MS exam 1: Chapter 73
A client has been prescribed goserelin (Zoladex). The nurse is reviewing discharge teaching with the client. Which statement by the client indicates a need for further teaching? a. "I must call 9-1-1 right away if I have chest pain." b. "This medicine goes deep into my muscle." c. "I will be careful when I dispose of my needles." d. "I'll want to keep an eye on my heart rate and follow up with my primary health care provider."
B
A client has returned to the floor after a vaginoplasty. Which assessment finding would concern the nurse? a. Edema of the perineum b. Drainage in the Jackson-Pratt drain c. Numbness in the right leg d. Request for pain medication every 4 hours
C
From what age may a child begin to feel a sense of maleness or femaleness? a. Birth b. 6 months c. 2 years d. 5 years
C
what does gender dysphoria mean?
Emotional or psychological distress caused by an incongruence between one's natal (birth) sex and gender identity
why do male to female transgender patients take 5-alpha-reductase inhibitors (Proscar)?
-BPH (non-transitioning patients) -lowers testosterone and shrinks the prostate
what should you do if you call your patient by the wrong pronoun?
-apologize and correct yourself -move on, do not continue apologizing
what should you ask a transgender patient during their health history?
-ask about interventions a transgender patient has used (if any), or if there are plans to use them in the future -inquire about the use of drug therapy -record any surgical history -to help increase the patient's comfort with examinations and the purpose of the assessment, explain why the information or examination is important to their health care -do you live part time or full time in this gender role?
what are the interventions for transgender people who experience gender dysphoria?
-changes in gender expression that may involve living part time or full time in another gender role -psychotherapy to explore gender identity and expression, improve body image, or strengthen coping mechanisms -hormone therapy to feminize or masculinize the body -surgery to change primary and/or secondary sex characteristics (breasts/chest, facial features, internal and/or external genitalia)
what laboratory/imaging studies are needs with feminizing drugs?
-chemistry panel (including glucose and electrolytes) -liver function tests -lipid profile -complete blood count -prostate-specific antigen (PSA) if recommended for age group -mammogram (when breast tissue develops) -pap smear (if vagina present)
what surgeries do male to female patients need to get?
-clitoralplasty (creating labia and vulva) -vaginoplasty (creating a vagina) -breast augmentation -voice surgery (reduce size of thyroid to decrease the size of the Adam's apple) -penectomy (removal of the penis) -orchiectomy (taking off the scrotum)
what is the criteria for hormone therapy?
-continuing/documented gender dysphoria -ability to make fully informed decision/consent -older than 18 -stable medical/mental problems, if any
what are the psychosocial concerns for transgender patients?
-depression -PTSD -stress -vulnerability to bias-related violence and verbal harassment, including threats and intimidation
what are the non-surgical options for transgender patients?
-drug therapy -voice or communication therapy -reproductive health options
what are the side effects of testosterone?
-edema -acne -seborrhea (oily skin) -headache -weight gain -possible psychotic symptoms
what are the expected physical changes of feminizing drugs?
-enlargement of breast tissue (gynecomastia) -decreased testicular size -decreased erectile function -decreased libido (sex drive) -decreased body hair growth -decreased male pattern baldness -increased fat compared with muscle -softening of the skin
what medications are male to female transgender patients put on?
-estrogen or androgen-reducing agents (blocks testosterone) -spironolactone -5-alpha-reductase inhibitors (Proscar) -BnRH agonists (Zoladex):
what health risks can estrogen cause?
-estrogen-dependent cancers, hypertension, gallbladder disease, and VTE (DVT- redness, warmth, pain, swelling) -you need to look for these and educate your patient to be looking for these
what are the barriers to care for transgender patients?
-fear of lack of respect and understanding -lack of health insurance -lack of knowledge by provider (some transgender patients have to educate their providers before receiving care)
what are the side effects of estrogen?
-headache -breast tenderness -N/V -weight gain or loss
what post-vaginoplasty care needs to be done for your transgender patient?
-ice to the perineum for comfort and pain control -self-care instructions: ~instructions to dilate the new vagina several times a day for months after the procedure with a water-based lubricant or with sexual intercourse ~douche regularly after intercourse to avoid infections ~foley care (catheter stays in for 7-10 days post-op)
what are the complications of a phalloplasty?
-infection -scarring of donor site -necrosis of the new penis -stenosis of the urinary tract
why do male to female transgender patients take BnRH agonists (Zoladex)?
-inhibits release of FSH and LH -subQ injection (need to teach patients how to do these injections, need to numb the area before injection)
why do male to female transgender patients take spironolactone and what do you need to educate them about when taking this med?
-inhibits testosterone secretion and inhibits androgen binding receptor -watch for hyperkalemia and educate the patient to avoid excess potassium -if your patient is hyperkalemic, put them on a heart monitor -teach them to monitor their BP
what laboratory/imaging studies need to be done with masculinizing drugs?
