Med-surg Ch. 73, Care of Transgender Patients

When obtaining a patient's sexual history, which nursing question most reflects a nonjudgmental approach?

"Do you have sex with men, women, or both?"

A male-to-female patient wishes to discuss breast augmentation surgery. What statement by the patient indicates the need for further education by the nurse?

"Fat can be used instead of implants for a more natural look."

Which nursing assistant statement regarding addressing a transgender patient requires nursing intervention?

"I should check the driver's license and base patient identification on it."

The male-to-female transgender patient has been prescribed estrogen therapy. Which statement made by the patient indicates she understands the potential side effects of the medication?

"I shouldn't sit for long periods of time because this medication increases my risk of blood clots."

The male-to-female (MtF) patient is seeking gender reassignment surgery. Which statement made by the patient indicates she will not be a candidate for this surgery?

"I take a beta blocker for my coronary artery disease."

The nurse is completing preoperative teaching for a patient who is having a phalloplasty. Which statement by the patient indicates further education is necessary?

"I will get my implant during the last surgery."

A patient is beginning transdermal estrogen therapy. Which statement by the patient indicates the need for additional health teaching by the nurse?

"I will need to change out the patch once a month."

The nurse is completing discharge teaching for a patient who has been prescribed finasteride. What statement by the patient indicates that reinforcement is required?

"I will need to have my potassium checked regularly."

Which statement regarding the Gay and Lesbian Medical Association (GLMA) is accurate?

"It addresses the special health care needs of members of LGBTQ populations across the entire lifespan."

A male-to-female patient 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?

"It is made with inverted penile tissue."

Which nursing student statement regarding the American Nurses Association (ANA) Code of Ethics (2001) is accurate in order to reduce health disparities faced by lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients?

"Nurses should practice with compassion and respect for the dignity and worth of every patient."

The patient is prescribed intramuscular testosterone. The patient asks the nurse why he cannot just take oral testosterone. What is the nurse's best response?

"Oral testosterone is the least-effective form of the drug."

A nurse is caring for a male-to-female transgender patient who wishes to undergo gender-reassignment surgery. Which information provided by the nursing student indicates a need for further education?

"Orchiectomy requires at least six months of hormone therapy."

Which patient statement regarding hormone therapy set forth by the World Professional Association for Transgender Health (WPATH) requires further teaching by the nurse?

"Patients older than 14 years are eligible for hormone therapy."

Which nursing statement indicates a need for better understanding of the psychosocial assessment of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients?

"Patients should be informed that the presence of a family member or significant other is mandatory during questioning."

Which nursing statement to a transgender patient indicates a need for further education regarding health disparities?

"People like you don't understand that changing your sex is actually going against nature."

A patient considering transition from male to female asks the nurse about reproductive health options. How does the nurse respond?

"Sperm banking before the transition process should be considered."

A patient has been prescribed goserelin. The nurse is reviewing discharge teaching with the patient. Which statement by the patient indicates an incorrect understanding of the teaching?

"This medicine goes deep into my muscle."

The nurse is reviewing options and providing education for a patient who is experiencing gender dysphoria. What statement by the patient indicates that further discussion with the health care team is needed?

"To avoid scrutiny at the pharmacy, I'll buy my hormones on the Internet."

A patient 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?

"What you say here will be confidential."

Which nursing student question about gender and sexuality of a transgender patient indicates a need for further education?

"Why are you so anxious to change your gender all of a sudden?"

The mother of a teenage patient tells a nurse, "The doctor says that my child has gender dysphoria. Can you explain what that means?" What is the appropriate nursing response?

"Your child isn't comfortable with his or her natal sex and identifies as the opposite gender."

From what age may a child begin to feel a sense of maleness or femaleness?

2 years

The nurse is providing postoperative instructions to the patient following vaginoplasty. What does the nurse tell the patient about douching?

A solution of vinegar and water can be used for douching.

Which explanation provides the rationale for performing a chondroplasty in the female-to-male transgender patient?

Achieving a deeper voice

What are the most common side effects of testosterone therapy? Select all that apply.

