54 TRANSGENDER CLIENTS

Question 1

1. A nurse is reviewing the chart of a new client in the family medicine clinic and notes the client is identified as George Smith. The nurse enters the room and finds a woman in a skirt. What action by the nurse is best?
2. Apologize and declare confusion about the client.
3. Ask Mrs. Smith where her husband is right now.
4. Ask the client about preferred forms of address.
5. Explain that the chart must contain an error.

Answer 1

3.Ask the client about preferred forms of address

The nurse may encounter transgender clients whose outward appearance does not match their demographic data. In this case, the nurse should greet the client and ask the client to explain his or her preferred forms of address. Lengthy apologies can often create embarrassment. The nurse should not assume the client is not present in the room. The chart may or may not contain errors, but that is not related to determining how the client prefers to be addressed.

Question 2

2. A nurse is providing health teaching to a middle-aged male-to-female (MtF) client who has undergone gender reassignment surgery. What information is most important to this client?
3. Be sure to have an annual prostate examination.
4. Continue your normal health screenings.
5. Try to avoid being around people who are ill.
6. You should have an annual flu vaccination.

Answer 2

1.Be sure to have an annual prostate examination.

The MtF client retains the prostate, so annual screening examinations for prostate cancer remain important. The other statements are good general health teaching ideas for any client.

Question 3

3. A transgender client is taking transdermal estrogen (Climara). What assessment finding does the nurse report immediately to the provider?
4. Breast tenderness
5. Headaches
6. Red, swollen calf
7. Swollen ankles

Answer 3

3.Red, swollen calf

A red, swollen calf could be a manifestation of a deep vein thrombosis, a known side effect of estrogen. The nurse reports this finding immediately. The other manifestations are also side effects of estrogen, but do not need to be reported as a priority.

Question 4

4. A transgender client taking spironolactone (Aldactone) is in the internal medicine clinic reporting heart palpitations. What action by the nurse takes priority?
5. Draw blood to test serum potassium.
6. Have the client lie down.
7. Obtain a STAT electrocardiogram (ECG).
8. Take a set of vital signs.

Answer 4

3.Obtain a STAT electrocardiogram (ECG).
ANS: 3
Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause cardiac dysrhythmias. The nurse’s priority is to obtain an ECG, then to facilitate a serum potassium level being drawn. Having the client lie down and obtaining vital signs are also important care measures, but do not take priority.

Question 5

5. The nurse is teaching a transgender client about the medication goserelin (Zoladex). What action by the client indicates good understanding?
6. Takes a manual blood pressure
7. Administers a subcutaneous injection
8. Prepares an implanted port for IV insertion
9. States that the axillary area will be clothed

Answer 5

2. Administers a subcutaneous injectionANS: 2

Goserelin is administered via subcutaneous injection. The other

Question 6

6. A client is preparing for gender reassignment surgery and will transition from male to female. The client is worried about the voice not sounding feminine enough. What action by the nurse is best?
7. Ask if the client has considered vocal cord surgery to change the voice.
8. Refer the client for vocal therapy with speech-language pathology.
9. Teach the client that there will be no effect on the client’s voice.
10. Tell the client that the use of hormones will eventually change the voice.

Answer 6

2. Refer the client for vocal therapy with speech-language pathology.

Question 7

7. A client has returned from the postanesthesia care unit after a vaginoplasty. What comfort measure does the nurse provide for this client?
8. Apply ice to the perineum.
9. Elevate the legs on pillows.
10. Position the client on the left side.
11. Raise the head of the bed.

Answer 7

1. Apply ice to the perineum.

Question 8

8. A client had a vaginoplasty under epidural anesthetic. Which action by the nurse is most important?
9. Ensure that the urinary catheter is securely attached to the leg.
10. Instruct the client not to try to get out of bed unassisted.
11. Monitor the client’s dressings and wound drainage.
12. Position the Jackson-Pratt drain to the contralateral side.

Answer 8

2. Instruct the client not to try to get out of bed unassisted.

Question 9

9. After a vaginoplasty, what instruction by the nurse is most important?
10. Avoid vaginal douching to prevent infection.
11. Do not have sexual intercourse for at least 6 months.
12. Use oil-based lubricants with the vaginal dilators.
13. You must dilate the vagina several times a day for months.

Answer 9

4. You must dilate the vagina several times a day for months.

Question 10

10. The nurse is reviewing possible complications from a phalloplasty. What factors does the nurse include?

(Select all that apply.)

1. Infection of donor site
2. Necrosis of the neopenis
3. Rectal perforation
4. Urinary tract stenosis
5. Vaginal infections

Answer 10

1. Infection of donor site
2. Necrosis of the neopenis
3. Urinary tract stenosis

Question 11

11. A student nurse is learning about the health care needs of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients. Which terms are correctly defined? (Select all that apply.)
12. Gender dysphoria Distress caused by incongruence between natal sex and gender identity
13. Gender queer A label used when gender identity does not conform to male or female
14. Natal sex The sex one is born with or is assigned to at birth
15. Transgender A person who dresses in the clothing of the opposite sex
16. Transition The time between questioning and establishing a sexual identity

Answer 11

1. Gender dysphoria Distress caused by incongruence between natal sex and gender identity
2. Gender queer A label used when gender identity does not conform to male or female
3. Natal sex The sex one is born with or is assigned to at birth

ANS: 1, 2, 3

Question 12

12. A nurse works with many transgender clients. What routine monitoring is important for the nurse to facilitate in this population? (Select all that apply.)
13. Lipid profile
14. Liver function tests
15. Mammograms if breast tissue is present
16. Prostate-specific antigen (PSA) for natal males
17. Renal profile

Answer 12

ANS: 1, 2, 3, 4

1. Lipid profile
2. Liver function tests
3. Mammograms if breast tissue is present
4. Prostate-specific antigen (PSA) for natal males