Comprehensive Advanced Practice Examination for Sexual
Assault Nurse Examiner (SANE) Competency: Forensic Evidence
Collection, Medicolegal Principles, and Trauma-Informed Care
Across Adult and Pediatric Populations
Section 1: Foundational Principles & Trauma-Informed Care (Questions 1–25)
1. A 16-year-old patient presents after an alleged assault but refuses a full examination, only agreeing to let you collect
oral swabs. Which trauma-informed action is most appropriate?
A) Inform the patient that incomplete evidence may weaken prosecution
B) Perform only the consented procedures and document refusal of other components
C) Contact law enforcement to mandate a full exam
D) Proceed with a limited exam but collect additional specimens if the patient appears unsure
Correct Answer: B
Rationale: Trauma-informed care respects patient autonomy and consent. Performing only consented procedures,
documenting refusals, and avoiding coercion is essential. Mandating or proceeding beyond consent re-traumatizes.
2. Which statement best reflects the sanctuary model of trauma-informed care in a SANE program?
A) Focus exclusively on physical evidence collection
B) Create a physically and emotionally safe environment where the patient can regain control
C) Prioritize law enforcement needs over patient comfort
D) Use a single fixed protocol for all ages and genders
Correct Answer: B
Rationale: The sanctuary model emphasizes safety, emotional regulation, and shared governance, helping patients
move from victim to survivor.
3. A SANE notices a patient dissociating during the anogenital examination. What is the priority action?
A) Continue the exam quickly to finish
B) Stop, reorient the patient, and ask permission to proceed
C) Call a psychiatrist immediately
D) Document dissociation as non-compliance
Correct Answer: B
Rationale: Dissociation is a common trauma response. The SANE must pause, reorient, and re-establish consent.
Continuing without acknowledgment worsens trauma.
4. Which is a key component of a trauma-informed medical history taking?
A) Asking leading questions to clarify details
B) Starting with “Why didn’t you fight back?” to assess resistance
C) Using open-ended questions like “Can you tell me what happened?”
D) Having law enforcement present during the history
,Correct Answer: C
Rationale: Open-ended questions allow the patient to share what they choose without feeling judged or guided.
Leading or blame-oriented questions are contraindicated.
5. A 7-year-old discloses sexual abuse during a SANE exam. The child becomes tearful and says, “I want my mom.” The
mother is in the waiting room. What should the SANE do?
A) Continue the exam to avoid delaying evidence collection
B) Stop, bring the mother in if the child assents, and delay non-urgent portions
C) Tell the child that mom cannot come in due to evidence contamination
D) Ask the child to describe the abuse again to confirm details
Correct Answer: B
Rationale: Pediatric SANE exams prioritize emotional safety. Halting, supporting caregiver presence (when appropriate
and if not the alleged perpetrator), and resuming with child’s assent is trauma-informed.
6. A SANE is conducting a telehealth follow-up with an adult sexual assault survivor. Which action best demonstrates
trauma-informed care?
A) Asking the patient to recount the assault in full detail
B) Telling the patient they should report to police immediately
C) Offering choices about discussing symptoms, referrals, or forensic follow-up
D) Recording the conversation without explicit consent for “quality assurance”
Correct Answer: C
Rationale: Telehealth trauma-informed care emphasizes choice and control. Offering agenda-setting respects
autonomy. Recording requires specific consent.
7. According to the National Protocol for Sexual Assault Medical Forensic Examinations (adult/adolescent), the SANE’s
primary role is:
A) Investigator and advocate
B) Healthcare provider and forensic evidence collector
C) Law enforcement liaison and detective
D) Psychotherapist and case manager
Correct Answer: B
Rationale: The SANE functions as both a clinician (treating injuries, STI prophylaxis) and a neutral forensic evidence
collector, not an investigator or therapist.
8. Which patient statement indicates a potential barrier to trauma-informed care due to institutional betrayal?
A) “I don’t remember everything that happened.”
B) “Last time I went to a hospital, they didn’t believe me.”
C) “I want a rape kit done but I’m not sure about calling police.”
D) “Can I have a female examiner?”
Correct Answer: B
Rationale: Institutional betrayal refers to harm caused by an institution that fails to protect or believe survivors. Prior
negative healthcare experiences create distrust.