Acne Edema Headaches

A nurse is caring for a transgender patient who has been abusing alcohol and other substances in the community health care setting. Which core principles must the nurse apply to minimize health disparities in caring for this patient? Select all that apply.

Act as patient advocate for families and communities. Show respect for patients with nonconforming gender identities. Provide continuity of care or refer patients who need constant quality health care.

"The nurse practices with compassion and respect for dignity and worth of every patient" is part of which organization's Code of Ethics?

American Nurses Association

What is the appropriate nursing action when assessing a female-to-male transgender patient?

Ask how the patient wishes to be addressed.

Which nursing action taken during the assessment of a transgender patient will help reduce health disparities?

Asking how the patient would like to be addressed

The transgender individual is admitted to the hospital due to post-traumatic stress syndrome (PTSD) and depression. What is the priority nursing intervention?

Assess the patient frequently for suicidal ideation

A male-to-female (MtF) patient has a body mass index of 29 and is planning to have transvaginal surgery. The nurse is aware that this patient is at higher risk for which complications? Select all that apply.

Atelectasis Wound infection Difficulty ambulating

A nurse is caring for a male-to-female transgender patient and a female-to-male transgender patient. With respect to the core principles of the World Professional Association for Transgender Health, which nursing practices are accurate? Select all that apply.

Being knowledgeable about the health care needs of transgender and other gender-nonconforming people Facilitating patient access to the appropriate and knowledgeable health care providers Being aware of the treatment options for transgender patients and the required follow-up care

Androgen-reducing agents are often prescribed in addition to estrogen therapy to achieve which outcome?

Block the effects of testosterone

A male-to-female patient is beginning estrogen therapy. Which pieces of data obtained from the patient's history are of particular concern to the nurse? Select all that apply.

Body mass index of 32 One pack-per-day smoker Takes multiple medications for blood pressure control

A patient is beginning testosterone therapy and asks the nurse what effects are to be expected. What physical changes does the nurse tell the patient to anticipate? Select all that apply.

Breast atrophy Deepening voice Menstruation cessation

During a physical assessment, the patient tells the nurse he has been experiencing anxiety and sadness related to being transgender. What is the priority intervention for the nurse to take?

Consult with the health care provider for further evaluation by a qualified mental health professional.

For the 12 proceeding months prior to surgery, what is one of the requirements for a patient requesting a vaginoplasty or a phalloplasty?

Continuously living in the role of the desired gender identity

Which evaluation findings does the nurse anticipate for a patient on testosterone therapy? Select all that apply.

Edema Headaches Decreased high-density lipoproteins

A nursing student is listing factors that increase the risk for violence in the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) population. Which factor mentioned by the nursing student indicates a need for further teaching by the precepting nurse?

Education

What additional sources of stress do transgender individuals face when accessing health care? Select all that apply.

Fear of discrimination and ridicule Lack of health insurance due to unemployment Coverage for health care related to gender transition is often denied Lack of health care professional knowledge regarding the health needs of transgender individuals

The male-to-female transgender patient was recently started on hormone therapy. She is at the clinic today complaining of dizziness, cold sweats, and chills. The nurse knows these are common side effects of which medication?

Finasteride

Which organization developed a companion document to address the special health care needs of lesbian, gay, bisexual, and transgender (LGBT) patients when this information was not included in Healthy People 2010?

Gay and Lesbian Medical Association (GLMA)

Most often, what is the last option for transitioning from one's natal sex to one's inner gender identity?

Gender reassignment surgery

Which term describes the patient whose gender identity does not conform to either male or female?

Genderqueer

Which publication related to health care improvements does not address improving health care for lesbian, gay, bisexual, and transgender (LGBT) people?

Healthy People 2010

To prevent health disparities, what will the nurse do for a young, homeless patient who states that he or she is attracted to people of the same sex?

Help provide a safe environment to prevent the risk of violence.

Which statement regarding the Institute of Medicine's (IOM) report on health disparities of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients is true?

Identifies the special health care concerns of LGBTQ people of all ages

The nurse is serving on a committee to create a safe, welcoming environment for lesbian, gay, transgender, and questioning (LGBTQ) patients. Which recommendations from The Joint Commission are appropriate for the nurse to suggest? Select all that apply.

