Question: A community health nurse visits a family with four children. The father behaves angrily, finds fault with a child, and asks twice, “Why are you such a stupid kid?” The wife says, “I have difficulty disciplining the children. It’s so frustrating.” Which comments by the nurse will facilitate the interview with these parents? (Select all that apply.)

Answer Options:
a. “Tell me how you punish your children.”
b. “How do you stop your baby from crying?”
c. “Caring for four small children must be difficult.”
d. “Do you or your husband ever beat the children?”
e. “Calling children ‘stupid’ injures their self-esteem.”

Answer: a. “Tell me how you punish your children.”
b. “How do you stop your baby from crying?”
c. “Caring for four small children must be difficult.”

Question: 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?

Answer Options:
a. Victim
b. Survivor
c. Plaintiff
d. Perpetrator

Answer: b. Survivor

Question: A person was abducted and raped at gunpoint. The nurse observes this person is confused, talks rapidly in disconnected phrases, and is unable to concentrate or make simple decisions. What is the person’s level of anxiety?

Answer Options:
a. Minimal
b. Mild
c. Moderate
d. High

Answer: d. High

Question: A person was abducted and raped at gunpoint by an unknown assailant. Which assessment finding best indicates the person is in the acute phase of rape trauma syndrome?

Answer Options:
a. Confusion and disbelief
b. Decreased motor activity
c. Flashbacks and dreams
d. Fears and phobias

Answer: a. Confusion and disbelief

Question: 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?

Answer Options:
a. Somatic reaction
b. Repression
c. Projection
d. Denial

Answer: d. Denial

Question: A child was abducted and raped. Which personal reaction by the nurse could interfere with the child’s care?

Answer Options:
a. Disgust
b. Concern
c. Empathy
d. Compassion

Answer: a. Disgust

Question: 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?

Answer Options:
a. “She was very beautiful.”
b. “She wanted sex the sex.”
c. “I have issues with my mother.”
d. “I’ve been depressed for a long time.”

Answer: b. “She wanted sex the sex.”

Question: A rape victim asks an emergency department nurse, “Maybe I did something to cause this attack. Was it my fault?” Which response by the nurse is the most therapeutic?

Answer Options:
a. Pose questions about the rape, helping the patient explore why it happened.
b. Reassure the victim that the outcome of the situation will be positive.
c. Make decisions for the victim because of the temporary confusion.
d. Support the victim to separate issues of vulnerability from blame.

Answer: d. Support the victim to separate issues of vulnerability from blame.

Question: A rape victim tells the nurse, “I should not have been out on the street alone.” Which is the nurse’s most therapeutic response?

Answer Options:
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.”

Answer: c. “You believe this would not have happened if you had not been alone?”

Question: The nursing diagnosis rape trauma syndrome applies to a rape victim in the emergency department. Which outcome should occur before the patient’s discharge?

Answer Options:
a. Patient states, “I feel safe and entirely relaxed.”
b. Memory of the rape is less vivid and frightening
c. Physical symptoms of pain and discomfort are no longer present.
d. Patient agrees to keep a follow-up appointment with the rape crisis center.

Answer: d. Patient agrees to keep a follow-up appointment with the rape crisis center. ​

Question: The nurse cares for a victim of a violent sexual assault. What is the most therapeutic intervention?

Answer Options:
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.

Answer: a. Use accepting, nurturing, and empathetic communication techniques.

Question: What is the primary motivator for most rapists?

Answer Options:
a. Anxiety
b. Need for humiliation
c. Overwhelming sexual desires
d. Desire to inflict violence or control others

Answer: d. Desire to inflict violence or control others

Question: A nurse working a rape telephone hotline should focus communication with callers toward what intervention?

Answer Options:
a. Arranging long-term counseling
b. Serving as a sympathetic listener
c. Obtaining information to relay to the local police
d. Explaining immediate steps that a victim of rape should take

Answer: d. Explaining immediate steps that a victim of rape should take

Question: A rape victim tells the emergency department nurse, “I feel so dirty. Please let me take a shower before the doctor examines me.” How should the nurse respond to the request?

Answer Options:
a. Arrange for the patient to shower.
b. Explain that washing would destroy evidence.
c. Give the patient a basin of hot water and towels.
d. Instruct the victim to wash above the waist only.

Answer: b. Explain that washing would destroy evidence.

Question: Which situation constitutes consensual sex rather than rape?

Answer Options:
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.

Answer: b. A person’s lover pleads to have oral sex. The person gives in but then regrets the decision.