-lipid profile -liver function tests . (testosterone increases liver enzymes, increases LDL, decreases HDL) -complete blood count -PAP smear (if vagina present) -mammogram
what post-op care needs to be done for your patient who was given regional anesthesia?
-make sure they do not get up without you the first time -want them to ambulate early -IS -monitor vital signs, surgical sites, drains, and I&O (if I&O is low, consider kinks in the tubing and how much was drained in the OR)
what surgeries do female to male patients need?
-mastectomy (breasts removed) -hysterectomy -vaginectomy -phalloplasty (creating a penis) -scrotoplasty (creating a scrotum)
what psychosocial assessments should be completed on transgender patients?
-reassure patient regarding confidentiality -are you experiencing challenges, concerns, or anxiety related to your sexuality -related to your gender, how do you identify? -are you experiencing any sadness, depression, or thoughts of hurting yourself? -have you experienced any violence or discrimination in your personal or work life? (evidence of abuse must be reported by law) -are you currently being seen by a counselor or psychologist related to your sexuality and gender identity? if so, why?
what community based care do you need to complete with your transgender patients?
-teach patients that ongoing follow-up is needed to maintain health and detect any complications -assess support systems and coping mechanisms -collaborate with care manager -urogenital care needed for patients who have gender reassignment surgery -preventive health screenings are of importance (Pap smear, mammogram) -provide your patient with community resources
what are the gender neutral pronouns?
-they/their/their -ze/hir/hir
before the first dose of transdermal estrogen, what should you teach your patient?
-to apply the patch to an area that is hairless to ensure good contact with the skin -when changing the patch, wash any excess drug from the skin where the previous patch was applied
what are the expected physical changes of masculinizing drugs?
-voice deepening -body hair growth (hirsutism) -breast atrophy -increased libido -increased aggression -clitoral growth -redistribution of fat -laryngeal prominence
The nurse is providing teaching to a transgender female to male client who will be started on testosterone therapy. Which information should the nurse include in the teaching session? Select all that apply. 1. Weight loss can be expected. 2. Expect the clitoris to enlarge. 3. Papanicolaou tests are no longer necessary. 4. Menses will stop after the first dose of testosterone. 5. Liver enzymes and cholesterol levels will need to be monitored.
2, 5
A client who has recently been prescribed finasteride (Proscar) calls the clinic to report having dizziness, cold sweats, and chills. What will the nurse tell this client? a. "These are common effects that usually diminish over time." b. "These effects are not related to the finasteride." c. "Schedule an appointment to discuss these symptoms with your primary health care provider." d. "You need to stop taking the medication immediately."
A
A male-to-female client wishes to discuss breast augmentation surgery. What statement by the client indicates the need for further education by the nurse? a. "Fat can be used instead of implants for a more natural look." b. "I may take hormones for about a year before my surgery." c. "If I take hormones, I will have to get a mammogram." d. "The surgeons will use either silicone or saline implants."
A
The nurse is orienting a newly hired unlicensed assistive personnel (UAP) to the clinic. One of the clients has self-identified as transgender. The UAP states "I don't want to say the wrong thing. What do I call him or her?" What is the nurse's best response? a. "Ask how the client would like to be addressed." b. "Just call the client by his or her name." c. "Just be polite and it won't matter." d. "Look at the client's driver's license and use that."
A
The nurse is reviewing options and providing education for a client who is experiencing gender dysphoria. What statement by the client indicates that further discussion with and education from the health care team is needed? a. "To avoid scrutiny at the pharmacy, I'll buy my hormones on the Internet." b. "I could live as the other sex full time if I want to." c. "Surgery is an option to change my breasts and face." d. "Talking to a psychotherapist might help me understand my identity and strengthen my coping skills."
A
Which patient teaching about testosterone therapy will the nurse provide to a female transitioning to male (FtM) patient? A. "Avoid sharing needles, as this can transmit HIV or hepatitis." B. "Testosterone therapy will cause your voice to become higher." C. "The effects of testosterone therapy will be evident in less than a month." D. "Do not wash your hands after applying testosterone; this allow it to absorb faster."
A
what does gender reassignment surgery mean?
A group of surgical procedures that change primary and/or secondary sex characteristics to affirm a person's gender identity
what does coming out mean?
A lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) person's public disclosure regarding sexual orientation or gender identity
what does gender identity mean?
