MH Chapter 29 Sexual Assault AQ
3 States and tribal governments are required to pay or reimburse for sexual assault exams. Failure to comply with this mandate results in loss of funding from the Violence Against Women grant initiatives. This mandate is patient-centered and gives control back to individuals who should be the primary decision makers in personal health and legal matters. Payment by private foundations, the victims' insurance, or the hospital are incorrect.
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 Patients that have been "roofied" were given flunitrazepam. The nurse understands to check the patient for airway protection and gastrointestinal decontamination to ensure that the patient has not been overdosed. Assessing pulse, reflexes, and vision will not determine overdose.
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
4 The nurse should assess the availability and usefulness of the patient's social support system. Most of the time a patient's family and friends fail to support the patient, as they don't understand the patient's feelings. They are not considered the best support available to the patient. The nurse should carefully consider both verbal and nonverbal clues given by the patient; it helps to document the evidence properly. It also reflects the moral support that the patient has from the support groups. The nurse should not ask the patient questions starting with "Why." The patient may feel rejected and assume that the nurse is insensitive to the situation. The nurse should interact with the patient's family and friends and other health care providers to effectively document the patient's clinical history and case history.
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.
2 The patient who was sexually assaulted has mild anxiety even after effective treatment. The patient has reduced concentration due to anxiety, so the patient may not remember verbal instructions. The nurse must give printed information to the patient for reference. The information on victim compensation, legal matters, emotional reactions, and so on is provided in the printed material. It serves as a referral to the health care provider for the continuity of treatment and care of the patient in the future. The nurse should call the patient within 24 to 48 hours of discharge to reassess the patient's emotional state. The nurse should instruct the patient to follow up at least 2, 4, and 6 weeks after the initial evaluation. The patient is assessed for psychological progress and sexually transmitted diseases during the follow-up visits. The nurse should take the updated contact information of the patient. It helps to assess the patient's condition and to refer to support systems if the patient needs any legal assistance or counseling.
A patient who was sexually assaulted was treated effectively and discharged. What appropriate action should the nurse follow while discharging the patient? 1 The nurse should avoid calling the patient after the discharge. 2 The nurse should give printed follow-up instructions to the patient. 3 The nurse should instruct the patient to follow up every 6 months. 4 The nurse should refrain from taking contact information from the patient.
2 The clothing has evidence and should be preserved according to the agency's policy. Nurses are instrumental in not only providing holistic care for those who have been sexually assaulted, but also in helping to preserve evidence. Preservation of evidence can lead to the prosecution of a crime or exoneration of an accused assailant. The clothing should not be discarded. While it is the victim's choice about what should happen to the clothing, the woman's decision-making is likely to be impaired from the trauma of the rape.
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?"
1 The presence of the nurse is reassuring, especially when the patient is experiencing disorganization and the environment is confusing.
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 Statistics on sexual violence are unreliable because these crimes are underreported. Approximately 19.3% of women and 1.7% of men in the United States have been raped at some time in their lives. Women who identify as multiracial are the most likely to be raped, followed by American Indian/Alaskan Native and Black non-Hispanic. A male who is raped is more likely to experience physical trauma.
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
3 Completed rape is defined by the FBI as "penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim." Assault by a stranger on an unsuspecting victim, sexual desire satisfied inappropriately, and an act prompted by early childhood neglect are not accurate definitions of completed rape.
Which of the following is the best description of completed rape? 1 Sexual desire satisfied inappropriately 2 An act prompted by early childhood neglect 3 Penetration without the consent of the victim 4 Assault by a stranger on an unsuspecting victim
4 Flunitrazepam is a "date rape" drug banned in most countries. It is available in the form of a pill and the impact is within 10 to 30 minutes. It causes muscle relaxation, amnesia, and psychomotor slowing. Tachycardia, anxiety, and tremors are seen due to g-hydroxybutyric acid (GHB). Another "date rape" drug available as a powder is active within 5 to 20 minutes.
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
1 This patient's situation indicates that the patient has nightmares related to the rape. The nurse should document that the patient frequently reexperiences the incident of the assault, which are intrusive symptoms. Avoiding the emotions related to the incident means that the patient is not willing to be reminded about the incident. The patient with avoidance behavior may avoid any place or object that remind them of the experience. The patient is able to sleep but is suddenly awakened due to frightening nightmares. Therefore, the nurse cannot document that the patient has reduced concentration and has difficulty sleeping. In this situation, the patient is not displaying aggressive behavior.
The nurse is caring for a patient with acute stress disorder who is also a rape victim. The patient wakes up suddenly from sleep and cries out loudly. This takes place about 2-3 times every night. What should the nurse document in the patient's case file? 1 The patient has frequent re-experiences of the assault. 2 The patient avoids expressing emotions related to the assault. 3 The patient has reduced concentration and has difficulty sleeping. 4 The patient becomes aggressive occasionally without any reason.
