Questions and Answers
What should the SANE do when the victim denies drug-facilitated sexual assault?
What is the most appropriate action for the SANE regarding the victim's purse when requested by law enforcement?
How should the SANE respond to the officer's question about whether the patient was raped?
Which of the following is NOT a reason for law enforcement not being present during a medical forensic exam?
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What should the SANE tell the patient about how the SART will respond to her situation?
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What is the SANE's best response regarding the use of law enforcement's Spanish translator?
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What is the most appropriate way to explain a forensic exam to a 12-year-old female patient whose mother is present?
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Which statement is true regarding the use of an alternate light source?
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What is the immediate concern for the SANE when caring for a patient who may have experienced drug-facilitated sexual assault?
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What is the most appropriate action for the pediatric SANE when concerned about a recent drug-or-alcohol-facilitated sexual assault?
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What should the pediatric SANE do when the assault occurred 2 days ago?
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What is the most appropriate action for the pediatric SANE regarding a 15-year-old patient who experienced sexual intercourse?
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What is the most common drug used to facilitate sexual abuse/assault?
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What is the most appropriate action regarding evidence collection for a patient who has experienced sexual abuse?
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What should be used to collect blood for toxicology testing?
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What is the correct way to perform the double swab technique?
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What are the four general categories of evidence?
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How can the greatest concentration of specimen be obtained during collection?
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Where are specimens for vaginal evidence collection best collected from?
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What is the recommended treatment for Neisseria gonorrhoeae?
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What is the recommended treatment for chlamydia?
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What is the treatment for trichomoniasis?
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What is the HPV vaccination schedule?
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What medications are given to patients after possible exposure to HIV?
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Developing training for the local sexual assault response team (SART) regarding trauma-informed care is a competency for which standard of practice?
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The sexual assault nurse examiner and the SANE's team want to create a project to lessen intimate partner violence in the community through primary prevention. The SANE knows that the team is on the right track when the team members suggest that the team could:
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A victim who has been assaulted by a male caregiver, has had a more violent assault, and is less likely to report than other victims is most likely to be a:
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When considering each individual team member's role, what is the most important consideration the sexual assault response team (SART) should discuss?
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The advocate can assist the sexual assault nurse examiner during the examination and evidence collection by all of the following except:
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After the medical forensic exam, the SANE gives an update to law enforcement. What is the best response from the SANE when law enforcement asks specific questions about the assault?
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The four core disciplines that comprise a sexual assault response team (SART) are:
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An advocate present with a victim during a medical forensic examination may assist the SANE during the exam by:
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A sexual assault nurse examiner is one of the core members of a sexual assault multidisciplinary team and provides the following except:
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What should the ED staff do when the advocate arrives before the SANE does?
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During a case review, what should the SANE do if the victim mentions crucial evidence placed in the hamper?
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Which of the following purposes is not a focus of a sexual assault multidisciplinary team?
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Which of the following is not a role of the advocate?
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What information should a sexual assault nurse examiner provide to a teen's non-offending parent regarding local child advocacy centers?
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How does a sexual assault response team (SART) differ from a coordinated community response (CCR)?
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A 'Dual' coordinated community response team (SART) may be best for rural communities for all of the following reasons except:
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The SANE may be included in all of the following collaborative processes except:
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What should a SANE do when a child is brought to the ED in case of sexual assault?
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The implementation of a sexual assault response team within a community improves all of the following except:
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There are variations in the development and implementation of multidisciplinary teams for all of the following reasons except:
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When a victim recants her testimony after an assault, what should be the ideal response by the sexual response team in the community?
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What can the Rape Crisis Center advocate appropriately assist a victim with?
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What is the most appropriate action of the SANE when a patient wants a medical forensic exam but does not want to notify law enforcement?
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What should the SANE do when law enforcement requests medical records after a victim decides to report the assault?
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Studies have shown that multidisciplinary teams improve all of the following except:
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What is the most appropriate action to be taken by the SANE when faced with a patient whose daughter has power of attorney and refuses the exam?
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If law enforcement suspects a victim has been using drugs and wants toxicology results without charging the victim, what should the SANE consider?
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Which of the following best describes expert witness testimony in a sexual abuse trial? (Select all that apply)
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What is the purpose of questioning a sexual assault nurse examiner regarding their qualifications in court?
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What are the stages of grooming?
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What is the most appropriate way to communicate medical forensic exam options for a patient who speaks minimal English?
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What is the most important follow-up care for a patient who believes they have been sexually assaulted?
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What is the most important way to proceed with a young patient who presents with pelvic inflammatory disease and unexplained contusions?
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Which statement best describes the role of a forensic nurse?
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What is the most effective communication strategy with a teenage patient who is a survivor of sexual assault?
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Which statement about teenage dating violence (TDV) is correct?
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What are the six trauma-informed principles to assist in the recovery of acute sexual assault patients?
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Statistically, which statement is correct about Native American females and sexual violence?
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Which of the following is a forensic nursing standard of practice?
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What does the ACE study predict for patients with several adverse childhood experiences (ACEs)?
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Which statement about bullying is true?
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What statement from parents may indicate that they have been groomed by a perpetrator of sexual abuse?
