Intimate Partner Violence and Sexual Assault: Recognition, Safety, Documentation, and Reporting Practice Questions

25 multiple-choice questions on Intimate partner violence and sexual assault: recognition, safety, documentation, and reporting for paramedic and EMT students, from Chapter 46 (Patients With Special Challenges). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Intimate partner violence is best defined as:

   1. A. Any assault that occurs inside a private home
   2. B. Violence committed by a stranger during a robbery
   3. C. Abuse by a current or former partner or spouse
   4. D. Physical fights between adult siblings or roommates
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   Answer: C. Abuse by a current or former partner or spouse

   IPV is physical, sexual, or psychological harm by a current or former intimate partner, whether or not they live together. Location alone does not define it; an assault by a stranger at home is not IPV.

2. The three-phase cycle of violence described in many abusive relationships consists of:

   1. A. Denial, bargaining, and acceptance of the abuse
   2. B. Isolation, exploitation, and financial dependence
   3. C. Verbal threats, stalking, and eventual separation
   4. D. Tension building, battering, and reconciliation
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   Answer: D. Tension building, battering, and reconciliation

   Tension builds, an explosive battering incident follows, then a 'honeymoon' or reconciliation phase of apology and calm keeps the victim in the relationship. Denial, bargaining, and acceptance are stages of grief, not the cycle of violence.

3. A 31-year-old woman who says she tripped has bruises on her chest, breasts, and abdomen, but none on her hands, knees, or face. This pattern most suggests:

   1. A. A typical forward fall onto a hard floor
   2. B. Abuse aimed at areas clothing will hide
   3. C. A bleeding disorder causing easy bruising
   4. D. Seat belt injury from a minor car crash
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   Answer: B. Abuse aimed at areas clothing will hide

   Abusers often strike the chest, breasts, abdomen, back, and upper arms, places that clothing covers, so the injuries stay hidden; a story that does not fit the pattern adds to the concern. Interview her privately and document each injury objectively. A forward fall injures the hands, wrists, knees, and often the face or chin, which are uninjured here. A bleeding disorder or anticoagulant causes bruising in many places, including the limbs, and does not explain why only covered areas are hurt, although you should still ask about blood thinners. A seat belt leaves a band across the chest and lower abdomen after a crash, and she reports no crash. (Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

4. A 22-year-old woman with lower abdominal pain says her boyfriend flushes her birth control pills and refuses to use condoms because he wants her pregnant. This behavior is best described as:

   1. A. Reproductive coercion, a form of IPV
   2. B. A normal disagreement about family plans
   3. C. A religious choice she should respect
   4. D. A concern once she becomes pregnant
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   Answer: A. Reproductive coercion, a form of IPV

   Interfering with contraception, pressuring someone into pregnancy, or controlling pregnancy outcomes is reproductive coercion, a recognized form of intimate partner violence that often occurs alongside physical abuse. Consider pregnancy, including ectopic pregnancy, in her assessment, talk with her privately, and offer IPV resources. Destroying her pills is control, not a normal disagreement. Nothing suggests a shared religious choice; the decision is being forced on her. It is harmful now, not only once she becomes pregnant. (ACOG Committee Opinion 554; CDC.)

5. You are treating a woman with facial injuries when her partner becomes loud and threatening toward your crew. Your priority is to:

   1. A. Restrain the partner until police arrive
   2. B. Continue care and ignore the partner's threats
   3. C. Tell the partner you are reporting him to police
   4. D. Retreat to safety and request law enforcement
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   Answer: D. Retreat to safety and request law enforcement

   Crew safety comes first: leave or stage until police control the scene, taking the patient with you if you safely can. Physically restraining or confronting the abuser exposes the crew to injury and is a police function.

6. A woman says her husband choked her with both hands 30 minutes ago. She now speaks clearly, but her voice is slightly hoarse and it hurts to swallow. You should:

   1. A. Transport, because airway swelling can be delayed
   2. B. Release her on scene, since she is speaking normally
   3. C. Advise her to apply ice and follow up tomorrow
   4. D. Recheck her voice in an hour before deciding
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   Answer: A. Transport, because airway swelling can be delayed

   Strangulation can cause delayed laryngeal edema, carotid dissection, and stroke even when the patient looks well; hoarseness and painful swallowing are red flags. Normal speech now does not exclude airway swelling over the next several hours.

