SANE Certification Practice Questions

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Questions and Answers

What should the SANE do when the victim denies drug-facilitated sexual assault?

Obtain the patient's blood and urine for toxicology and reassure the patient that law enforcement will not charge her if drugs are found

Collect the patient's blood and urine for toxicology and plan to discuss this at the next SART meeting

Follow the protocol that the hospital has in place (correct)

Collect the patient's blood and urine for toxicology as requested by law enforcement

What is the most appropriate action for the SANE regarding the victim's purse when requested by law enforcement?

Retrieve the patient's purse and give it to the sex crimes supervisor

Inform the patient that the purse needs to be collected as evidence and ask the patient to release it as evidence

Inform law enforcement that it is not the role/responsibility of the SANE to take a purse from a patient even if it contains drugs (correct)

Retrieve the patient's purse and give it to law enforcement and plan to discuss this at the next sexual assault response team meeting

How should the SANE respond to the officer's question about whether the patient was raped?

She's pretty inconsistent so I don't think she was raped

She stated that she was assaulted. The results of the SANE exam are consistent with her history. (correct)

I am not sure. I think this is a case for our MDT to review and decide

I didn't find any physical evidence of rape

Which of the following is NOT a reason for law enforcement not being present during a medical forensic exam?

The SANE is uncomfortable with having law enforcement present Signup and view all the answers

What should the SANE tell the patient about how the SART will respond to her situation?

The SART can respond to the patient's needs, such as options for care and reporting. Local law enforcement will gather information and take custody of evidence collected until it can be turned over to law enforcement who will be investigating the case in the jurisdiction in which the crime occurred. Signup and view all the answers

What is the SANE's best response regarding the use of law enforcement's Spanish translator?

Tell law enforcement that the hospital that the SANE works for has a policy that only hospital translators can be used for patients. Signup and view all the answers

What is the most appropriate way to explain a forensic exam to a 12-year-old female patient whose mother is present?

Explain the purpose and process of forensic evidence collection to both the patient and mother. Signup and view all the answers

Which statement is true regarding the use of an alternate light source?

An alternate light source may be used to help guide the collection of evidentiary swabs. Signup and view all the answers

What is the immediate concern for the SANE when caring for a patient who may have experienced drug-facilitated sexual assault?

Drug-facilitated sexual assault. Signup and view all the answers

What is the most appropriate action for the pediatric SANE when concerned about a recent drug-or-alcohol-facilitated sexual assault?

Collect blood and urine specimens for alcohol and drug testing Signup and view all the answers

What should the pediatric SANE do when the assault occurred 2 days ago?

Collect a dirty urine specimen for drug testing Signup and view all the answers

What is the most appropriate action for the pediatric SANE regarding a 15-year-old patient who experienced sexual intercourse?

Explain forensic evidence collection procedure. Obtain patient assent. Collect forensic evidence using a standardized kit. Signup and view all the answers

What is the most common drug used to facilitate sexual abuse/assault?

Alcohol. Signup and view all the answers

What is the most appropriate action regarding evidence collection for a patient who has experienced sexual abuse?

Offer evidence collection of the cervical os via the use of a vaginal speculum and anal swabs. Signup and view all the answers

What should be used to collect blood for toxicology testing?

Sodium fluoride and potassium oxalate. Signup and view all the answers

What is the correct way to perform the double swab technique?

Use a single moistened cotton swab, followed by a single dry cotton swab. Signup and view all the answers

What are the four general categories of evidence?

Physical, documentary, demonstrative, testimonial. Signup and view all the answers

How can the greatest concentration of specimen be obtained during collection?

Using the minimum number of swabs per site. Signup and view all the answers

Where are specimens for vaginal evidence collection best collected from?

The vaginal vault. Signup and view all the answers

What is the recommended treatment for Neisseria gonorrhoeae?

Ceftriaxone 250mg intramuscular injection as a single dose one time. Signup and view all the answers

What is the recommended treatment for chlamydia?

Azithromycin 1 g orally as a one-time single dose or doxycycline 100 mg orally twice a day for 7 days. Signup and view all the answers

What is the treatment for trichomoniasis?

Metronidazole 2 g orally in a one-time single dose or tinidazole 2g orally in a one-time dose. Signup and view all the answers

What is the HPV vaccination schedule?

