Interpersonal Violence: Sexual Assault, Intimate Partner Violence, and Abuse Across the Lifespan
This domain tests recognition and response across sexual assault, intimate partner violence, child and elder abuse, trafficking, and strangulation. The exam emphasizes lethality risk, mandatory reporting, and not dismissing subtle presentations.
Core concepts
- Sexual assault includes stranger and known-assailant violence; consent requires capacity and freedom from coercion.
- Screen for intimate partner violence privately, without the partner present; use a validated danger assessment.
- Strangulation is a lethality marker even without visible injury; ask open-ended questions about choking, voice change, swallowing, breathing, and incontinence.
- Child abuse and elder or vulnerable adult abuse require mandatory reporting and coordination with protective services.
- Trafficking indicators include control, debt bondage, confinement, fear, and scripted answers; do not confront a suspected trafficker.
Worked example
A patient reports that her partner "choked" her, but she has no neck marks and normal oxygen saturation. Strangulation often leaves no visible injury but can cause delayed carotid or airway death. The nurse should document symptoms, arrange urgent medical evaluation, assess lethality and safety planning, and report according to law, not dismiss the report because the examination is normal.
Traps that cost marks
- Equating no visible injury with no assault or no strangulation.
- Asking "Were you choked?" instead of open questions that elicit symptoms.
- Screening for intimate partner violence in front of the partner.
- Failing to report child or elder abuse or to recognize trafficking coercion.