The nurse in the emergency department is documenting the appearance and care provided to a victim of rape. Which statement should the nurse include when documenting this care?

A) Victim has blood stains on both inner thighs.
B) Victim claims to be raped but does not appear fearful or traumatized.
C) Victim handling the incident well by talking with the male police officers.
D) Victim wearing provocative low-cut lace blouse and bra and short skirt with high heels.


A
Feedback:
When documenting the care and condition of a victim of rape, the nurse needs to be certain that statements are accurate and unbiased. The nurse should describe the victim's appearance in unbiased detail, including the presence and location of injuries. Making a statement such as "victim claims to be raped but does not appear fearful or traumatized" is a biased statement. The statement that the victim is handling the incident well by talking with male police officers and using the word "provocative" when describing the victim's clothing are biased statements and should not be a part of the medical record.

Nursing

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