Chapter 68 Transgender

The nurse is caring for a client who had a vaginoplasty yesterday. Which assessment finding will the nurse report to the health care provider? A. Perineal pain B. Lower extremity swelling C. Constipation D. Urinary retention

B. Lower extremity swelling

The nurse is caring for a client who had a vaginoplasty yesterday. Which assessment finding will the nurse report to the health care provider? A.Perineal pain B.Lower extremity swelling C.Constipation D.Urinary retention

B.Lower extremity swelling

The nurse is caring for a client who reports beginning to transition from male to female. Which nursing action is appropriate regarding pronoun use? A. Ask the patient which pronouns are preferred and use those B. Implement use of "he/him" pronouns as the client's natal sex is male C. Use "Miss or Mrs." since the client has begun the transition to female D. Document that male or female pronouns are appropriate to use at this time

A. Ask the patient which pronouns are preferred and use those Rationale: Patient-centered care always begins with asking the client how they wish to be addressed. When caring for a patient who is transgender, it is appropriate to also ask which pronouns are preferred, and then use them consistently.

A client is admitted to the post-anesthesia care unit (PACU) following a vaginoplasty. For which surgical complications will the nurse monitor in the PACU? A. Bleeding B. Urinary retention C. Urinary incontinence D. Surgical site infection

A. Bleeding Rationale: From OR pt. will have a urinary catheter, so incontinence and retention are not correct answers. Wound infections typically occur several days after surgery, However, immediately after surgery in the PACU, the nurse will monitor for bleeding & rectal perforation.

While working in the emergency department, the nurse is conducting an interview with a 17 year old victim of parental abuse. Which step should the nurse take first? A. Contact the appropriate legal services. B. Obtain parental consent to interview a minor. C. Request a security guard's presence D. Insist that the parents leave the premises

A. Contact the appropriate legal services. Rationale: Abuse cases must be reported to the appropriate authorities.

Which nursing action is most likely to increase the risk for health care disparities for transgender clients? A. Determine gender identity based on clothing worn B. Seek to understand the experience of the transgender client C. Upon meeting the client, ask what name and which pronouns are desired D. Explain how the health history and assessment are affected by gender identity

A. Determine gender identity based on clothing worn Rationale: Appropriate nursing actions when caring for a client who is transgender include seeking to understand the client's experience, asking the client what name and pronouns are preferred, and explaining how the health history and assessment are affected by gender identity. The nurse will not assume...

The nurse is caring for a client who reports beginning to transition from male to female. Which nursing action is appropriate regarding pronoun use? A.Ask the patient which pronouns are preferred and use those B.Implement use of "he/him" pronouns as the client's natal sex is male C.Use "Miss or Mrs." since the client has begun the transition to female D.Document that male or female pronouns are appropriate to use at this time

A.Ask the patient which pronouns are preferred and use those

The nurse provides health teaching for a client receiving estrogen therapy for MtF transition. Which statement by the client indicates a need for further teaching? A. "I will call my doctor if I have any redness or swelling in my legs." B. "I will be glad when I no longer have to take these hormones." C. "I know that the drug will cause my breast to feel tender." D. "I may get frequent headaches from taking this drug."

B. "I will be glad when I no longer have to take these hormones." Rationale: Estrogen therapy can cause side effects such as headache, breast tenderness, and DVT (for which redness and swelling are classic signs). Hormone therapy will be required life-long.

Drug Alert

Before the first dose of transdermal estrogen, teach the patient to apply the patch to an area that is hairless to ensure good contact with the skin. When changing to a new patch, wash any excess drug and adhesive from the skin where the previous patch was applied.

While teaching a client in the process of male-to-female transition about transdermal estrogen and spironolactone therapies, what instructions will you provide for the patient before beginning drug therapy? A. "You can apply the Estrogen patch to any area if skin as long as you change it as prescribed." B. "Spironolactone is a low-cost diuretic to help with fluid retention associated with Estrogen therapy." C. "Spironolactone inhibits testosterone secretion and androgen binding to decrease male sex characteristics." D. "Headache, breast tenderness, nausea/vomiting, and weight gain are expected side effects about which you need not be concerned."

C. "Spironolactone inhibits testosterone secretion and androgen binding to decrease male sex characteristics." Rationale: The patch is applied to an area that is hairless to ensure good contact with the skin. Follow up is needed to monitor adverse side-effects. Spironolactone is a low-cost diuretic, but it also inhibits testosterone secretion and androgen binding to androgen receptors.

A MtF client is beginning estrogen therapy. The student nurse is reviewing data obtained from the client's history that are of concern. Which item identified by the student to increase risk for DVT requires correction? A. Obesity B. 1 PPD smoker C. Seasonal allergies D. History of hypertension

C. Seasonal allergies Rationale: Seasonal allergies do not increase risk for DVT, but Obesity, smoking, and HTN increase risk for DVT especially in combination with hormone therapy.

