Chapter 37 — Exercises

Work these without looking back at the chapter first; then check yourself. Items marked † have full worked solutions in the answers appendix. There are no answers in this file. The chapter's subject matter is sensitive; treat every item soberly and clinically, as the chapter does. Mix of recall, applied reasoning, evidence interpretation, "spot the overstatement," ethics, and a cold-case extension.

A. Recall and definitions

  1. Define forensic nursing in one sentence, and state the single feature that distinguishes it from both ordinary bedside nursing and from the rest of this book's (mostly post-mortem) disciplines.

  2. What does SANE stand for, and name three specific things the SANE's specialized training adds beyond general emergency nursing?

  3. † Define evidence from the living and explain how it overturns an assumption about evidence collection that held for the previous thirty-six chapters.

  4. What is the sexual-assault evidence kit, and what is the one thing it is designed to do (and the one thing it cannot do by itself)?

  5. Define strangulation findings and list four signs or reported symptoms a forensic examiner documents in a strangulation assessment that are not marks on the neck.

  6. Define trauma-informed practice and state its dual payoff (one benefit to the patient, one to the evidence).

  7. Distinguish a laboratory delay (a queued kit) from the backlog of untested kits (never submitted). Why does conflating the two let responsible parties hide?

  8. What is a SART, and what problem for the victim is it designed to reduce?

B. Applied reasoning

  1. † Explain why "medical needs first" is not only an ethical rule but frequently the route to better evidence. Use the pre-SANE emergency-department model to illustrate how poor care and poor evidence were "the same failure."

  2. A patient consents to the exam and kit but declines to report to law enforcement. Describe what happens to the kit in many U.S. jurisdictions, name the rationale (decoupling collection from the decision to prosecute), and state what storage/tracking obligation this creates.

  3. Why is the chain of custody (Chapter 2) unusually fragile for a sexual-assault kit compared with most evidence? Name the specific feature of the living-victim exam that creates the extra risk.

  4. † Explain the "dry, not wet" collection principle for biological evidence in the kit, connecting it to the lesson about plastic bags (Chapter 2) and sample integrity (Chapter 7). What degrades, and why does moisture accelerate it?

  5. A swab from a kit yields a clean DNA profile that matches a suspect at a random match probability of one in many billions. Write the single most important interpretive limitation on what this establishes about the case (as opposed to the contact).

  6. Why are older, previously untested kits more likely to present as mixtures or low-template samples (Chapter 8)? Does this make them useless? Explain.

  7. Explain how the freeze response and the absence of injury are, as the chapter puts it, "two faces of the same misconception." What is the underlying false belief?

C. Evidence interpretation

  1. † Re-read Figure 37.2 ("A neck that looks unremarkable"). The patient's neck shows little external injury. List the findings that nonetheless make a strangulation reading defensible, and explain why the reported symptoms (loss of consciousness, visual change) may matter more than the visible ones.

  2. Re-read Figure 37.3 ("An account that doesn't run in a straight line"). Identify the four features of the account that are the documented signature of traumatic memory, and state precisely what the figure says the fragmentation does and does not prove.

  3. Re-read Figure 37.1 (the chain-of-custody diagram). Trace the path of an unreported ("restricted") kit, and explain at which box "the backlog" appears and why it is drawn as a broken branch rather than a normal step.

  4. An examiner's note reads: "2 cm bruise, left upper arm, bluish, non-tender." A second note reads: "defensive injury from being grabbed by the assailant." Identify which is an observation and which is an interpretation, and explain why the distinction protects both the patient and the case.

D. Spot the overstatement / junk-science alert

  1. † A prosecutor's slide reads: "The genital injury proves the contact was non-consensual." Name the specific overstatement and rewrite it honestly. What can an injury finding support, and what can it never establish?

  2. A defense expert testifies: "There were no injuries, therefore no assault occurred (or the contact was consensual)." Explain why this inference is invalid, using the chapter's symmetric statement about the presence and absence of injury.

  3. An examiner testifies that, from a bruise's color, the injury "occurred exactly three days ago." Using the chapter's caution about bruise dating, identify the overreach and state what the examiner could honestly say instead.

  4. A television scene shows a "rape kit" tested in an afternoon, naming the attacker by the next scene. Using §37.3 and §37.5, give two reasons this is false to how kits actually function.

E. Ethics and reasoning

  1. † A forensic nurse worries that caring for and believing the patient will bias their later testimony. Using the Cognitive-Bias Watch in §37.2 (and Chapter 31), explain the actual safeguard (documenting observations vs. conclusions) and why "believing the patient" and "documenting objectively" are not in tension.

  2. The chapter argues the kit backlog was, in significant part, a bias failure operating at the institutional level. Explain how the misconceptions in §37.4 and §37.6 ("real victims fight / are injured") could translate into thousands of discretionary decisions not to submit kits.

  3. You are asked to testify that a particular injury pattern "individualizes" the object that caused it. Drawing the analogy to bite marks (Chapter 16) and bloodstain pattern analysis (Chapter 10), explain why you should decline and what you can honestly say instead.

  4. A jurisdiction proposes a law requiring every collected kit to be submitted to a lab and tracked in a system victims can access online. Explain how this addresses the bias cause of the backlog (not merely the resource cause), and why both a technical fix and a policy fix are needed together.

F. Synthesis and validity spectrum

  1. † Place these four activities on the NAS 2009 / PCAST 2016 validity spectrum (strong → overstated), justifying each: single-source DNA typing of a kit swab (Chapters 7–9); documenting the size and location of an injury; inferring the specific object that made a pattern injury; inferring non-consent from an injury.

  2. Explain how memory under stress is "a single thread" running through this chapter (§37.6), the science of eyewitness memory (Chapter 32), and false confessions (Chapter 33). What is the common underlying fact about human memory?

  3. In one paragraph, explain how this chapter advances at least two of the book's four themes (exclusion over proof; the validity spectrum; cognitive bias; the CSI effect cutting both ways). Name which themes and how.

G. Cold-case extension

  1. † Cold Case. A years-old domestic-violence report involving Dana Whitfield and Marcus Diallo surfaces when the homicide case is reopened. Write the entry you would add to the Mill Creek evidence log (Appendix I). State (a) how the report should be treated (context vs. accusation), (b) what the physical evidence establishes about Dana, (c) the honest running status, and (d) the methodological lesson about not converting a prior report of victimization into a presumption of present guilt.

  2. Cold Case extension. An investigator argues, "There was prior conflict between Dana and the victim, so we should focus on her." Using the chapter's account of institutional bias (§37.5) and the evidence-from-the-living frame, explain why this reasoning is exactly the failure the chapter dissects — and what evidence-led reasoning would do instead.

  3. Cold Case, integrative. Dana is excluded by alibi and DNA non-association (consistent with earlier chapters). Explain why the evidence-from-the-living review of the old report changes nothing about that exclusion — and, if anything, clarifies the scope of the inquiry. What would it have meant, methodologically, to let the old report reopen suspicion despite the exclusionary evidence?

H. Short writing

  1. In 150–200 words, explain to a juror why the absence of physical injury in a sexual-assault or strangulation case is not evidence that nothing happened — and why a "real victim would have fought" is a scientifically unsupported intuition.

  2. † In 150–200 words, make the chapter's central argument in your own words: that care and evidence are not a trade-off but, done well, the same thing. Use the pre-SANE model and at least one principle of trauma-informed practice to support the claim.