Nokea
When an emergency department nurse teaches a victim of rape about reactions that may occur during the long-term organization (delayed) phase, 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
Correct Answer: A,C,D
Rationale: Fears, phobias, numbness, flashbacks, and dreams are common in the long-term reorganization phase. Decreased motor activity and syncopal episodes are not expected.
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A rape victim tells the nurse, 'I should not have been out on the street alone.' Which is the nurse's most therapeutic response?
- A. Rape can happen anywhere.'
- B. Blaming yourself only increases your anxiety and discomfort.'
- C. You believe this would not have happened if you had not been alone?'
- D. You are right. You should not have been alone on the street at night.'
Correct Answer: C
Rationale: A reflective communication technique helps the victim explore their role in the event, aiding understanding. The other options discount the victim's perceived role or interfere with further discussion.
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.
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.
Which situation constitutes consensual sex rather than rape?
- A. After coming home intoxicated from a party, a person forces the spouse to have sex. The spouse objects.
- B. A person's lover pleads to have oral sex. The person gives in but then regrets the decision.
- C. A person is beaten, robbed, and forcibly subjected to anal penetration by an assailant.
- D. A physician gives anesthesia for a procedure and has intercourse with an unconscious patient.
Correct Answer: B
Rationale: Only the scenario where the person gives in to oral sex describes consensual sex, as it involves agreement, even if later regretted. The other scenarios involve force or lack of consent.
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.