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SANE-A practice questions

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Question 1SANE Role, Scope of Practice, and Professional Issues

Which action best describes the core function of the sexual assault nurse examiner (SANE) role?

  1. Conducting the forensic exam and evidence collection Correct answer.
  2. Providing long-term psychotherapy for survivors of assault
  3. Determining whether a suspect should be charged with assault
  4. Serving as the lead investigator in a criminal case

Explanation

The SANE combines clinical assessment, forensic documentation, evidence collection, and trauma-informed care. Long-term psychotherapy, criminal investigation, and charging decisions fall outside the SANE scope of practice.

Question 2SANE Role, Scope of Practice, and Professional Issues

An adult patient discloses a recent sexual assault and states she does not want police involved. What is the SANE's most appropriate action?

  1. Tell the patient she must file a report before evidence can be collected
  2. Refuse to perform the examination unless police are notified
  3. Report to law enforcement without the patient's consent regardless of age
  4. Respect the adult's decision while offering advocacy and resources Correct answer.

Explanation

For a competent adult, reporting is generally the patient's choice, and the medical-forensic examination can proceed without a police report. Mandatory reporting laws apply to minors and certain vulnerable adults, not to all adults.

Question 3SANE Role, Scope of Practice, and Professional Issues

During evidence collection, a SANE transfers a sealed envelope containing swabs to the investigating detective. Which documentation element is essential to maintain chain of custody?

  1. The name of the suspect
  2. The patient's insurance information
  3. The estimated cost of the evidence kit
  4. Date, time, and signature of each handler Correct answer.

Explanation

Chain of custody requires an unbroken, documented record of every person who handled the evidence and when. Insurance details, suspect identity, and kit cost are not components of the chain of custody.

Question 4SANE Role, Scope of Practice, and Professional Issues

A patient arrives after a sexual assault and is visibly intoxicated but conversant. What is the SANE's initial priority regarding consent?

  1. Obtain consent from the patient's spouse
  2. Assess capacity and obtain informed consent Correct answer.
  3. Proceed with the exam because evidence may be lost
  4. Wait 24 hours before requesting consent

Explanation

Informed consent is required before examination and evidence collection. The SANE assesses the patient's decision-making capacity; intoxication requires evaluation but does not automatically eliminate capacity.

Question 5SANE Role, Scope of Practice, and Professional Issues

Which statement accurately describes the SANE-A certification?

  1. A certification for RNs who examine adolescent and adult patients Correct answer.
  2. A license issued by state boards of nursing
  3. A certification limited to pediatric patients
  4. Required to practice as a forensic nurse in every state

Explanation

SANE-A is a certification for registered nurses who examine adolescent and adult patients; the pediatric credential is SANE-P. It is a certification rather than a state license, and practice requirements vary by jurisdiction.

Question 6SANE Role, Scope of Practice, and Professional Issues

A SANE is asked to serve as both the medical examiner and the victim's personal advocate during the same case. What is the best response?

  1. Ask the patient to choose which role the nurse should perform
  2. Clarify role boundaries and maintain forensic objectivity Correct answer.
  3. Accept both roles because continuity improves care
  4. Delegate the forensic exam to a non-clinical staff member

Explanation

Combining forensic examiner and personal advocate roles can create conflicts and undermine objectivity. Clear role boundaries and separate advocacy services protect both the patient and the integrity of the case.

Question 7SANE Role, Scope of Practice, and Professional Issues

During testimony, an attorney asks the SANE to give an opinion about whether the patient was truthful. What is the most appropriate response?

  1. State a definitive opinion based on the patient's demeanor
  2. Refuse to answer any questions from the attorney
  3. Explain that credibility is for the jury; testify to findings Correct answer.
  4. Ask the judge to answer the question on the nurse's behalf

Explanation

SANE testimony addresses clinical findings and the nursing process, not witness credibility. Offering an opinion on truthfulness exceeds the forensic nursing role and invades the jury's province.

Question 8SANE Role, Scope of Practice, and Professional Issues

Which documentation practice best supports forensic accuracy?

  1. Using vague descriptors to avoid legal scrutiny
  2. Summarizing the patient's statement without quotation marks
  3. Documenting objective findings, quoted statements, and times Correct answer.
  4. Recording only findings that support the patient's account

Explanation

Forensic documentation should be objective, detailed, and verifiable, including exact quotations and timing of collection. Selective or vague documentation undermines accuracy and credibility.