7. Which period carries the highest risk of serious injury or homicide for a victim of intimate partner violence?

   1. A. During the reconciliation phase of the cycle
   2. B. In the first week after the couple marries
   3. C. When the victim leaves or tries to leave
   4. D. After the abuser enters a treatment program
   Show answer

   Answer: C. When the victim leaves or tries to leave

   Separation is the most dangerous time because the abuser senses a loss of control, which is why safety planning matters. The reconciliation phase is relatively calm, which is what makes the cycle hard to break.

8. Which finding in an IPV victim's history indicates a higher risk of lethal violence?

   1. A. The victim is employed outside the home
   2. B. The abuser has access to a firearm
   3. C. The couple has been together for many years
   4. D. The victim has called police in the past
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   Answer: B. The abuser has access to a firearm

   Abuser access to a gun is one of the strongest predictors of IPV homicide and a key question in lethality assessments. Prior calls to police do not lower the risk; they often reflect an escalating pattern.

9. A 38-year-old woman who uses a power wheelchair says her husband takes the chair's battery and hides her medications when he is angry. This behavior is best described as:

   1. A. A normal dispute over shared property
   2. B. A form of intimate partner violence
   3. C. Emotional abuse but not true IPV
   4. D. Stress-related anger, not abuse
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   Answer: B. A form of intimate partner violence

   Controlling a partner's access to mobility aids, medications, or personal care is a recognized form of intimate partner violence, and people with disabilities experience IPV at higher rates than others. Interview her privately, document her words, offer accessible resources, and follow your reporting law, since many states also cover abuse of dependent adults. The chair is her means of moving, not ordinary shared property. IPV is not limited to hitting; controlling, emotional, and economic abuse by a partner are all forms of IPV. Stress may be real but does not excuse removing her mobility and medications. (Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

10. After you transport a woman injured by her boyfriend, a man phones your station, says he is her brother, and asks which hospital she went to. You should:

    1. A. Tell him, since he says he is family
    2. B. Give the hospital but not her condition
    3. C. Decline to share her information
    4. D. Ask him to describe her injuries first
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    Answer: C. Decline to share her information

    Her destination is protected health information under HIPAA, and you cannot verify who is calling; abusers sometimes pose as relatives to find a partner who has left. Decline politely and suggest the caller contact the hospital, which can check with the patient. Saying he is family does not prove it or give him a right to the information. The hospital's name alone could lead an abuser straight to her. Asking him to describe her injuries does not confirm his identity and may reveal more than you learn. (HIPAA Privacy Rule, 45 CFR 164.510; Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

11. Laws on reporting intimate partner violence against a competent adult:

    1. A. Are identical in every state and require police contact
    2. B. Are set by one federal law rather than by states
    3. C. Forbid a report unless the victim signs a written consent
    4. D. Vary by state, so you must know your local requirements
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    Answer: D. Vary by state, so you must know your local requirements

    Reporting rules for injuries in a competent adult differ by state. A few states, such as California and Colorado, require health care providers to report domestic violence injuries to police; many require reports only of gunshot, stab, or other assault injuries; others leave the choice to the patient, and the laws differ on which providers they cover. Know your state law and agency protocol. The rules are not identical, and most states do not require police contact for every adult IPV injury. No single federal law sets adult IPV reporting; it is state law. No law forbids a required report because the victim has not signed consent. Child abuse reporting is mandatory in every state and elder abuse reporting in nearly all, but adult IPV rules are not uniform. (Houry 2002; Futures Without Violence compendium.)

12. A woman who discloses abuse wants the domestic violence hotline number, but she says her partner checks her phone and her purse. The best way to give her the information is to:

    1. A. Ask her what way would be safe for her
    2. B. Enter the hotline in her phone contacts
    3. C. Put a printed brochure in her purse
    4. D. Mail the brochure to her home address
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    Answer: A. Ask her what way would be safe for her

    Abusers often monitor phones, mail, and belongings, and the survivor knows best what is safe: memorizing the number, keeping a small card somewhere else, or saving it under a code name. A hotline entry in her phone can be found and can trigger more violence. A brochure in a purse he checks carries the same risk. Mail to the home may be opened by the partner. The National Domestic Violence Hotline is 1-800-799-7233, and survivors can text START to 88788. (National Domestic Violence Hotline, safety planning.)

