Chapter 37 — Self-Check Quiz

24 questions: multiple choice and short answer. Try them closed-book. The answer key is in the collapsed block at the bottom. The subject matter is sensitive; the questions are clinical by design.

Multiple choice

1. Forensic nursing is defined above all by: - A. Working only with deceased patients - B. Holding medical care and evidence collection as co-equal, deliberate goals of a single encounter - C. Replacing the crime laboratory - D. Performing autopsies

2. A SANE is a: - A. Crime-scene investigator - B. Registered nurse with specialized education to care for sexual-assault patients, collect evidence, and testify - C. Type of laboratory instrument - D. Police officer trained in forensics

3. "Evidence from the living" differs from evidence from a body or scene chiefly because: - A. It is always more reliable - B. The source is a person entitled to direct what is done to their body, so collection requires ongoing, revocable consent and must minimize harm - C. It never requires a chain of custody - D. It cannot be used in court

4. When the medical and evidentiary mandates appear to conflict, the forensic nurse: - A. Always prioritizes the evidence, since the case depends on it - B. Prioritizes the patient's care; the human being comes first - C. Defers to the investigating detective - D. Stops the examination entirely

5. The sexual-assault evidence kit is best described as: - A. A device that identifies the attacker automatically - B. A standardized package for collecting, labeling, and preserving evidence for possible lab analysis - C. A test that proves a crime occurred - D. A medication kit

6. A DNA profile from a kit swab that matches a suspect: - A. Proves the suspect committed a crime - B. Establishes whose biological material is present, but does not by itself establish that a crime occurred (DNA is largely silent on consent) - C. Is meaningless without a confession - D. Proves the contact was non-consensual

7. In much of the U.S., a victim may have a forensic exam and kit collected: - A. Only after agreeing to prosecute - B. Without deciding then and there whether to report to law enforcement (the kit may be stored for a statutory period) - C. Only with a court order - D. Only if visibly injured

8. Biological evidence in the kit is packaged: - A. Wet and sealed in plastic, to preserve moisture - B. Air-dried, in paper/cardboard that breathes, because moisture accelerates DNA degradation - C. Frozen at the scene without drying - D. However is fastest

9. A key fact about strangulation is that: - A. It always leaves obvious external marks - B. It can be lethal or cause serious injury with little or no external mark - C. It is never medically serious - D. It can be ruled out if the neck looks normal

10. Among the most important findings in a strangulation assessment are: - A. Only visible neck bruises - B. The patient's reported peri-event symptoms, such as loss of consciousness or loss of bladder control - C. The patient's height and weight - D. The color of the patient's clothing

11. The absence of visible injury in a sexual-assault case is: - A. Proof that no assault occurred - B. Consistent with an assault (injury is often absent); it is not exculpatory - C. Proof the contact was consensual - D. Irrelevant to anything

12. A "pattern injury" can usually support: - A. Individualizing the exact object that caused it - B. Consistency — that the injury is consistent with a kind of object or mechanism - C. The precise day the injury occurred, from its color - D. The mental state of consent

13. The kit backlog properly refers to: - A. Kits waiting their turn in an overloaded lab's queue - B. Kits collected from victims but never submitted to a laboratory for testing - C. Kits that failed testing - D. Kits that were lost in transit

14. Detroit's emblematic discovery (2009) was approximately: - A. 110 untested kits - B. 1,100 untested kits - C. 11,000 untested kits - D. 110,000 untested kits

15. Testing previously shelved backlog kits and uploading profiles to CODIS notably revealed: - A. That the kits were all useless - B. Large numbers of hits, including links exposing serial offenders across multiple cases - C. That DNA does not work on old samples - D. Nothing of investigative value

16. The chapter argues the backlog was, in significant part: - A. Purely a budgeting problem with no human cause - B. A bias failure operating at the institutional level, shaped by misconceptions about how "real" victims behave - C. Caused by the science being unreliable - D. The fault of the victims

17. Trauma-informed practice is best described as: - A. Merely being polite - B. An evidence-based approach that avoids re-traumatizing the person and, in doing so, improves the reliability of the evidence and testimony - C. A way to get victims to prosecute - D. A laboratory technique

18. Memory encoded under acute stress is typically: - A. An orderly, video-like recording - B. Fragmented and non-chronological, with vivid central details, impaired sequence, and gaps — the normal signature of traumatic memory - C. Always completely erased - D. More accurate than ordinary memory in every respect

Short answer

19. In two sentences, explain why the sexual-assault evidence kit can establish whose biological material is present yet generally cannot establish that a crime occurred.

20. Distinguish a lab delay from an untested-kit backlog, and state why the distinction matters for assigning responsibility.

21. Name three signs or reported symptoms (beyond neck marks) documented in a strangulation assessment, and state why a normal-appearing neck does not rule out serious injury.

22. A defense attorney argues that small inconsistencies in a victim's account across retellings prove fabrication. Using the neurobiology of trauma, explain what is wrong with this inference.

23. Explain the "freeze response" and why the absence of physical resistance is not consent.

24. Write one sentence an honest examiner could say on the stand about an injury finding in a sexual-assault case, and one sentence that would overstate it.

Answer key (click to expand) **Multiple choice:** 1-B · 2-B · 3-B · 4-B · 5-B · 6-B · 7-B · 8-B · 9-B · 10-B · 11-B · 12-B · 13-B · 14-C · 15-B · 16-B · 17-B · 18-B **Short answer (model points):** **19.** DNA from a kit swab can identify *whose* biological material is present (and can cleanly exclude a suspect) at a stated statistical weight, but the presence of another person's DNA is consistent with consensual contact as well as with assault. The forensic question the kit answers is usually "whose material is this?", while the legal question is "was there consent?" — and DNA is largely silent on the second. **20.** A *delay* is a kit that was submitted but is waiting in an overloaded lab's queue — a resource shortfall. A *backlog* of untested kits is evidence that was collected but *never submitted* to the lab at all — a decision (or non-decision) by the holding agency. Conflating them lets responsible parties hide a discretionary failure to submit behind the more sympathetic story of an under-resourced lab; they are different failures with different fixes. **21.** Any three, e.g.: petechiae (pinpoint hemorrhages) in the eyes/eyelids/face; voice change or hoarseness; difficulty swallowing; reported loss of consciousness; reported loss of bladder or bowel control; reported visual changes ("things went gray"). A normal-appearing neck does not rule out serious injury because strangulation injury is largely *internal* (airway, blood vessels, brain via oxygen deprivation), it takes little pressure to be dangerous, and some consequences (stroke, delayed swelling) appear hours or days later. **22.** Memory encoded under acute stress is normally fragmented, non-chronological, vivid in some central details and absent or inconsistent in peripheral ones, and recalled in pieces with gaps. A victim whose account shifts in peripheral details across retellings is behaving *exactly as the science predicts a traumatized person will* — so the inconsistencies are expected features of traumatic encoding, not evidence of lying. Treating them as ordinary contradictions misunderstands how human memory works under threat. **23.** The freeze response (sometimes called tonic immobility) is an involuntary, physiological threat response in which a person is unable to move or resist even though they wish to — as automatic as a flinch. Because it is involuntary, it is not consent and not weakness; the absence of struggle (and of struggle-related injury) is therefore not evidence that the contact was consensual. **24.** **Honest:** "The documented injuries are consistent with the history the patient gave; their presence neither proves nor disproves consent, and their absence would not have ruled out an assault." **Overstated:** "This injury proves the contact was non-consensual" (or "the absence of injury proves the contact was consensual").