SANE-A Certification Exam 2026: Adult/Adolescent Forensic Nurse
Examiner Practice Test — Sexual Assault Assessment, Evidence
Collection, Trauma-Informed Care, Documentation, Legal Issues &
Patient Safety — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Domain 1: Assessment and Documentation (Questions 1–61)
Question 1
A 24-year-old patient presents to the emergency department 18 hours after a reported
sexual assault. She is tearful, has difficulty maintaining eye contact, and repeatedly
apologizes for "being a burden." Which response best demonstrates trauma-informed care?
A. "You have nothing to apologize for. Let's focus on getting the exam done so you can go
home."
B. "I can see this is difficult. You are not a burden, and we will move at whatever pace feels
right for you."
C. "Why do you keep apologizing? You didn't do anything wrong."
D. "We need to complete the exam quickly to preserve evidence. Please try to stay calm."
Correct Answer: B
Explanation: Trauma-informed care validates the patient's experience without judgment,
offers control, and avoids retraumatization. Acknowledging difficulty while affirming the
patient's worth builds trust and supports autonomy.
Question 2
A SANE is assessing a 19-year-old patient who reports she was "choked" during the assault.
Which assessment finding is most concerning for strangulation?
,A. Complaint of sore throat
B. Petechiae on the soft palate
C. Mild tenderness to anterior neck
D. Hoarse voice
Correct Answer: B
Explanation: Petechiae on the soft palate or conjunctivae suggest increased intrathoracic
pressure from strangulation, a potentially life-threatening finding requiring urgent medical
evaluation and possible imaging.
Question 3
A 32-year-old patient reports the assault occurred 96 hours ago. She has not changed
clothes or showered. Which statement regarding evidence collection is most accurate?
A. Evidence collection is contraindicated after 72 hours.
B. Evidence may still be collected, but the yield of biological evidence is reduced.
C. Only clothing evidence should be collected at this time.
D. The patient should be instructed to shower before the exam to reduce contamination.
Correct Answer: B
Explanation: While the optimal window is within 72 hours, evidence can be collected beyond
that time. Biological evidence yield diminishes with time, hygiene, and elimination, but trace
evidence may persist.
Question 4
,During a medical forensic history, a patient states, "I froze. I couldn't fight back. I just let it
happen." What is the most appropriate SANE response?
A. "That is a common response. Freezing is a neurobiological survival response, not
consent."
B. "Did you try to scream or push him away?"
C. "It's important to document whether you resisted."
D. "Why do you think you didn't fight back?"
Correct Answer: A
Explanation: Tonic immobility is a common involuntary trauma response. Educating the
patient that freezing is neurobiological, not consent, reduces self-blame and corrects
misconceptions about "resistance."
Question 5
A SANE is documenting a patient's injuries. The patient has a 2 cm linear erythematous
abrasion on the right inner thigh. Which documentation method provides the most forensic
value?
A. Written description only
B. Written description with diagrammatic documentation and photograph with scale
C. Photograph without scale to avoid alarming the patient
D. Narrative description in the patient's own words only
Correct Answer: B
, Explanation: Forensic documentation should include written description, diagram, and
photograph with a scale in the same plane as the injury. This triad supports accurate
measurement and court admissibility.
Question 6
A 28-year-old patient presents after an assault and reports she was "drugged." She has
difficulty recalling events, feels drowsy, and has muscle weakness. Which specimen is the
priority for toxicology collection?
A. Hair sample
B. Oral swab
C. Urine collected as soon as possible
D. Fingernail clippings
Correct Answer: C
Explanation: Urine is the preferred specimen for detecting most drug-facilitated sexual
assault substances, including GHB, which has a short half-life. Early collection maximizes
detection.
Question 7
Which finding during anogenital examination is most consistent with acute penetrating
trauma in an adult female?