A person's inner sense of being a male, a female, or an alternative gender (e.g., genderqueer)
A client who is transitioning from female to male asks the nurse what options are available to make his voice "more real to who he is." What options does the nurse discuss with this client? Select all that apply. a. Masculinizing hormones such as testosterone b. Voice specialist to help with pitch and intonation c. Surgery to alter the vocal cords d. Adaptation to current vocal pattern e. Human growth hormone
A, B
a client is admitted to the PACU following a vaginoplasty. for which surgical complications will the nurse monitor in the PACU? select all that apply. a. bleeding b. rectal perforation c. urinary incontinence d. surgical site infection e. urinary retention
A, B
A client is preparing to be discharged home after her gender reassignment surgery. What are the key points that the nurse will include in her discharge teaching? Select all that apply. a. "The drain will be removed in about 3 to 5 days." b. "You will need to douche routinely to prevent infection." c. "Place the stents or dilators several times a day." d. "Do not engage in sexual intercourse for at least 6 weeks." e. "When you insert the dilators, remember to use petroleum jelly."
A, B, C
A client wants to know what complications may occur after a phalloplasty. About which complications does the nurse inform the client? Select all that apply. a. Dissatisfaction with results b. Donor graft site scarring c. Penile necrosis d. Prostate cancer e. Urinary tract stenosis
A, B, C, E
Which routes are used for testosterone administration? Select all that apply. a. Buccal b. Intramuscular c. Intravenous d. Oral e. Transdermal
A, B, D, E
the nurse provides health teaching for a client receiving estrogen therapy. which statement by the client indicates that the teaching was effective? select all that apply. a. i need to check my BP frequently when taking this drug b. i'll call my doctor is i have any redness or swelling in my legs c. i'll drink extra fluids because this drug will cause me to urinate a lot d. i know that the drug will cause me to urinate a lot e. i can get frequent headaches from taking this drug
A, B, D, E
A male-to-female client has a body mass index of 29 and is planning to have transvaginal surgery. The nurse is aware that this client is at higher risk for which complications? Select all that apply. a. Atelectasis b. Difficulty ambulating c. Ileus formation d. Nausea/vomiting e. Wound infection
A, B, E
A client is beginning testosterone therapy and asks the nurse what effects are to be expected. What physical changes does the nurse tell the client to anticipate? Select all that apply. a. Breast atrophy b. Decreased libido c. Deepening voice d. Development of penile tissue e. Menstruation cessation
A, C, E
A male-to-female client is beginning estrogen therapy. Which data obtained from the client's history are of particular concern to the nurse? Select all that apply. a. Body mass index of 32 b. Client has a twin sibling c. One pack-per-day smoker d. History of environmental allergies e. Takes multiple medications for blood pressure control
A, C, E
what does transgender mean?
An adjective to describe a person who crosses or transcends culturally defined categories of gender
what does genderqueer mean?
An identity label used by some people whose gender identity does not conform to one of the two categories of male or female
A client is beginning transdermal estrogen (Climara) therapy. Which statement by the client indicates the need for additional health teaching by the nurse? a. "I will monitor my blood pressure while I am taking this medicine." b. "I will need to change out the patch once a month." c. "My blood work will be checked regularly." d. "This medicine will increase my risk of blood clots."
B
A client presents to the clinic to discuss options for treatment for gender dysphoria. He states "I'm confused and I need to talk to somebody, but I don't know what to do and who to talk to. I don't want my parents to know. Can you help me?" What is the nurse's priority response? a. "I'll tell the doctor you want to talk to him." b. "What you say here will be confidential." c. "Let's see if we can get a therapist to see you." d. "It depends on what kind of insurance you have."
B
A female-to-male client wishes to retain the option of having biological children after transitioning. What available option does the nurse suggest to the client? a. Oocyte freezing can occur after hormone therapy has started and before menstruation ceases. b. Oocyte freezing can occur prior to hormone therapy or gender reassignment surgery. c. Oocyte freezing can occur any time before gender reassignment surgery. d. No options are available to a client with gender dysphoria.
B
A male-to-female client and her partner come to the preoperative appointment. "My partner has some questions. He wants to know about my new vagina. What will it be made of?" What is the nurse's best response? a. "The neovagina is made from silicone." b. "It is made with inverted penile tissue." c. "It will be made from parts of the scrotum." d. "The surgeon uses skin grafts to create the neovagina."
B
A transwoman presents to her primary health care provider's office reporting difficulty sleeping, anxiety, and hypervigilance. She states "I just can't stop thinking about what they did to me last New Year's Eve at work. They slashed my tires. They took my purse. I see it over and over." What is the nurse's best action? a. Ask if the client has been abusing drugs or alcohol. b. Consult with the primary health care provider for referral to a counselor. c. Document the statements and proceed with the remainder of the assessment. d. Look for signs of self-harm.
B
For feminizing surgery, in what position would the client be placed? a. Fowler's b. Lithotomy c. Prone d. Trendelenburg
B
For the 12 months prior to surgery, what is one of the requirements for a client requesting a vaginoplasty or a phalloplasty? a. Therapy sessions with a licensed psychotherapist as needed b. Continuously living in the role of the desired gender identity c. Hormone therapy d. Monthly vocal coaching
B
The nurse is completing preoperative teaching for a client who is having a phalloplasty. Which statement by the client indicates further education is necessary? a. "Fat may be needed to make my penis bigger." b. "I will get my implant during the last surgery." c. "They will take skin flaps to make my penis." d. "This is going to take several surgeries to complete."
