ACTUAL SEXUAL ASSAULT NURSE
EXAMINER (SANE-A®/SANE-P®)
CERTIFICATION| RATIONALES BASED ON
THE CFNC TEST HIGH-QUALITY EXAM
QUESTIONS WITH ANSWERS
1. During a medical forensic examination, the patient asks the SANE, "Do you believe
me?" What is the most appropriate response?
a. "It's not my job to decide whether I believe you or not."
b. "I believe you, and I'm here to support you."
c. "That's a question for the police."
d. "Why would you think I wouldn't believe you?"
Answer: b. "I believe you, and I'm here to support you."
Rationale: Expressing belief and support is therapeutic and validates the patient's experience.
Many victims fear they will not be believed. The SANE's role is to provide nonjudgmental,
supportive care, not to investigate or determine credibility .
2. The SANE is documenting findings from the medical forensic examination.
Which documentation practice is most consistent with forensic nursing standards?
a. Documenting only injuries that are clearly visible
b. Using subjective terms like "small" or "large" to describe findings
c. Using objective, descriptive language, including measurements and body diagrams
,d. Documenting opinions about how injuries occurred
Answer: c. Using objective, descriptive language, including measurements and body
diagrams
Rationale: Forensic documentation must be objective, accurate, and descriptive.
Measurements, body diagrams, and photographs provide clear documentation. Subjective terms
and opinions about causation are inappropriate and may not be admissible in court
.
3. A patient presents for a sexual assault forensic examination 72 hours after the assault.
Which medication should the SANE discuss with the patient for sexually transmitted
infection (STI) prophylaxis?
a. Metronidazole only
b. Ceftriaxone, azithromycin, and metronidazole (CDC-recommended regimen) c. Acyclovir
d. No prophylaxis is needed after 72 hours
Answer: b. Ceftriaxone, azithromycin, and metronidazole (CDC-recommended regimen)
*Rationale: CDC guidelines recommend presumptive STI prophylaxis for sexual assault patients,
including ceftriaxone (gonorrhea), azithromycin (chlamydia), and metronidazole
(trichomoniasis). This regimen is effective even beyond 72 hours, though timing for HIV PEP is
more time-sensitive .*
4. A patient presents 4 hours after a sexual assault and requests emergency contraception.
Which medication is most commonly used?
a. Metformin
b. Levonorgestrel (Plan B) or ulipristal acetate (Ella)
,c. Medroxyprogesterone acetate
d. Oral contraceptive pills taken for 21 days
Answer: b. Levonorgestrel (Plan B) or ulipristal acetate (Ella)
Rationale: Emergency contraception options include levonorgestrel (effective up to 72 hours)
and ulipristal acetate (effective up to 120 hours). The SANE should discuss options, efficacy, and
side effects, and offer pregnancy testing before administration .
5. A patient who experienced sexual assault reports that the perpetrator may have used a
"date rape drug." Which specimen is most important to collect for toxicology testing?
a. Blood and urine, collected as soon as possible
b. Only blood
c. Only urine
d. Hair samples only
Answer: a. Blood and urine, collected as soon as possible
*Rationale: Many drugs used in drug-facilitated sexual assault (e.g., GHB, benzodiazepines) are
rapidly metabolized and cleared from the body. Blood and urine should be collected as soon as
possible, ideally within 96 hours. The SANE should follow jurisdictional protocols for
toxicology collection and chain of custody .*
6. The SANE is conducting a medical forensic examination on a patient who reports a
sexual assault that occurred 6 hours ago. The patient is tearful and avoids eye contact.
Which nursing approach is most consistent with traumainformed care?
a. Proceed quickly through the examination to minimize the patient's distress
b. Explain each step before performing it and offer the patient choices whenever possible
c. Ask detailed questions about the assault to ensure all forensic evidence is collected
, d. Have multiple staff members present to provide emotional support
Answer: b. Explain each step before performing it and offer the patient choices whenever
possible
Rationale: Trauma-informed care emphasizes safety, trustworthiness, choice, collaboration, and
empowerment. Explaining procedures and offering choices restores a sense of control to the
patient who experienced powerlessness during the assault. Moving quickly, asking detailed
questions without preparation, or having multiple strangers present can retraumatize the patient
.
7. According to the IAFN SANE Education Guidelines, which of the following is an
essential component of the SANE's role in caring for patients who have experienced
interpersonal violence?
a. Investigating the crime to determine what happened
b. Providing comprehensive, patient-centered care that addresses medical, forensic, and
psychological needs
c. Determining whether the patient is telling the truth about the assault
d. Ensuring the patient presses charges against the perpetrator
Answer: b. Providing comprehensive, patient-centered care that addresses medical,
forensic, and psychological needs
Rationale: The SANE's role is to provide holistic care that addresses the patient's medical needs
(injuries, prophylaxis), forensic needs (evidence collection), and psychological needs (crisis
intervention, support). Investigation and determination of truth are the roles of law enforcement
and the legal system .
