Nokea
An unconscious person is brought to the emergency department by a friend. The friend found the person in a bedroom at a college fraternity party. Semen is observed on the person's underclothes. What is the priority action the staff members should focus on?
- A. Maintaining effective gas exchange
- B. Preserving all rape evidence
- C. Interviewing the friend for additional information
- D. Determining whether any alcohol or drugs were ingested
Correct Answer: A
Rationale: The unconscious patient is at risk for respiratory depression and airway obstruction, making gas exchange the priority. Other actions are secondary to preserving physiological functioning.
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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.
The nurse cares for a victim of a violent sexual assault. What is the most therapeutic intervention?
- A. Use accepting, nurturing, and empathetic communication techniques.
- B. Educate the victim about strategies to avoid attacks in the future.
- C. Discourage the expression of feelings until the victim stabilizes.
- D. Maintain a matter-of-fact manner and objectivity.
Correct Answer: A
Rationale: Victims require unconditional acceptance, nurturing, and empathy to meet their needs and build trust. Focusing on avoidance strategies is premature, and the other options do not promote acceptance.
A nurse working in the county jail interviews a man who recently committed a violent sexual assault against a woman. Which comment from this perpetrator is most likely?
- A. She was very beautiful.'
- B. She wanted the sex.'
- C. I have issues with my mother.'
- D. I've been depressed for a long time.'
Correct Answer: B
Rationale: Rape involves a need for control, power, degradation, and dominance. The correct response shows a lack of remorse or guilt, common in antisocial personality. The other responses suggest appreciation, psychological conflict, or self-disclosure, not expected from a perpetrator.
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 person was abducted and raped at gunpoint by an unknown assailant. Which interventions should the nurse use while caring for this person in the emergency department? (Select all that apply.)
- A. Allow the person to talk at a comfortable pace.
- B. Pose questions in nonjudgmental, empathic ways.
- C. Place the person in a private room with a caregiver.
- D. Reassure the person that a family member will arrive as soon as possible.
- E. Invite family members to the examination room and involve them in taking the history.
- F. Put an arm around the person to offer reassurance that the nurse is caring and compassionate.
Correct Answer: A,B,C
Rationale: Neutral, nonjudgmental care, empathetic questions, and privacy with a caregiver are critical for crisis management. Family involvement may compromise privacy, and touching may escalate anxiety.