A patient says, "I was assigned male at birth, and I have always known I am a woman." Which term names her inner sense of being a woman?
Gender identity
✓
Gender expression
Sexual orientation
Sex assigned at birth
Correct Answer
Gender identity
Gender identity is a person's deeply held internal sense of their own gender, which may differ from the sex recorded at birth. Gender expression is how a person outwardly presents gender through clothing, voice or behavior. Sexual orientation describes whom a person is attracted to, a separate characteristic. Sex assigned at birth is the designation made at birth, usually from external anatomy, and here it differs from her identity.
Category: Gender Terminology
Question 2
A nonbinary patient describes choosing clothing, hairstyle and voice to present outwardly in a way that feels right. Which term describes this outward presentation?
Gender identity
Gender expression
✓
Gender dysphoria
Sexual orientation
Correct Answer
Gender expression
Gender expression is the way a person shows gender to others through appearance, behavior and voice, and it may or may not match social expectations. Gender identity is the internal sense of one's gender rather than its outward display. Gender dysphoria is distress that can arise when identity and assigned sex do not align. Sexual orientation refers to attraction to others.
Category: Gender Terminology
Question 3
A patient's chart lists a legal name, but the patient says, "Please call me Alex, and I use they and them." What should the nurse do?
Use the legal name until it is changed in court
Choose pronouns based on the patient's appearance
Use the name Alex and they/them pronouns, and document them
✓
Avoid using any name when speaking to the patient
Correct Answer
Use the name Alex and they/them pronouns, and document them
Using the name and pronouns a patient gives, and recording them so every team member does the same, builds the trust that safe care depends on; the legal name is still used where identification rules require it. Use the legal name until it is changed in court ignores the patient's stated name and signals disrespect. Choose pronouns based on the patient's appearance replaces the patient's own answer with an assumption. Avoid using any name when speaking to the patient is impersonal and can make identification errors more likely.
Category: Affirming Communication
Question 4
A transgender man comes to the emergency department with a sprained ankle. Which approach to questions about his body fits respectful, clinically focused care?
Ask about every surgery he has had to transition
Ask him to describe his genital anatomy in detail
Ask him why he decided to transition
Ask only about anatomy relevant to the injury
✓
Correct Answer
Ask only about anatomy relevant to the injury
Questions about anatomy, surgery or transition history should be asked only when the answers affect the care being given, and an ankle sprain does not require them. Ask about every surgery he has had to transition goes beyond what the injury requires. Ask him to describe his genital anatomy in detail is intrusive and unrelated to an ankle injury. Ask him why he decided to transition reflects curiosity rather than clinical need and can damage trust.
Category: Affirming Communication
Question 5
While giving care, the nurse accidentally uses the wrong pronoun for a transgender woman. What should the nurse do?
Briefly apologize, use the correct pronoun and continue
✓
Apologize at length and explain how the mistake happened
Say nothing so that the mistake is not noticed
Ask her to excuse the error because pronouns are hard
Correct Answer
Briefly apologize, use the correct pronoun and continue
A short apology followed by the correct pronoun acknowledges the error without putting the patient in the position of comforting the nurse. Apologize at length and explain how the mistake happened draws extra attention to the error and shifts focus to the nurse. Say nothing so that the mistake is not noticed leaves the misgendering uncorrected. Ask her to excuse the error because pronouns are hard places a burden on the patient and minimizes the mistake.
Category: Affirming Communication
Question 6
Which factor commonly leads some transgender patients to delay routine preventive health care?
Hormone therapy replacing the need for screening
Past mistreatment in health care settings
✓
A lower need for screening in transgender people
Gender-affirming care being offered only in hospitals
Correct Answer
Past mistreatment in health care settings
Many transgender and nonbinary people have faced harassment or care that was not accepting, and some avoid preventive services as a result, so an affirming environment is part of nursing care. Hormone therapy replacing the need for screening is incorrect, because hormone therapy creates its own screening needs. A lower need for screening in transgender people is false; screening follows the organs a person has and the hormones they take. Gender-affirming care being offered only in hospitals is inaccurate, since much of this care is delivered in clinics and primary care offices.
Category: Affirming Communication
Question 7
How does estradiol lower testosterone levels in feminizing hormone therapy?
