The nurse is caring for a client with acromegaly. Following a transsphenoidal hypophysectomy, the nurse should:
A. Monitor the client’s blood sugar
B. Suction the mouth and pharynx every hour
C. Place the client in a low Trendelenburg position
D. Encourage the client to cough
Correct Answer: A. Monitor the client’s blood sugar
Option A: Growth hormone levels generally decrease rapidly after hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia so it is important for the nurse to monitor the sugar level.
Option B: Suctioning traumatizes the oral mucosa.
Option C: The client’s head should be elevated to reduce pressure on the operative site.
Option D: It increases pressure on the operative site that can lead to a leak of cerebrospinal fluid.