Which nursing action decreases the risk for health care disparities for transgender clients? Select all that apply. A.Refer to the client's identification card for name B.Determine gender identity based on clothing worn C.Seek to understand the experience of the transgender client D.Apologize several times if the wrong name is used for the client E.Upon meeting the client, ask what name and which pronouns are desired F.Explain how the health history and assessment are affected by gender identity

C.Seek to understand the experience of the transgender client E.Upon meeting the client, ask what name and which pronouns are desired F.Explain how the health history and assessment are affected by gender identity

The nurse provides health teaching for a transgender woman receiving estrogen therapy. Which statement by the client indicates a need for further teaching? A. "I'll call my doctor if I have any redness or swelling in my legs." B. "I'll have less hair on my body after taking this drug." C. "I know that the drug will make my breasts bigger." D. "I think I will have more sex drive when taking this drug."

D. "I think I will have more sex drive when taking this drug." Rationale: You recall from OB & endocrine that estrogen enhances female sex characteristics & increases DVT risk. However, estrogen usually reduces sex drive (libido).

A transgender female client reports difficulty sleeping, anxiety, and hypervigilance. She states "I just can't stop thinking about what they did to me at Prom. They slashed my tires. They took my purse. I see it over and over." What is the appropriate nursing action? A. Look for signs of self-harm. B. Ask about drug and alcohol use. C. Document the statements and conduct a health history. D. Consult with the health care provider for referral to a counselor

D. Consult with the health care provider for referral to a counselor Rationale: The compassionate action is to help her seek psychological support. Other responses are indifferent or make assumptions.

The nurse is facilitating a discussion at an LGBTQ gathering at a college. One student asks what kind of surgeries are available for someone who wants to transition from female to male (FtM). Which option will not be included? A. Vaginectomy B. Scrotoplasty C. Metoidioplasty D. Penectomy

D. Penectomy Rationale: Metoidioplasty creates a penis from the erectile tissue (clitoris), scrotoplasty creates a scrotum, and vaginectomy resects/ removes vaginal tissue. Removal of the penis (penectomy) would not be necessary for FtM transition.

How will the nurse refer to a client who self-identifies as the opposite gender? A. Gay B. Lesbian C. Transvestite D. Transgender individual

D. Transgender individual Rationale: A transgender individual is one who self-identifies as the opposite of one's natal sex.

Drug Alert

Teach patients taking spironolactone to monitor their blood pressure for hypotension. Remind them to expect polyuria and possible polydipsia. Periodic laboratory tests to assess for hyperkalemia may be needed for patients with renal insufficiency (Burchum & Rosenthal, 2019; Deutsch, 2016). Remind those patients that increased serum potassium can cause cardiac dysrhythmias and skeletal muscle spasticity.

TABLE 68.1 Core Principles for Health Care Professionals Who Care for Transgender Patients

• Become knowledgeable about the health care needs of transgender and other gender-nonconforming people. • Become knowledgeable about the treatment options for transgender patients and required follow-up care. • Do not assume that all transgender patients are the same; treat each one as an individual and develop an individualized plan of care. • Demonstrate respect for patients with nonconforming gender identities. • Provide culturally sensitive care and use appropriate terminology that affirms the patient's gender identity. • Facilitate patient access to appropriate and knowledgeable health care providers. • Seek informed consent before providing treatment. • Offer continuity of care or refer patients for ongoing quality health care. • Advocate for patients within their families and communities.

Feminizing Drug Therapy for MtF Patients: Expected Changes

• Breast tissue development • Reduced or absent sperm count and ejaculatory fluid • Reduced muscle mass • Change in emotions • Change in sweat and odor patterns • Decreased testicular size • Reduced erectile function • Decreased libido (sex drive) • Decreased body hair growth • Softening of skin

Postoperative Teaching for Patients Who Have a Vaginoplasty

• Resume taking showers after the first postoperative follow-up visit. • Do not take baths (submerged in water) for 8 weeks after surgery. • Avoid strenuous activities for at least 6 weeks. • Avoid swimming or bike riding for 3 months. • Expect minimal vaginal bleeding/spotting and/or a brownish-yellow drainage for 6 to 8 weeks; use a soap and water douche to minimize these problems. • Avoid tobacco or smoking for at least a month after surgery to promote healing. • Take stool softeners as prescribed to help prevent constipation. • Take acetaminophen as prescribed for pain control at home. • Carefully follow the prescribed individualized dilator protocol. • Do not have sexual intercourse until at least 3 months after surgery.

TABLE 68.3 Masculinizing Drug Therapy for FtM Patients: Expected Changes

• Voice deepening • Body hair growth (hirsutism), but possibly hairline recession and male pattern baldness • Increased muscle mass • Increased libido • Increased aggression • Vaginal dryness • Clitoral growth • Redistribution of fat • Cessation of menses