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A person was abducted and raped at gunpoint by an unknown assailant. Which assessment finding best indicates the person is in the acute phase of rape trauma syndrome?
- A. Confusion and disbelief
- B. Decreased motor activity
- C. Flashbacks and dreams
- D. Fears and phobias
Correct Answer: A
Rationale: Shock, emotional numbness, confusion, disbelief, restlessness, and agitated motor activity depict the acute phase of rape trauma syndrome. Flashbacks, dreams, fears, and phobias occur in the long-term reorganization phase. Decreased motor activity is not specific to any phase.
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A rape victim asks an emergency department nurse, 'Maybe I did something to cause this attack. Was it my fault?' Which response by the nurse is the most therapeutic?
- A. Pose questions about the rape, helping the patient explore why it happened.
- B. Reassure the victim that the outcome of the situation will be positive.
- C. Make decisions for the victim because of the temporary confusion.
- D. Support the victim to separate issues of vulnerability from blame.
Correct Answer: D
Rationale: The victim is not to blame for the rape, though they may have made choices that increased vulnerability. Supporting the victim to separate vulnerability from blame is therapeutic. The other options suggest nontherapeutic communication, assume outcomes, or do not address control restoration.
A nurse works with a person who was raped 4 years ago. This person says, 'It took a long time for me to recover from that horrible experience.' Which term should the nurse use when referring to this person?
- A. Victim
- B. Survivor
- C. Plaintiff
- D. Perpetrator
Correct Answer: B
Rationale: A survivor is an individual who has experienced sexual assault, participated in interventions, and is moving forward in life. Victim refers to a person who experienced a recent sexual assault. Plaintiff refers to a person bringing a civil complaint to the court system. Perpetrator refers to a person who commits a crime.
A survivor in the long-term organization (delayed) phase of the rape trauma syndrome has experienced intrusive thoughts of the rape and developed a fear of being alone. Which finding demonstrates this survivor has made improvement?
- A. The survivor expresses a need to regularly withdraw from social situations.
- B. The survivor describes personal coping strategies for fearful situations.
- C. The survivor uses increased activity to reduce feelings of fear.
- D. The survivor expresses a deep desire to be with others.
Correct Answer: B
Rationale: Describing personal coping strategies shows a willingness and ability to address fear effectively. The other options demonstrate continued ineffective coping.
A victim of a sexual assault that occurred approximately 1 hour earlier sits in the emergency department rocking back and forth and repeatedly saying, 'I can't believe I've been raped.' This behavior is characteristic of which phase of the rape trauma syndrome?
- A. Anger phase
- B. Acute phase
- C. Outward adjustment phase
- D. Long-term reorganization phase
Correct Answer: B
Rationale: The victim's response, showing cognitive, affective, and behavioral disruptions, is typical of the acute phase. It does not reflect behaviors of the anger, outward adjustment, or long-term reorganization phases.
A patient comes to the hospital for treatment of injuries sustained during a rape. The patient abruptly decides to decline treatment and return home. Before theå?? patient leaves, the nurse should provide what support?
- A. Assure the patient, 'Before you leave you receive prophylactic treatment for sexually transmitted infections (STIs).'
- B. Provide written information concerning the physical and emotional reactions that may be experienced.
- C. Explain the need and importance of human immunodeficiency virus (HIV) testing in this situation.
- D. Offer to stay with the victim until stability is regained.
Correct Answer: B
Rationale: Providing written information about physical and emotional reactions helps the anxious patient who cannot retain verbal information. The other options are premature, violate privacy, or suggest a rescue fantasy.