After chemotherapy for a high-burden lymphoma, a client develops hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and rising creatinine. Which action should the nurse anticipate?
1Restrict IV fluids and give potassium until the cardiac rhythm stabilizes.
2Give calcium routinely before addressing phosphate or cardiac instability.
3Begin prescribed IV hydration and rasburicase with close cardiac and laboratory monitoring.✓ Correct answer
4Delay treatment until the electrolyte abnormalities resolve without medication.
Explanation
The laboratory pattern after treatment of a high-burden malignancy indicates tumor lysis syndrome with acute kidney and arrhythmia risk. The nurse should anticipate aggressive prescribed IV hydration, uric-acid reduction with rasburicase for established high-risk hyperuricemia, frequent potassium, phosphorus, calcium, uric acid, and creatinine checks, and cardiac monitoring. Potassium administration, delayed treatment, or routine calcium before evaluating severe hyperphosphatemia can worsen complications.
Clinical reasoning Rapid tumor-cell breakdown releases potassium, phosphate, and nucleic-acid products. Uric acid and calcium-phosphate precipitation can obstruct renal tubules while hyperkalemia threatens the heart.
Decision rule Treat tumor lysis syndrome as an oncologic emergency: hydrate as prescribed, rapidly lower uric acid when indicated, monitor the rhythm and metabolic panel closely, and escalate dialysis indications promptly.
Scenario 22-year-old male with new ALL high WBC starting induction chemo; high TLS risk.
Tumor lysis syndrome — An oncologic emergency caused by rapid malignant-cell breakdown, producing hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and kidney injury.
Rasburicase — A urate oxidase used to rapidly reduce uric acid in clients at risk for or experiencing tumor lysis syndrome.