3 Contrary to the belief that women are raped only in dark alleys, evidence suggests that more than 50% of rapes occur inside homes. Asking the adolescent to come home directly after school indicates that the parents believe that the child is unsafe outside the house. Based on the adolescent's statement, it cannot be said that the parents believe that only females are raped, or that rape is usually an impulsive act, or that women really want to be raped. Some people do believe that only females are raped, but evidence suggests that there are a growing number of male rape victims. Some people also believe that rape is usually an impulsive act, but rape is usually a well-planned act. The belief that many women want to be raped is a myth. Studies show that violence towards women shown in the media has led to the attitudes that foster tolerance of rape in women.
The nurse is teaching a group of adolescents about sexual violence. During the discussion, an adolescent states, "My parents tell me to avoid going out with my friends. They ask me to come home directly after school. When I ask the reason, they say that they fear that someone would hurt me." According to the adolescent's statement, what is the myth related to rape that the adolescent's parents believe?
2 The nurse should document the debris and dirt on the patient's clothing immediately after a reported rape. This serves as essential evidence and should be documented carefully and in detail. The nurse should provide a support person to stay with the patient and should not leave the patient alone. Prophylactic antibiotics are generally administered to patients immediately following a reported rape to prevent sexually transmitted infections. Written follow-up instructions should be provided at discharge.
Which nursing action has priority for a patient immediately following a reported rape? 1 Provide written follow-up instructions. 2 Document the debris and dirt on the patient's clothing. 3 Give the patient alone time to recover after the incident. 4 Give the patient prophylactic analgesics after the incident.
2 The nurse can reduce the patient's anxiety after a physical assault incident by providing support and care. The nurse should conduct a detailed head-to-toe physical assessment to check for signs of physical injury, but this will not reduce anxiety. Asking the patient to verbalize his or her thoughts enables the nurse to assess the patient's cognitive coping mechanisms, but is not the best intervention for reducing anxiety. The nurse should ask the patient's relatives for details regarding the assault in case the patient is unconscious or disabled. It helps ascertain the patient's support system, but it will not help reduce anxiety in the patient.
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
4 Which response illustrates the best practice in giving care to a patient who has just been sexually assaulted? 1 Assertive: "Let's talk about new coping skills you can use." 2 Sympathetic: "I'm so sorry for what you have been through." 3 Reassuring: "Don't worry. It's hard now, but everything will be alright." 4 Supportive: "I am going to stay with you. We can talk as long as you want to."
Which response illustrates the best practice in giving care to a patient who has just been sexually assaulted? 1 Assertive: "Let's talk about new coping skills you can use." 2 Sympathetic: "I'm so sorry for what you have been through." 3 Reassuring: "Don't worry. It's hard now, but everything will be alright." 4 Supportive: "I am going to stay with you. We can talk as long as you want to."
1 The duration of ketamine is only 30 to 60 minutes. The duration of clonazepam, flunitrazepam, and GHB is up to 12 hours.
Which drug associated with date rape has the shortest duration? 1 Ketamine 2 Clonazepam 3 Flunitrazepam 4 G-hydroxybutyric acid (GHB)
3 The patient was date-raped after the administration of G-hydroxybutyric acid (GHB). The patient exhibits the effects of GHB, including agitation, bradycardia, and hypothermia. Therefore, an anticholinergic such as atropine should be administered to manage bradycardia and stabilize the heart rate. Intubation is used to manage severe respiratory distress. Vomiting may be used to empty the stomach and reduce overdose toxicity. Benzodiazepines are used to control the occurrence of seizures.
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 Special K is a slang term for ketamine, an anesthetic drug sometimes used associated with date rape. Assessing the friend's airway and breathing pattern is the highest priority. Because ketamine is an anesthetic, pain is unlikely. Contacting the friend's parent or legal guardian and obtaining a SAECK can occur later.
An adolescent brings a friend to the emergency department. The adolescent says to the triage nurse, "My friend was raped. Somebody gave her some Special K." The friend is confused, dazed, and drooling. What is the nurse's priority action? 1 Contact the friend's parent or legal guardian. 2 Assess whether the friend is experiencing pain. 3 Assess the friend's airway and breathing pattern. 4 Obtain a Sexual Assault Evidence Collection Kit (SAECK).
4 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 post-traumatic stress disorder. Such trauma is not maturational in nature because it is not associated with a developmental stage. A dissociative disorder or generalized anxiety disorder are not usual post-assault outcomes.
Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of which of the following? 1 A maturational crisis 2 A dissociative disorder 3 Generalized anxiety disorder 4 Post-traumatic stress disorder
1 The patients of sexual assault are referred to as victims in the legal system. They are referred to as patients in the healthcare system. These patients are known as the survivor in advocacy groups such as support groups. The victims of sexual assault are not referred to as client.
In the legal system, what is a patient of sexual assault known as? 1 Victim 2 Client 3 Patient 4 Survivor
1 Revictimization refers to the trauma of the examination itself because the patient may experience it as another violation of the body. Sexual abuse trauma is not specifically related to the examination and the sense of the exam being a violation of the body. PTSD is a psychological condition in which the patient relives the memories of a traumatic event over and over. Acute stress disorder is a psychiatric reaction to a serious trauma but not to the examination itself.
