# A 9-year-old presents with disclosure of sexual abuse by an adult caregiver. Which actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375143&lang=en  
> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

A 9-year-old presents with disclosure of sexual abuse by an adult caregiver. Which actions are appropriate? Select all that apply.

1

Provide a private, calm space and use trauma-informed communication

2

Offer STI testing and post-exposure prophylaxis as clinically indicated, with informed assent

3

Repeatedly question the child to clarify perpetrator details for the chart

4

Coordinate forensic examination by a pediatric SANE/SAFE within the appropriate window

5

Make a report to Child Protective Services and law enforcement as a mandatory reporter

## Explanation

Child sexual abuse care: report to CPS and law enforcement as mandatory reporter (regardless of state, regardless of perpetrator identity). Use trauma-informed care — private space, calm presence, minimal questioning to avoid retraumatization and forensic contamination. Forensic exam by trained pediatric SANE/SAFE within state-specific window (often 72-120 hours). Discuss STI testing and HIV PEP, emergency contraception per age and protocol, with informed assent of child and consent of nonperpetrator caregiver. REPEATED questioning by multiple providers re-traumatizes and undermines forensic interview by trained child interviewer.

## In-depth explanation

Acute care priorities: safety, medical stabilization, evidence preservation, mandated reporting, mental health linkage. Forensic interview by specialist (CAC) — not bedside RN.

## Clinical scenario

Disclosure within 72 hours. Child accompanied by school counselor. Mother en route.

## Key concepts

- **SANE** — Sexual Assault Nurse Examiner; specially trained for forensic and medical care.
- **child advocacy center** — Multidisciplinary center for child abuse evaluation and forensic interview.
- **retraumatization** — Re-experiencing trauma due to current interaction such as repeated questioning.

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