Which of the following are priority nursing assessments related to a client post-op transsphenoidal hypophysectomy for a tumor of the pituitary g (Select All that Apply.)

A. Monitor for increased intracranial pressure is correct. Following a transsphenoidal hypophysectomy, it is essential to monitor for signs of increased intracranial pressure (ICP) due to the proximity of the surgery to the brain and the risk of complications such as bleeding, swelling, or fluid buildup. Symptoms of increased ICP include headache, nausea, vomiting, and altered level of consciousness.
B. Monitor incision under the top lip for infection is correct. The incision for a transsphenoidal hypophysectomy is typically made under the top lip or at the base of the nose, and it is essential to monitor this site for signs of infection, such as redness, swelling, drainage, or increased pain.
C. Assess for signs of deep vein thrombosis (DVT) is incorrect. Although DVT prevention (e.g., ambulation, use of compression stockings) is important after surgery, monitoring for DVT is not a priority assessment specifically related to a transsphenoidal hypophysectomy. The other assessments are more directly related to potential complications from this specific type of surgery.
D. Development of meningitis is correct. Meningitis is a potential complication after a transsphenoidal hypophysectomy, especially if there is a breach in the nasal cavity or sinus, allowing for infection to spread. Signs of meningitis include fever, nausea, stiff neck, and headache.
E. Assess for signs of cerebrospinal fluid (CSF) leak is correct. A CSF leak is a serious complication of transsphenoidal surgery, as it can occur if the dura is punctured during the procedure. This leads to leakage of cerebrospinal fluid, which may manifest as a clear, watery drainage from the nose, a condition that should be assessed for immediately to prevent further complications like infection.