It blocks androgen receptors in body tissues
It blocks conversion of testosterone to dihydrotestosterone
It suppresses pituitary release of gonadotropins
✓
It destroys the testosterone-making cells of the testes
Correct Answer
It suppresses pituitary release of gonadotropins
Estrogen feeds back on the hypothalamus and pituitary to reduce release of LH and FSH, so the testes make less testosterone; estrogen also directly drives feminizing changes. It blocks androgen receptors in body tissues describes spironolactone. It blocks conversion of testosterone to dihydrotestosterone describes finasteride. It destroys the testosterone-making cells of the testes is not how estrogen acts; testosterone production is suppressed, not destroyed.
Category: Feminizing Estrogens
Question 8
Which form of estrogen is avoided in feminizing hormone therapy because it carries a higher risk of blood clots?
Oral estradiol
Transdermal estradiol
Estradiol valerate injection
Ethinyl estradiol
✓
Correct Answer
Ethinyl estradiol
Ethinyl estradiol, the synthetic estrogen in many combined oral contraceptives, is linked to a higher risk of venous thromboembolism, so feminizing regimens use estradiol itself instead. Oral estradiol is a commonly used form of feminizing estrogen. Transdermal estradiol is often chosen for patients with higher clot risk because it avoids first-pass liver metabolism. Estradiol valerate injection is an accepted parenteral option.
Category: Feminizing Estrogens
Question 9
A transgender woman taking estradiol asks whether the hormone will raise the pitch of her voice. Which response is accurate?
Estrogen does not change voice pitch, but voice training can help
✓
Pitch rises gradually as estrogen levels increase
Pitch rises once an antiandrogen is added
Pitch rises only with injectable estrogen
Correct Answer
Estrogen does not change voice pitch, but voice training can help
Testosterone lengthens and thickens the vocal cords during puberty, and estrogen does not reverse that change, so patients who want a different voice often work with a speech-language professional. Pitch rises gradually as estrogen levels increase is incorrect because estrogen has no effect on the adult larynx. Pitch rises once an antiandrogen is added is also incorrect; blocking androgens does not shorten the vocal cords. Pitch rises only with injectable estrogen is false because no estrogen route changes voice pitch.
Category: Feminizing Estrogens
Question 10
Before feminizing estrogen therapy begins, which part of the history should the nurse explore because it raises the risk of blood clots?
Seasonal allergies
Current tobacco smoking
✓
A past appendectomy
Mild childhood asthma
Correct Answer
Current tobacco smoking
Smoking adds to the clotting risk of estrogen, so smoking status is assessed before therapy and cessation support is offered. Seasonal allergies do not affect clot risk with estrogen. A past appendectomy that has healed does not raise the risk of thrombosis. Mild childhood asthma is not a clotting risk factor.
Category: Feminizing Estrogens
Question 11
Which effect should the nurse prepare a patient for when spironolactone is started as an antiandrogen?
Constipation
Deepening of the voice
Increased urination
✓
Fluid retention and weight gain
Correct Answer
Increased urination
Spironolactone is a potassium-sparing diuretic, so patients should expect to urinate more and should rise slowly if they feel lightheaded. Constipation is not a typical effect of spironolactone. Deepening of the voice is an androgen effect, the opposite of what an antiandrogen produces. Fluid retention and weight gain are the opposite of a diuretic's action.
Category: Antiandrogen Therapy
Question 12
Which effect of spironolactone is unwanted in heart failure care but desired in feminizing hormone therapy?
Elevated serum potassium
Dizziness on standing
Lower blood pressure
Breast tissue growth
✓
Correct Answer
Breast tissue growth
By blocking androgen receptors, spironolactone can enlarge breast tissue, an adverse effect for most patients that is a goal of feminizing therapy. Elevated serum potassium is a hazard in every setting and is monitored rather than desired. Dizziness on standing reflects volume loss and is never a treatment goal. Lower blood pressure is often a benefit in heart failure, not an unwanted effect.
Category: Antiandrogen Therapy
Question 13
Why is finasteride a weaker antiandrogen than spironolactone?
It blocks conversion to dihydrotestosterone but not testosterone itself
✓
It is absorbed poorly from the digestive tract
It acts only on the skin where it is applied
It works only after the testes are removed
Correct Answer
It blocks conversion to dihydrotestosterone but not testosterone itself
Finasteride inhibits 5-alpha-reductase, the enzyme that converts testosterone to the more potent dihydrotestosterone, but it neither lowers testosterone production nor blocks testosterone's receptors. It is absorbed poorly from the digestive tract is incorrect; finasteride is an oral tablet that is well absorbed. It acts only on the skin where it is applied is wrong because it is taken by mouth and acts systemically. It works only after the testes are removed is false; it acts whether or not the testes are present.
Category: Antiandrogen Therapy
Question 14
When given continuously, how do GnRH agonists such as leuprolide lower sex hormone levels?
