOP: Nursing Process: Implementation

18. An unconscious teenager is treated in the emergency department. The teenager's friends suspect a rape occurred at a party. Priority action by the nurse should focus on: a. preserving rape evidence. b. maintaining physiologic stability. c. determining what drugs were ingested. d. obtaining a description of the rape from a friend.

B Because the patient is unconscious, the risk for airway obstruction is present. The nurse's priority will focus on maintaining physiologic stability. The distracters are of lower priority than preserving physiological functioning. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 556-558 TOP: Nursing Process: Planning

3. After an abduction and rape at gunpoint by an unknown assailant, which assessment finding best indicates that a patient is in the acute phase of the rape-trauma syndrome? a. Decreased motor activity c. Flashbacks and dreams b. Confusion and disbelief d. Fears and phobias

B Reactions of the acute phase of the rape-trauma syndrome are shock, emotional numbness, confusion, disbelief, restlessness, and agitated motor activity. Flashbacks, dreams, fears, and phobias are seen in the long-term reorganization phase of the rape-trauma syndrome. Decreased motor activity by itself is not indicative of any particular phase. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 554 | Page 558 (Table 29-2) | Page 560 (Nursing Care Plan 29-1) TOP: Nursing Process: Assessment

6. A nurse in the emergency department assesses an unresponsive victim of rape. The victim's friend reports, "That guy gave her salty water before he raped her." Which question is most important for the nurse to ask of the victim's friend? a. "Does the victim have any kidney disease?" b. "Has the victim consumed any alcohol?" c. "What time was she given salty water?" d. "Did you witness the rape?"

B Salty water is a slang/street name for GHB (γ-hydroxy-butyric acid), a Schedule III central nervous system depressant associated with rape. Use of alcohol would produce an increased risk for respiratory depression. GHB has a duration of 1-12 hours, but the duration is less important that the potential for respiratory depression. Seeking evidence is less important than the victim's physiologic stability. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 554 (Table 29-1) TOP: Nursing Process: Implementation

5. A rape victim tells the emergency nurse, "I feel so dirty. Help me take a shower before I get examined." The nurse should: (select all that apply) a. arrange for the victim to shower. b. explain that bathing destroys evidence. c. give the victim a basin of water and towels. d. offer the victim a shower after evidence is collected. e. explain that bathing facilities are not available in the emergency department.

B, D As uncomfortable as the victim may be, she should not bathe until the examination is completed. Collection of evidence is critical for prosecution of the attacker. Showering after the examination will provide comfort to the victim. The distracters will result in destruction of evidence or are untrue. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 557-558 (Box 29-1) TOP: Nursing Process: Implementation

Tara, a 19-year-old freshmen college student, arrives for a follow-up appointment at the mental health clinic where you work. She had previously been seen in the clinic for crisis intervention three weeks ago after being raped. Tara states, "My mom says I was asking for trouble because of the way I was dressed at the party. She says when girls dress so sexy, men can't help themselves." Your response is guided by the knowledge that: a. Statistics show that women who dress provocatively are more likely to be raped. b. The party setting is more a factor in rape occurrences than what the victim is wearing. c. Rape is an act of violence, aggression, and power, not an expression of sexual needs. d. Tara is exhibiting symptoms of an acute phase of rape-trauma syndrome and will need further counseling sessions.

C

You are working in the emergency department caring for 21-year-old Larissa, who has just been raped. Which is your best initial nursing response? a. "We need to examine you for injuries and collect evidence for the police." b. "May I get your consent to test you for pregnancy and HIV?" c. "You are safe here." d. "I will get you the number for the crisis intervention specialist."

C

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 she seems unable to believe the event really happened. The nurse can assess this behavior as the client demonstrating a(an) A. defense mechanism that involves lying about the rape. B. behavioral reaction to the rape. C. emotional affective response to the rape. D. somatic reaction to stress from the rape.

C Emotional/Affective responses to rape can include fear of separation, abandonment, and for personal safety; anger or outrage; helplessness, hopelessness, or powerlessness; sadness or grief; denial, disbelief, or numbness; and guilt and distrust.

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

C Helping the client feel safe and giving emotional support are two important interventions to combat the disorganization common during the acute phase of rape trauma syndrome.

Which statement reflects a truth about rape? A. Some women want to be raped. B. Rapists are oversexed. C. Most rapes are planned. D. Most women are raped by strangers

C Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated.

A rape victim in the emergency department keeps repeating, "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 A. anxiety relief. B. an overwhelming sexual desire. C. a desire to dominate and humiliate. D. a wish to be apprehended and punished.

C 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.