Administer first dose of HPV vaccine series, administer second dose 1-2 months after first dose and administer third dose at 6 months. Signup and view all the answers

What medications are given to patients after possible exposure to HIV?

Emtricitabine/tenofovir: one tablet orally every day for 28 days PLUS lopinavir/ritonavir: two tablets orally twice daily for 28 days. Patients with baseline abnormal renal function should not receive these medications. Signup and view all the answers

Developing training for the local sexual assault response team (SART) regarding trauma-informed care is a competency for which standard of practice?

Collaboration Signup and view all the answers

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:

Help to build a home for women experiencing IPV Signup and view all the answers

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:

Female experiencing elderly sexual abuse Signup and view all the answers

When considering each individual team member's role, what is the most important consideration the sexual assault response team (SART) should discuss?

The impact joint interviews will have on admissibility at trial Signup and view all the answers

The advocate can assist the sexual assault nurse examiner during the examination and evidence collection by all of the following except:

Acting as a scribe for the SANE in documenting injury Signup and view all the answers

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?

The SANE should explain to law enforcement that follow-up questions should be asked directly by the officer Signup and view all the answers

The four core disciplines that comprise a sexual assault response team (SART) are:

Law enforcement, advocacy, SANE, and prosecutors Signup and view all the answers

An advocate present with a victim during a medical forensic examination may assist the SANE during the exam by:

Providing emotional, trauma-informed support to the victim during the examination Signup and view all the answers

A sexual assault nurse examiner is one of the core members of a sexual assault multidisciplinary team and provides the following except:

A diagnosis that a sexual assault has occurred Signup and view all the answers

What should the ED staff do when the advocate arrives before the SANE does?

Ask the victim if they would like to talk to the advocate and if they agree, introduce them Signup and view all the answers

During a case review, what should the SANE do if the victim mentions crucial evidence placed in the hamper?

Contact the patient and ask if it's OK to share this information with police Signup and view all the answers

Which of the following purposes is not a focus of a sexual assault multidisciplinary team?

Perform case analysis to determine if a crime occurred Signup and view all the answers

Which of the following is not a role of the advocate?

Provide detailed documentation of the assault Signup and view all the answers

What information should a sexual assault nurse examiner provide to a teen's non-offending parent regarding local child advocacy centers?

The CAC is the only location that can properly serve children Signup and view all the answers

How does a sexual assault response team (SART) differ from a coordinated community response (CCR)?

A SART typically functions to serve only sexual assault victims Signup and view all the answers

A 'Dual' coordinated community response team (SART) may be best for rural communities for all of the following reasons except:

The needs and responses to sexual assault and domestic violence are similar Signup and view all the answers

The SANE may be included in all of the following collaborative processes except:

The development of policies outlining the charging and prosecution of offenders Signup and view all the answers

What should a SANE do when a child is brought to the ED in case of sexual assault?

Obtain history from the mother and complete examination Signup and view all the answers

The implementation of a sexual assault response team within a community improves all of the following except:

Increased conviction rates and sentence lengths Signup and view all the answers

There are variations in the development and implementation of multidisciplinary teams for all of the following reasons except:

Healthcare is not always available Signup and view all the answers

When a victim recants her testimony after an assault, what should be the ideal response by the sexual response team in the community?

Discuss the rationale behind the decision to charge with false report Signup and view all the answers

What can the Rape Crisis Center advocate appropriately assist a victim with?

Provide support and information about resources Signup and view all the answers

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?

Discuss options for reporting and evidence collection with the patient Signup and view all the answers

What should the SANE do when law enforcement requests medical records after a victim decides to report the assault?

Inform law enforcement that permission from the victim is required Signup and view all the answers

Studies have shown that multidisciplinary teams improve all of the following except:

Identification of false reports Signup and view all the answers

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?

Consult hospital administration and Adult Protective Services Signup and view all the answers

If law enforcement suspects a victim has been using drugs and wants toxicology results without charging the victim, what should the SANE consider?