Question 9SANE Role, Scope of Practice, and Professional Issues

Which team member is primarily responsible for coordinating victim advocacy and community resources after a sexual assault?

  1. The rape crisis advocate Correct answer.
  2. The forensic laboratory technician
  3. The SANE
  4. The prosecuting attorney

Explanation

Rape crisis advocates provide emotional support, resource coordination, and ongoing advocacy. The SANE focuses on medical-forensic care, while attorneys and laboratory personnel have distinct roles.

Question 10SANE Role, Scope of Practice, and Professional Issues

A police officer requests the patient's medical record without a warrant or patient authorization. What is the SANE's best action?

  1. Ask the officer to sign a blank release form
  2. Provide only the patient's address and phone number
  3. Explain that a warrant, court order, or authorization is required Correct answer.
  4. Release the entire record because police requests override privacy

Explanation

Protected health information requires legal authority or patient authorization before release. The SANE follows HIPAA and state law and discloses only what is legally required.

Question 11SANE Role, Scope of Practice, and Professional Issues

Which approach best reflects trauma-informed care during a SANE examination?

  1. Keeping the patient's support person out of the room to preserve privacy
  2. Requiring the patient to describe the assault repeatedly to each clinician
  3. Completing the exam quickly to minimize discussion
  4. Explaining each step and offering choices before procedures Correct answer.

Explanation

Trauma-informed care emphasizes safety, choice, collaboration, and transparency. Repeated retelling and exclusion of a chosen support person can retraumatize the patient.

Question 12SANE Role, Scope of Practice, and Professional Issues

A patient presents with a severe head injury and altered mental status after an assault. What is the SANE's priority?

  1. Obtaining a detailed history before any treatment
  2. Ensuring medical stabilization before forensic examination Correct answer.
  3. Calling the police before medical stabilization
  4. Proceeding with the forensic evidence kit first

Explanation

Life-threatening medical needs take priority over forensic evidence collection. The SANE ensures stabilization and triage, then coordinates forensic steps when the patient is stable.

Question 13SANE Role, Scope of Practice, and Professional Issues

Which organization publishes the Sexual Assault Nurse Examiner Education Guidelines and standards of practice?

  1. NIJ
  2. IAFN Correct answer.
  3. AMA
  4. Joint Commission

Explanation

The International Association of Forensic Nurses publishes SANE education guidelines and standards of practice. The AMA, Joint Commission, and NIJ have different professional or regulatory roles.

Question 14SANE Role, Scope of Practice, and Professional Issues

Which requirement is typically part of maintaining SANE-A certification?

  1. Earning continuing education for recertification Correct answer.
  2. Holding a master's degree in forensic science
  3. Retaking the certification exam every year
  4. Practicing only in an emergency department

Explanation

Certification maintenance generally involves continuing education and periodic recertification. Annual re-examination, a forensic science master's degree, and a single practice setting are not standard requirements.

Question 15SANE Role, Scope of Practice, and Professional Issues

A rural hospital without a SANE on site requests a remote forensic consultation. Which practice is most appropriate?

  1. Document the consultation and clarify limits of remote guidance Correct answer.
  2. The local nurse should perform the exam without documentation
  3. The consulting SANE should direct evidence collection without reviewing any records
  4. The patient should be transferred solely to complete the kit

Explanation

Telehealth consultation can support care but requires clear documentation and acknowledgment of the limits of remote guidance. Directing collection without records or transferring solely for kit completion is not best practice.

Question 16SANE Role, Scope of Practice, and Professional Issues

A 15-year-old patient requests confidential care and asks the SANE not to notify her parents. What is the SANE's most appropriate action?

  1. Follow state law on adolescent consent and reporting Correct answer.
  2. Refuse to examine the patient until a parent arrives
  3. Notify the parents immediately without further assessment
  4. Promise absolute confidentiality to the patient

Explanation

Adolescent consent and parental notification rules vary by state. The SANE must know and follow applicable law and explain the limits of confidentiality honestly.

Question 17SANE Role, Scope of Practice, and Professional Issues

Which factor is most important when deciding whether to collect forensic evidence after a sexual assault?

  1. Time elapsed and jurisdictional guidelines Correct answer.
  2. The patient's marital status
  3. The patient's occupation
  4. Whether the patient has health insurance

Explanation

Evidence collection decisions depend on the time since the assault, the type of contact, and local protocols. Demographic factors such as marital status, insurance, and occupation are irrelevant.

