D449 Psychology and Mental Health - Set 5 - Part 3

Correct Answer: Provide a safe and private environment

Option c is correct because the first priority for sexual assault patients upon arrival in an emergency setting is providing a safe, private environment with access to a community-based advocate, establishing trust before any examination or evidence collection procedures begin. Option a is incorrect because beginning evidence collection immediately without first establishing a safe environment and building rapport uses a task-oriented approach that fails to address the patient's acute emotional trauma and can feel re-victimizing during an extremely vulnerable moment. Option b is incorrect because allowing the patient to shower before assessment would destroy critical forensic evidence needed for potential prosecution, though the nurse must explain this gently while providing emotional support and maintaining the patient's sense of dignity and control. Option d is incorrect because calling law enforcement to the bedside before establishing a safe environment and obtaining the

Correct Answer: Document and preserve all collected evidence

Option a is correct because proper evidence collection requires meticulous documentation of all physical findings through both written records and photographs, along with careful evidence preservation and chain-of-custody procedures to ensure forensic integrity for potential legal proceedings. Option b is incorrect because allowing the patient to handle evidence bags compromises the chain of custody and could introduce contamination, as all evidence must be collected, sealed, labeled, and maintained exclusively by trained personnel following strict forensic evidence protocols. Option c is incorrect because photographic documentation of injuries is an established component of the forensic examination protocol, and completing the exam without photographs eliminates critical visual evidence that supports written findings in potential legal proceedings following sexual assault. Option d is incorrect because torn clothing is forensic evidence that may contain DNA, fibers, and other trace ma

Correct Answer: STD prophylaxis and follow-up care plans

Option d is correct because the standard of care for sexual assault patients includes medically appropriate sexually transmitted disease prophylaxis, emergency contraception when indicated, and comprehensive follow-up care planning including counseling referrals and medical appointments. Option a is incorrect because limiting discharge planning to legal referrals alone neglects the critical medical components including STD prophylaxis, emergency contraception, wound care, and psychological support that sexual assault patients require as part of comprehensive trauma-informed discharge planning. Option b is incorrect because written instructions alone do not fulfill the discharge standard of care, which requires active provision of STD prophylaxis, emergency contraception, safety planning, community resource connections, and scheduled follow-up appointments for the sexual assault patient. Option c is incorrect because providing prescriptions without establishing follow-up care fails to m

Correct Answer: Trained specifically for this patient population

Option b is correct because sexual assault nurse examiners receive specialized training in forensic evidence collection, trauma-informed care, and proper documentation techniques specifically designed to provide expert, compassionate care for the sexual assault patient population. Option a is incorrect because while SANEs may provide legal testimony, their primary role encompasses comprehensive forensic examination, evidence collection, injury documentation, trauma-informed patient care, and connecting survivors with community resources beyond courtroom involvement alone. Option c is incorrect because while best practice recommends SANE involvement whenever possible, not all facilities have SANEs available for every assault case, and their involvement is a recommended standard of care rather than a universal legal mandate across all jurisdictions. Option d is incorrect because sexual assault nurse examiners are not limited to overnight shifts, and many hospitals maintain SANE coverage

Correct Answer: Respect the decision and complete the exam

Option c is correct because competent adult sexual assault patients have the right to complete forensic evidence collection while declining law enforcement involvement, and the nurse must use a trauma-informed approach that respects patient autonomy and decision-making throughout the process. Option a is incorrect because overriding a competent adult patient's refusal to involve law enforcement violates patient autonomy and the principles of trauma-informed care, potentially re-traumatizing the survivor by removing their control during an already deeply disempowering experience. Option b is incorrect because refusing to perform the forensic examination without a police report denies the patient access to critical medical care and evidence preservation, and patients have the right to receive examination and treatment regardless of their decision about law enforcement notification. Option d is incorrect because delaying the forensic examination risks degradation of time-sensitive ph