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Which three standards focus on outreach to colleagues for a sexual assault nurse examiner?
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For a transgender male patient after a violent sexual assault, the SANE should prioritize obtaining which of the following?
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What is the best culturally responsive care for a Muslim female patient presenting in a burka?
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What response is best when a 21-year-old male patient expresses concern about having been sexually assaulted but does not want to report it?
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What should the SANE consider when examining a physically and developmentally disabled patient who has been sexually assaulted?
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What is important for a sexual assault nurse examiner to do when treating a patient forced to come to the hospital by their parents?
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Which information correlates a patient's childhood with their current sexual assault?
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What should a sexual assault nurse examiner prioritize when treating a patient who has been sexually assaulted by their boyfriend?
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Why does a sexual assault nurse examiner believe that a patient may be experiencing intimate partner violence?
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Why is delayed disclosure common in elder sexual assault?
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Which statement is true about elderly adults?
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What does the patient’s history suggest about the perpetrator of a sexual assault?
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Study Notes
Expert Witness Testimony
- Expert witnesses provide testimony based on their specialized knowledge, skills, and experience and can offer opinions related to their expertise.
- Testimony does not advocate for patients or favor any attorney's position.
Establishing Expert Witness Qualifications
- Direct examination highlights a witness's qualifications, including education and training, to establish expert status before the court.
- Opposing counsel conducts voir dire questioning to challenge qualifications.
Stages of Grooming
- Key stages include victim identification, increasing the perpetrator's role in the victim's life, creating power imbalances, gaining trust, establishing secrecy, isolating the victim, and slowly introducing sexual contact.
Communication with Limited English Proficiency
- A professional medical interpreter is essential for effective communication with patients who have language barriers to provide patient-centered care.
Follow-Up Care for Vulnerable Populations
- Immediate contact with advocacy services and ongoing support is crucial for patients after a potential sexual assault.
Evaluating Risk in Young Patients
- Assess for risks of human trafficking or sexual exploitation in young patients presenting with unexplained injuries or frequent visits.
Role of Forensic Nurses
- Forensic nursing is a dynamic field integrating nursing science, forensic science, and legal systems, focusing on a broad scope of care.
Communication with Adolescent Patients
- Use open-ended questions in a nonjudgmental manner to facilitate effective communication with teens.
Teenage Dating Violence (TDV)
- Teenagers experiencing TDV are at higher risk of encountering interpersonal violence as adults.
Trauma-Informed Principles
- Incorporate principles of safety, trustworthiness, peer support, collaboration, empowerment, and cultural sensitivity in therapy and care settings.
Native American Females and Sexual Violence
- Native American females often experience higher rates of interracial sexual assault compared to non-Hispanic white females.
Forensic Nursing Standards
- Evaluation is a critical standard of practice in forensic nursing, alongside ethics, education, and evidence-based practice.
Adverse Childhood Experiences (ACEs)
- Patients with a history of multiple ACES are at a heightened risk for developing chronic health problems in the future.
Bullying Statistics
- Bullying occurs equally through electronic means and in-person interactions, highlighting its pervasive nature.
Parental Grooming Indicators
- Statements from parents that reflect trust or denial towards a known abuser can indicate potential grooming.
Collaborative Standards of Practice
- Collaboration, leadership, and quality of practice are key standards for effective cooperation among healthcare professionals.
Sexual Assault in Vulnerable Populations
- Individuals with disabilities face a high risk of revictimization, often by previous perpetrators.
Consent and Patient Autonomy
- Patients must provide consent for medical examinations, with their autonomy respected during decision-making.
Trauma Correlation in Assault Cases
- Past experiences of abuse, especially if not believed, can correlate with current trauma and impact a victim’s situation.
Patient Centered Assessment
- Patient-centered care approaches stress the importance of collecting relevant information to provide informed and compassionate care.
Intimate Partner Violence Indicators
- Feelings of anxiety linked to a partner’s excessive communication can signal intimate partner violence.
Elderly Abuse Reporting Challenges
- Coercion by caregivers often contributes to underreporting of sexual abuse among elderly populations, impacting their recovery.
Elderly Care Vulnerabilities
- Elderly adults are considered a vulnerable population, often depending on others for essential care, which may jeopardize their safety.
Dynamics of Perpetrator Behavior
- Perpetrators may exhibit bullying behavior towards victims, creating a history of power imbalance that can lead to future assault.
Community Action Against Violence
- Building shelters for victims of intimate partner violence represents a proactive approach to prevention and support.
Reporting Trends in Elderly Abuse
- Elderly females face higher rates of violent assault without reporting, particularly in caregiving scenarios.
Team Dynamics in Sexual Assault Cases
- The consistency of victim narratives across professional domains is critical during investigations and impacts legal processes.### Joint Interviews and Trial Admissibility
- Joint interviews may affect the credibility of witness statements in court.
- Multiple witnesses can provide corroborative evidence, potentially strengthening a case.
- The presence of advocates or legal counsel in interviews can influence testimony and admissibility.
- Interviews might be scrutinized for leading questions, which could impact their use in trial.