13. A 40-year-old man has scratches on his face and a bite mark on his forearm. He quietly says his wife did it. You should:

    1. A. Assume the injuries came from a fight with another man
    2. B. Treat it as possible IPV, as with a female victim
    3. C. Note it as mutual combat since he is larger
    4. D. Treat the wounds but leave his statement out
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    Answer: B. Treat it as possible IPV, as with a female victim

    Men, including those in same-sex relationships, are IPV victims too and are often reluctant to disclose because of stigma. Labeling it mutual combat because of his size dismisses his disclosure, and assuming a fight with another man ignores what he told you. His own words belong in the report, quoted accurately, and the bite mark needs wound care because human bites infect easily.

14. Regarding intimate partner violence in same-sex relationships, it is true that:

    1. A. It occurs at least as often as in other couples
    2. B. It does not meet the legal definition of IPV
    3. C. It is usually mutual and therefore not reportable
    4. D. It seldom involves any serious physical injury
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    Answer: A. It occurs at least as often as in other couples

    Surveys show IPV in LGBTQ relationships at rates equal to or higher than in heterosexual couples, and victims may face extra barriers such as fear of being outed. It meets the same definitions and causes the same injuries.

15. You need to remove the clothing of a woman who was sexually assaulted to assess an injury. To help preserve evidence, you should:

    1. A. Cut directly through the torn areas
    2. B. Shake the clothing out before bagging
    3. C. Rinse visible stains off the fabric
    4. D. Cut around holes, tears, or stains
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    Answer: D. Cut around holes, tears, or stains

    Holes, tears, and stains can hold evidence such as fibers, fluids, or marks from a weapon, so cut around them, place each item in its own paper bag, and give the bags to police or the hospital. Cutting through torn areas destroys that evidence. Shaking clothing scatters hairs and fibers. Rinsing stains washes away biological evidence. Life-saving care always comes first. (DOJ National Protocol for Sexual Assault Medical Forensic Examinations.)

16. A woman whose partner has hit her in the head many times over several years now has frequent headaches, poor concentration, and memory problems. You should consider:

    1. A. Normal stress from the relationship
    2. B. Early-onset Alzheimer disease
    3. C. Brain injury from repeated blows
    4. D. Side effects of her birth control
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    Answer: C. Brain injury from repeated blows

    Repeated blows to the head and nonfatal strangulation cause traumatic brain injury in many IPV survivors, and it is often missed; headaches, poor concentration, and memory loss are typical. Assess for new deficits, document, and make sure the receiving staff know. Stress alone does not explain cognitive deficits after years of head trauma. Early-onset Alzheimer disease is rare and does not fit this history. Hormonal contraception does not cause memory loss. (CDC, IPV and TBI.)

17. A woman who was sexually assaulted 3 hours ago wants a medical exam but is not ready to talk to police. You should tell her that:

    1. A. The exam requires a police report first
    2. B. She must decide about police before transport
    3. C. She can have the exam without a police report
    4. D. Evidence kits are collected by EMS on scene
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    Answer: C. She can have the exam without a police report

    Federal law (the Violence Against Women Act) requires states to make sure survivors can receive a forensic medical exam at no cost and without having to report to or cooperate with police; evidence can be stored while she decides. A police report is therefore not a precondition for the exam. She does not have to decide about police before you transport her. Evidence kits are collected by trained examiners, often a SANE, at the hospital, not by EMS. (VAWA, 34 USC 10449; DOJ National Protocol.)

18. A man who was sexually assaulted 6 hours ago asks about medicine to prevent HIV. You should know that HIV post-exposure prophylaxis works best when started:

    1. A. Within 7 days of the assault
    2. B. As soon as possible, within 72 hours
    3. C. After his HIV test comes back positive
    4. D. Two weeks later, once symptoms appear
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    Answer: B. As soon as possible, within 72 hours

    Nonoccupational HIV post-exposure prophylaxis is started as soon as possible and no later than 72 hours after the exposure, because its benefit falls with every hour of delay; transport promptly and tell the hospital that he is asking for it. Seven days is outside the window. PEP prevents infection, so waiting for a positive test would turn prevention into treatment. Waiting for symptoms misses the window entirely. Male survivors need the same care as female survivors. (CDC nPEP guidelines.)