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? A. "It makes sense that rape is a crime of violence, not a crime of sex." B. "Who would have guessed that most rape victims know the rapist?" C. "So if you dress conservatively, your risk of being raped is small." D. "I always thought rapes happened at night, but now I know that isn't true."

C 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 responding to the hotline call of a rape victim advises her to go to the nearest emergency department for treatment. When the woman states, "I'll think it over while I take a shower," the nurse A. questions her regarding the circumstances of the rape. B. advises her not to take too long before seeking treatment. C. explains that doing so could destroy evidence. D. asks if she may call a police woman to accompany her to the hospital.

C 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.

Nicole alternates between sobbing and being quiet and withdrawn. Which of the following illustrates best practice in giving care to a patient who has just been sexually assaulted? A. Sympathetic: "I'm so sorry for what you have been through." B. Reassuring: "Don't worry. It's hard now, but everything will be alright." C. Supportive: "I am going to stay with you. We can talk as long as you want to." D. Assertive: "Let's talk about new coping skills you can use."

C 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.

10. A rape victim visited a rape crisis counselor weekly for 8 weeks. At the end of this counseling period, which comment by the victim best demonstrates that reorganization was successful? a. "I have a rash on my buttocks. It itches all the time." b. "Now I know what I did that triggered the attack on me." c. "I'm sleeping better although I still have an occasional nightmare." d. "I have lost 8 pounds since the attack, but I needed to lose some weight."

C Rape-trauma syndrome is a variant of posttraumatic stress disorder. The absence of signs and symptoms of posttraumatic stress disorder suggest that the long-term reorganization phase was successfully completed. The victim's sleep has stabilized; occasional nightmares occur, even in reorganization. The distracters suggest somatic symptoms, appetite disturbances, and self-blame, all of which are indicators that the process is ongoing. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 562 TOP: Nursing Process: Evaluation

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

D 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.

It has now been 1 year since Nicole's rape. Which of the following statements by Nicole would indicate that she has recovered from the trauma? A. "I don't walk home anymore because I am terrified it may happen again." B. "I am sleeping better but still only get about 5 hours of sleep at night because of bad dreams about the rape." C. "I realize that I was partly to blame for the rape because of walking in an unsafe neighborhood." D. "My husband and I are having sex again and I enjoy it."

D 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, 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.

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. I should have tried harder." A supportive response for the nurse to make would be A. "Try not to think about it. Put it out of your mind." B. "We each behave in characteristic ways in a crisis. That was your way." C. "Do you think others will think badly of you for not trying to fight?" D. "The way you behaved was the right thing to do at the time."

D 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.

8. A rape victim tells the nurse, "I should not have been out on the street alone." Select the nurse's most therapeutic response. a. "Rape can happen anywhere." b. "Blaming yourself increases your anxiety and discomfort." c. "You are right. You should not have been alone on the street at night." d. "You feel as though this would not have happened if you had not been alone."

D A reflective communication technique is most helpful. Looking at one's role in the event serves to explain events that the victim would otherwise find incomprehensible. The distracters discount the victim's perceived role and interfere with further discussion. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 556-557,559-560 TOP: Nursing Process: Implementation

2. A woman was found confused and disoriented after being abducted and raped at gunpoint by an unknown assailant. The emergency department nurse makes these observations about the woman: talking rapidly in disjointed phrases, unable to concentrate, indecisive when asked to make simple decisions. What is the woman's level of anxiety? a. Weak c. Moderate b. Mild d. Severe

D Acute anxiety results from the personal threat to the victim's safety and security. In this case, the patient's symptoms of rapid, dissociated speech, inability to concentrate, and indecisiveness indicate severe anxiety. Weak is not a level of anxiety. Mild and moderate levels of anxiety would allow the patient to function at a higher level. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 560 (Nursing Care Plan 29-1) + learning from Chapter 15 TOP: Nursing Process: Assessment

9. The nursing diagnosis Rape-trauma syndrome applies to a rape victim in the emergency department. Select the most appropriate outcome to achieve before discharging the patient. a. The memory of the rape will be less vivid and less frightening. b. The patient is able to describe feelings of safety and relaxation. c. Symptoms of pain, discomfort, and anxiety are no longer present. d. The patient agrees to a follow-up appointment with a rape victim advocate.

D Agreeing to keep a follow-up appointment is a realistic short-term outcome. The victim is in the acute phase; the distracters are unlikely to be achieved during the limited time the victim is in an emergency department. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 556 | Page 558 | Page 561 TOP: Nursing Process: Planning/Outcomes Identification

1. The nurse at a university health center leads a dialogue with female freshmen about rape and sexual assault. One student says, "If I avoid strangers or situations where I am alone outside at night, I'll be safe from sexual attacks." Choose the nurse's best response. a. "Your plan is not adequate. You could still be raped or sexually assaulted." b. "I am glad you have this excellent safety plan. Would others like to comment?" c. "It's better to walk with someone or call security when you enter or leave a building." d. "Sexual assaults are more often perpetrated by acquaintances. Let's discuss ways to prevent that."