Ensure the victim is fully aware of the request and its implications Signup and view all the answers

Which of the following best describes expert witness testimony in a sexual abuse trial? (Select all that apply)

The witness presents the patient's medical history and physical exam findings and can offer an opinion based on the witness's area of expertise. Signup and view all the answers

What is the purpose of questioning a sexual assault nurse examiner regarding their qualifications in court?

To establish the witness as an expert by highlighting their professional qualifications including education, specialized training, and experience. Signup and view all the answers

What are the stages of grooming?

Identify a victim, increase role in victim's life, make assurance of power difference, gain trust, establish secrecy, isolate, slowly introduce nonsexual to sexual touch. Signup and view all the answers

What is the most appropriate way to communicate medical forensic exam options for a patient who speaks minimal English?

Obtain a professional medical language interpreter for communication Signup and view all the answers

What is the most important follow-up care for a patient who believes they have been sexually assaulted?

Immediate contact with and ongoing support through advocacy services and social support. Signup and view all the answers

What is the most important way to proceed with a young patient who presents with pelvic inflammatory disease and unexplained contusions?

Evaluate for risk of human trafficking and commercial sexual exploitation Signup and view all the answers

Which statement best describes the role of a forensic nurse?

A dynamic role that integrates nursing science, forensic science, and the legal system Signup and view all the answers

What is the most effective communication strategy with a teenage patient who is a survivor of sexual assault?

Ask open-ended questions in a nonjudgmental way Signup and view all the answers

Which statement about teenage dating violence (TDV) is correct?

Teenagers experiencing TDV are more likely to experience interpersonal violence as adults Signup and view all the answers

What are the six trauma-informed principles to assist in the recovery of acute sexual assault patients?

Safety, Trustworthiness, Peer support, Collaboration, Empowerment, and Cultural, historical, and gender issues. Signup and view all the answers

Statistically, which statement is correct about Native American females and sexual violence?

They experience interracial sexual assault more than their non-Hispanic white counterparts Signup and view all the answers

Which of the following is a forensic nursing standard of practice?

Evaluation Signup and view all the answers

What does the ACE study predict for patients with several adverse childhood experiences (ACEs)?

A higher chance of developing chronic health issues in the future Signup and view all the answers

Which statement about bullying is true?

Bullying seems to occur equally by electronics or in person Signup and view all the answers

What statement from parents may indicate that they have been groomed by a perpetrator of sexual abuse?

'He is like a second father to her. He would never do that.' Signup and view all the answers

Which three standards focus on outreach to colleagues for a sexual assault nurse examiner?

Collaboration, leadership, and quality of practice Signup and view all the answers

For a transgender male patient after a violent sexual assault, the SANE should prioritize obtaining which of the following?

Testing and treatment for sexually transmitted disease Signup and view all the answers

What is the best culturally responsive care for a Muslim female patient presenting in a burka?

Provide respect and privacy/modesty for the patient when changing and during the exam Signup and view all the answers

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?

'Our conversation today is completely confidential. Can you tell me more about your concerns?' Signup and view all the answers

What should the SANE consider when examining a physically and developmentally disabled patient who has been sexually assaulted?

There is a high risk of revictimization, often by the same perpetrator Signup and view all the answers

What is important for a sexual assault nurse examiner to do when treating a patient forced to come to the hospital by their parents?

Perform the medical forensic exam only if the patient wants and consents to the exam Signup and view all the answers

Which information correlates a patient's childhood with their current sexual assault?

At the age of 6 she had an uncle who fondled her, but no one believed her. Signup and view all the answers

What should a sexual assault nurse examiner prioritize when treating a patient who has been sexually assaulted by their boyfriend?

Collecting information relative to the patient's situation, because this is essential to perform trauma-informed care. Signup and view all the answers

Why does a sexual assault nurse examiner believe that a patient may be experiencing intimate partner violence?

Feels unsafe because he calls nonstop, which makes her anxious Signup and view all the answers

Why is delayed disclosure common in elder sexual assault?

Victims are often coerced or threatened when the perpetrator is also the caregiver Signup and view all the answers

Which statement is true about elderly adults?

They are a vulnerable population that often depend on others for basic care needs Signup and view all the answers

What does the patient’s history suggest about the perpetrator of a sexual assault?

The perpetrator bullied your patient and teased him about being gay Signup and view all the answers

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.

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.

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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Description

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.