9. A SANE is examining a transgender male (female-to-male, no gender-affirming surgery) after an assault. Which
, approach is trauma-informed?
A) Use only male pronouns as the patient identifies as male
B) Ask the patient “What terms do you use for your body parts?”
C) Insist on using anatomical terms like “vagina” to avoid confusion
D) Skip the genital exam if the patient seems uncomfortable
Correct Answer: B
Rationale: Asking preferred terminology respects identity and reduces dysphoria. Avoiding assumptions and
individualizing care is essential.
10. A SANE documents “patient declined HIV PEP” without exploring reasons. This violates which principle?
A) Beneficence
B) Informed consent and shared decision-making
C) Non-maleficence only
D) Forensic chain of custody
Correct Answer: B
Rationale: Informed consent includes discussing risks/benefits of PEP. Simply documenting refusal without counseling
fails the standard of care.
11. What is the recommended response when a child makes a spontaneous disclosure of abuse during a non-forensic
interview portion of the exam?
A) Ask detailed follow-up questions to clarify
B) Listen, do not interrogate, and document the exact statement
C) Immediately call child protective services
D) Ask the caregiver to leave the room for more disclosure
Correct Answer: B
Rationale: SANEs document verbatim disclosures without leading questions. Detailed forensic interviewing is done by
specialized child interviewers.
12. Which is a red flag for possible trafficking in an adolescent presenting for a SANE exam?
A) Patient has a government ID
B) Patient has a tattoo of a name on the neck
C) Patient is accompanied by an unrelated adult who answers questions for them
D) Patient refuses a chaperone
Correct Answer: C
Rationale: A controlling unrelated adult answering for the patient is concerning for trafficking. Tattoos may be
branding but alone are not diagnostic.
13. The SANE is preparing to collect evidence from a patient who is intoxicated but conscious and able to
communicate. The patient says “I don’t know—just do what you need to.” The SANE should:
A) Proceed because implied consent is sufficient
B) Stop and re-assess capacity; explain each step and obtain explicit verbal consent
C) Have law enforcement obtain a warrant
D) Proceed but document “patient unable to consent”
Correct Answer: B
Assault Nurse Examiner (SANE) Competency: Forensic Evidence
Collection, Medicolegal Principles, and Trauma-Informed Care
Across Adult and Pediatric Populations
Section 1: Foundational Principles & Trauma-Informed Care (Questions 1–25)
1. A 16-year-old patient presents after an alleged assault but refuses a full examination, only agreeing to let you collect
oral swabs. Which trauma-informed action is most appropriate?
A) Inform the patient that incomplete evidence may weaken prosecution
B) Perform only the consented procedures and document refusal of other components
C) Contact law enforcement to mandate a full exam
D) Proceed with a limited exam but collect additional specimens if the patient appears unsure
Correct Answer: B
Rationale: Trauma-informed care respects patient autonomy and consent. Performing only consented procedures,
documenting refusals, and avoiding coercion is essential. Mandating or proceeding beyond consent re-traumatizes.
2. Which statement best reflects the sanctuary model of trauma-informed care in a SANE program?
A) Focus exclusively on physical evidence collection
B) Create a physically and emotionally safe environment where the patient can regain control
C) Prioritize law enforcement needs over patient comfort
D) Use a single fixed protocol for all ages and genders
Correct Answer: B
Rationale: The sanctuary model emphasizes safety, emotional regulation, and shared governance, helping patients
move from victim to survivor.
3. A SANE notices a patient dissociating during the anogenital examination. What is the priority action?
A) Continue the exam quickly to finish
B) Stop, reorient the patient, and ask permission to proceed
C) Call a psychiatrist immediately
D) Document dissociation as non-compliance
Correct Answer: B
Rationale: Dissociation is a common trauma response. The SANE must pause, reorient, and re-establish consent.
Continuing without acknowledgment worsens trauma.
4. Which is a key component of a trauma-informed medical history taking?
A) Asking leading questions to clarify details
B) Starting with “Why didn’t you fight back?” to assess resistance
C) Using open-ended questions like “Can you tell me what happened?”
D) Having law enforcement present during the history
,Correct Answer: C
Rationale: Open-ended questions allow the patient to share what they choose without feeling judged or guided.