D Females know their offenders in almost 70% of all violent crimes committed against them, including rape. The nurse should share this information along with encouraging discussion of safety measures. The distracters fail to provide adequate information or encourage discussion. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 553-554 | Page 560 (Nursing Care Plan 29-1) TOP: Nursing Process: Assessment

15. Before a victim of sexual assault is discharged from the emergency department, the nurse should: a. notify the victim's family to provide emotional support. b. offer to stay with the patient until stability is regained. c. advise the patient to try not to think about the assault. d. provide referral information verbally and in writing.

D Immediately after the assault, rape victims are often disorganized and unable to think well or remember instructions. Written information acknowledges this fact and provides a solution. The distracters violate the patient's right to privacy, evidence a rescue fantasy, and offer a platitude that is neither therapeutic nor effective. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 556 | Page 558 (Box 29-1) | Page 561 TOP: Nursing Process: Implementation

13. A nurse cares for a rape victim who was given a drink that contained flunitrazepam (Rohypnol) by an assailant. Which intervention has priority? Monitoring for: a. coma. c. hypotonia. b. seizures. d. respiratory depression.

D Monitoring for respiratory depression takes priority over hypotonia, seizures, or coma. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 554 (Table 29-1) TOP: Nursing Process: Intervention

4. A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, "I can't talk about it. Nothing happened. I have to forget." What is the patient's present coping strategy? a. Compensation c. Projection b. Somatization d. Denial

D The patient's statements reflect use of denial, an ego defense mechanism. This mechanism may be used unconsciously to protect the person from the emotionally overwhelming reality of the rape. The patient's statements do not reflect somatization, compensation, or projection. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 558 (Table 29 - 2) + learning from Chapter 15 TOP: Nursing Process: Assessment

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? a) "I'm here to listen, and we can talk about your feelings." b) "You don't need to go to the hospital if you don't want to." c) "If you don't go to the hospital, we can't collect evidence to help convict your rapist." d) "Why are you afraid to seek medical attention?"

a) "I'm here to listen, and we can talk about your feelings."

During the immediate post-rape period what verbal nursing intervention would best lower client anxiety and increase feelings of well-being? a) "You are safe here. I will stay with you while you have your examination." b) "I know you feel confused. We will make all the necessary decisions for you." c) "Please tell me as much about the details of the rape as you can remember." d) "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."

a) "You are safe here. I will stay with you while you have your examination."

How is the act of rape is best described? a) An act of violence using sex as the weapon. b) Assault by a stranger on an unsuspecting victim. c) Sexual desire satisfied inappropriately. d) An act prompted by early childhood neglect.

a) An act of violence using sex as the weapon. Rape is a violent crime. Sex is only the medium for perpetrating the crime (page 545; Table 29-4).

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? a) Fear b) Eagerness c) Aggression d) Disinterest

a) Fear

Which statement would be an appropriate long-term outcome for a rape client? a) Integrate of the rape event and resumption of an optimal level of functioning. b) Identify and develop coping skills necessary to reduce level of anxiety. c) Appropriately blame the rapist rather than blaming herself for the situation. d) Repress feelings of shame, embarrassment, and self-blame.

a) 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 (page 548).

Which racial identification places a women at the greatest risk of being sexually assaulted in her lifetime? a) Multiracial b) American Indian c) Black non-hispanic e) Caucasian

a) Multiracial

Which signs and symptoms are associated with acute stress disorder and are often observed in patients who have been sexually assaulted? Select all that apply. a) Outbursts of anger. b) Depression c) Auditory hallucinations d) Flashbacks e) Amnesia of the event.

a) Outbursts of anger. b) Depression d) Flashbacks e) Amnesia of the event.

Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of which psychiatric disorder? a) Posttraumatic stress disorder (PTSD). b) A maturational crisis. c) A dissociative disorder. d) Obsessive compulsive disorder (OCD).

a) Posttraumatic stress disorder (PTSD).

To provide discharge treatment and support, the nurse should realize that the most common outcome of acquaintance rape is which psychosocial dysfunction? a) Sexual distress b) Fear of men c) Depression d) Anxiety

a) 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 (page 541).