- Joint interviews can help maintain consistency in narratives, which can be beneficial during legal proceedings.
Involvement of Advocates
- Advocates support victims emotionally during medical examinations.
- They provide information about resources like Crime Victims Compensation funds.
- Advocates should not document injuries during medical examinations, as this role belongs to the forensic nurse examiner.
Sexual Assault Nurse Examiner (SANE) Role
- SANEs are key members of sexual assault response teams (SARTs).
- They collect evidence and provide vital testimony in court cases.
- SANEs are not responsible for diagnosing sexual assault but can explain what medical forensic examinations entail.
Team Collaboration and Communication
- Effective sexual assault multidisciplinary teams facilitate communication among law enforcement, advocacy, SANEs, and prosecutors.
- Teams must undergo cross-training to understand each member's roles and responsibilities.
- SART meetings can help in discussing case reviews and improving team responses.
Patient-Centered Care
- Patients have the right to consent to emotional support and information sharing.
- Medical forensic exams can be conducted without immediate law enforcement notification if the patient desires.
- Cases involving minors require immediate reporting to Child Protective Services and law enforcement.
Ethical Considerations
- Permission from victims is required to discuss their medical records with law enforcement.
- Advocates should assist victims without intruding or compromising the investigative process.
- Patient autonomy is crucial, and their decisions should guide the actions of professionals involved.
Response to Law Enforcement Requests
- Law enforcement should not influence the medical examination process or the conduct of SANEs.
- SANEs should prioritize patient care and confidentiality over law enforcement demands.
- Any collection of specimens must follow hospital protocols, especially concerning toxicology, to ensure patient safety.
Misunderstandings and Victim Support
- Support teams must prevent any victim-blaming narratives, especially concerning false reporting allegations.
- SARTs must work to understand the rationale behind law enforcement actions and provide support without condoning improper handling of victims.
Unique Situations in Forensic Response
- Special considerations arise in cases involving elderly victims or sensitive family dynamics, necessitating caution from SANEs.
- Teams must consider varying factors such as community resources, patient needs, and sexual assault dynamics when developing response strategies.
- Maintaining trust and transparency with victims is essential for further cooperation in the legal process.### SANE and SART Response
- SANE and advocacy provide advocacy and medical forensic care.
- SART members can address patient needs for options regarding care and reporting.
- Local law enforcement will secure evidence until it can be transferred to the appropriate jurisdiction.
- Evidence collection may involve physical examinations and provision of emergency contraception and STI prophylaxis.
- Evidence collected can be turned over to law enforcement when the patient returns to report the crime.
Translation Use in Forensic Exams
- Hospital policy mandates the use of hospital translators for patient assistance.
- Law enforcement's translator cannot be used due to policy restrictions.
- It is important to maintain clear communication with the patient during examinations.
Forensic Exam Explanation
- Explain forensic evidence collection clearly to both the pre-adolescent patient and her mother, ensuring comprehension.
Use of Alternate Light Source
- An alternate light source is useful for guiding the collection of evidentiary swabs.
Concerns in Drug-Facilitated Assaults
- Immediate concern for patients with memory loss after consuming alcohol may include potential drug-facilitated sexual assault.
- Urgent care involves collecting appropriate specimens for testing within a specific timeframe to confirm drug presence.
Testing Timeframes and Specimens
- For potential drug/alcohol-facilitated assault within 20 hours, collect both blood and urine for testing.
- For events that occurred 2 days prior, a "dirty" urine specimen for drug testing is appropriate.
Age of Consent and Evidence Collection
- In jurisdictions where age of consent is 16, minors involved in sexual activities should have forensic evidence collected, with appropriate assent obtained.
Common Drugs in Sexual Assault
- Alcohol is the most common drug used to facilitate sexual assault.
Evidence Collection Techniques
- For sexual abuse cases, evidence should include cervical os collection via vaginal speculum and anal swabs as appropriate.
- Blood for toxicology analysis requires specific gray-top tubes containing sodium fluoride and potassium oxalate.
Evidence Collection Methods
- Utilize the double swab technique by using a moistened cotton swab followed by a dry one.
- Collect vaginal evidence primarily from the vaginal vault for optimal specimen concentration.
Treatment Guidelines
- Recommended treatments include:
- Neisseria gonorrhoeae: Ceftriaxone 250mg IM as a single dose.
- Chlamydia: Azithromycin 1g orally as a single dose or doxycycline 100mg orally twice daily for 7 days.
- Trichomoniasis: Metronidazole 2g orally or tinidazole 2g orally as a single dose.
HPV Vaccination Schedule
- Administer the first dose of the HPV vaccine series, followed by:
- Second dose at 1-2 months after the first.
- Third dose at 6 months.
Post-Exposure HIV Prophylaxis
- For potential HIV exposure, prescribe emtricitabine/tenofovir (one tablet daily for 28 days) and lopinavir/ritonavir (two tablets twice daily for 28 days).
- Monitor renal function to ensure safety before prescribing these medications.
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Test your knowledge with practice questions for the SANE certification, focusing on expert witness testimony in sexual abuse trials. This quiz will help reinforce your understanding of key concepts and prepare you for the certification exam.