Question 18SANE Role, Scope of Practice, and Professional Issues

What is the SANE's primary role in legal proceedings related to a sexual assault case?

  1. To testify about the examination and findings Correct answer.
  2. To represent the patient as legal counsel
  3. To negotiate a plea agreement
  4. To determine the suspect's guilt

Explanation

SANEs testify as fact and expert witnesses about clinical findings and documentation. They do not decide guilt, provide legal representation, or negotiate pleas.

Question 19SANE Role, Scope of Practice, and Professional Issues

A SANE program notices inconsistent documentation of injury descriptions. Which action best reflects quality improvement?

  1. Removing injury documentation from the record
  2. Disciplining the nurse with the fewest documented injuries
  3. Asking patients to write their own injury descriptions
  4. Auditing charts and standardizing documentation training Correct answer.

Explanation

Quality improvement uses systematic review and education to standardize practice and improve outcomes. Discipline without analysis, removing documentation, and shifting documentation to patients are inappropriate.

Question 20SANE Role, Scope of Practice, and Professional Issues

A patient who speaks limited English presents for a forensic exam. What is the most appropriate action?

  1. Use the patient's child as an interpreter
  2. Proceed without an interpreter and rely on gestures
  3. Ask a bystander in the waiting room to interpret
  4. Arrange a qualified medical interpreter Correct answer.

Explanation

Qualified interpreters support informed consent and accurate communication. Children, bystanders, and gestures are not appropriate substitutes for language-concordant care.

Question 21Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

At which site is the hymen located?

  1. At the vaginal introitus, within the vestibule Correct answer.
  2. Along the anterior vaginal wall behind the urethra
  3. At the apex of the vagina, encircling the cervix
  4. Between the labia majora and the mons pubis

Explanation

The hymen is a thin fold of tissue at the vaginal introitus that separates the vaginal lumen from the vestibule. Its appearance varies widely among adolescents, and it is normally not a complete barrier. It is not located at the vaginal apex or along the vaginal wall.

Question 22Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which vaginal fornix is deepest and lies adjacent to the rectouterine pouch?

  1. The lateral fornix, which lies near the ureters
  2. The posterior fornix, adjacent to the rectouterine pouch Correct answer.
  3. The inferior fornix, which lies near the perineal body
  4. The anterior fornix, which rests against the bladder base

Explanation

The posterior fornix is the deepest of the vaginal fornices and is separated from the rectouterine pouch (pouch of Douglas) only by vaginal wall and peritoneum. This relationship is why free pelvic fluid can be sampled through the posterior fornix.

Question 23Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

In a typical adolescent girl, menarche occurs approximately how long after thelarche (breast budding)?

  1. Menarche usually precedes thelarche
  2. About 2 to 2.5 years Correct answer.
  3. About 5 to 6 years
  4. About 6 months

Explanation

Breast budding is usually the first sign of puberty in girls, and menarche follows roughly 2 to 2.5 years later, after the peak of the growth spurt. This predictable interval helps clinicians gauge whether pubertal progress is normal.

Question 24Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Ovulation is triggered by which hormonal event?

  1. A fall in follicle-stimulating hormone at midcycle
  2. A gradual decline in estradiol across the follicular phase
  3. A sustained rise in progesterone from the corpus luteum
  4. A midcycle surge of luteinizing hormone Correct answer.

Explanation

Peak estradiol from the mature follicle produces positive feedback that generates the midcycle LH surge, which induces ovulation roughly 24 to 36 hours later. Progesterone dominance and corpus luteum function occur after ovulation, not before it.

Question 25Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A client reports clear, stretchy vaginal discharge at midcycle. This finding is best explained by which change?

  1. Falling luteinizing hormone dries the mucus
  2. Progesterone thickens and reduces cervical mucus
  3. Rising estradiol increases mucus elasticity Correct answer.
  4. Follicular atresia reduces cervical gland secretions

Explanation

Estrogen dominance in the late follicular phase produces abundant, clear, elastic cervical mucus (spinnbarkeit) that facilitates sperm transport. After ovulation, progesterone converts the mucus to a scant, thick plug.

Question 26Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

How does the vaginal pH of a prepubertal girl typically compare with that of a reproductive-age woman?

