# A client receiving induction chemotherapy for high-tumor-burden Burkitt lymphoma has labs showing K 6.2, phosphate 6.8, calcium 7.4, uric acid 11.0. Which actions should the nurse anticipate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374986&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

A client receiving induction chemotherapy for high-tumor-burden Burkitt lymphoma has labs showing K 6.2, phosphate 6.8, calcium 7.4, uric acid 11.0. Which actions should the nurse anticipate? Select all that apply.

1

Administer rasburicase IV for the elevated uric acid

2

Administer IV calcium chloride immediately to correct the calcium of 7.4

3

Prepare the client for possible emergent dialysis if metabolic derangement worsens

4

Initiate IV isotonic fluids at high rate to maintain urine output above 100 mL per hour

5

Treat the potassium of 6.2 with calcium gluconate, insulin/dextrose, and a potassium binder

## Explanation

TLS management: aggressive IV hydration to flush metabolites and maintain UO above 100 mL/hour, urate-lowering therapy with rasburicase (preferred over allopurinol when uric acid is high or risk is high), treat hyperkalemia per protocol with cardiac stabilization plus shifting plus removal, and prepare for renal replacement therapy if persistent. Asymptomatic hypocalcemia in TLS is usually NOT corrected because giving calcium with high phosphate causes calcium phosphate precipitation and AKI worsening — calcium is reserved for symptomatic hypocalcemia or membrane stabilization in hyperkalemia.

## In-depth explanation

Cairo-Bishop criteria define TLS. Highest risk: high WBC hematologic malignancies, bulky lymphoma, pretreatment uric acid above 7.5.

## Clinical scenario

Day 2 of chemo. Urine output 35 mL/hr. EKG with peaked T waves.

## Key concepts

- **tumor lysis syndrome** — Massive cell breakdown releasing potassium, phosphate, urate; can cause AKI and arrhythmia.
- **rasburicase** — Recombinant urate oxidase converting uric acid to allantoin.
- **allopurinol** — Xanthine oxidase inhibitor preventing new urate formation; less effective acutely than rasburicase.

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