Include gender-neutral language on all medical forms and documents. Ensure that visitation policies are equitable for families of LGBTQ patients. Post the Patients' Bill of Rights and nondiscrimination policies in a visible place.

What physical changes are expected from estrogen therapy? Select all that apply.

Increased body fat Breast enlargement Decreased erectile function

Which of the following laboratory changes are expected with the use of testosterone therapy?

Increased liver enzymes

A male-to-female (MtF) patient is unable to tolerate estrogen therapy, so she has been prescribed spironolactone. What are the mechanisms of action when used in this context? Select all that apply.

Inhibits testosterone secretion Inhibits androgen binding to androgen receptors

What statement regarding the U.S. Department of Health and Human Services' Healthy People 2010 initiative is true with respect to health care of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients?

It did not address the need for better health care for LGBTQ patients.

Why is spironolactone prescribed for the male-to-female transgender patient?

It inhibits testosterone secretion.

Which point regarding The Health of LGBT People: Building a Foundation for Better Understanding is accurate?

It is aimed at developing a system of identifying patients who are lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ).

The nursing instructor asks a student to list factors contributing to a high risk for suicidal ideation or suicide attempts in transgender people. Which student response requires further teaching by the nursing instructor?

Level of education

Periodic labs will be monitored for a female-to-male patient who is taking testosterone. Which lab tests does the nurse tell the patient to anticipate will be monitored? Select all that apply.

Lipid profile Liver profile Blood glucose

For feminizing surgery, in what position should the patient be placed?

Lithotomy

The patient was born with male genitalia but lives as a female. What is the most appropriate term to describe the patient?

Male-to-female

A patient 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 patient? Select all that apply.

Masculinizing hormones like testosterone Voice specialist to help with pitch and intonation

What potential side effects does the nurse teach to the patient taking estrogen? Select all that apply.

Nausea/Vomiting Feelings of depression Venous thromboembolism

A patient has returned to the floor after a vaginoplasty. Which assessment finding would concern the nurse?

Numbness in the right leg

What do the Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) Institute state with regard to health disparity?

Nurses should be competent to provide care with sensitivity and respect for diverse patients.

A transgender patient tests positive for HIV and syphilis. What does the nurse understand about sex work among transgender individuals?

Only a small subset of transgender individuals engage in sex work.

A female-to-male patient wishes to retain the option of having biological children after transitioning. What available option does the nurse suggest to the patient?

Oocyte freezing can occur prior to hormone therapy or gender reassignment surgery.

A patient had a vaginoplasty 6 hours ago. An epidural for pain control is in place. Which finding requires immediate attention?

Oozing on the surgical dressing

Which routes are used for testosterone administration? Select all that apply.

Oral Buccal Transdermal Intramuscular

The patient is prescribed transdermal estrogen. The nurse knows transdermal estrogen is preferred over oral estrogen for which reason?

Oral estrogen can increase the risk of venous thromboembolism.

Which statement regarding health insurance coverage for transgender patients is accurate?

Patients are often denied coverage for gender-reassignment surgery and hormone therapy by insurance companies.

When assessing the surgical history of a male-to-female (MtF) patient, what does the nurse inquire about? Select all that apply.

Penectomy Vaginoplasty Breast surgery Prostate problems

A patient wants to know what complications may occur after a phalloplasty. About which complications does the nurse inform the patient? Select all that apply.

Penile necrosis Urinary tract stenosis Donor graft site scarring Dissatisfaction with results

The patient is considering phalloplasty. Which statement made by the nurse is accurate?

Phalloplasty is performed in several stages.

A patient is receiving Androderm for female-to-male (FtM) transition. What does the nurse include in teaching?

Practice good handwashing.

What are the recommendations of The Joint Commission for creating a safe, welcoming environment for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients? Select all that apply.

Provide information on the special health care concerns of LGBTQ patients. Use the patient's choice of terminology in communication and documentation. Keep a patient's bill of rights and nondiscrimination policies visible to patients.

To what does gender identity refer?

