Sexual Assault Nurse Examiner - Adult/Adolescent (SANE-A) Exam Review

The Sexual Assault Nurse Examiner - Adult/Adolescent certification indicates a higher level of training and specialization for those nurses who work with adult and adolescent patients who have been involved in a sexual assault. These nurses are frequently employed by hospital emergency rooms and specialty practices that treat this special patient population.

In order to take the Sexual Assault Nurse Examiner - Adult/Adolescent certification exam, the applicant must be a licensed Registered Nurse who has worked a minimum of 2 years as an RN. An accredited Sexual Assault Nurse Examiner (SANE) education course that includes either 40 continuing education hours in the classroom or three semester hours should have been completed. In addition, documentation is required that the RN has undergone supervision in clinical practice and it has been determined that he or she is competent in sexual assault practice.

The Sexual Assault Nurse Examiner - Adult/Adolescent certification exam is offered twice a year, both in the Fall, at various testing sites across the United States. The fee to take the exam is $225 for International Association of Forensic Nurses (IAFN) members and $350 for non-members.

The exam consists of 150-200 questions and the RN is allotted 4 hours in which to complete the exam. The majority of the exam tests the RN's knowledge on evaluating and managing the sexual assault patient. The exam also contains questions pertaining to the judicial process and gathering potential evidence. There are questions regarding professional practice and ethical issues as well.

The Sexual Assault Nurse Examiner - Adult/Adolescent certification is valid for 3 years. At the end of that time period, the licensed RN must have worked in the field of sexual assault nursing over the past 3 years. In addition, at least 45 continuing education hours should have been completed with at least 30 of those hours in the area of sexual assault nursing. If the continuing education hours are not completed, the RN can retake the exam in order to maintain certification. The fee for recertification is $175 for IAFN members and $300 for non-members who recertify by maintaining continuing education hours. For those RNs who wish to retake the exam for recertification, the fee is $225 for IAFN members and $350 for non-members.

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Practice Questions

1. Which of the following drug regimens are the Centers for Disease Control (CDC)-recommended antibiotic prophylaxis to prevent sexually transmitted disease in a patient who was sexually assaulted?

a. One dose of ceftriaxone 250 mg IM PLUS one dose of metronidazole 2 g PO PLUS one dose of azithromycin 1 g PO or doxycycline 100 mg PO twice daily for 7 days.
b. One dose of ceftriaxone 125 mg IM PLUS one dose of metronidazole 2 g PO.
c. One dose of benzathine penicillin G 2.4 million units.
d. Doxycycline 100 mg orally twice daily for 14 days PLUS tetracycline 500 mg four times daily for 14 days

2. Which of the following techniques should be used when collecting a saliva swab for evidence under bite mark guidelines?

a. Use one dry swab only, but avoid air-drying.
b. Use one wet swab only, air-drying for 60 seconds after swabbing.
c. Use a wet swab followed by a dry swab, but avoid air-drying.
d. Use a wet swab followed by a dry swab, air-drying both for 60 seconds after swabbing.

3. If a patient who was sexually assaulted does not recall the attack and presents with sensory distortions, hypertension, slurred speech, seizures, and numbness, which of the following is the most likely drug used to facilitate the assault?

a. Alcohol
b. Ketamine
c. GHB
d. Rohypnol

4. Which of the following statements is the BEST approach to use with a female patient who denies a sexual assault and refuses the sexual assault examination but exhibits bite marks and bruises suggestive of sexual assault?

a. "You can help to make sure other women are not assaulted."
b. "You could become pregnant or develop a sexually transmitted disease.
c. "I can provide you with medications to help prevent sexually transmitted diseases and pregnancy."
d. "I need to collect evidence as soon as possible after an assault."

5. Which of the following is the MOST important when preparing a homeless victim of sexual assault for discharge?

a. Specific directions for medication or treatments, including side effects.
b. Information sheets outlining signs for all risk factors.
c. List of safe shelters and assistance in applying for welfare assistance or Social Security.
d. Follow-up appointment dates, with physicians, labs, or other healthcare providers.

Answers & Explanations

1. A: The CDC recommends the following antibiotic prophylaxis: one dose of ceftriaxone 250 mg IM PLUS one dose of metronidazole 2 g PO PLUS one dose of azithromycin 1 g PO or doxycycline 100 mg PO twice daily for 7 days. Prophylaxis should be offered to the patient and administered during the examination. This regimen covers a broad spectrum of STDs. Patients should be counseled about the signs and symptoms of STDs as well as incubation periods.

2. D: A two-swab technique should be used to collect saliva according to bite mark guidelines. The first swab should be moistened with water, and the saliva is collected by rolling the tip of the swab over the skin in a circular motion and then allowing the swab to air dry for 60 seconds. The second swabbing is done in the same manner except the swab is dry. The second swab should also be air dried for 60 seconds, and both are placed together in a sealed envelope.

3. B: These symptoms are characteristic of ketamine ingestion. Ketamine is an anesthetic agent used primarily in veterinary medicine with a very rapid onset of action. Ketamine is produced in liquid and powder form. Victims may also report out-of-body experiences and may exhibit aggressive behavior under the influence of the drug. Motor function is impaired. In some cases, victims remain aware but cannot move or fight back to prevent the assault. In other cases, memory of the event is impaired.

4. C: The best approach to use with a patient who has suffered a probable sexual assault is to point out services that benefit the patient, such as prophylaxis to prevent STDs and pregnancy. In the aftermath of an assault, patients are often frightened, confused, and concerned with themselves more than other potential victims, so pressuring them to protect others or trying to frighten them more by suggesting they might be pregnant or develop an STD is a negative approach that may be counterproductive.

5. C: While all of these are important, patients who are homeless require further assistance with discharge, because compliance with treatment and follow-up appointments is poor in the homeless population. Interventions that are most important include:

  • Lists of safe shelters and places they can go to bathe, eat, and get mail.
  • Assistance in applying for welfare assistance or Social Security.

Discharge planning should begin on admission and must be a joint effort so that the transfer and discharge documents provide the information that the individual needs.

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Last Updated: 12/29/2017


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