Which of the following are myths surrounding rape? Select all that apply. a) Women are usually raped by a stranger. b) Women do not "ask" to be raped by their behavior or dress. c) Most rapes occur away from home areas such as alleys and behind buildings. d) Documented rape cases include women from 8 to 70 years old. e) Rape is an expression of aggression and anger. f) Rape is usually an impulsive, spur-of-the-moment decision by the rapist. g) Unless the assailant is armed, most women should be able to get away and avoid the rape.

a) Women are usually raped by a stranger. c) Most rapes occur away from home areas such as alleys and behind buildings. d) Documented rape cases include women from 8 to 70 years old. f) Rape is usually an impulsive, spur-of-the-moment decision by the rapist. g) Unless the assailant is armed, most women should be able to get away and avoid the rape.

Which statement made by a sexually assaulted patient strongly suggests the drug gamma-hydroxybutyrate acid (GHB) was involved in the attack? a) "I remember everything that happened, but felt too tired to fight back." b) "The drink I was given has a salty taste to it." c) "They tell me I was unconscious for 24 hours." d) "I heard that I was fighting the nursing staff and saying that they were trying to kill me."

b) "The drink I was given has a salty taste to it."

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? a) The risk of pregnancy after rape is high, up to 50%. b) About 5% of women who are raped become pregnant as a result. c) Reproductive functions shut down during a violent attack, and as a result pregnancy does not occur. d) The client may be worried about how her spouse will accept the baby.

b) About 5% of women who are raped become pregnant as a result.

Which statement is an accurate depiction of sexual assault? a) Rape is a sexual act. b) Most rapes occur in the home. c) Rape is usually an impulsive act. d) Women are usually raped by strangers.

b) Most rapes occur in the home.

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? a) Refer the woman for social services counseling. b) Report and document the request. c) Ask the supervising nurse to reassign the client. d) Ask the client to reevaluate her request after 24 hours.

b) 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 (page 544-545).

Which statement best illustrates support in giving care to a patient who has just been sexually assaulted? a) "I'm so sorry for what you have been through." b) "Don't worry. It's hard now, but everything will be alright." c) "I am going to stay with you. We can talk as long as you want to." d) "Let's talk about new coping skills you can use."

c) "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.

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? a) "I'm not having as many nightmares about the rape so I do get a little sleep at night." b) "My husband has been very supportive during this whole thing." c) "I am not going to let that rapist be in control of my life. I know things will keep getting better." d) "I am not pressing charges because I want this whole thing to be over with so I can move on."

c) "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.

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? a) "It makes sense that rape is a crime of violence, not a crime of sex." b) "Who would have guessed that most rape victims know the rapist?" c) "So if you dress conservatively, your risk of being raped is small." d) "I always thought rapes happened at night, but now I know that isn't true."

c) "So if you dress conservatively, your risk of being raped is small."

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: a) Re-experiencing b) Hyperarousal c) Avoidance d) Physical effects

c) Avoidance

Perpetrators of sexual assult 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: a) Boast of their assault history. b) Feel regret and remorse. c) Do not acknowledge the need for change. d) Are unable to recognize rape is a crime.

c) Do not acknowledge the need for change.

Which statement reflects a truth about rape? a) Some women want to be raped. b) Rapists are oversexed. c) Most rapes are planned. d) Most women are raped by strangers.

c) 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 (page 545; Table 29-4).

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: a) Ron's family is being judgmental. b) Ron's family should leave the hospital. c) Ron's family will also need support. d) Dysfunctional family dynamics.

c) Ron's family will also need support.

Considering the guilt that women feel after being sexually assaulted, which nursing assessment question has priority? a) "Do you want the police to be called?" b) "Did you recognize the person who assaulted you?" c) "Do you have someone you trust that can stay with you?" d) "Do you have any thoughts of harming yourself?"

d) "Do you have any thoughts of harming yourself?"

Which of the following statements by a woman who was sexually assaulted a year ago would indicate that she has recovered from the trauma? a) "I don't walk home alone anymore because I am terrified it may happen again." b) "I am sleeping better but still only get about 5 hours of sleep at night because of bad dreams about the rape." c) "I realize that I was partly to blame for the rape because of walking in an unsafe neighborhood." d) "My husband and I are having sex again and I enjoy it."

d) "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.

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? a) "Try not to think about it. Put it out of your mind." b) "We each behave in characteristic ways in a crisis. That was your way." c) "Do you think others will think badly of you for not trying to fight?" d) "The way you behaved was the right thing to do at the time."

d) "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 (page 545; Table 29-4).

The stress of being raped often results in suffering similar to people who have witnessed a murder or had a physiological reaction to trauma, resulting in: a) Posttraumatic stress disorder b) Anxiety c) Depression d) All of the above

d) All of the above

Anticipatory teaching for a rape victim should include information addressing what common survivor problem? a) Denial of the event. b) Headaches and fatigue. c) Shock and numbness. d) Intrusive thoughts.

d) 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.