lOMoAR cPSD| 6672187
2025 UPDATEDTEST BANK FOR MEDICAL
SURGICAL NURSING 9TH DITION BY
IGNATAVICIUSWITH FULLY UPDATED
CHAPTERS. GUARANTEED EXAM EXCELLENCE
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.
DIF: Understanding/Comprehension REF:
1496 KEY: LGBTQ| therapeutic
communication
MSC: Integrated Process: Nursing Process:
Assessment NOT: Client Needs Category:
Psychosocial Integrity
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
, lOMoAR cPSD| 6672187
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.
DIF: Applying/Application REF: 1496
KEY: LGBTQ| health screening| male reproductive
problems MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance
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.
DIF: Applying/Application REF: 1497
KEY: LGBTQ| venous thromboembolism| estrogens| nursing
assessment MSC: Integrated Process: Communication and
Documentation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
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.
, lOMoAR cPSD| 6672187
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.
DIF: Applying/Application REF:
1498 KEY: LGBTQ| electrolyte
imbalances
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
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.
DIF: Evaluating/Synthesis REF: 1498
KEY: LGBTQ| medication administration| patient
education MSC: Integrated Process: Nursing Process:
Evaluation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
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.
, lOMoAR cPSD| 6672187
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.
DIF: Applying/Application REF:
1498 KEY: LBGTQ| referrals|
communication
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
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.
2025 UPDATEDTEST BANK FOR MEDICAL
SURGICAL NURSING 9TH DITION BY
IGNATAVICIUSWITH FULLY UPDATED
CHAPTERS. GUARANTEED EXAM EXCELLENCE
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.
DIF: Understanding/Comprehension REF:
1496 KEY: LGBTQ| therapeutic
communication
MSC: Integrated Process: Nursing Process:
Assessment NOT: Client Needs Category:
Psychosocial Integrity
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
, lOMoAR cPSD| 6672187
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.
DIF: Applying/Application REF: 1496
KEY: LGBTQ| health screening| male reproductive
problems MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance
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.
DIF: Applying/Application REF: 1497
KEY: LGBTQ| venous thromboembolism| estrogens| nursing
assessment MSC: Integrated Process: Communication and
Documentation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
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.
, lOMoAR cPSD| 6672187
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.
DIF: Applying/Application REF:
1498 KEY: LGBTQ| electrolyte
imbalances
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
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.
DIF: Evaluating/Synthesis REF: 1498
KEY: LGBTQ| medication administration| patient
education MSC: Integrated Process: Nursing Process:
Evaluation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
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.
, lOMoAR cPSD| 6672187
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.
DIF: Applying/Application REF:
1498 KEY: LBGTQ| referrals|
communication
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
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.
