The emergency nurse plans care for a female victim of sexual assault. Which of the following interventions should the nurse include in the care plan? Select all that apply.

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NCLEX® CHANGE AS OF 2017 - Please note that select-all-that-apply (SATA) questions on NCLEX can now include any number of correct responses. Only ONE option or up to ALL options may be correct. UWorld questions now reflect this change. Visit NCSBN® NCLEX FAQs for more information. Sexual assault, or the coercing or forcing of sexual encounters (eg, groping, rape, incest, human trafficking), may happen to any individual regardless of age, gender, ethnicity, or relationship to the perpetrator. Nurses providing emergency care should support victims' complex physical and psychosocial needs, initiate preventive and therapeutic treatments, and collect and preserve forensic evidence. Priority nursing actions include: Determining whether the client has bathed, showered, or douched, as these actions may compromise evidence (Option A) Educating the victim that a pelvic examination is recommended to identify injuries and collect evidence (Option B) Obtaining the date of the client's last menstrual period and current method of birth control to identify risk for pregnancy (Option C) Performing a head-to-toe assessment to identify physical injuries requiring treatment and thoroughly documenting all injuries on a body map (Option D) Providing prophylactic therapies for sexually transmitted infections and pregnancy (Option E) Educational objective: Emergency nursing care of sexual assault victims includes determining whether evidence has been compromised (eg, shower, bath, douche), date of the last menstrual period, and current method of birth control. The nurse should inform the client about the pelvic examination, assess and thoroughly document all physical injuries on a body map, and provide prophylactic therapies for sexually transmitted infections and pregnancy.

The Emergency Nurse Plans Care for a Female Victim of Sexual