  1. It is more acidic because of higher lactobacilli counts
  2. It is strongly alkaline because of cervical mucus secretion
  3. It is higher, because estrogen and glycogen are low Correct answer.
  4. It is identical because vaginal pH does not change with age

Explanation

Before puberty, low estrogen means little glycogen in the vaginal epithelium, so lactobacilli are sparse and pH is closer to neutral or slightly alkaline. At puberty, estrogen-driven glycogen supports lactobacilli and lowers pH to about 3.8 to 4.5.

Question 27Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which statement correctly contrasts the internal and external anal sphincters?

  1. The external sphincter is smooth muscle under autonomic control
  2. Both sphincters are smooth muscle supplied by the pudendal nerve
  3. The external sphincter is skeletal muscle under voluntary control Correct answer.
  4. The internal sphincter is skeletal muscle under voluntary control

Explanation

The internal anal sphincter is a continuation of the circular smooth muscle of the rectum and is involuntary. The external anal sphincter is striated skeletal muscle innervated by the pudendal nerve and is under voluntary control.

Question 28Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which structure does the male urethra pass through immediately after leaving the bladder?

  1. The membranous urethra
  2. The prostate gland Correct answer.
  3. The bulb of the penis
  4. The corpus spongiosum

Explanation

The male urethra has four segments in order: prostatic, membranous, bulbous, and penile (spongy). The prostatic urethra traverses the prostate gland directly after the bladder neck.

Question 29Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Lymph from most of the vulva drains primarily to which node group?

  1. The para-aortic nodes via the ovarian vessels
  2. The deep pelvic (internal iliac) nodes directly
  3. The superficial inguinal nodes Correct answer.
  4. The presacral nodes

Explanation

The vulva drains mainly to the superficial inguinal nodes, which is why inguinal evaluation matters in vulvar disease. Only the clitoris and glans may drain directly to deep inguinal or pelvic nodes, and the ovaries drain to para-aortic nodes.

Question 30Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

The internal pudendal artery primarily supplies which region?

  1. The upper vagina and cervix
  2. The uterine fundus and ovaries
  3. The perineum and external genitalia Correct answer.
  4. The bladder dome and urachus

Explanation

The internal pudendal artery, a branch of the internal iliac artery, supplies the perineum, external genitalia, and the anal canal below the pectinate line. The uterus and upper vagina are supplied by the uterine artery.

Question 31Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

The pudendal nerve, which carries somatic sensation from the vulva, arises from which spinal levels?

  1. Ventral rami of L4 through S1
  2. Ventral rami of T10 through L1
  3. Ventral rami of S1 through S3
  4. Ventral rami of S2 through S4 Correct answer.

Explanation

The pudendal nerve arises from the ventral rami of S2, S3, and S4 and supplies sensation to the vulva, perineum, and lower anal canal. It also carries motor fibers to the external anal and urethral sphincters.

Question 32Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A client reports being choked during an assault and now has a hoarse voice and neck pain. Which finding is most concerning for internal airway injury?

  1. A single 1-cm bruise on the forearm
  2. A complaint of a mild headache
  3. Anxiety and tearfulness during the interview
  4. Stridor with difficulty swallowing Correct answer.

Explanation

Stridor, dysphagia, and voice change suggest laryngeal edema or structural injury and warrant urgent medical evaluation. External neck bruising is often absent in strangulation, so symptoms carry important diagnostic weight.

Question 33Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

An adolescent assault survivor has a heart rate of 118 beats/min, blood pressure 108/86 mm Hg, and cool extremities. These findings are most consistent with which stage of shock?

  1. Irreversible shock with loss of consciousness
  2. Neurogenic shock with warm, dry skin
  3. Compensated shock with narrowed pulse pressure Correct answer.
  4. Septic shock with a widened pulse pressure

Explanation

Early hypovolemic shock produces tachycardia, cool clammy skin, and a narrowed pulse pressure as vasoconstriction preserves systolic pressure. Measurable hypotension is a late, decompensated finding.

Question 34Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A client asks how old a bruise on the inner thigh is. What is the most accurate response about dating bruises?

  1. Color change varies widely and cannot date a bruise Correct answer.
  2. Color reliably dates the bruise to within one hour
  3. Yellow color indicates injury within the past 12 hours
  4. Bruises should never be described in the record

Explanation

Bruise color cannot be used to assign a precise age because it depends on depth, skin tone, body location, and individual healing. Documentation should describe size, color, shape, and location without stating an estimated age.

Question 35Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

The labia majora are embryologically homologous to which male structure?