They block androgen receptors in target tissues
They desensitize the pituitary so it releases less LH and FSH
✓
They inhibit the enzyme that forms dihydrotestosterone
They speed the liver's breakdown of testosterone
Correct Answer
They desensitize the pituitary so it releases less LH and FSH
Constant stimulation of GnRH receptors, after a brief initial surge, downregulates the pituitary so LH and FSH fall and the gonads make much less sex hormone. They block androgen receptors in target tissues describes spironolactone. They inhibit the enzyme that forms dihydrotestosterone describes finasteride. They speed the liver's breakdown of testosterone is not a mechanism of GnRH agonists.
Category: GnRH Agonists
Question 15
Long-term GnRH agonist therapy without enough sex hormone exposure puts which measurement at risk of declining?
Hearing acuity
Intraocular pressure
Bone mineral density
✓
Thyroid hormone level
Correct Answer
Bone mineral density
Sex hormones help maintain bone, so prolonged suppression with a GnRH agonist can lower bone mineral density, and at-risk patients have bone density screening. Hearing acuity is not affected by GnRH agonists. Intraocular pressure is not a recognized concern with these drugs. Thyroid hormone level is not lowered by GnRH agonist therapy.
Category: GnRH Agonists
Question 16
Which effect of testosterone usually persists even if therapy is stopped?
Increased muscle mass
Absent menstrual periods
Oily skin and acne
Voice deepening
✓
Correct Answer
Voice deepening
Testosterone thickens the vocal cords, and the deeper voice usually remains after the hormone is stopped, as do facial and body hair growth and clitoral growth. Increased muscle mass declines when testosterone is stopped. Absent menstrual periods are not a lasting change, because menses usually return after stopping. Oily skin and acne usually improve once testosterone is withdrawn.
Category: Testosterone Therapy
Question 17
A transgender man whose periods stopped on testosterone reports new vaginal bleeding. What should the nurse do?
Report the bleeding to the provider for evaluation
✓
Explain that the bleeding is expected and harmless
Tell him to stop testosterone right away
Suggest a heating pad and watchful waiting
Correct Answer
Report the bleeding to the provider for evaluation
New bleeding after menses have stopped may reflect low hormone levels, missed doses or a uterine problem, so it needs evaluation by the provider. Explain that the bleeding is expected and harmless gives false reassurance. Tell him to stop testosterone right away changes therapy without an order and could worsen bleeding. Suggest a heating pad and watchful waiting delays needed assessment.
Category: Testosterone Therapy
Question 18
A transgender man on testosterone reports loud snoring, gasping during sleep and daytime sleepiness. Which adverse effect should the nurse suspect?
Hyperkalemia
Sleep apnea
✓
Narcolepsy
Hypoglycemia
Correct Answer
Sleep apnea
Testosterone can cause or worsen obstructive sleep apnea, which produces snoring, pauses in breathing and daytime sleepiness. Hyperkalemia causes weakness and heart rhythm changes rather than snoring. Narcolepsy is a neurologic disorder of sudden sleep attacks, not a testosterone effect. Hypoglycemia causes shakiness, sweating and confusion rather than breathing pauses during sleep.
Category: Testosterone Therapy
Question 19
After a transgender woman has both testes removed, how does her feminizing regimen usually change?
Estrogen is no longer needed
Both hormones must be stopped
The antiandrogen can usually be stopped
✓
Testosterone is added to protect bone
Correct Answer
The antiandrogen can usually be stopped
Removing the testes removes the main source of testosterone, so a drug such as spironolactone is usually no longer needed, while estrogen continues for feminization and bone health. Estrogen is no longer needed is incorrect; without the testes and without estrogen she would have almost no sex hormone, putting bone at risk. Both hormones must be stopped is wrong for the same reason. Testosterone is added to protect bone would undo feminizing goals; estrogen is what protects her bone.
Category: Monitoring and Fertility
Question 20
When laboratory results are interpreted for a transgender patient, which information should the nurse share with the pharmacist and provider?
The patient's reasons for transitioning
The patient's sexual orientation
The patient's clothing preferences
The hormones the patient takes and how long they have used them
✓
Correct Answer
The hormones the patient takes and how long they have used them
The hormones a patient takes, and for how long, change body composition, drug handling and laboratory results, so the team needs this information to interpret values and adjust drug therapy. The patient's reasons for transitioning do not affect laboratory interpretation. The patient's sexual orientation has no bearing on drug handling. The patient's clothing preferences are unrelated to laboratory values.
Category: Monitoring and Fertility