B
What is the correct way to refer to a client who self-identifies as the opposite gender? a. A transgender b. Transgender c. Transgendered d. Transvestite
B
Which patient statement requires immediate nursing intervention? A. "I'm comfortable with my sexuality." B. "My boyfriend hits me when he is mad." C. "I have been thinking about gender reassignment surgery." D. "Recently, I began seeing a counselor to talk about my gender identity."
B
A client wishes to begin hormone therapy. What criteria must be met for the client to be eligible? Select all that apply. a. Over age 25 b. Continued and well-documented gender dysphoria c. Evaluation by a qualified mental health professional d. Signed informed consent e. No medical history issues
B, C, D
Periodic laboratory tests will be monitored for a female-to-male client who is taking testosterone. Which laboratory tests does the nurse tell the client to anticipate will be monitored? Select all that apply. a. Arterial blood gases (ABGs) b. Blood glucose c. Blood urea nitrogen (BUN)/creatinine d. Lipid profile e. Liver profile
B, D, E
The nurse is facilitating a discussion at an LGBTQ gathering at the local community college. One student asks what kind of genital surgeries are available for someone who wants to transition from female to male (FtM). What options will the nurse tell the group are available for FtM clients? Select all that apply. a. Penectomy b. Vaginectomy c. Mastectomy d. Metoidioplasty e. Scrotoplasty
B, D, E
A client has recently had a vaginoplasty and has noticed stool coming from her vagina. She calls her primary health care provider's office and the nurse advises her to immediately go the emergency department. What is the nurse's concern? a. Dislodgement of the urinary catheter b. Labial hematoma c. Prolapse d. Vaginal-rectal fistula
D
A client is scheduled for her final preoperative visit before a vaginoplasty. Which statement by the client indicates a need for further teaching prior to surgery? a. "My surgeon wants me to take vitamin C so I will heal more quickly." b. "I have to let my doctor know I am allergic to metronidazole (Flagyl)." c. "I will need to start taking the laxatives the day before the surgery." d. "I cannot drink anything at all once I start the bowel preparation."
D
A new transgender client is admitted to the unit for treatment. The nurse uses the wrong pronoun when addressing the client and taking the admitting history. What would the nurse do? a. Apologize repeatedly throughout the shift. b. Ask for reassignment to another client. c. Report the error to the charge nurse and write a variance. d. Self-correct and continue with the admitting history.
D
The nurse has completed discussing the process of gender reassignment surgery with a male-to-female client during her first visit to the office. Which statement by the client indicates a need for more education? a. "I will need to take hormones for 12 months before my surgery." b. "My insurance probably won't cover this." c. "I will need to have at least one referral from a therapist before I have surgery." d. "The surgeon who performed my appendectomy can do my surgery."
D
The nurse is caring for Brian Wayne, a patient whose natal sex is male. The patient tells the nurse that he identifies as a female named Brianne. How should the nurse address the patient? A. "It's nice to meet you, Brian." B. "How are you feeling today, Brianne?" C. "Mr. Wayne, I am happy to be your nurse today." D. "My name is Ann. How would you like me to address you?"
D
which transgender patients need voice or communication therapy?
Male to female patients need voice and communication therapy the most because feminizing agents have no effect on the voice, but testosterone lowers the voice so female to male patients may not need this therapy
what do you need to talk to your patient about if they are considering sex reassignment surgery?
Talk to them about banking their sperm or freezing their eggs if they want to begin transitioning
what does transsexual mean?
Term often used by health care professionals to describe people who want to change or have changed their primary and/or secondary sex characteristics
what does transition mean?
The period of time when transgender people change from the gender role associated with their sex to a different gender role
when does the sense of gender and feelings toward maleness or femaleness develop?
as early as 2 years old and present in most children during early elementary years
what are the side effects of 5-alpha-reductase inhibitors (Proscar)?
dizziness, cold sweats, and chills
what does LGBTQ stand for?
lesbian, gay, bisexual, transgender, and queer/questioning
what are the side effects of BnRH agonists (Zoladex)?
tachycardia and arrhythmias
what medications do female to male transgender patients take?
testosterone
what do you need to educate your patient about when they are taking testosterone?
that the results may take up to 1 year to appear
what does sex (natal sex) mean?
the gender assigned at one's birth
what is a transgender female to male?
transmen
what is a transgender male to female?
transwoman
in general, how should you address your patient using pronouns?
use the pronouns based on how they look (if they look like a woman, call them she) unless the request otherwise