  1. The penile shaft
  2. The glans penis
  3. The prostate gland
  4. The scrotum Correct answer.

Explanation

In the absence of androgen, the labioscrotal swellings develop into the labia majora; with androgen they fuse to form the scrotum. The genital tubercle gives rise to the glans clitoris or glans penis.

Question 36Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which hormonal pattern is expected in a postmenopausal woman who is not using hormone therapy?

  1. Low estradiol with elevated FSH and LH Correct answer.
  2. Elevated estradiol with low FSH and LH
  3. Low FSH with normal cyclic progesterone
  4. High progesterone with low gonadotropins

Explanation

After follicular depletion, the ovary produces little estradiol and inhibin, removing negative feedback on the pituitary. Gonadotropins rise markedly, with FSH typically higher than LH.

Question 37Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

The axillary tail of Spence is best described as which structure?

  1. A pad of fat overlying the sternum
  2. A lymphatic channel draining to parasternal nodes
  3. A separate glandular structure within the pectoralis major
  4. Breast tissue that extends into the axilla Correct answer.

Explanation

The axillary tail of Spence is normal breast tissue that projects through the axillary fascia into the axilla. It can be mistaken for a mass or lymphadenopathy and is a recognized site of ectopic breast tissue.

Question 38Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Neisseria gonorrhoeae and Chlamydia trachomatis primarily infect which cervical cell type?

  1. Squamous epithelial cells of the ectocervix
  2. Columnar epithelial cells of the endocervix Correct answer.
  3. Fibroblasts of the cervical stroma
  4. Basal cells of the vaginal epithelium

Explanation

Both organisms attach to columnar epithelium of the endocervix and transformation zone. Adolescents often have a larger area of cervical ectopy, which increases susceptibility to infection.

Question 39Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Pelvic inflammatory disease most commonly develops by which mechanism?

  1. Ascending infection from the lower genital tract Correct answer.
  2. Direct extension from the urinary bladder
  3. Hematogenous spread from a distant skin infection
  4. Lymphatic spread from the inguinal nodes

Explanation

PID usually results from ascending spread of organisms such as chlamydia, gonorrhea, and anaerobes from the cervix and vagina into the endometrium, tubes, and peritoneum. This ascent explains the role of lower tract infection in tubal damage and infertility.

Question 40Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Approximately how long is the adult anal canal?

  1. About 0.5 centimeters
  2. About 4 centimeters Correct answer.
  3. About 8 centimeters
  4. About 12 centimeters

Explanation

The anal canal measures roughly 3 to 5 cm, extending from the anorectal junction at the puborectalis to the anal verge. The pectinate line within it divides visceral (insensate) from somatic (sensitive) portions.

Question 41Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which structures make up the erectile tissue of the clitoris?

  1. Paired crura and bulbs with a glans Correct answer.
  2. The bulbocavernosus muscles alone
  3. The labia minora and posterior fourchette
  4. The periurethral and Skene glands

Explanation

The clitoris comprises a glans, a body formed by two corpora cavernosa that diverge as the crura, and the vestibular bulbs (corpora spongiosa) lying beneath the labia minora. The bulbs are continuous with the glans and engorge with arousal.

Question 42Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

An adolescent reports heavy menstrual bleeding since menarche and frequent nosebleeds. Which underlying condition should be considered first?

  1. von Willebrand disease Correct answer.
  2. Chronic pelvic inflammatory disease
  3. Endometriosis of the posterior cul-de-sac
  4. Polycystic ovary syndrome

Explanation

Heavy menses beginning at menarche plus mucocutaneous bleeding such as epistaxis suggests an inherited bleeding disorder. von Willebrand disease is the most common inherited bleeding disorder and is a classic cause of this presentation.

Question 43Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A client presents 8 hours after a possible drug-facilitated assault and GHB exposure is suspected. Which specimen is most likely to remain useful for detection?

  1. Serum, because GHB persists in blood for days
  2. Hair, because GHB deposits within 12 hours
  3. Urine, because GHB is excreted in urine Correct answer.
  4. Saliva, because GHB concentrates in saliva

Explanation

GHB has a short half-life, so blood levels become difficult to interpret within about 6 to 8 hours, while urine may remain positive for roughly 12 hours or occasionally longer. Hair requires weeks of growth and cannot document a single recent exposure.

Question 44Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which set of vital signs is within normal limits for a resting 15-year-old?

