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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.
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A victim of a violent rape has been in the emergency department for 3 hours. Evidence collection is complete. As discharge counseling begins, the victim says softly, 'I will never be the same again. I can't face my friends. There is no sense of trying to go on.' Select the nurse's most important response.
- A. Are you thinking of suicide?'
- B. It will take time, but you will feel the same as before.'
- C. Your friends will understand when you tell them.'
- D. You will be able to find meaning in this experience as time goes on.'
Correct Answer: A
Rationale: The victim's words suggest hopelessness, indicating a risk for suicide. Directly addressing suicidal ideation is critical. The other options offer reassurance without assessing the risk.
What is the primary motivator for most rapists?
- A. Anxiety
- B. Need for humiliation
- C. Overwhelming sexual desires
- D. Desire to inflict violence or control others
Correct Answer: D
Rationale: Rape is a crime of power, control, and violence, not sex. The perpetrator aims to subjugate the victim. The other options are not the primary motivators for rape.
A nurse interviews a person abducted and raped at gunpoint by an unknown assailant. The person says, 'I can't talk about it. Nothing happened. I have to forget!' What is the person's present coping strategy?
- A. Somatic reaction
- B. Repression
- C. Projection
- D. Denial
Correct Answer: D
Rationale: Disbelief is common during the acute stage following sexual assault. Denial is evidence of this disbelief, used unconsciously to protect the person from the emotionally overwhelming reality of rape. The statements do not reflect somatic symptoms, repression, or projection.
A child was abducted and raped. Which personal reaction by the nurse could interfere with the child's care?
- A. Disgust
- B. Concern
- C. Empathy
- D. Compassion
Correct Answer: A
Rationale: Feelings of empathy, concern, and compassion are helpful. Disgust may make objectivity impossible and can increase the child's anxiety and shame.
When working with rape victims, what is the focus of initial care?
- A. Collecting forensic evidence
- B. Notifying law enforcement
- C. Helping the victim feel safe
- D. Documenting the victim's comments
Correct Answer: C
Rationale: Helping the victim feel safe is the first focus, as the vulnerable individual may perceive assessments as intrusive or threatening. Other actions are secondary and may depend on the victim's decisions.