EXAMINER (SANE-A®/SANE-P®)
CERTIFICATION| RATIONALES BASED ON
THE CFNC TEST HIGH-QUALITY EXAM
QUESTIONS WITH ANSWERS
1. During a medical forensic examination, the patient asks the SANE, "Do you believe
me?" What is the most appropriate response?
a. "It's not my job to decide whether I believe you or not."
b. "I believe you, and I'm here to support you."
c. "That's a question for the police."
d. "Why would you think I wouldn't believe you?"
Answer: b. "I believe you, and I'm here to support you."
Rationale: Expressing belief and support is therapeutic and validates the patient's experience.
Many victims fear they will not be believed. The SANE's role is to provide nonjudgmental,
supportive care, not to investigate or determine credibility .
2. The SANE is documenting findings from the medical forensic examination.
Which documentation practice is most consistent with forensic nursing standards?
a. Documenting only injuries that are clearly visible
b. Using subjective terms like "small" or "large" to describe findings
c. Using objective, descriptive language, including measurements and body diagrams
,d. Documenting opinions about how injuries occurred
Answer: c. Using objective, descriptive language, including measurements and body
diagrams
Rationale: Forensic documentation must be objective, accurate, and descriptive.
Measurements, body diagrams, and photographs provide clear documentation. Subjective terms
and opinions about causation are inappropriate and may not be admissible in court
.
3. A patient presents for a sexual assault forensic examination 72 hours after the assault.
Which medication should the SANE discuss with the patient for sexually transmitted
infection (STI) prophylaxis?
a. Metronidazole only
b. Ceftriaxone, azithromycin, and metronidazole (CDC-recommended regimen) c. Acyclovir
d. No prophylaxis is needed after 72 hours
Answer: b. Ceftriaxone, azithromycin, and metronidazole (CDC-recommended regimen)
*Rationale: CDC guidelines recommend presumptive STI prophylaxis for sexual assault patients,
including ceftriaxone (gonorrhea), azithromycin (chlamydia), and metronidazole
(trichomoniasis). This regimen is effective even beyond 72 hours, though timing for HIV PEP is
more time-sensitive .*
4. A patient presents 4 hours after a sexual assault and requests emergency contraception.
Which medication is most commonly used?
a. Metformin
b. Levonorgestrel (Plan B) or ulipristal acetate (Ella)
,c. Medroxyprogesterone acetate
d. Oral contraceptive pills taken for 21 days
Answer: b. Levonorgestrel (Plan B) or ulipristal acetate (Ella)
Rationale: Emergency contraception options include levonorgestrel (effective up to 72 hours)
and ulipristal acetate (effective up to 120 hours). The SANE should discuss options, efficacy, and
side effects, and offer pregnancy testing before administration .
5. A patient who experienced sexual assault reports that the perpetrator may have used a
"date rape drug." Which specimen is most important to collect for toxicology testing?
a. Blood and urine, collected as soon as possible
b. Only blood
c. Only urine
d. Hair samples only
Answer: a. Blood and urine, collected as soon as possible
*Rationale: Many drugs used in drug-facilitated sexual assault (e.g., GHB, benzodiazepines) are
rapidly metabolized and cleared from the body. Blood and urine should be collected as soon as
possible, ideally within 96 hours. The SANE should follow jurisdictional protocols for
toxicology collection and chain of custody .*
6. The SANE is conducting a medical forensic examination on a patient who reports a
sexual assault that occurred 6 hours ago. The patient is tearful and avoids eye contact.
Which nursing approach is most consistent with traumainformed care?
a. Proceed quickly through the examination to minimize the patient's distress
b. Explain each step before performing it and offer the patient choices whenever possible
c. Ask detailed questions about the assault to ensure all forensic evidence is collected
, d. Have multiple staff members present to provide emotional support
Answer: b. Explain each step before performing it and offer the patient choices whenever
possible
Rationale: Trauma-informed care emphasizes safety, trustworthiness, choice, collaboration, and
empowerment. Explaining procedures and offering choices restores a sense of control to the
patient who experienced powerlessness during the assault. Moving quickly, asking detailed
questions without preparation, or having multiple strangers present can retraumatize the patient
.
7. According to the IAFN SANE Education Guidelines, which of the following is an
essential component of the SANE's role in caring for patients who have experienced
interpersonal violence?
a. Investigating the crime to determine what happened
b. Providing comprehensive, patient-centered care that addresses medical, forensic, and
psychological needs
c. Determining whether the patient is telling the truth about the assault
d. Ensuring the patient presses charges against the perpetrator
Answer: b. Providing comprehensive, patient-centered care that addresses medical,
forensic, and psychological needs
Rationale: The SANE's role is to provide holistic care that addresses the patient's medical needs
(injuries, prophylaxis), forensic needs (evidence collection), and psychological needs (crisis
intervention, support). Investigation and determination of truth are the roles of law enforcement
and the legal system .