  1. Heart rate 72, respirations 16, BP 112/68 Correct answer.
  2. Heart rate 52, respirations 10, BP 150/95
  3. Heart rate 130, respirations 26, BP 90/50
  4. Heart rate 100, respirations 28, BP 140/90

Explanation

Typical adolescent resting values are a heart rate of about 60 to 100, respiratory rate of 12 to 20, and blood pressure below the 95th percentile for age, sex, and height. The other sets show tachycardia, bradycardia with tachypnea, or hypertension.

Question 45Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A 16-year-old presents 4 days after unprotected intercourse and declines a copper IUD. Which option is most appropriate for emergency contraception?

  1. Combined oral contraceptive pills started at the next menses
  2. Medroxyprogesterone injection given immediately
  3. Ulipristal acetate 30 mg taken now Correct answer.
  4. Levonorgestrel 1.5 mg taken 10 days after intercourse

Explanation

Ulipristal acetate 30 mg is effective for up to 120 hours after unprotected intercourse, as is the copper IUD. Levonorgestrel is labeled for up to 72 hours and is less effective near ovulation and in individuals with higher body weight.

Question 46Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

In most females, which physical change is typically the first sign of puberty?

  1. Peak height velocity
  2. Breast budding Correct answer.
  3. Pubic hair growth
  4. First menstrual period

Explanation

Thelarche (breast budding) is usually the earliest pubertal event in females, typically appearing between ages 8 and 13. Pubic hair and menarche follow, with menarche occurring roughly 2 to 2.5 years after breast budding. Peak height velocity occurs later in the pubertal sequence, after breast and pubic hair development are underway.

Question 47Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

Which structure lies immediately posterior to the pubic symphysis and anterior to the vagina?

  1. The urinary bladder Correct answer.
  2. The sigmoid colon
  3. The rectum
  4. The uterus

Explanation

The bladder sits in the anterior pelvis directly behind the pubic symphysis and in front of the anterior vaginal wall. This relationship matters clinically, since a full bladder can alter pelvic examination findings and is prone to injury during anterior vaginal or urethral trauma.

Question 48Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A 16-year-old rests supine for five minutes. Blood pressure is 118/74 mm Hg with a pulse of 72. After standing for two minutes, blood pressure is 96/70 mm Hg with a pulse of 94. Which interpretation is most accurate?

  1. Findings are within normal limits for age
  2. Orthostatic hypotension is present Correct answer.
  3. The readings indicate hypovolemic shock
  4. The readings suggest a vasovagal response

Explanation

Orthostatic hypotension is defined as a fall of at least 20 mm Hg systolic or 10 mm Hg diastolic within three minutes of standing; here the systolic pressure fell 22 mm Hg. A rise in heart rate of 20 beats/min or more with standing also supports reduced intravascular volume. These findings warrant evaluation for bleeding, dehydration, or other causes of volume loss.

Question 49Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A 19-year-old reports progressively worsening dysmenorrhea, deep dyspareunia, and chronic pelvic pain. Examination reveals a fixed, retroverted uterus and tender nodularity along the uterosacral ligaments. Which condition is most likely?

  1. Endometriosis Correct answer.
  2. Primary dysmenorrhea
  3. Bacterial vaginosis
  4. Ovarian torsion

Explanation

Cyclic pain, deep dyspareunia, a fixed retroverted uterus, and nodular uterosacral ligaments are classic exam features of endometriosis, in which ectopic endometrial tissue causes inflammation and scarring. Primary dysmenorrhea produces cramping with menses but no structural exam findings. Imaging or laparoscopy is generally needed to confirm the diagnosis.

Question 50Anatomy, Physiology, and Patient Assessment (Adult and Adolescent)

A 20-year-old with a complete T4 spinal cord injury develops a pounding headache and facial flushing during a speculum examination. Blood pressure is 178/104 mm Hg (baseline 104/66 mm Hg) and pulse is 52. Which explanation is most likely?

  1. A vasovagal response to anxiety
  2. Orthostatic hypotension from positioning
  3. A migraine headache unrelated to the injury
  4. Autonomic dysreflexia triggered by the examination Correct answer.

Explanation

In injuries at T6 or above, a noxious stimulus below the level of injury, such as speculum insertion or vaginal distension, can trigger a massive sympathetic discharge with severe hypertension, pounding headache, flushing, and compensatory bradycardia. The examination should be paused and the stimulus removed while the blood pressure is managed. This is a medical emergency.