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)
2, 4 Rape is categorized as completed or attempted. Completed rape is the penetration of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person. Attempted rape includes threats of rape or intention to rape another person, but the act is not carried out or is unsuccessful. Targeted, intentional, or unintentional rape are not established categories of rape.
What are the categories of rape? Select all that apply. 1 Targeted rape 2 Attempted rape 3 Intentional rape 4 Completed rape 5 Unintentional rape
4 The psychological effects in a rape victim depend on the relationship of the victim with the perpetrator. If the patient is raped by the spouse, it is most likely that the patient has sexual distress. If the patient has been raped by a stranger, the most likely effect would be that of fear and anxiety. Aggression is usually not a common psychological response to rape.
A female patient is raped by her husband frequently. What psychological effect would the nurse observe in this patient? 1 Fear 2 Anxiety 3 Aggression 4 Sexual distress
1 Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated. Some women want to be raped, most charges of rape are unfounded, and most women are raped by strangers are not true statements.
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 Patients who have been sexually assaulted often experience acute stress. The symptoms of posttraumatic stress disorder are grouped into five categories, including arousal symptoms. Arousal symptoms include insomnia, difficulty in concentration, feeling tense, and angry outbursts. Intrusive symptoms include having frightening thoughts and dreams. In avoidance, the patient avoids remembering the events or the objects that remind him or her of the incident. In this phase, the patient may have symptoms of numbness, guilt, and depression.
A nurse is caring for a patient who was sexually assaulted. The nurse reports to the primary healthcare provider that the patient has arousal symptoms. Which symptom is the nurse referring to in the patient? 1 The patient has insomnia and reduced concentration. 2 The patient has repeated frightening thoughts and dreams. 3 The patient has depression and feelings of guilt and numbness. 4 The patient avoids remembering the events of being sexually assaulted.
4 People believe myths about the incidents of rape. The nurse should educate people and teach the facts about rape. It is a myth that rape occurs in dark alleys but the fact is that more than 50% of all rapes occur in the home. Only females are raped is a myth, and there are, in fact, an increasing number of male rape victims. Rape is not a sexual act. It is a violent expression of aggression, anger, and need for power. Most rapes are planned, not impulsive
A nurse is teaching a group of nursing students about sexual assault. Which information should the nurse include in the teaching? 1 Rape is a sexual act. 2 Only females are raped. 3 Most rapes are impulsive. 4 Fifty percent of all rapes occur in the home.
4 Signs of recovery after sexual assault include sleeping well with occasional nightmares or broken sleep, eating as one did before the rape, feeling calm or only mildly suspicious, fearful, or restless, getting support from family and friends, generally positive self-regard, absent or mild somatic reactions, and returning to pre-rape sexual functioning. "Sometimes I wonder if I secretly wanted to be raped," "Now I realize what I did that caused this assault to happen," and I'm emotionally stable but now I have frequent headaches and stomach pain" show guilt, significant somatization, and self-reprisal.
A patient who was raped one year ago talks with the nurse. Which comment by the patient indicates a successful resolution of this traumatic event? 1 "Sometimes I wonder if I secretly wanted to be raped." 2 "Now I realize what I did that caused this assault to happen." 3 "I'm emotionally stable but now I have frequent headaches and stomach pain." 4 "Although I have a nightmare once in a while, most of the time I sleep soundly."
4 The nurse should directly ask the patient whether he or she has had thoughts about suicide or has attempted to commit suicide. Direct questioning regarding suicidal tendencies is an effective method to assess the patient's mental status and immediately conduct a thorough suicide assessment. The nurse should refrain from asking "why" questions because they sound judgmental and may distress the patient. Information that is relevant only to the immediate physical and psychological treatment of the patient should be determined. The nurse should not rush the patient and speak at a comfortable pace
The nurse assesses a patient who was raped. Which component of the assessment has priority? 1 Ask the patient why the event occurred. 2 Determine every detail related to the event. 3 Ask the patient to swiftly respond to questions. 4 Ask the patient about suicidal tendencies directly.
3 In order to assess the probability of the patient becoming pregnant due to the rape, the nurse should ask the patient about her last menstrual period. By knowing this, the nurse can calculate the approximate date of ovulation. If the time of the rape incident coincides with or is close to the approximate date of ovulation, there is a greater chance that the patient may become pregnant. Morning sickness characterized by nausea and vomiting occurs later in pregnancy. Thus, the nurse should not ask this question to a victim who has been raped recently. The nurse should not ask questions that start with "why" as they are inherently evaluative. The nurse should never ask the patient to describe the rape. Such questions may make the patient feel uncomfortable and embarrassed.
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?"
4 These symptoms are part of the response to rape trauma and parallel symptoms experienced by other victims of post-traumatic stress disorder.
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 The advanced practice nurse provides individual and group psychotherapy to rape victims. This will help them to cope with the physical and psychological symptoms related to the rape. The Sexual Assault Nurse Examiners are responsible for conducting medical and legal evaluations, and serve as expert witnesses in the court.
What is the role of the advanced practice nurse in the management of a rape victim? 1 Provide legal consultation. 2 Be an expert witness in court. 3 Conduct the medical evaluation. 4 Provide individual psychotherapy.