Sense of maleness or femaleness

Debbie is a male-to-female transgender presenting to the clinic in a dress and heels. Debbie's gender is listed as male in the medical records. What pronoun does the nurse use when referring to Debbie?

She

A patient wishes to begin hormone therapy. What criteria must be met for the patient to be eligible? Select all that apply.

Signing an informed consent Having an evaluation by a qualified mental health professional Presenting with continued and well-documented gender dysphoria

Which of the following specialists would be involved in the care treatment team of a patient undergoing a male-to-female (MtF) transition?

Speech-language pathologist

A patient on long-term testosterone therapy should be monitored for which of the following comorbidities?

Stroke

The transgender patient is at highest risk for which of the following conditions?

Substance abuse

With whom should a nurse collaborate to provide a safe and effective care environment to reduce health disparities in the transgender population? Select all that apply.

Surgeon Vocal or speech specialist Mental health professional

Which intervention is appropriate for a transgender individual experiencing gender dysphoria?

Surgery to change primary and/or secondary sex characteristics

What major drug is used for achieving masculinizing effects in female-to-male transgender patients?

Testosterone

Which organization recommends designating unisex or single-stall restrooms in health care facilities for the welfare of transgender patients?

The Joint Commission (TJC)

Which organization recommends posting a patient's bill of rights and nondiscrimination policies in a visible place in health care facilities to promote a safe and welcoming environment for transgender patients?

The Joint Commission (TJC)

Which publications by the U.S. Department of Health and Human Services and private health care organizations call for improvements in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) health care? Select all that apply.

The Joint Commission field guide for LGBT care Institute of Medicine (IOM) report on LGBT health World Professional Association for Transgender Health (WPATH) standards of care

A male-to-female transgender is admitted to the hospital. In which gender category does the nurse place the patient?

The category defined by the patient

What is indicated by pink triangle, rainbow, and "safe zone" signs posted in the waiting room of a health care facility?

The facility will treat lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients respectfully and with knowledgeable quality care.

Which points regarding community-based care of transgender patients are accurate? Select all that apply.

The nurse should collaborate with the case manager to ensure a smooth transition into the community. The nurse should assess the patient's support system and coping strategies. The nurse should teach the patient that urogenital care is essential after gender reassignment surgery.

What does the nurse know about patients who identify themselves as transgender?

These patients have a sense of being born in the wrong body.

A nurse is caring for a genderqueer patient. What is the most appropriate way for the nurse to refer to the patient?

They

What is the correct way to refer to a patient who self-identifies as the opposite gender?

Transgender

People who are transgender are often grouped under one population category described by the acronym LGBTQ: lesbian, gay, bisexual, transgender, and queer/questioning. Why does the nurse know these sexual orientation labels are misleading?

Transgender individuals may identify as homosexual, heterosexual, both, or neither.

The nurse is providing postoperative instructions to a patient following a vaginoplasty. What does the nurse tell the patient about vaginal stents?

Vaginal stents must be inserted several times a day following surgery.

A patient has recently had a vaginoplasty and has noticed stool coming from her vagina. She calls her provider's office and the nurse advises her to immediately go the emergency department. What is the nurse's concern?

Vaginal-rectal fistula

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 patients? Select all that apply.

Vaginectomy Metoidioplasty Scrotoplasty

A male-to-female (MtF) patient is requesting genital surgery for sex reassignment. Which procedure does the nurse prepare to discuss?

Vaginoplasty

A health care facility has different visitation policies for families of lesbian, gay, bisexual, transgender, and queer/question (LGBTQ) patients; gender-segregated restrooms; a patient's bill of rights and nondiscrimination policies displayed in the visible places; Safe Zone, rainbow, or pink triangle signs displayed in and around the waiting area; and medical forms and documents containing relationship status details. Which aspects of the facility violate the recommendations of The Joint Commission's (TJC)? Select all that apply.

Visitation policies Restroom segregation Medical forms and document formats

What should the nurse tell the patient before applying the first dose of transdermal estrogen?

Wash excess drug from the skin when removing the patch.

Which organization has published a document that outlines core principles for nurses that should be followed in the care of transgender patients?

World Professional Association for Transgender Health (WPATH)