Leading or blame-oriented questions are contraindicated.
5. A 7-year-old discloses sexual abuse during a SANE exam. The child becomes tearful and says, “I want my mom.” The
mother is in the waiting room. What should the SANE do?
A) Continue the exam to avoid delaying evidence collection
B) Stop, bring the mother in if the child assents, and delay non-urgent portions
C) Tell the child that mom cannot come in due to evidence contamination
D) Ask the child to describe the abuse again to confirm details
Correct Answer: B
Rationale: Pediatric SANE exams prioritize emotional safety. Halting, supporting caregiver presence (when appropriate
and if not the alleged perpetrator), and resuming with child’s assent is trauma-informed.
6. A SANE is conducting a telehealth follow-up with an adult sexual assault survivor. Which action best demonstrates
trauma-informed care?
A) Asking the patient to recount the assault in full detail
B) Telling the patient they should report to police immediately
C) Offering choices about discussing symptoms, referrals, or forensic follow-up
D) Recording the conversation without explicit consent for “quality assurance”
Correct Answer: C
Rationale: Telehealth trauma-informed care emphasizes choice and control. Offering agenda-setting respects
autonomy. Recording requires specific consent.
7. According to the National Protocol for Sexual Assault Medical Forensic Examinations (adult/adolescent), the SANE’s
primary role is:
A) Investigator and advocate
B) Healthcare provider and forensic evidence collector
C) Law enforcement liaison and detective
D) Psychotherapist and case manager
Correct Answer: B
Rationale: The SANE functions as both a clinician (treating injuries, STI prophylaxis) and a neutral forensic evidence
collector, not an investigator or therapist.
8. Which patient statement indicates a potential barrier to trauma-informed care due to institutional betrayal?
A) “I don’t remember everything that happened.”
B) “Last time I went to a hospital, they didn’t believe me.”
C) “I want a rape kit done but I’m not sure about calling police.”
D) “Can I have a female examiner?”
Correct Answer: B
Rationale: Institutional betrayal refers to harm caused by an institution that fails to protect or believe survivors. Prior
negative healthcare experiences create distrust.
9. A SANE is examining a transgender male (female-to-male, no gender-affirming surgery) after an assault. Which
, approach is trauma-informed?
A) Use only male pronouns as the patient identifies as male
B) Ask the patient “What terms do you use for your body parts?”
C) Insist on using anatomical terms like “vagina” to avoid confusion
D) Skip the genital exam if the patient seems uncomfortable
Correct Answer: B
Rationale: Asking preferred terminology respects identity and reduces dysphoria. Avoiding assumptions and
individualizing care is essential.
10. A SANE documents “patient declined HIV PEP” without exploring reasons. This violates which principle?
A) Beneficence
B) Informed consent and shared decision-making
C) Non-maleficence only
D) Forensic chain of custody
Correct Answer: B
Rationale: Informed consent includes discussing risks/benefits of PEP. Simply documenting refusal without counseling
fails the standard of care.
11. What is the recommended response when a child makes a spontaneous disclosure of abuse during a non-forensic
interview portion of the exam?
A) Ask detailed follow-up questions to clarify
B) Listen, do not interrogate, and document the exact statement
C) Immediately call child protective services
D) Ask the caregiver to leave the room for more disclosure
Correct Answer: B
Rationale: SANEs document verbatim disclosures without leading questions. Detailed forensic interviewing is done by
specialized child interviewers.
12. Which is a red flag for possible trafficking in an adolescent presenting for a SANE exam?
A) Patient has a government ID
B) Patient has a tattoo of a name on the neck
C) Patient is accompanied by an unrelated adult who answers questions for them
D) Patient refuses a chaperone
Correct Answer: C
Rationale: A controlling unrelated adult answering for the patient is concerning for trafficking. Tattoos may be
branding but alone are not diagnostic.
13. The SANE is preparing to collect evidence from a patient who is intoxicated but conscious and able to
communicate. The patient says “I don’t know—just do what you need to.” The SANE should:
A) Proceed because implied consent is sufficient
B) Stop and re-assess capacity; explain each step and obtain explicit verbal consent
C) Have law enforcement obtain a warrant
D) Proceed but document “patient unable to consent”
Correct Answer: B
