12 hours after induction chemotherapy for acute leukemia, which finding requires the nurse's immediate action?
1Hemoglobin 8.9 g/dL with fatigue when walking to the bathroom
2Platelet count 86,000/mm3 with scattered bruises on both forearms
3Potassium 6.2 mEq/L with new peaked T waves on the cardiac monitor✓ Correct answer
4White blood cell count 2,900/mm3 with an oral temperature of 37.2 C
Explanation
Rapid tumor breakdown can release intracellular potassium and cause lethal dysrhythmias. Potassium 6.2 mEq/L with peaked T waves is an active cardiac emergency requiring immediate notification, monitoring, and prescribed treatment.
Quick answer Treat hyperkalemia with electrocardiographic changes as the immediate tumor lysis emergency.
Why this is correct Induction therapy can destroy many malignant cells at once, releasing potassium, phosphate, and nucleic acids. Peaked T waves show that the elevated potassium is already affecting cardiac conduction, so stabilization cannot wait for routine follow-up.
Easy analogy or mental picture Tumor lysis is like many storage cells breaking open at once and flooding the electrical system. The analogy highlights the sudden electrolyte load but does not replace measurement of potassium, phosphate, calcium, uric acid, and kidney function.
Memory hook After chemotherapy, high potassium plus ECG change means act now.
NCLEX decision rule Prioritize a laboratory abnormality when it is paired with present organ dysfunction. In suspected tumor lysis syndrome, dysrhythmia risk outranks stable anemia, noncritical thrombocytopenia, or leukopenia without fever.
Why the other choices are wrong The anemia and thrombocytopenia need follow-up but show no immediate instability. Leukopenia raises infection risk, yet the listed temperature does not indicate fever.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
NCI Dictionary of Cancer Terms: Tumor Lysis SyndromeNational Cancer Institute
[3]
Tumor Lysis SyndromeNational Library of Medicine Bookshelf