Chapter 73: Care of Transgender Pt

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

ANS: B Epidural anesthesia will cause the client to not be able to move (or feel) the legs for several hours. It is important for client safety that adequate help is available prior to this client trying to get out of bed. Securing the catheter to the leg and monitoring dressings and drainage are important for any client after surgery. Positioning the drain to the contralateral side is not needed.

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

ANS: A Ice is applied to the perineum to reduce pain and discomfort. Elevating the legs on pillows is not recommended after a lengthy procedure in the lithotomy position, which predisposes the client to venous thromboembolism. Positioning the client on the left side and raising the head of the bed are not comfort measures related to this procedure.

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? a. Be sure to have an annual prostate examination. b. Continue your normal health screenings. c. Try to avoid being around people who are ill. d. You should have an annual flu vaccination.

ANS: A 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.

2. 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.) a. Gender dysphoria Distress caused by incongruence between natal sex and gender identity b. Gender queer A label used when gender identity does not conform to male or female c. Natal sex The sex one is born with or is assigned to at birth d. Transgender A person who dresses in the clothing of the opposite sex e. Transition The time between questioning and establishing a sexual identity

ANS: A, B, C Gender dysphoria is emotional distress caused by the incongruence between natal sex (sex assigned at birth) and gender identity. Gender queer is a label sometimes used by people whose gender identity does not fit the established categories of male or female. Natal sex describes the gender a person is born with or is assigned to at birth. Transgender is an adjective to describe a person who crosses or transcends culturally defined categories of gender. Transition is the period of time when transgender individuals change from the gender role associated with their sex to a different gender role.

3. A nurse works with many transgender clients. What routine monitoring is important for the nurse to facilitate in this population? (Select all that apply.) a. Lipid profile b. Liver function tests c. Mammograms if breast tissue is present d. Prostate-specific antigen (PSA) for natal males e. Renal profile

ANS: A, B, C, D Common routine monitoring for this population includes lipid and liver panels, mammograms if any breast tissue is present, and PSA for natal males as the prostate is not removed during a vaginoplasty/penectomy. Renal profiles are not required based on treatment options for this population.

1. The nurse is reviewing possible complications from a phalloplasty. What factors does the nurse include? (Select all that apply.) a. Infection of donor site b. Necrosis of the neopenis c. Rectal perforation d. Urinary tract stenosis e. Vaginal infections

ANS: A, B, D Complications from phalloplasty include infection or scarring of the donor site, necrosis, and stenosis of the urinary tract. Rectal perforation can occur with vaginoplasty, as can infections.

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

ANS: B Goserelin is administered via subcutaneous injection. The other actions are not related to self-management while on this medication.

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? a. Ask if the client has considered vocal cord surgery to change the voice. b. Refer the client for vocal therapy with speech-language pathology. c. Teach the client that there will be no effect on the clients voice. d. Tell the client that the use of hormones will eventually change the voice.

ANS: B Male-to-female clients can consult with a speech-language pathologist for vocal training to help with intonation and pitch. While vocal surgery is possible, it may not be the best first option due to cost and invasiveness. Telling the client there will be no change to the voice does not give the client information to address the concern. While the hormones this client is taking will not affect the voice, simply stating that fact does not help the client manage this issue.

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

ANS: C 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.

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

ANS: C Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause cardiac dysrhythmias. The nurses 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.

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? a. Apologize and declare confusion about the client. b. Ask Mrs. Smith where her husband is right now. c. Ask the client about preferred forms of address. d. Explain that the chart must contain an error.

ANS: C 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.

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

ANS: D Self-care management for this client includes instructions to dilate the new vagina several times a day for months after the procedure, using water-based lubricant. The client also needs to douche regularly, especially after intercourse, to avoid infections. Sexual intercourse is another way to keep the vagina dilated.