Correct Answer: Acute stress disorder

Option c is correct because acute stress disorder occurs between three days and one month after a traumatic event, and this patient's presentation at one week post-fire with intrusive memories, avoidance, hypervigilance, and sleep disturbance falls squarely within that diagnostic timeframe. Option a is incorrect because while grief responses can include emotional distress after traumatic loss, the specific combination of intrusive memories, hypervigilance, exaggerated startle response, and avoidance behaviors represents a clinical acute stress response that exceeds normal grief reactions. Option b is incorrect because while depressive symptoms can follow traumatic events, this patient's primary features of hypervigilance, exaggerated startle, intrusive trauma memories, and avoidance are hallmark acute stress symptoms rather than the characteristic mood and anhedonia patterns of major depression. Option d is incorrect because post-traumatic stress disorder cannot be diagnosed

Correct Answer: Substance use disorder comorbidity

Option d is correct because patients with PTSD who begin self-medicating with alcohol to manage hyperarousal symptoms are at significant risk for developing a comorbid substance use disorder, which complicates treatment and increases the danger of self-harm and overall decline. Option a is incorrect because acute stress disorder occurs within the first month after trauma and cannot progress or develop four months post-deployment, as this veteran's symptoms have already exceeded the acute stress timeframe and meet criteria for post-traumatic stress disorder. Option b is incorrect because while anxiety symptoms are present, the veteran's specific symptom cluster of trauma-related nightmares, emotional numbing, avoidance, and hyperarousal with a clear traumatic precipitant indicates PTSD rather than generalized anxiety as the primary concern. Option c is incorrect because while the veteran avoids crowded places, this avoidance is directly related to trauma-associated hypervigila

Correct Answer: Cognitive behavioral therapy with exposure

Option a is correct because cognitive behavioral therapy combined with exposure techniques is the evidence-based frontline treatment for acute stress disorder, helping patients process traumatic memories and reduce avoidance behaviors to prevent the development of chronic PTSD. Option b is incorrect because long-term benzodiazepine monotherapy is not recommended for acute stress or PTSD treatment, as benzodiazepines can interfere with trauma processing, create dependence, and are indicated only for short-term use while evidence-based psychotherapy is established. Option c is incorrect because acute stress disorder does not automatically require inpatient admission unless the patient presents with active suicidal ideation or poses a danger to others, and outpatient CBT with exposure therapy is the preferred treatment approach for this diagnosis. Option d is incorrect because sleep medication alone without psychotherapy addresses only one symptom while failing to treat the underlying tra

Correct Answer: When symptoms persist beyond one month

Option c is correct because the key diagnostic distinction between acute stress disorder and PTSD is the duration of symptoms, with acute stress disorder occurring from three days to one month post-trauma and PTSD diagnosed when symptoms persist beyond one month. Option a is incorrect because the transition from acute stress to PTSD is determined by symptom duration rather than severity, and a patient can have severe acute stress symptoms that resolve within one month without ever meeting the temporal criteria for a PTSD diagnosis. Option b is incorrect because nightmares can occur in both acute stress disorder and PTSD, and their regular occurrence does not independently determine the diagnostic transition, which is based on the one-month temporal threshold rather than the presence of specific symptoms like nightmares. Option d is incorrect because avoidance of trauma-related triggers is a feature of both acute stress disorder and PTSD, and the onset of avoidance behavior does not det

Correct Answer: Processing at the patient's own pace

Option a is correct because evidence-based trauma treatment emphasizes allowing patients to process traumatic experiences at their own pace, as forced or premature detailed processing can overwhelm coping mechanisms and potentially worsen acute stress symptoms rather than accelerating recovery. Option b is incorrect because unlimited unstructured trauma discussion without therapeutic pacing can lead to retraumatization and emotional flooding, which overwhelms the patient's coping capacity and may actually intensify intrusive symptoms rather than promoting the gradual, controlled processing needed for recovery. Option c is incorrect because complete avoidance of the traumatic topic prevents the therapeutic processing necessary for recovery and reinforces the avoidance behaviors that characterize acute stress disorder, making gradual, paced exposure the recommended approach rather than total topic avoidance. Option d is incorrect because rapid intensive exposure without adequate the