A. Smooth, symmetrical labia majora
B. A 5 mm superficial abrasion at the posterior fourchette
C. Annular hymen with no erythema
D. Vaginal rugae with normal moisture
Examiner Practice Test — Sexual Assault Assessment, Evidence
Collection, Trauma-Informed Care, Documentation, Legal Issues &
Patient Safety — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Domain 1: Assessment and Documentation (Questions 1–61)
Question 1
A 24-year-old patient presents to the emergency department 18 hours after a reported
sexual assault. She is tearful, has difficulty maintaining eye contact, and repeatedly
apologizes for "being a burden." Which response best demonstrates trauma-informed care?
A. "You have nothing to apologize for. Let's focus on getting the exam done so you can go
home."
B. "I can see this is difficult. You are not a burden, and we will move at whatever pace feels
right for you."
C. "Why do you keep apologizing? You didn't do anything wrong."
D. "We need to complete the exam quickly to preserve evidence. Please try to stay calm."
Correct Answer: B
Explanation: Trauma-informed care validates the patient's experience without judgment,
offers control, and avoids retraumatization. Acknowledging difficulty while affirming the
patient's worth builds trust and supports autonomy.
Question 2
A SANE is assessing a 19-year-old patient who reports she was "choked" during the assault.
Which assessment finding is most concerning for strangulation?
,A. Complaint of sore throat
B. Petechiae on the soft palate
C. Mild tenderness to anterior neck
D. Hoarse voice
Correct Answer: B
Explanation: Petechiae on the soft palate or conjunctivae suggest increased intrathoracic
pressure from strangulation, a potentially life-threatening finding requiring urgent medical
evaluation and possible imaging.
Question 3
A 32-year-old patient reports the assault occurred 96 hours ago. She has not changed
clothes or showered. Which statement regarding evidence collection is most accurate?
A. Evidence collection is contraindicated after 72 hours.
B. Evidence may still be collected, but the yield of biological evidence is reduced.
C. Only clothing evidence should be collected at this time.
D. The patient should be instructed to shower before the exam to reduce contamination.
Correct Answer: B
Explanation: While the optimal window is within 72 hours, evidence can be collected beyond
that time. Biological evidence yield diminishes with time, hygiene, and elimination, but trace
evidence may persist.
Question 4
,During a medical forensic history, a patient states, "I froze. I couldn't fight back. I just let it
happen." What is the most appropriate SANE response?
A. "That is a common response. Freezing is a neurobiological survival response, not
consent."
B. "Did you try to scream or push him away?"
C. "It's important to document whether you resisted."
D. "Why do you think you didn't fight back?"
Correct Answer: A
Explanation: Tonic immobility is a common involuntary trauma response. Educating the
patient that freezing is neurobiological, not consent, reduces self-blame and corrects
misconceptions about "resistance."
Question 5
A SANE is documenting a patient's injuries. The patient has a 2 cm linear erythematous
abrasion on the right inner thigh. Which documentation method provides the most forensic
value?
A. Written description only
B. Written description with diagrammatic documentation and photograph with scale
C. Photograph without scale to avoid alarming the patient
D. Narrative description in the patient's own words only
Correct Answer: B
, Explanation: Forensic documentation should include written description, diagram, and
photograph with a scale in the same plane as the injury. This triad supports accurate
measurement and court admissibility.
Question 6
A 28-year-old patient presents after an assault and reports she was "drugged." She has
difficulty recalling events, feels drowsy, and has muscle weakness. Which specimen is the
priority for toxicology collection?
A. Hair sample
B. Oral swab
C. Urine collected as soon as possible
D. Fingernail clippings
Correct Answer: C
Explanation: Urine is the preferred specimen for detecting most drug-facilitated sexual
assault substances, including GHB, which has a short half-life. Early collection maximizes
detection.
Question 7
Which finding during anogenital examination is most consistent with acute penetrating
trauma in an adult female?
A. Smooth, symmetrical labia majora
B. A 5 mm superficial abrasion at the posterior fourchette
C. Annular hymen with no erythema
D. Vaginal rugae with normal moisture