19. A 16-year-old girl says her boyfriend checks her phone constantly, tracks her location, and shoved her into a wall last week. She says, 'It's not abuse, we're just dating.' You should recognize this as:

    1. A. Normal jealousy in a new relationship
    2. B. Not abuse, since she has no lasting injuries
    3. C. A school discipline issue, not a medical one
    4. D. Teen dating violence, a form of IPV
    Show answer

    Answer: D. Teen dating violence, a form of IPV

    Controlling behavior such as monitoring a phone or tracking location, combined with physical violence, is dating violence even between teens. It is common and raises the risk of injury, depression, and suicide. Treat her injuries, speak with her privately, share resources, and follow mandatory reporting rules for minors. Abuse does not require visible injury.

20. Common reasons that IPV victims stay in an abusive relationship include:

    1. A. Financial dependence and fear of retaliation
    2. B. A lack of any injuries severe enough to report
    3. C. Belief that the abuse is mutual and harmless
    4. D. Legal rules that prevent them from leaving
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    Answer: A. Financial dependence and fear of retaliation

    Victims stay because of money, children, housing, isolation from support, and fear that leaving will make the violence worse. Judging the patient for staying discourages her from seeking help later.

21. At an IPV call, you notice two young children in the home who watched the assault. You should:

    1. A. Note them in the report but take no action
    2. B. Report concern for the children as required
    3. C. Ask the injured mother whether to report it
    4. D. Take the children to the hospital without permission
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    Answer: B. Report concern for the children as required

    Children exposed to IPV are at risk of abuse and neglect, and many states treat exposure as reportable to child protective services. Noting the children without acting does not meet a reporting duty, and the decision to report does not depend on a parent's permission. Removing the children without legal authority is not the crew's role; police and child protective services decide where they stay.

22. Which statement about intimate partner violence is correct?

    1. A. It occurs in all income, age, and ethnic groups
    2. B. It occurs mainly in low-income families
    3. C. It is limited to couples who are legally married
    4. D. It is seldom the reason for an EMS call
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    Answer: A. It occurs in all income, age, and ethnic groups

    IPV crosses every socioeconomic, age, racial, and religious group, and it affects dating, cohabiting, and former partners as well as spouses. Assuming it happens only in certain groups causes providers to miss it.

23. A woman with a split lip asks you not to write down that her partner hit her because she is afraid he will read the report. You should:

    1. A. Leave out the cause of the injury to honor her request
    2. B. Tell the hospital verbally but leave it off the report
    3. C. Write that the cause of the injury is unknown
    4. D. Record it accurately and explain it is confidential
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    Answer: D. Record it accurately and explain it is confidential

    The patient care report must be accurate, and it is a protected medical record that her partner cannot simply obtain; explaining this may ease her fear. Writing that the cause is unknown when she told you otherwise is inaccurate, and a verbal handoff alone leaves no record. An accurate report could help her later in court.

24. A woman says her partner choked her until she nearly passed out an hour ago. You find no marks on her neck. You should know that:

    1. A. No marks means the choking was brief and minor
    2. B. Marks should be visible within 30 minutes
    3. C. Many strangled patients have no visible marks
    4. D. Without marks, transport is not needed
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    Answer: C. Many strangled patients have no visible marks

    In large case reviews, about half of strangled women had no visible neck injury, and many more had marks too faint to photograph. Nearly losing consciousness means a serious strangulation, with risk of delayed airway swelling, carotid dissection, and stroke, so transport and document her symptoms. A lack of marks says nothing about how long or how hard she was choked. Bruising can take hours or days to appear, or never appear. Transport is indicated because of the mechanism and her near loss of consciousness, not because of visible marks. (Strack 2001; Training Institute on Strangulation Prevention.)

25. A 33-year-old woman who says she was 'pushed around' has bruises along the outer (ulnar) surfaces of both forearms. These are most likely:

    1. A. Defensive injuries from blocking blows
    2. B. Injuries from falling onto outstretched hands
    3. C. Bruising from a tight blood pressure cuff
    4. D. Pressure from gripping a steering wheel
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    Answer: A. Defensive injuries from blocking blows

    Raising the arms to shield the face exposes the ulnar forearms to blows, so bruising there suggests defense against an attacker. A fall onto outstretched hands injures the palms and wrists instead.