Chapter 32: Sexual Assault Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. When beginning a health maintenance exam, the health care provider learns that an adult patient has been sexually assaulted the previous day. What is the initial responsibility of the provider?

a. Notify the police and encourage the patient to press criminal charges.

b. Perform a thorough gynecological exam and obtain cultures.

c. Question the patient about the events surrounding the assault.

d. Refer the patient to the emergency department (ED) for a forensic examination.

ANS: D

If a patient has been sexually assaulted within the past 5 days, and especially if within the previous 72 hours, the provider should defer a physical examination and refer the patient to the ED for a forensic examination. It is not necessary to notify the police unless the victim is a child, elderly, or disabled. The provider should not perform the exam a forensic exam ensures that standard protocol is followed, and appropriate evidence is obtained. Retelling the story of the assault may be traumatizing to the patient, so this should be left to providers performing the forensic exam.

2. A patient who was sexually assaulted one month prior tells her provider that she is concerned about contracting human immunodeficiency virus (HIV). When is it appropriate to perform testing?

NURSINGTB.COM a. Immediately and then every 6 months for the first year b. Immediately with definitive results c. In 2 weeks and then 3 to 6 months after the assault d. Three to six months after the assault

ANS: C a. Recommending counseling at a local mental health center b. Referring the patient to the emergency department for sexually transmitted infection (STI) testing c. Reporting the alleged assault to law enforcement d. Suggesting that the patient report the incident to the school

Because of the length of time for seroconversion to occur, patients concerned about HIV exposure should be tested 6 weeks after and then 3 to 6 months after the assault. Immediate results will not provide accurate information. The initial testing should be 6 weeks after potential exposure.

3. During a health maintenance examination, 17-year-old female reports having been raped repeatedly at a college party during the previous semester and tells the practitioner that she did not seek help at the time. Which action is a priority for the primary care provider?

ANS: C

Any sexual assault perpetrated on a victim younger than 18 years must be reported to the local child or adult protective agency as well as to law enforcement, regardless of whether the patient reports that sexual assault occurred. Counseling, STI testing, and reporting the incident to the school are important, but are not the priority.